Introduction: Stroke is associated with a high prevalence of dysphagia in the elderly population. Hence, dysphagia evaluation and management are key issues in stroke rehabilitation. The McGill Ingestive Skills Assessment (MISA) is a recently developed mealtime observational tool aimed at evaluating the functional aspects of the oral phase of ingestion. Objective: To determine the discriminative validity of the MISA by assessing known/extreme groups of elderly individuals presenting with stroke, who have been admitted to an acute-care-hospital or a rehabilitation center. Participants were allocated to one of two groups: 1) individuals with stroke and no dysphagia, who are on a regular diet and 2) individuals with stroke and dysphagia, who are permitted only purees. Methods: Participants were evaluated with the MISA and a comprehensive chart review was conducted. Analysis: Groups were compared on socio-demographic and clinical characteristics. Univariate tests were performed to test the significance of between-group differences. Conclusion and significance: The results of the study are satisfactory, and enhance the clinical usefulness of the tool for dysphagia management. These results also support future studies addressing the responsiveness of the MISA.

Background: In South Africa there data is lacking on the health of the older population. This study aims to report on actions taken by general practitioners on abnormal blood pressure, blood glucose and osteoporosis screen identified by registered nurses, conducting home based visits to older clients. Methods An agency piloted the Comprehensive geriatric assessment (CGA) tool in an urban affluent population. In this cross sectional secondary study analysis, 465 participants aged 60 years and over had a nurse visit in their homes and a subsequent General Practitioner (GP) visit. The prevalence of specific geriatric problems was assessed as well as the frequency of initiated procedures by the GP. This study will focus on initiated actions by the General Practitioners in response to abnormal blood pressures, blood glucose, and osteoporosis screen. Results Frequency tables were utilised to identify prevalence of the abnormal blood pressures, blood glucose and osteoporosis screen. . Abnormal blood pressures were detected (230/465, 49%) of the subjects , the GP initiated actions on only 15/465 (3.2%) of clients. Abnormal blood sugars were detected 106/465 (23%) of the GP initiated actions on 23/465 (5%) of clients. Clinical risk factors for the development of osteoporosis were detected in 252 /465 (54%) subjects GP initiated actions on 11/465 (3%) Conclusion This study explored the relationships between comprehensive geriatric assessment and subsequent GP actions and found using the CGA in this population will be successful in identifying abnormal health findings which will enable intervention. However, due to challenges in the communications and marketing of this service, GP’s were not well informed of their role and did not act on majority of the abnormal findings detected by nurses / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2011.

No description available.

The elderly are the fastest growing population in the United States. Nurses' attitudes toward caring for the elderly are a very real concern and may determine nurses' behaviors with the elderly. The purpose of this study was to examine the attitudes of nurses toward caring for the elderly residing in long term care institutions. A modified questionnaire, "Attitudes Toward Caring for the Elderly" was used. A combination of Jean Watson's theory of caring and the Ajzen & Fishbein's theory of reasoned action was the theoretical framework used for the study. Three research questions were asked. Data were collected from 32 registered nurses in four long term care institutions. Results showed that nurses attitudes toward caring for the elderly were positive. There were no significant relationships between demographic and personal data and nurses' attitudes toward caring for the elderly. Full time versus part time employment was a significant predictor of nurses attitudes toward caring for the elderly. The low reliability of the tool (Cronbach's alpha = 0.57) could have contributed to the lack of significant data. The study should be repeated after further development of validity and reliability of the tool. / School of Nursing

The purpose of this study was to compare two groups of nurses's attitudes towards the elderly and the knowledge base of the nurses as to signs, symptoms and interventions with depression and dementia in the elderly. The theoretical framework for this study was Oren's (1985) self-care deficit theory. Attitude was measured using the Koan Attitude Toward Old People Scale (Koan, 1961) and knowledge was measured using a scale developed by (Myton, Allen, and Baldwin, 1991).The population studied was registered nurses working at these state hospitals in a midwestern state and agency nurses from four agencies that provide staff coverage at these hospitals. The convenience sample consisted of state nurses (n=65) and agency nurses (n=38). A cover letter explaining confidentiality and voluntary participation was attached to each survey. Completion of the survey constituted consent to participate in the study. There were no identified risks related to participation in the study.The study did not identify significant differences between groups in any of the variables involving attitude toward the elderly, ability to differentiate signs, symptoms, and interventions for dementia and depression in the elderly. Both groups were able to correctly identify signs, symptoms and interventions for dementia and depression about one-half the time. The treatment modalities are different for dementia and depression. The problem is significant because if signs, symptoms and interventions are not identified correctly the patient will not be assisted toward recovery and self-care may decrease. The recommendation for increased inservice education on gerontological nursing are applicable to both groups. / School of Nursing

Introduktion: De nordiske hospitaler er i disse år præget af talrige organisationsændringer. Evalueringer heraf foregår traditionelt kvantitativt. Der er ikke tradition for at anvende kvalitative metoder. Patientperspektivet undersøges i Danmark kvantitativt gennem årlige patienttilfredsheds-undersøgelser, men resultaterne her af kan ikke ses i sammenhæng med en given aktivitet på et givent sengeafsnit. Medarbejderperspektivet medtages slet ikke i forbindelse med evalueringer af organisatoriske ændringer i sundhedsvæsenet. Formål: Formålet med denne evaluering er at undersøge sammenhænge mellem den konkrete målopfyldelse på udvalgte kvalitetsindikatorer, medarbejdernes oplevelser af og syn på at arbejde på det geriatriske sengeafsnit samt de pårørende og patienternes oplevelser under indlæggelsen.  Det er hensigten at tegne et så nuanceret billede som muligt af det geriatriske sengeafsnit og at få afdækket såvel hensigtsmæssige som uhensigtsmæssige forhold i medarbejdernes arbejdsliv og i patienternes oplevelse af indlæggelsen. Metode: Andel af opfyldte kvalitetsindikatorer måles ved auditgennemgang af 50 konsekutivt udvalgte patientjournaler fra indlæggelser på det geriatriske sengeafsnit. Patient- og pårørendeperspektivet belyses gennem 4 interviews i umiddelbar tilslutning til patienternes udskrivelse og Medarbejderperspektivet undersøges gennem to individuelle interviews med lederne af afsnittet og et fokusgruppeinterview med otte medarbejdere fra det geriatriske sengeafsnit. De kvantitative data fremstilles i tabelform og de kvalitative data indholdsanalyseres og fremstilles i citatform. De indbyrdes sammenhænge mellem de bearbejdede data undersøges og fremstilles. Resultater: Medarbejderne udtrykker frustration og mangel på ledelse. De har svært ved at se sammenhæng i hverdagens aktiviteter og oplever mangel på ro og meningsfuldhed i dagligdagen. De finder ikke de kliniske kvalitetsindikatorer relevante for deres arbejde. Der er lav andel af opfyldte kliniske kvalitetsindikatorer. Dette understøttes af patienterne og de pårørendes oplevelser under indlæggelsen og det forklares til en vis grad af medarbejdernes opfattelse af nødvendigheden af at opfylde de forventede krav og i særlig grad af medarbejdernes oplevelse af mangel på ledelse, sammenhæng og meningsfuldhed. Konklusion: Der findes konsistent sammenhæng mellem de tre perspektiver. Medarbejderperspektivet beskriver årsagsforklaringer til den lave andel af opfyldte kliniske kvalitetsindikatorer og patient- og pårørendeperspektivet peger på konsekvenserne af samme. Metodetrianguleringen til evaluering af en organisationsændring har dermed vist sig hensigtsmæssig til at forstå baggrund og sammenhænge i resultatet af en organisationsændring i højere grad end de traditionelle evalueringsmetoder. / Introduction:  The Nordic Hospitals have these years seem a lot of organizational changes. They are traditionally quantitatively evaluated. There is no tradition to use qualitative evaluation methods. The perspective of the patients is examined quantitatively by a patient satisfaction survey each year, but it is not possible to see the results of these surveys in coherence to a given activity in a given ward in the hospital. The perspective of the employees is not included in evaluations of organizational changes. Purpose: The purpose of this evaluation is to examine coherence between the indicators that have been fulfilled, and the employees’ experience of their daily work, together with the patients – and their relatives’ experience of the admittance at the ward.  It is the intention to show a picture as varied as possible of the geriatric ward and both reasonable and not reasonable conditions in the employees work life and in the patients’ experiences.  Method: The clinical indicators of quality are examined by an audit reading of 50 consecutively chosen patient files from the geriatric ward. The patients – and the relatives perspective is illuminated by four interviews with patients and relatives directly following their admittance to the ward and the perspective of the employees is illuminated by two interviews with the managers of the ward and a focus group interview with eight staff members of the ward. Results: The employees express frustration and lack of management. It is not easy for them to see coherence in the daily activities and they experience absence of peace and meaning in their daily work. In their opinion, the clinical indicators of quality are not relevant for their work. Only a low part of the indicators of clinical quality fulfil the expected goals. This find is in concordance with the experiences of the patients and the relatives and to some extent, can be explained, by the employees’ way of understanding the quality indicators. The most probable explanation to the low fulfilment of the goals is the employees’ experience of lack of management, coherence, and meaningfulness in their daily activities. Conclusion: There is a consistent connection between the three perspectives. The perspective of the employees describes possible causes to the low part of clinical indicators of quality, which fulfil the goals. The perspective of patients and relatives points at the consequences of this. The triangulation of the methods in an evaluation of organizational changes has shown a successful way, to understand conditions and coherence in the results of an organizational change, than the traditional method of evaluation. / <p>ISBN 978-91-85721-20-7</p>

Effective communication in the doctor-patient relationship is an essential component to proper diagnosis and treatment (Gordon & Gerber, 2010). While a greater focus on improving doctor-patient communication needs to be addressed, nowhere is it more important than in interactions between geriatric patients and general practitioners. This study analyzes and synthesizes the findings of 16 selected socio-medical journal articles that report on the views of geriatric patients’ needs and desires when interacting with general practitioners. The findings of this study contribute a geriatric perspective to the current debate regarding patient-centred care and also identify communication barriers and facilitators that can be avoided or used by physicians when interacting with geriatric patients. By bringing together multiple socio-medical qualitative studies that look at geriatric patients’ perspectives, this research seeks to create an evidence base that is valued by both medical practitioners and policy-makers. / Thesis (Master, Cultural Studies) -- Queen's University, 2013-09-27 14:34:32.474

Bibliography: leaves 249-260. / xvii, 260, [35] leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Systematically explores the relationship between medications, dry mouth and dental caries in a longitudinal study of older people. / Thesis (Ph.D.)--University of Adelaide, Dept. of Dentistry, 1999

Globally the population is ageing and as a consequence people are living longer with multiple chronic conditions. A range of factors, including decreased lengths of hospital stay and a greater focus on community based care, has lead to an increasing acuity of patients admitted to acute care settings, many with complex care needs. To date, models of nursing care in acute settings have been configured to focus on acute, procedural care and do not meet the unique needs of the older person. In order to ensure optimal health outcomes of older hospitalised people, nursing care needs to be responsive to the priorities and needs of patients and their families. This study sought to collaboratively develop a model of nursing care with nurse clinicians to improve the care of older people in the acute care setting. Model development was driven by an action research framework, using evidence-based principles and a comprehensive needs assessment. A three phased, mixed method design was embedded within the overarching conceptual and philosophical framework of action research. The first phase of the study comprised a needs assessment and allowed appraisal of the needs of patients as perceived by patients, carer’s and nurses, this was performed using the Caring Activity Scale [CAS](1). Qualitative data and semi-structured interviews added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. Managing the discharge process and carer burden arose mainly from the carer semi-structured interviews only. Data revealed significant differences between patients, carer’s and nurses in relation to priority and satisfaction with care. Patients did not place a large importance on discharge care which contrasted with the focus of nursing initiatives. During the subsequent phases of the study a collaborative approach, using action research principles, was used to develop and implement a model of nursing care. A key feature of this model was the introduction of a team structure with a focus on patient centred care. Significant differences were identified in the pre model and post model patient groups in relation to satisfaction with care, with the post model group more satisfied than the pre group model group. Further, improvements in functional status and medication knowledge were demonstrated among patients cared for under the new model. This study has demonstrated that developing a model of care appropriate to the needs of patients, carer’s and nurses can be achieved through the use of action research principles. Study data illustrates the importance of collaboration, empowerment and change management principles in driving clinical improvement and patient satisfaction with care. The findings also underscore the importance of promoting and educating patients and carers as well as nurses about the importance of discharge planning to optimise post-discharge health outcomes. / Doctor of Philosophy (PhD)

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.