<p>Old people's life situation when receiving municipal help and care in theirlast period of life is sparsely investigated from their own perspective. Thepurpose of this study was focused on the thoughts of the aged people andtheir personal experiences on what quality is within the geriatric care. Inthis qualitative study, 10 elderly people aged 75-90 years wereinterviewed from 3 different nursing homes within Solna Municipality.Qualitative interviews, with the emphasis on their present life situationespecially what brought about a good life, were performed. The interviewswere analysed using qualitative content analysis. The implication of theterm “meaningful existence” is individual and differs from person toperson. This study has identified six categories that could lead to ameaningful existence for the elderly living in nursing homes. These were:to feel secure, maintaining self determination, maintaining relations, to berespected, to feel comfort and to be active. In conclusion it was found thata meaningful existence, what ever it may be to the single individual, isimportant the quality of life for the elderly person residing in nursing homes.</p>

The main aim of this thesis has been to compare psychosocial working conditions in workplaces with different forms of ownership, i.e. public, private and cooperative. A second aim has been to study how organisational characteristics of relevance for psychosocial working conditions (in terms of management control strategies and prerequisites for management) are manifested in these ownership forms. The empirical data is based on structured interviews with managers at 60 workplaces within the service sector and on a questionnaire to all employees working in the participating workplaces, resulting in a set of 1384 individuals. An additional seven interviews with first-line managers within geriatric care were also conducted for the last study. The results show that employees in cooperatives perceived that they had better opportunities to influence decisions concerning the workplace as a whole, although there were also results showing advantages for public and private employees. Regarding opportunities for employees to influence their own work situation, there were no differences between the ownership forms. Differences were found in the prerequisites for first-line geriatric care managers. As a result of an earlier organisational change, the public managers were now further away from the strategic level and had to focus on daily, operative work tasks, while simultaneously also being responsible for keeping within the budget. The private managers, on the other hand, having group leaders to deal with the daily work concerning personnel and operations, could focus more on strategic work related to financial results in terms of planning and follow-up of the budget. One conclusion is that there are certain differences in both psychosocial working conditions and organisational characteristics between the ownership forms, but when the comparisons were restricted to only one type of service, in this case the provision of care, it is rather the similarities within the care organisations, regardless of ownership form, that are most pronounced.

Old people's life situation when receiving municipal help and care in theirlast period of life is sparsely investigated from their own perspective. Thepurpose of this study was focused on the thoughts of the aged people andtheir personal experiences on what quality is within the geriatric care. Inthis qualitative study, 10 elderly people aged 75-90 years wereinterviewed from 3 different nursing homes within Solna Municipality.Qualitative interviews, with the emphasis on their present life situationespecially what brought about a good life, were performed. The interviewswere analysed using qualitative content analysis. The implication of theterm “meaningful existence” is individual and differs from person toperson. This study has identified six categories that could lead to ameaningful existence for the elderly living in nursing homes. These were:to feel secure, maintaining self determination, maintaining relations, to berespected, to feel comfort and to be active. In conclusion it was found thata meaningful existence, what ever it may be to the single individual, isimportant the quality of life for the elderly person residing in nursing homes.

Bakgrund: Runt omkring oss i samhället finns det organisationer av olika slag. De organisationer som påverkar oss mest i vårt dagliga liv är dock troligen de kommersiella. För sådana organisationer utgör ägarna en stark intressentgrupp då de tillför kapital till verksamheten och för detta kräver ersättning i form av avkastning. För många kommersiella organisationer finns det dock fler intressenter med andra krav på organisationen och dess verksamhet, till exempel måste industrier investera i reningsanläggningar för att inte släppa ut skadlig rök till omgivningen. För de flesta organisationer finns det följaktligen minst två olika måldimensioner. Å ena sidan har vi ägare och investerare som vill ha avkastning på sitt kapital. Å andra sidan finns det intressenter som kräver saker som hög kvalitet, hög säkerhet och tillförlitlighet. Dessa olika krav kan skapa en målkonflikt för verksamheten. Syfte: Syftet med denna uppsats är att studera och analysera hur målkonflikten mellan intressenters säkerhets- och lönsamhetskrav hanteras i verksamhetsstyrningen. Genomförande: Med hjälp av intervjuer har vi genomfört fallstudier vid organisationer inom äldreomsorg och kärnkraftsindustri. Resultat: Vår studie visar på en rad faktorer som bör tas i beaktning vid organisationer med målkonfliktsproblematiken. Ledningen måste vara tydlig i sin målprioritering och kommunikation, ha en tydlig hantering av sina intressenter och deras krav samt att det bör finnas tillfredställande system för felidentifiering och rapporteringsmöjligheter för de anställda. / Background: In the society we live in, there are different kinds of organizations. The organizations that affect us the most however are probably the commercial ones. For these organizations, the owners form a strong a group of stakeholders since they invest capital and therefore require return on their investments. Nevertheless, some organizations also face demands of safety and quality from other stakeholders. With this in mind it becomes clear that organizations sometimes have to handle at least two dimensions of goals, owners that demand yield and the general public that demands a satisfying amount of safety. These different kinds of goals and demands can create a goal conflict situation within the organizations. Aim: The purpose of this study is to explore and analyze how the conflict between safety and economic goals is handled in the operating control.' Completion: A case study was carried out in the geriatric care and nuclear power industry by means of qualitative interviews. Results: The result of this study indicates that there are certain aspects to bear in mind for organizations facing the goal conflict situation. The management has to be clear about what to prioritize and then clearly communicate this priority to the employees. The organization should also have a clearly defined stakeholder strategy concerning their demands and requirements. Finally, it is also important for an organization that employees have proper communication channels and failure identification systems, so that problems can be emphasized.

The welfare of the elderly population is one of the most important goals of the public health services. At macro level the Swedish National Board of Health and Welfare state that the premier goal is for elderly people to have dignified and comfortable lives. They should have a life with a sense of value and feel confident. These ethical values which are expressed on macro level or as normative ethics are expected to prevail at micro level. In our study the micro level is the caring encounter between the elderly patient, next of kin and nurses. Ethical values and morals are important aspects that influence the quality of care, videlicet in empiric ethics. The aim of study (I) was to identify and describe the ethical values experienced by the older person in the daily interaction with nurses in a ward for older people during caring encounters. In study (II) the aim was to identify and describe the governing ethical values that next of kin experience in interaction with nurses who care for elderly patients at a geriatric clinic. Study (I) which was an empirical observational study included follow-up interviews. Twenty-two older people participated voluntarily. In study (II) interviews with fourteen next of kin were conducted. In both studies Constant comparative analysis, the core foundation of grounded theory was used. Five categories; Being addressed, receiving respect, desiring to participate, increasing self-determination and gaining self-confidence formed the basis for the core category in study (I): Approaching. Approaching concerns the way people become closer to each other in a physical space .It also includes how people become closer to each other in a dialogue, which involves verbal or bodily communication. Approaching indicates the ethical values that guide nurses in their caring encounters with older people. This ethical value is noted by the older person and has an individual value, as well as leading to improved quality of their care. The older person will be confident and satisfied with the caring encounter if the desired components in the nurse’s approaching are exhibited. Four categories were identified in study (II): Receiving, showing respect, facilitating participation and showing professionalism. These categories formed the basis of the core category: “Being amenable”, a concept identified in the next of kin’s description of the ethical values that they and the elderly patients perceive in the caring encounter. Being amenable means that the nurses are guided by ethical values; taking into account the elderly patient and next of kin. Nurses who focus on elderly patients’ well-being as a final principle will affect next of kin and their experience of this fundamental situation.

Äldreriktat tal avser kommunikationsanpassningar gentemot äldre liknande de som görs till små barn. Anpassningarna sker inom flera språkliga domäner och är en del av äldres kommunikativa miljö. Ämnet är relativt outforskat och få eller inga studier har gjorts i Sverige. Föreliggande studies syfte var att undersöka eventuell förekomst av äldreriktat tal, samt beskriva dess karakteristika då personal på olika typer av boenden för äldre samtalar med en äldre. Deltagare är fem personer som arbetar på olika former av boenden för äldre. Samtal mellan personal och äldre samt samtal mellan personal och en kollega spelades in och grovtranskriberades. Inspelningarna klipptes till filer utifrån varje analys syfte. Arbetet antog en datadriven ansats och data studerades utifrån tidigare forskning kring äldreriktat och barnriktat tal. I föreliggande studie påvisades att deltagande personal på boende för äldre, i varierande grad, anpassade sin kommunikation inom flera språkliga domäner. Anpassningarna förekom huvudsakligen inom den prosodiska domänen men förekom i viss utsträckning även inom den grammatiska. Anpassningar inom den pragmatiska domänen påvisades till viss del medan anpassningar inom den semantiska domänen ej förekom. Tendenser till talanpassningar förekom hos majoriteten av deltagarna. Följande tillägg av delaspekter till äldreriktat tal föreslås; upprepat användande av namn, mindre samtidigt tal och färre tvekfenomen. / The term elderspeak refers to the adjustments of communication towards elderly people which are similar to those made towards young children. The adjustments are made within several language domains, and are a part of the communicative environment of the elders. The subject is relatively uninvestigated, and few, if any, studies have been conducted on the subject in Sweden. Thus the aim of the present study was to investigate the possible occurrence of elderspeak, and to describe its characteristics. The present study is based upon five participants working at different forms of geriatric institutions. Conversations between a caregiver and a resident and conversations between a caregiver and a colleague were recorded and broadly transcribed. The recordings were cut into separate files according to the purpose of respective analysis. The study was carried out with a data-driven perspective and previously established aspects of elderspeak and child directed speech was searched for. The present study established that caregivers to a varying extent adjusted their communication within several language domains. The adjustments mainly took place within the prosodic domain but they also took place within the grammatical domain. Adjustments within the pragmatic domain were found to some extent, but no adjustments within the semantic domain were found. Tendencies to adjustments of the speech were present in the majority of the participants. The present study suggests the following additions to the aspects of the elderspeak phenomenon; frequent use of name, less hesitation phenomena and less frequent simultaneous speech.

Despite considerable debate surrounding an age associated cognitive decline in non-demented elders, recent studies indicate that changes attributable to normal aging affect cognitive processes and fluid abilities. Additionally, studies indicate that factors such as physical illness, depression, neurological damage, medication side effects, drug interactions, and the effects of surgery and anesthesia may also cause varying degrees of cognitive impairment. Impairment of cognitive function is known to affect treatment and rehabilitation outcomes for older persons, and increase their likelihood of institutionalization. Although proper screening and identification of cognitive deficits in geriatric patients are crucial in developing treatment plans, there is evidence in the medical and nursing literature that cognitive decline in older non-demented patients is often not identified. Proper screening in this case, refers not only to whether or not clinicians engage in assessment behavior, but that they adhere to evidence-based practices and utilize standardized instruments which can identify the type, extent, and implications of the cognitive deficits. This study used an exploratory, non-experimental design and the population of interest consisted of occupational therapists providing physical rehabilitation to patients >65 years of age in the United States. The Ecological Systems Model was chosen as the theoretical framework, because it depicts human behavior as the product of the interaction between the individual's personal attributes and the physical and social environment in which the individual functions. Given the changes in health care, and the limits imposed by third party payers, it would seem important to inquire as to the effect of personal and practice contexts on therapists' assessment practices in geriatric rehabilitation. Although results of the study indicate that factors in the practice context are stronger predictors of therapists' use of standardized cognitive screening and assessment instruments, the study supports principles of Ecological Systems Models in that both practice and personal contexts contribute to therapists' assessment practices.

I vårt samhälle informeras det frekvent om alkohol och dess effekter på vår population. Nya forskningsrön gällande alkohol uppkommer med jämna mellanrum, men sällan rör dessa den äldre befolkningen. Samtidigt visar socialstyrelsen att en ny generation äldre med förändrade alkoholvanor växer fram, vilka tar med sig sina vanor in i pensionsåldern. I vår studie har vi valt att lägga fokus på alkoholbruk bland den äldre befolkningen, och i arbetet har vi valt att rikta oss till personal på äldreboenden. Syftet med studien har varit att undersöka hur alkoholkonsumtionen bland de boende bemöts och hanteras av vårdpersonal, detta i kombination med att äldres riskbruk tenderar att öka. För att få svar på våra problemformuleringar har vi genomfört en kvalitativ intervjustudie. Urvalet bestod av sex vårdpersonal, varav fem av dessa var undersköterskor. Den teoretiska utgångspunkten har legat till grund för utformningen av intervjuerna, samt våra funna resultat. Utifrån utsagor från intervjuerna fann vi ut fyra teman som rör vårt syfte och problemformuleringar: en bild av konsumtionen, självbestämmande och livskvalitet, svårhanterliga situationer, samt skilda upplevelser. Med hjälp av dessa teman analyserade vi de resultat som bland annat visar på brist på utbildning gällande alkoholrelaterade frågor, mycket fokus på självbestämmande men även maktmissbruk. / In our society we are frequently informed about alcohol and its effects on our population. New research findings regarding alcohol occur at regular intervals, but they rarely involve the elderly. At the same time, the social board to a new generation of older people with changing consumption patterns emerge, who tend to bring their habits into the years of retirement. In our study, we chose to focus on alcohol use among the elderly, and in this work we have chosen to find information through the nursing staff at geriatric care. The aim of the study is to investigate how alcohol consumption among the residents is treated and handled by nursing staff, this combined with that the alcohol consumption that is bordering on abuse is increasing amongst the elderly. In order to properly answer this, we have conducted qualitative interviews. The selection consisted of six nursing staff. The theoretical starting point has been the basis for the design of the interviews and the results we found. Based on statements from the interviews we found four themes related to our purpose and problem formulations: a picture of consumption, self-determination and quality of life, cumbersome situations, and different experiences. With the help of these themes, we analyzed the results that among other things show the low level of education concerning alcohol in elder care, a lot of focus on self-determination, but also abuse of power.

Memory monitoring, or the ability to accurately assess one’s memory retrieval success, is known to be declined for older adults. The behavioral decline has been well explored, and is specific to tasks of source monitoring; tasks involving item memory monitoring do not show age-related deficits. This study attempts to further characterize the decline by exploring neuroanatomical contributions to the decline, and genetic influences that may explain performance variability in older adults. Older adults were genotyped for the serotonin transporter (5-HTTLPR) gene, and those that are carriers of the low-expressing allele demonstrate the expected age-related decline of source monitoring performance when compared to younger adults. Interestingly, older adults who lack this allele did not display any decline in performance when compared to younger adults. Neuroanatomical correlates of task performance indicate that prefrontal regions in the inferior and lateral cortices support accurate source memory monitoring, likely through their role in the proper selection of memory cues and inhibition of irrelevant information. This relationship suggests that age-related atrophy occurring in these structures could be responsible for the performance deficits on source memory monitoring tasks. There was no direct relationship seen between genotype for the 5-HTTLPR gene and cortical volumes, however diffusion tensor imaging shows that older adults who carry this allele have altered connections between the medial temporal lobe, responsible for memory retrieval, and prefrontal cortex, which monitors the retrieval process. Through stronger connections of critical networks, older adults who lack the 5-HTTLPR short allele may be able to compensate for the age-related atrophy seen in the prefrontal cortex. Functional results further indicate that the older adult non-carriers recruit inferior and lateral frontal regions to a greater extent than the older adult carriers during accurate memory monitoring. These results begin to suggest a neuroprotective mechanism for the 5-HTTLPR genotype, wherein some older adults may be able to postpone the expected decline of memory monitoring by retaining the ability to recruit essential inferior frontal structures through more organized white matter pathways. / text

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