This qualitative descriptive study described how seven older homeless women with depression characterized their homelessness, depression, and aging. The women, with a mean age of 54 years, were concerned with day-to-day survival, and contemplating aging while remaining homeless was frightening. The women described feeling depressed and most had received treatment for depression; however they did not describe their depression as hindering their ability to find housing. The themes were aging, homelessness, depression, and chronic health conditions. Homelessness contained the subthemes of addictions, loss of relationships, and lack of income. Depression contained the subthemes of history, experience, and treatment of depression. Although chronic health conditions and chronic pain were concerns for all participants, only one woman had access to ongoing health care. The majority of the women had no income. Nearly all the women had attended school beyond high school but this did not translate into better paying employment because most of them had worked at jobs with no benefits. Implications for policy development included expanding the safety net to provide housing options for homeless women in the 50-60 year range. Recommendations for practitioners included the suggestion that older homeless women be viewed as geriatric clients with care provided at that level. Future research should explore the connection between addictions and homelessness for older homeless women, the impact of chronic pain or chronic illness on their daily functioning, and the potential benefits of treating older homeless women according to standards of care developed for the geriatric general population.

Purpose: An open mouth approach is used in voice therapy for enhancing speech and voice production and relaxing the laryngeal musculature. The acoustic and physiological consequences of an open jaw posture, however, have not been clearly understood due to a paucity of cross-system studies taking the age effect into consideration. The major aims of this study are twofold (1) to examine if the geriatric voice may be improved using an “open jaw” posture and (2) if an aging effect on the voice of normal healthy adults can be detected through acoustic and physiological measures Method: The main part of this study involved simultaneous multi-channel voice recordings obtained from 85 healthy adults aged between 38 and 93 years. A convenience sampling strategy was used to recruit at least five females and five males in each of four age groups, 35-59 years (35+), 60-69 (60+), 70-79 (70+), and above 80 (80+). For simultaneous acoustic, electroglottographic (EGG), and jaw displacement recordings, participants were asked to perform two tasks which included a sustained vowel task and a sentence production task. The sustained vowel task involved sustaining the vowel /a/ in five different conditions, an isolated vowel /a/ produced at normal, low, and high pitch levels and the vowel /a/ initiated with a consonant (/m/ and /h/). The sentence production task involved production of the sentence 'We saw two cars,' containing the vowels /i, ɔ, u, a/. For simultaneous airflow-EGG recordings, participants were asked to sustain the vowel /a/ at normal pitch. For simultaneous airflow-air pressure-EGG recordings, participants were asked to repeat /pa/ five times in one breath. Participants were asked to perform all of the tasks using two jaw postures (normal and open). A series of univariate analysis of variances were used to identify instrumental measures sensitive for discriminating between the four age groups and the two jaw postures. A follow-up perceptual study was conducted to determine the effect of an open jaw posture on vowel intelligibility and voice clarity. A quota sampling strategy was used to recruit 40 normal hearing participants, including 20 females (age range = 18-42 years, mean = 25.3, SD = 7.9) and 20 males (age range = 18-47, mean = 23.6, SD = 6.7). These listeners were presented with vowels segmented from the sentences recorded in the first experiment and asked to perform a vowel identification and a voice clarity discrimination task. The vowel samples were taken from 40 speakers, with five females and five males in each of the four age groups (35+, 60+, 70+, and 80+). The percentages of correct vowel identification for voices produced with normal and open jaw postures were compared. The percentages of vowels judged as 'clearer' in a normal-open jaw contrast pairs were also calculated for comparison. Results: Significant age group effects were found in this study for both genders on fundamental frequency (F0), voice onset time (VOT) (/ka/), open quotient (OQ), and speed quotient (SQ), with additional age differences detected for females on %jitter, %shimmer, signal-to-noise ratio (SNR), and the second formant frequency (F2), and for males a significant age group effect was found on VOT (/tu/). Results for both females and males revealed significant open jaw posture effects on F0, F2, VOT (/ka/), MFR, SPL and vowel space area. In addition, for females significant posture effects were found on F1, subglottal pressure and the H1-H2 amplitude difference, and for males, significant posture effects were found on %jitter and VOT-/tu/. Results from the follow-up perceptual study revealed that an open jaw posture was associated with better vowel identification and better voice clarity. Conclusions: A selection of instrumental measures was shown to be useful for detecting voice changes due to aging. Instrumental and perceptual evidence was found that an open jaw posture was associated with positive changes in vocal behaviours, including improved phonatory stability, vocal power, and voice clarity.

Thesis (MEd (Human Resource Studies)) -- University of South Australia, 1994

Thesis--University of Tulsa. / eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 54-58.

Thesis--University of Tulsa. / eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 54-58.

Thesis--University of Michigan. / Includes bibliographical references (leaves 74-84).

Thesis--University of Michigan. / Includes bibliographical references (leaves 74-84).

Thesis--Wisconsin. / Includes bibliographical references (leaves 68-72).

Research into the health needs of Asian elders has been scarce, that which does exist has lacked a theoretical framework. A first attempt is made in the present research study to relate the literature on race and ethnicity to theory and practice in gerontology. A stress and coping model from the gerontological literature was adapted to account for outcomes of physical/psychological health and well-being amongst south Asian elders. In order to test the applicability of this model the first aim of the study was to gain an insight into the circumstances and situations of Asian elders on a range of demographic, support, health and well-being factors. And then-secondly, to see how these factors may interrelate according to the stress and coping model. A range of specific hypotheses were formulated on the basis of this model. Data were collected using semi-structured interviews conducted with a community sample of 70 South Asian elders who were 55 years and over. The interview schedule consisted of both standardised measures of health, stress and coping as well as structured questions on the use of formal/informal support, satisfaction with life and attitudes towards old age. Data were analysed in two phases. The results from the first phase which were largely descriptive, suggest that a significant number of Asian elders were living either alone or with their spouse. In general Asian elders were living in circumstances of material disadvantage, suffering from poor health and chronic illnesses, reporting high levels of psychological distress with little formal and informal support. Awareness and receipt of specialist support services for older adults was low. The results from the second phase involving analyses of correlations and regressions, indicate significant correlations between outcome measures of health/mental health and satisfaction with life with measures of coping, appraisals and to some extent resource variables. There were also significant correlations between positive/negative outcomes of health and well-being with positive/negative ways of coping, appraisal and some resource variables. The factor associated most strongly with outcome variables was social support (resource) rather than coping. Overall, the stress and coping model appears to account well for most of the research findings. The results were discussed in relation to previous research literature and implications for future research and clinical practice were discussed.

Benzodiazepine dependence is a significant national problem. Although benzodiazepines — a class of drugs that includes drugs such as alprazolam, lorazepam, temazepam, clonazepam, and diazepam—have a wide range of uses including the treatment of insomnia, anxiety, and seizures; they are addictive. Individuals taking these drugs can quickly develop dangerous tolerances. Therefore, these drugs should not be selected as first choice nor used for more than short periods, yet a significant portion of the population uses benzodiazepines for long periods. This problem is significantly more pronounced in the elderly, a population that scholars have agreed should not use these drugs outside of extreme circumstances. Because benzodiazepines may be wrongfully perceived as an easy treatment for so many common afflictions, providers continue to prescribe them, and patients may be reluctant to discontinue use due to the symptoms associated with withdrawal (i.e., insomnia and anxiety). To avoid these symptoms, the standard discontinuation approach seen in an outpatient setting is a long-term taper that may take eight to 12 weeks of gradual reduction. However, in an inpatient setting, this long-term approach is unfeasible due to the short length of patient stays. The literature has given little consideration to this problem. Thus, it was necessary to review evidence and develop a guideline for benzodiazepine tapering in elderly patients receiving inpatient psychiatric care. The purpose of this project was to develop a guideline to taper benzodiazepines in the elderly using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). The guideline was validated by expert peer reviewers using the AGREE II instrument. The completed guidelines offer recommendations on the tapering of benzodiazepines in an inpatient geropsych unit and best practices for interventions to increase the success rate of discontinuation.