Hospital stays have grown increasingly shorter with a corresponding increase in the use of homecare services. However, we have a limited understanding of how homecare services are allocated in Ontario, particularly homecare rehabilitation services. The primary objective of this research is to explore the current decision-making processes for the allocation of occupational and physical therapy services in homecare for the long stay clients. To address this objective a exploratory study using key informant interviews was conducted. The results indicate that the process of decision making for the allocation of therapy services is comprised of a series of stages called intake, assessment, referral to service provider and reassessment. Amongst these the process of determining the volume of therapy services varies widely across different region. These variations are primarily due to the regional contextual (e.g. financial constraints) factors of the individual CCACs.

Controlling for the wide variability in the physical health status of geriatric populations is important as severity of illness is known to both moderate and suppress relationships examined in psychosocial research. The purpose of the present investigation was to develop a uniform, easily administered quantitative index of illness severity, composed of disease-specific scales, that was independent of psychosocial factors and appropriate for use with a geriatric population. As well, the aim was to collect preliminary data on the reliability and validity of the scale. The development of the Severity of Illness-Geriatric (SOI­G) scale involved the adaptation of a previously developed severity of illness instrument Severity of Renal Disease Scale (SORDS). <p>The present investigation involved five programmatically linked studies. Study 1 involved the determination of the items to be included on SOI-G while Study 2 defined the severity criteria for each item. In Study 3, five geriatric specialists scaled each level of each item on the same underlying threat to life scale. There was a high level of initial agreement between the raters supporting the reliability of the severity values. The final scale consisted of 32 items. <p>In Study 4, archival data was collected on 61 patients admitted to the geriatric unit of a rehabilitation hospital. The SOI-G was compared to the Cumulative Illness Rating Scale-Geriatric (CIRS-G) and a global severity rating. <p>SOI-G inter-rater reliability estimates were low (likely due to rater error) but promising. SOI-G demonstrated support for content validity, face validity, and construct validity but evidence for convergent validity was not established. SOI-G scores were sensitive to differences among patients with respect to discharge outcome. The utility of SOI-G as a moderator variable in psychosocial research with the elderly could not be explored in Study 5 due to a limited sample size. <p>It was concluded that the present investigation demonstrated the potential usefulness of SOI-G in psychosocial research with the elderly but further research is needed before definitive conclusions can be made. The SOI-G offers researchers a tool for controlling disease variability that is not measured by psychological tests but must be accounted for in research designs.

The purpose of the present study was to examine the effect of environmental density on the behavior (Disruptive and Nondisruptive) of elderly residents with dementia living on a special care unit. A building project that led to relocation of residents from high density units to units that varied in density (low vs. high) provided a natural context for this study. Disruptive and Nondisruptive behavior are composite variables that together include the full range of behavioral responses. Both are composed of several subvariables. Data were collected using direct behavioral observation using the Environment-Behavior Interaction Code (Stewart & Hiscock, 1992b) and a hand-held computer. The first objective of the study was to examine behavior patterns in relation to density and privacy. This objective was addressed with a quasi-experimental design (Study 1), in which three hypotheses were tested. It was predicted that residents who moved from a high density unit to a low density unit would exhibit a greater reduction in rate of Disruptive behavior (Hypothesis 1) and a greater increase in rate of Nondisruptive behavior (Hypothesis 2), compared to residents in a constant high density condition. It was also predicted that use of Private Time (time spent alone in one's bedroom) would be greater on the low density unit, where residents had private rooms (Hypothesis 3). Results of Study 1 provided support for Hypotheses 1 and 2, in relation to comparisons with the External Comparison Group only. Within subjects analyses provided additional support for Hypothesis 1 (Disruptive behavior). Hypothesis 3 (Private Time) was also supported. The second objective of the study was to explore the perceptions of family and staff caregivers with regard to the effect of the environment on resident behavior. This study was addressed with a qualitative design (Study 2) using the grounded theory method. Participants in Study 2 described the needs of residents with dementia in relation to the physical and social environment, and the outcomes that occurred when these needs were met or not met. (Abstract shortened by UMI.)

Older patients comprise a large portion of patients in the acute care setting. Registered Nurses (RNs) are the main care providers in the hospital setting. RNs caring for older hospitalized patients are affected by many factors including workload pressures, issues related to the acute care environment and attitudes toward older patients. However, a literature review identified a limited number of studies exploring the RNs experience of caring for older patients in the acute care setting. This study explored the RNs experience of caring for older patients (age 65 and older) on an orthopedic unit in an acute care hospital. Saturation was reached with a purposive sample of nine RNs working on the orthopedic unit, including eight females and 1 male. Participants were interviewed using broad open-ended questions, followed by questions more specific to emerging themes. All interviews were audio-taped and transcribed verbatim. Data were analyzed using Glasers (1992) grounded theory approach. Participants described the basic social problem as dealing with the complexity of older patients. The basic social process identified was the concept of looking beyond. Looking beyond was described as looking at the big picture to find what lies outside the scope of the ordinary. Three sub-processes of looking beyond were identified as connecting, searching, and knowing. Connecting was described as getting to know patients as a person by taking time, respecting and understanding the individual. Searching was described as digging deeper, searching for the unknown by looking for clues and mining everywhere for information. Knowing was described as intuitively knowing what is going to happen and what the older patient needs by pulling it all together and knowing what to expect. These dynamic sub-processes provided the RN with the relationship and information required to look beyond to manage the older patients complexity. The results of this study have implications for nursing practice, education and research. These findings may provide RNs with a process to manage the complex care of a large portion of our population.

Controlling for the wide variability in the physical health status of geriatric populations is important as severity of illness is known to both moderate and suppress relationships examined in psychosocial research. The purpose of the present investigation was to develop a uniform, easily administered quantitative index of illness severity, composed of disease-specific scales, that was independent of psychosocial factors and appropriate for use with a geriatric population. As well, the aim was to collect preliminary data on the reliability and validity of the scale. The development of the Severity of Illness-Geriatric (SOI­G) scale involved the adaptation of a previously developed severity of illness instrument Severity of Renal Disease Scale (SORDS). <p>The present investigation involved five programmatically linked studies. Study 1 involved the determination of the items to be included on SOI-G while Study 2 defined the severity criteria for each item. In Study 3, five geriatric specialists scaled each level of each item on the same underlying threat to life scale. There was a high level of initial agreement between the raters supporting the reliability of the severity values. The final scale consisted of 32 items. <p>In Study 4, archival data was collected on 61 patients admitted to the geriatric unit of a rehabilitation hospital. The SOI-G was compared to the Cumulative Illness Rating Scale-Geriatric (CIRS-G) and a global severity rating. <p>SOI-G inter-rater reliability estimates were low (likely due to rater error) but promising. SOI-G demonstrated support for content validity, face validity, and construct validity but evidence for convergent validity was not established. SOI-G scores were sensitive to differences among patients with respect to discharge outcome. The utility of SOI-G as a moderator variable in psychosocial research with the elderly could not be explored in Study 5 due to a limited sample size. <p>It was concluded that the present investigation demonstrated the potential usefulness of SOI-G in psychosocial research with the elderly but further research is needed before definitive conclusions can be made. The SOI-G offers researchers a tool for controlling disease variability that is not measured by psychological tests but must be accounted for in research designs.

Purpose The purpose of this study has been to investigate the documentation process following the guiding principles of the Quality Norms for Fall Prevention concerning fall risk assessment, risk identification, fall preventive measures, information and the making of an individual care plan. Method This study is a quantitative, descriptive and retrospective journal review study. There were 100 journals examine the existing documentation concerning fall risk assessment of patients who received treatment in geriatric patient care. The sample was consecutively. Results The results showed that fall risk assessment was documented in 79 of 100 examined journals. 56 (71 %) of the fall risk assessments were made within 24 hours. In 59 of 100 journals the patient, relatives or former caretakers was asked whether the patient had had a fall within the last year, and in 61 of 100 journals it was documented that the nursing staff had made an assessment that the patient was going to have a fall during his or her length of stay if no preventive measures were set in. The majority of fall risk factors and fall preventive measures were documented within the areas of walking and transfer. It was documented that the patient was informed of fall risk, fall risk factors and fall preventive measures in 15 of 100 journals. For 33 of 68 (49 %) patients with an identified increased fall risk, a care plan was established.  Conclusion Quality norm is recently introduced and enforced in the relative extent. Since the objective is to appropriate risk assessment should be performed on all enrolled patients in geriatric patient care, so it should be performed and documented in all patients. / Syfte Syftet med studien var att undersöka hur dokumentationen utförs utifrån riktlinjerna i kvalitetsnormen för fallprevention gällande fallriskbedömning, riskidentifiering, fallpreventiva åtgärder, information och upprättande av en individuell vårdplan. Metod Studien var en kvantitativ, deskriptiv och retrospektiv journalgranskningsstudie. Det var 100 journaler som granskades gällande dokumentation angående fallriskbedömning av patienter som vårdats inom geriatrisk sluten vård. Urvalet var konsekutivt. Resultat Resultatet visade att i 79 av 100 granskade journaler var fallriskbedömning dokumenterad. Det var 56 (71 %) fallriskbedömningar som var utförda inom 24 timmar. I 59 av 100 journaler har patienten, anhöriga eller tidigare vårdgivare tillfrågats om patienten fallit senaste året och i 61 av 100 journaler fanns det dokumenterat att vårdpersonalen gjort en bedömning om patienten kommer falla under vårdtiden om inga förebyggande åtgärder sätts in. Flest fallriskfaktorer och fallpreventiva åtgärder inom området gång och förflyttning dokumenterades. Det fanns dokumenterat att patienten blev informerad angående fallrisk, fallriskfaktorer och fallpreventiva åtgärder i 15 av 100 journaler. För 33 av 68 (49 %) patienter med en bedömd förhöjd fallrisk upprättades en vårdplan. Slutsats Kvalitetsnormen är nyligen införd och efterlevs i relativ stor utsträckning. Eftersom målet är att fallriskbedömning ska utföras på samtliga inskrivna patienter inom geriatrisk sluten vård så bör den utföras och dokumenteras på samtliga patienter.

Hur kan medbestämmande och inflytande i hemtjänsten komma till stånd? Syftet med denna uppsats var att ta reda på vad som upplevs ge medbestämmande och inflytande i hemtjänsten. Den övergripande frågeställningen formulerades utifrån om det finns skillnad i uppfattning hos personer som har erfarenhet och de som inte har erfarenhet av att ta emot hemtjänst? Det sociala synsättets tankar (Westlund, 2002), teorier om salutogenes (Antonowsky, 1991), (Sjöberg &amp; Westlund, 2005) samt ett socialkonstruktivistiska synsätt om synen på äldre (Jönsson, 2001) utgör de huvudsakliga teorierna. Metoden utformades som en fallstudie och genomfördes i Alvesta kommun. Fyra grupper intervjuades med vardera tre till fem slumpmässigt utvalda respondenter. Två av intervju-grupperna bestod av personer som har personlig erfarenhet av att ta emot hemtjänst och deltagarna i de två andra intervjugrupperna saknade denna erfarenhet. Resultatet visar att de flesta av intervjugruppernas deltagare ansett oavsett tidigare erfarenhet att hemtjänstens och äldreomsorgens kvalitet? i Alvesta överlag är bra eller mycket bra. Viss skillnad i vad som de olika grupperna betecknar vara ett gott liv kommer fram. Frågor om att få byta insats, bestämma om när den ska utföras, ha möjlighet till insats utan biståndsbeslut efter viss ålder, byte till timtaxa, servicecheckar eller ej, engagerar de flesta deltagarna i intervjugrupperna med personer som inte har egen erfarenhet av hemtjänst. Dessa frågor engagerar dock inte deltagarna nämnvärt i grupperna som redan har erfarenhet av hemtjänst. Vidare pekar studien på att nästan alla gruppdeltagare, oavsett erfarenhet eller ej, anser att beslutsgången vid ansökan om insats känns oklar, en fråga som framförallt framhålls som angelägen för respondenterna. En annan betydelsefull fråga för respondenterna är frågan om personalkontinuiteten. Det uttrycks angeläget att få till stånd en kommunikation omkring frågan om ombyggnad av det gamla sjukhemmet ”Högåsen”. Avslutningsvis visar resultatet på att ett stort intresse finns från de deltagare som inte har egen erfarenhet av hemtjänst för att socialt uppsökande verksamhet erbjuds alla vid en viss ålder. / How can co-determination and influence within the home-help service sector come about? The aim of this paper is to find out what is considered to give co-determination and influence within the home-help service sector. The overall question was formulated from the The social workers have a lot of authority, I think; I should like to have some authority too. - On co-determination and influence in Alvesta´s home-help service - anticipation that there is a difference in opinion between people who have experience and those who have no experience in receiving home-help service. Det sociala synsättets tankar (Westlund 2003), Theories about Salutogenes (Atonowski 1991), Sjöberg &amp; Westlund 2005) and Ett socilakonstruktivistiskt synsätt om synen på äldre (Jönsson, 2001) form the main theories. The method was constructed as a case study and was carried out in the town of Alvesta. Four groups were interviewed with three to five randomly chosen respondents in each group. Two of the interview groups consisted of persons who have personal experience of receiving home-help service and the participants in the two other interview groups lacked this experience. The result shows that most of the participants in the interview groups, disregarded earlier experience, are of the opinion that the quality of old age care in Alvesta overall is good or very good. A certain difference in what the different groups consider to be a good life is shown. Questions about be allowed to change service, decide when it is to be done, have possibility for services without formal authority decisions after a certain age, service cheques or not, engage most participants in the interview groups that have no personal experience of home-help service. These questions do not much engage the participants in the groups that already have experience from home-help service. Further, the study shows that nearly all group members, experience or no experience of home-help service, are of the opinion that the line of decision is unclear, a question that above all is regarded as urgent. Another important question for the respondent is the continuity in staffing. There is also a strong opinion about starting a communication regarding the reconstruction of the old nursing home “Högåsen”. Finally, the result shows that there is a great interest from the participants, who have no personal experience of home-help service, that everybody is offered an outreach programme from a certain age.

No description available.

<p>Hur kan medbestämmande och inflytande i hemtjänsten komma till stånd?</p><p>Syftet med denna uppsats var att ta reda på vad som upplevs ge medbestämmande och inflytande i hemtjänsten. Den övergripande frågeställningen formulerades utifrån om det finns skillnad i uppfattning hos personer som har erfarenhet och de som inte har erfarenhet av att ta emot hemtjänst?</p><p>Det sociala synsättets tankar (Westlund, 2002), teorier om salutogenes (Antonowsky, 1991), (Sjöberg & Westlund, 2005) samt ett socialkonstruktivistiska synsätt om synen på äldre (Jönsson, 2001) utgör de huvudsakliga teorierna.</p><p>Metoden utformades som en fallstudie och genomfördes i Alvesta kommun. Fyra grupper intervjuades med vardera tre till fem slumpmässigt utvalda respondenter. Två av intervju-grupperna bestod av personer som har personlig erfarenhet av att ta emot hemtjänst och deltagarna i de två andra intervjugrupperna saknade denna erfarenhet.</p><p>Resultatet visar att de flesta av intervjugruppernas deltagare ansett oavsett tidigare erfarenhet att hemtjänstens och äldreomsorgens kvalitet? i Alvesta överlag är bra eller mycket bra. Viss skillnad i vad som de olika grupperna betecknar vara ett gott liv kommer fram. Frågor om att få byta insats, bestämma om när den ska utföras, ha möjlighet till insats utan biståndsbeslut efter viss ålder, byte till timtaxa, servicecheckar eller ej, engagerar de flesta deltagarna i intervjugrupperna med personer som inte har egen erfarenhet av hemtjänst. Dessa frågor engagerar dock inte deltagarna nämnvärt i grupperna som redan har erfarenhet av hemtjänst.</p><p>Vidare pekar studien på att nästan alla gruppdeltagare, oavsett erfarenhet eller ej, anser att beslutsgången vid ansökan om insats känns oklar, en fråga som framförallt framhålls som angelägen för respondenterna. En annan betydelsefull fråga för respondenterna är frågan om personalkontinuiteten. Det uttrycks angeläget att få till stånd en kommunikation omkring frågan om ombyggnad av det gamla sjukhemmet ”Högåsen”.</p><p>Avslutningsvis visar resultatet på att ett stort intresse finns från de deltagare som inte har egen erfarenhet av hemtjänst för att socialt uppsökande verksamhet erbjuds alla vid en viss ålder.</p> / <p>How can co-determination and influence within the home-help service sector come about?</p><p>The aim of this paper is to find out what is considered to give co-determination and influence within the home-help service sector. The overall question was formulated from the The social workers have a lot of authority, I think; I should like to have some authority too.</p><p>- On co-determination and influence in Alvesta´s home-help service -</p><p>anticipation that there is a difference in opinion between people who have experience and those who have no experience in receiving home-help service.</p><p>Det sociala synsättets tankar (Westlund 2003), Theories about Salutogenes (Atonowski 1991), Sjöberg & Westlund 2005) and Ett socilakonstruktivistiskt synsätt om synen på äldre (Jönsson, 2001) form the main theories.</p><p>The method was constructed as a case study and was carried out in the town of Alvesta. Four groups were interviewed with three to five randomly chosen respondents in each group. Two of the interview groups consisted of persons who have personal experience of receiving home-help service and the participants in the two other interview groups lacked this experience.</p><p>The result shows that most of the participants in the interview groups, disregarded earlier experience, are of the opinion that the quality of old age care in Alvesta overall is good or very good. A certain difference in what the different groups consider to be a good life is shown. Questions about be allowed to change service, decide when it is to be done, have possibility for services without formal authority decisions after a certain age, service cheques or not, engage most participants in the interview groups that have no personal experience of home-help service. These questions do not much engage the participants in the groups that already have experience from home-help service.</p><p>Further, the study shows that nearly all group members, experience or no experience of home-help service, are of the opinion that the line of decision is unclear, a question that above all is regarded as urgent. Another important question for the respondent is the continuity in staffing. There is also a strong opinion about starting a communication regarding the reconstruction of the old nursing home “Högåsen”.</p><p>Finally, the result shows that there is a great interest from the participants, who have no personal experience of home-help service, that everybody is offered an outreach programme from a certain age.</p>

This study explores the relationship between living arrangement and psychological wellbeing in retired elderly individuals living in Yancheng, Jiangsu (PR China). Data on mode of residence, socio-economic background, daily activities, and intergenerational dynamics were collected from 200 subjects, and their potential correlations with depression (assessed via the Geriatric Depression Scale Short Version) were analyzed. Univariate as well as logistic regression confirmed mode of residence as a significant predictor of depression in this group. The following depression odds ratios associated with each mode of residence were derived via logistic regression: 1) nuclear household, i.e. living with a spouse only ¨C 1 [reference category], 2) multigenerational households in which a spouse is not present ¨C 4.341, 3) multigenerational households in which a spouse is present ¨C 0.781, and 4) living alone ¨C 3.018. Based on these ratios, we conclude that the traditional model of intergenerational coresidence is not, in itself, associated with less depression. Rather, it is the presence of a sharing spousal in a household (whether single or multigenerational) that protects against elderly depression. Other predictors of depression identified in backward logistic regression included presence of a chronic illness and self assessed wealth status. Additionally, a number of psychosocial variables were identified as independently correlated with depression, but were subsequently selected out by multivariate analysis. These included: educational background, religious affiliation, membership in an organization, attitude toward aging, and family status. Based on this study, we believe that efforts to promote mental wellbeing among today¡¯s Chinese elders should be directed toward psychosocial factors that are modifiable (education, building supportive social networks etc.) rather than insisting on the traditional ideal of multigenerational living and dependence on filial piety.