The purpose of this study was to identify the mental health services available to the elderly residents of Oregon, and to assess the effectiveness of these services in providing mental health treatment to elderly persons. In order to reasonably narrow the scope of this study, the investigation of mental health services was limited primarily to those agencies which are publicly funded and controlled by state or local bodies. In addition, Multnomah County was selected as a case study area in order to further narrow the scope of the study. Multnomah County was selected because of the convenience of its geographical location for this researcher and Student Public Interest Research Group (OSPIRG) personnel, but more importantly, because Multnomah County is one of the most urbanized areas of the state, with a large number of mental health services geographically accessible to its elderly residents. Additionally, this county contains approximately 31% of all elderly residents in Oregon.

No description available.

Ältere und auch pflegebedürftige Menschen werden den Alltag in den Zahnarztpraxen in den kommenden Jahren immer stärker prägen. Mit zunehmender Gebrechlichkeit der Betagten und Hochbetagten sollte sich die zahnmedizinische Behandlung in eine zahnmedizinische Betreuung wandeln. Auch bei einer, im Vergleich zu früher, später eintretenden Pflegebedürftigkeit sind in der Zukunft bei vielen Pflegebedürftigen die zweiten und dritten Zähne zu versorgen. Leider ist festzustellen, dass die zahnmedizinische Versorgung in Pflegeeinrichtungen noch nicht ausreichend standardisiert ist. Von den Pflegebedürftigen in Sachsen, Berlin und Nordrhein Westfalen besaßen nur 18,6 % stationär Pflegebedürftige und 41,2 % ambulant Pflegebedürftige ein zahnmedizinisches Bonusheft. Die Verteilung war regional sehr unterschiedlich. Anteilig besaßen die Pflegebedürftigen in Sachsen am häufigsten ein Bonusheft. Das Vorhandensein des Bonusheftes war weder von Alter oder Geschlecht abhängig. Der Verlust einer besseren Bonusregelung bei Zahnersatzleistungen wird dabei von den Pflegedienstleitungen und dem medizinischen Dienst völlig außer Acht gelassen, teilweise sind die Bonusregelungen auch nicht ausreichend bekannt. Die Organisation eines kontinuierlichen Konsildienstes könnte mit der Anforderung an das Führen eines zahnmedizinischen Bonusheftes verbessert werden. Hierzu müssen aber die Informationen zum Bonusheft gezielt an die Heimleitungen, die Heimaufsichten, die Heimräte, die Angehörigen und an den medizinischen Dienst herangetragen werden.

Background: The Swedish population is aging [1] and malnutrition is a common problem among elderly people [2]. A method called food registration is used to monitor the patients’ nutritional intake, with the purpose of reducing the risk of patients deteriorating in nutritional status during hospitalisation. However, the current method is not satisfactory and many food registration lists are incomplete. [3-6] Thus, patients do not receive a qualitative nutritional care since the assessment of the patients’ nutritional status is based on incomplete documentation. Purpose: The purpose of this master thesis is to increase the quality in the nutrition monitoring process in the geriatric units B72 and B74 at Karolinska University Hospital in Huddinge, Sweden. This should be done by increasing the prospects of providing caregivers with correct information about the patients’ nutritional intake and make the food registration more complete by introducing a new working system based on Lean Healthcare principles. The new working system should consist of a prototype of a food registration application and a new working approach with clear and standardised responsibilities for all occupational groups and shifts. Problem: Is it possible to create a visual and standardised working system that will increase the effectiveness and safety of the nutritional monitoring process? Methods: The current nutrition monitoring process was investigated by observations, interviews and timings. In addition, 100 registration lists were scrutinized and errors and missing information were noted and prototype of a food registration application was created using usability inspection methods. The prototype was tested in a usability test and evaluated in a survey that contained a standardised usability index called The System Usability Scale (SUS). Results: The review of old registration lists revealed that 59 per cent of the food registration lists missed information on how much the patient had been served and/or had consumed at one or more occasions. On average, each list contained 9.4 errors or points of missinged information. The SUS test generated a usability score of 86.75 out of 100, which is equivalent to an A in the A-F grading system. [7] During the usability test an average of 8.2 errors per test were made, though as 4.4 of these were corrected the net average was 3.8 errors per test. The three most common errors, which accounted for 69.5 per cent of all 82 errors, were to forget to specify quantity (36.6 per cent), to press ‘done’ before everything had been registered (18.3 per cent) and to not find the correct item (14.6 per cent). Conclusion: Hopefully, in the future, more food registrations will be correctly performed due to the built in mistake proofing systems of the food registration application and the introduction of the new working approach. The hope is that the new working system will provide caregivers with accurate information on the patients’ nutritional intake so that the patients’ nutritional care can be based on complete documentation. In this way, the quality and safety of the nutrition monitoring process will be increased. / Bakgrund: Sveriges befolkning blir allt äldre [1] och malnutrition är ett vanligt förekommande problem hos personer över 65 år [2]. För att övervaka patienternas näringsintag används så kallad kostregistrering där personalen antecknar vad och hur mycket patienten äter och dricker. Detta görs för att kunna stävja en pågående viktminskning eller fånga upp patienter som riskerar att bli undernärda. I dagsläget fungerar dock inte nutritionsmonitorering kostregistreringsprocessen inte tillfredsställande och många kostregistreringslistor blir ofullständigt ifyllda. [3-6] Konsekvenserna av detta blir bristande patientsäkerhet samt att patienterna inte får en kvalitativ nutritionsvård då bedömning av patientens nutritionstillstånd baseras på ofullständiga underlag. Syfte: Detta arbete syftar således till att öka kvaliteten i nutritionsmonitoreringsprocessen på geriatrikavdelningarna B72 och B74 på Karolinska Universitetssjukhuset i Huddinge för att på så vis öka förutsättningarna för att sjukvårdpersonalen får en korrekt bild av hur mycket kalorier patienterna får i sig samt att öka sannolikheten för att kostregistreringen blir korrekt utförd. Detta görs genom att introducera ett visuellt, standardiserat och mer effektivt arbetssystem kring kostregistreringen baserat på Lean Healthcares principer och bestående av en prototyp av en kostregistreringsapplikation och ett nytt arbetssätt. Frågeställning: Kan ett visuellt och standardiserat arbetssystem utformas för att öka effektivitetenseringen och säkerheten i nutritionsmonitoreringsprocessen? Metoder: den nuvarande nutritionsmonitoreringsprocessen undersöktes genom observationer, intervjuer och tidtagning vid kalorisammanräkning. Dessutom studerades 100 ifyllda kostregistreringslistor och fel samt saknad information noterades. En prototyp av en kostregistreringsapplikation skapades genom interaktionsanalysmetoder och testades i ett användartest som sedan utvärderades genom en enkät bestående av ett standardiserat användbarhetsindex, The System Usability Scale (SUS). Resultat: Vid undersökningen av ifyllda kostregistreringslistor framkom att 59 procent av kostregistreringslistorna saknade information om vad som serverats och/eller konsumerats vid minst ett av de fyra huvudmålen. Varje undersökt lista innehöll i genomsnitt 9,4 fel eller glömda saknad information. SUS-mätningen genererade en poäng på 86,75 av 100 möjliga, vilket motsvarar ett A enligt betygsskalan A-F. [7] Under användartestet gjordes i genomsnitt 8,2 fel per test och av dessa korrigerades i genomsnitt 4,4 av felen, vilket gav ett slutgiltigt antal fel på 3,8 fel per test. De tre vanligast förekommande felen, som utgjorde 69,5 procent av de totala 82 felen, var att glömma att fylla i mängd (36,6 procent), att trycka ”klar” innan samtliga poster registrerats (18,3 procent) och att inte kunna hitta rätt val (14,6 procent). Slutsats: Förhoppningsvis kommer kostregistreringsapplikationens olika felsäkringssystem och det nya arbetssättet att i framtiden leda till att fler kostregistreringar blir korrekt utförda. Förhoppningen är att det nya arbetssystemet kommer att leda till fler korrekta kostregistreringar, vilket leder till att fler patienter får en nutritionsvård som är baserad på bedömningar från korrekta underlag. Detta torde i sin tur öka kvaliteten i patienternas nutritionsvård och höja patientsäkerheten.

Bakgrund: Demenssjukdom är en ökande folksjukdom och nästan alla drabbas av beteendemässiga och psykiska symtom (BPSD) under sin sjukdomstid. Genom personcentrerad omvårdnad och individanpassade åtgärder kan BPSD-symtom förbyggas och lindras. Det är vanligt att äldre med demenssjukdom är i behov av vård på geriatrisk avdelning. Sjukhusmiljön orsakar en komplex omvårdnadssituation både för sjuksköterskan och personen med demenssjukdom.  Syfte: Syftet var att beskriva sjuksköterskans erfarenheter av främjande och hindrande faktorer för att lindra beteendemässiga och psykiska symtom vid demenssjukdom på geriatrisk avdelning.  Metod: En kvalitativ intervjustudie genomfördes med 10 sjuksköterskor yrkesverksamma på geriatrisk avdelning. Intervjuerna analyserade utifrån Granheim och Lundmans (2004) innehållsanalys med manifest fokus.  Resultat: Analysen ledde fram till två kategorier. Kategorin Främjande faktorer för att lindra BPSD på geriatrisk avdelning bröts ner i följande underkategorier: att tillgodose basala behov, att se hela personen, att vara kreativ i sina lösningar samt betydelsen av teamarbetet. Den andra kategorin Hindrande faktorer för att lindra BPSD på geriatrisk avdelning bröts ner i följande underkategorier: att inte ha kompetensen, att vårdmiljön inte är anpassad, att inte ha tillräckligt med personal och tid samt läkemedel som ger negativ effekt.  Slutsats: Sjuksköterskorna eftersträvade personcentrerat arbete med fokus på individens basala behovstillfredsställelse och lindring av BPSD-symtom genom teamarbete. Bristande kunskap och förutsättningar bidrog till svårigheter för att kunna lindra BPSD-symtom på geriatrisk avdelning. Medvetet och metodiskt arbete bidrar till ökad trygghet och välbefinnande för personen med demenssjukdom. / Background: Dementia is a public disease that is increasing and almost everyone who is affected has behavioral and psychological symptoms (BPSD) throughout the illness. Through person-centered care and individually tailored measures, BPSD-symptoms can be prevented and alleviated. It is common for elderly people with dementia to need care in a geriatric ward. The hospital environment causes a complex nursing situation for both the nurse and the person with dementia.  Aim: The aim was to describe the nurse's experiences of promoting and hindering factors in alleviating behavioural and psychological symptoms of dementia in a geriatric ward.  Method: A qualitative interview study was conducted with 10 nurses working in a geriatric ward. The interviews were analyzed based on Granheim and Lundman's (2004) content analysis with a manifest focus.  Results: The analysis led to two categories. The category Promoting factors to alleviate BPSD in the geriatric ward was broken down into the following subcategories: meeting basic needs, seeing the whole person, being creative in their solutions and the importance of teamwork. The second category Obstructing factors for alleviating BPSD in the geriatric ward was broken down into the following subcategories: not having the knowledge, that the care environment is not adapted, not having enough staff and time, and medicine that have a negative effect.  Conclusions: The nurses focused on person-centered work with the individual's basic needs in focus and alleviation of BPSD-symptoms through teamwork. Lack of knowledge and conditions contributed to difficulties in alleviating BPSD-symptoms in the geriatric ward. Conscious and methodical work contributes to increased security and well-being for the person with dementia.

Institution/department: Charles University, Faculty of Pharmacy in Hradec Kralove, Department of Social and Clinical Pharmacy Title of diploma thesis: Evaluation of the rationality of prescribing of selected potentially inappropriate medications in ambulatory geriatric patients Supervisor: Assoc. Prof. Daniela Fialova, PharmDr. Ph.D. Author: Roman Lestina Introduction: Rational therapy in the geriatric population is an essential area due to the ever-increasing percentage of geriatric patients in the population. Due to the frequent polypharmacotherapy in these patients, including possible polypragmatism, it is important to constantly monitor potential drug problems and address potential drug risks in a timely manner. As an auxiliary tool in rational geriatric pharmacotherapy, expert groups have defined many potentially inappropriate medications (PIMs), which often contribute to drug reactions in the elderly, and which should be given more attention in clinical practice. This diploma thesis focused on 10 selected, most frequently used PIMs in the geriatric outpatient clinic of the University Hospital in Hradec Králové, and its aim was to monitor how often these drugs are prescribed in high-risk situations in geriatric patients (i.e., in the presence of symptoms, laboratory results and diseases, which...

Possibilities of prevention reflecting geriatric principles: Functional status and depressivity in old age Hana Vaňková, MD Abstract Background: Given the population ageing in Europe and in the Czech Republic, strategies aiming to prevent functional decline in older age are of great importance. Depression in old age increases functional decline and is also associated with increased morbidity, mortality and deterioration of quality of life (Anstey et al., 2007; Karakaya et al., 2009). Therefore, there is a need for a comprehensive intervention addressing both functional status and depressive symptoms. Methods: Using comprehensive geriatric assessment, the relationship between functional status and depressive symptoms was examined in 308 residents of long-term care facilities (RCFs) in the Czech Republic. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. An additional randomized control trial (RCT) evaluated the effect of a dance-based therapy on depressive symptoms in 162 institutionalized older adults with average age over 80 years. Results: A multiple regression analyses adjusted for sociodemographic factors and for taking antidepressants found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to...

No description available.

No description available.

The purpose of this integrative review was to examine the effects of music therapy, a complementary intervention, on individuals with dementia. Peer-reviewed journals were retrieved from MEDLINE, CINAHL, CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Music Index to evaluate their relevance to music therapy use in people diagnosed with dementia. English and Spanish-language research articles published from 2000-2017 were included for the review (n=15). The literature indicates the use of music therapy as an adjuvant therapy for the treatment of dementia in older adults may be beneficial in decreasing symptoms of aggression, anxiety, agitation and depression. Music therapy is used in varying settings, but more specifically in long term care facilities. This complementary therapy enhances the quality of life in persons with dementia and facilitates empathetic relationships between residents and the staff.The literature indicates that music therapy, involving singing, listening to music, music and movement, when performed by a certified music therapist can have beneficial effects for people with dementia, especially when pharmacological treatments alone do manage symptoms associated with this disorder. Implications for nursing practice, education, policy and research are discussed along with study limitations.