A responsabilidade de cuidar de um idoso dependente normalmente recai sobre a família, e o número de idosos cuidadores está crescendo. As atitudes em relação à velhice, que referem-se a percepções pré-aprendidas que uma pessoa possui sobre características peculiares ao idoso, são importantes, pois podem interferir diretamente no modo de lidar com o outro. O objetivo geral deste estudo foi analisar quais fatores sociodemográficos, de saúde física e mental e de aspectos do cuidado estão associados às atitudes em relação à velhice, dos idosos cuidadores de idosos dependentes, residentes na área de abrangência das Unidades de Saúde da Família, de um município do interior paulista. Trata-se de um estudo quantitativo, transversal e exploratório, realizado com 313 idosos cuidadores de idosos dependentes. Para a coleta de dados, utilizaram-se um questionário de caracterização sociodemográfica, de saúde e de aspectos do cuidado, o Índice de Katz, a Escala de Lawton e Brody, o Mini Exame do Estado Mental (MEEM), o Inventário de Sobrecarga de Zarit (ZBI), a Escala de Estresse Percebido (PSS), a Escala de Depressão Geriátrica (GDS-15) e a Escala Neri de Avaliação de Atitudes em Relação à Velhice. Os idosos dependentes de cuidado tinham em média 74,0 anos, 68,7% eram homens, 68,4% independentes no Índice de Katz e 86,6% dependentes parciais na Escala de Lawton. Quanto aos idosos cuidadores, a média foi de 69,7 anos, 75,4% eram mulheres e 85,0% cuidavam do cônjuge. O escore médio nas escalas de avaliação foi de 17,7 na ZBI; 18,5 na PSS; 3,6 na GDS-15 e 22,9 no MEEM. Na avaliação funcional, 87,7% eram independentes no Índice de Katz e 57,5% dependentes parciais na Escala de Lawton. A pontuação média na Escala Neri de atitude foi de 3,0 pontos, a pontuação possível varia de 1 a 5 e quanto maior, mais negativas as atitudes. O domínio, desta escala, com pontuação mais negativa foi o Agência (3,2) e o mais positivo o Relacionamento Social (2,7). Na análise de regressão logística multinomial, as atitudes mais negativas em relação à velhice estiveram significativamente associadas (p<=0,05) à maior idade, morar na área urbana, tomar mais medicamentos por dia, cuidar de idosos dependentes (Índice de Katz), estar mais ou menos satisfeito com a vida e apresentar maiores níveis de estresse percebido. Menores níveis de escolaridade foram considerados fatores protetores para atitudes mais positivas. Evidencia-se a necessidade de políticas públicas voltadas à promoção de atitudes mais positivas em relação à velhice, com enfoque nos fatores a elas associados / The responsibility to care for a dependent elderly at home is usually given to the family, and the number of elderly caregivers is increasing. Attitudes toward the elderly, which refer to pre-conceptions that a person has on peculiar characteristics of the elderly, are important because they can influence a range of behaviors. This study analyzes which sociodemographic, physical and mental health, and care aspects are associated with attitudes toward aging, in a sample of older caregivers that cared for dependent elderly living in the area covered by the Family Health Units, of a municipality in São Paulo. This is a quantitative, cross-sectional, and exploratory study, developed with 313 elderly caregivers. Data collection was conducted using a sociodemographic, health, and care aspects questionnaire, Katz Index, Lawton and Brody Scale, Mini Mental Examination State (MMSE), Zarit Burden Interview (ZBI), Perceived Stress Scale (PSS), Geriatric Depressive Scale (GDS-15), and Neri Scale to Assess Attitudes Toward the Elderly. The dependent elderly had a mean age of 74 years, 68.7% were men, 68.4% independent in Katz Index, and 86.6% partial dependent in Lawton Scale. Regarding the elderly caregivers, the mean age was 69.7 years, 75.4% were women, and 85% cared for the spouse. The mean score was 17.7 in ZBI; 18.5 in PSS; 3.6 in GDS-15 and 22.9 in MMES. On functional evaluation 87.7% were independent in Katz Index and 56.5% partial dependents in Lawton Scale. The mean score in Neri Scale was 3.0, the possible score ranged from 1-5 with higher scores representing more negative attitudes. The more negative domain was Agency (3.2) and the more positive was Social Relationship (2.7). The multivariate logistic regression showed that attitudes toward the elderly was significantly associated (p<=0,05) with being older, living in urban setting, taking more medications per day, caring for dependent older person (Katz Index), being more or less satisfied with life, and having higher levels of perceived stress. To be less educated was considered a protector factor to more positive attitudes. The results highlight the need for public policies to promote more positive attitudes toward the elderly, focusing on their associated factors

A responsabilidade de cuidar de um idoso dependente normalmente recai sobre a família, e o número de idosos cuidadores está crescendo. As atitudes em relação à velhice, que referem-se a percepções pré-aprendidas que uma pessoa possui sobre características peculiares ao idoso, são importantes, pois podem interferir diretamente no modo de lidar com o outro. O objetivo geral deste estudo foi analisar quais fatores sociodemográficos, de saúde física e mental e de aspectos do cuidado estão associados às atitudes em relação à velhice, dos idosos cuidadores de idosos dependentes, residentes na área de abrangência das Unidades de Saúde da Família, de um município do interior paulista. Trata-se de um estudo quantitativo, transversal e exploratório, realizado com 313 idosos cuidadores de idosos dependentes. Para a coleta de dados, utilizaram-se um questionário de caracterização sociodemográfica, de saúde e de aspectos do cuidado, o Índice de Katz, a Escala de Lawton e Brody, o Mini Exame do Estado Mental (MEEM), o Inventário de Sobrecarga de Zarit (ZBI), a Escala de Estresse Percebido (PSS), a Escala de Depressão Geriátrica (GDS-15) e a Escala Neri de Avaliação de Atitudes em Relação à Velhice. Os idosos dependentes de cuidado tinham em média 74,0 anos, 68,7% eram homens, 68,4% independentes no Índice de Katz e 86,6% dependentes parciais na Escala de Lawton. Quanto aos idosos cuidadores, a média foi de 69,7 anos, 75,4% eram mulheres e 85,0% cuidavam do cônjuge. O escore médio nas escalas de avaliação foi de 17,7 na ZBI; 18,5 na PSS; 3,6 na GDS-15 e 22,9 no MEEM. Na avaliação funcional, 87,7% eram independentes no Índice de Katz e 57,5% dependentes parciais na Escala de Lawton. A pontuação média na Escala Neri de atitude foi de 3,0 pontos, a pontuação possível varia de 1 a 5 e quanto maior, mais negativas as atitudes. O domínio, desta escala, com pontuação mais negativa foi o Agência (3,2) e o mais positivo o Relacionamento Social (2,7). Na análise de regressão logística multinomial, as atitudes mais negativas em relação à velhice estiveram significativamente associadas (p<=0,05) à maior idade, morar na área urbana, tomar mais medicamentos por dia, cuidar de idosos dependentes (Índice de Katz), estar mais ou menos satisfeito com a vida e apresentar maiores níveis de estresse percebido. Menores níveis de escolaridade foram considerados fatores protetores para atitudes mais positivas. Evidencia-se a necessidade de políticas públicas voltadas à promoção de atitudes mais positivas em relação à velhice, com enfoque nos fatores a elas associados / The responsibility to care for a dependent elderly at home is usually given to the family, and the number of elderly caregivers is increasing. Attitudes toward the elderly, which refer to pre-conceptions that a person has on peculiar characteristics of the elderly, are important because they can influence a range of behaviors. This study analyzes which sociodemographic, physical and mental health, and care aspects are associated with attitudes toward aging, in a sample of older caregivers that cared for dependent elderly living in the area covered by the Family Health Units, of a municipality in São Paulo. This is a quantitative, cross-sectional, and exploratory study, developed with 313 elderly caregivers. Data collection was conducted using a sociodemographic, health, and care aspects questionnaire, Katz Index, Lawton and Brody Scale, Mini Mental Examination State (MMSE), Zarit Burden Interview (ZBI), Perceived Stress Scale (PSS), Geriatric Depressive Scale (GDS-15), and Neri Scale to Assess Attitudes Toward the Elderly. The dependent elderly had a mean age of 74 years, 68.7% were men, 68.4% independent in Katz Index, and 86.6% partial dependent in Lawton Scale. Regarding the elderly caregivers, the mean age was 69.7 years, 75.4% were women, and 85% cared for the spouse. The mean score was 17.7 in ZBI; 18.5 in PSS; 3.6 in GDS-15 and 22.9 in MMES. On functional evaluation 87.7% were independent in Katz Index and 56.5% partial dependents in Lawton Scale. The mean score in Neri Scale was 3.0, the possible score ranged from 1-5 with higher scores representing more negative attitudes. The more negative domain was Agency (3.2) and the more positive was Social Relationship (2.7). The multivariate logistic regression showed that attitudes toward the elderly was significantly associated (p<=0,05) with being older, living in urban setting, taking more medications per day, caring for dependent older person (Katz Index), being more or less satisfied with life, and having higher levels of perceived stress. To be less educated was considered a protector factor to more positive attitudes. The results highlight the need for public policies to promote more positive attitudes toward the elderly, focusing on their associated factors

Programs that address the needs of the elderly are especially important in Canada today as it experiences population aging. There are currently no pretest-posttest studies evaluating functional independence of patients attending the Geriatric Day Hospital at Bruyère Continuing Care in Ottawa, Ontario using the set of indicators and outcome measurement instruments in this study. Evaluation of older patients (age over 65) in this program using various outcome measures was carried out using a single group pretest-post test design. Results showed that there was statistically significant improvement between pretest and post-test scores measuring fear of falling, balance, and functional exercise capacity. However, no significant difference was found between pre- and post-scores for caregiver stress, for which various hypothesized reasons are proposed. There were similar findings for the subgroups analyzed (patients with a history of: stroke or TIA; previous falls; or osteoarthritis) with the exception of fear of falling, which did not show a significant decrease in the stroke subgroup. Some caregivers suggested that “burden” was not an appropriate word for describing their experience, as care-giving was often seen as a moral obligation or an act of love. Future evaluation research using a mixed methods approach and repeated measures design is recommended for a more comprehensive understanding of the effects of this Day Hospital. It may also be of value to compare the different geriatric day hospital programs at the local and regional levels.

abstract: Older adults diagnosed with a serious mental illness (SMI) often face a lifetime of psychiatric institutionalization, making them a very vulnerable population. However, music therapy research has not been conducted with this specific population. The purpose of this thesis was to develop an evidence-based proposed music therapy program for geriatric patients diagnosed with SMI utilizing both music-based and non-music based theoretical frameworks. The music-based approach used for the program is Dalcroze and the non-music based approach is Wellness with a focus on quality of life. The population diagnosed with SMI and the complications of aging for this population are discussed as well as the results of previous music therapy studies conducted with adults diagnosed with SMI. The components of the Dalcroze and Wellness approaches are described and the elements that are incorporated into the program include improvisation and eurhythmics and client strengths and the physical domain (movement). The proposed music therapy program will have the therapeutic goals of increased social interaction, increased self-esteem, and increased quality of life. The data collection tools are mentioned and how to measure results. The program is described in detail with session plans consisting of warm-up, improvisation, movement, and closing interventions. The recommendations for clinical evidence-based practice are discussed. / Dissertation/Thesis / Masters Thesis Music Therapy 2019

Dementia, a clinical condition that affects the psychological ability of patients, is distinguished by a significant overall decline in cognitive function that results in distorted perception. Guiding nursing practice in the long-term care (LTC) setting to decrease the unnecessary use of psychotropics is critical because doing so relates to the patients' quality of life and safety. In the LTC facility that served as the practicum site for this study, there was an observed overuse of psychotropic medications in the care of patients with dementia. The practice-focused question guiding this project asked whether a nursing staff development program would decrease the use of psychotropics in dementia patients. The purpose of the project was to inform nursing staff through an educational program on alternative methods to use when dementia patients exhibit increased disturbing behaviors. The conceptual framework for the project was the knowledge-to-action model. The nursing staff development program had a positive effect on the nursing staff as evidenced by a statistically significant improvement in knowledge and attitudes about the use of psychotropics in caring for dementia patients. The use of psychotropic in the dementia patient decreased from 22.32% to 15.77%, the lowest score achieved by the organization in 5 years. The dementia patients benefited from this project and its positive social change implications for nursing practice by decreasing dementia patients use of psychotropics, minimizing their side effects to the patients and providing an overall feeling of well-being.

Polypharmacy, the simultaneous use of multiple drugs to treat a single ailment or condition, is a major health problem among the elderly population that contributes to adverse drug side events, health risks, hospital readmissions, morbidity, and mortality. Therefore, a staff education program geared toward reduction of such adverse drug events was implemented at a single site. The purpose of the project was to determine if the staff education program would increase knowledge of adverse drug events due to geriatric polypharmacy. The Orem theory provided the theoretical support for the project, and the Iowa model guided the evidence-based practice change process. Topics covered in the education program included medication safety, appropriate drug usage, medication interactions, and other use issues of commonly prescribed drugs for elderly patients. Twenty staff members from 1 assisted-living facility were recruited for the education intervention. Assessments of staff member knowledge were collected before and after the education intervention. Descriptive statistics were used to compare preintervention and postintervention knowledge. Scores on the pretest ranged from 10% to 50% correct on the 10 items, and posttest scores ranged from 40% to 70% correct on the same items. The project is expected to produce social change due to reduced incidence of geriatric polypharmacy and, ultimately, decreased adverse drug effects resulting in patient morbidity, hospitalization, and mortality.

Hearing loss and cognitive impairment are significant health problems, threatening the independent function of older adults. While there appears to be a strong relationship between the two conditions, the mechanisms underlying this association are complex and are not fully elucidated. The purpose of this secondary analysis was to explore the relationship between hearing ability and cognitive performance in older adults. In addition, this study attempted to examine the role of depressive symptoms in the relationship between hearing loss and cognitive performance. Comprehensive measures of peripheral hearing, central auditory processing and cognitive performance were utilized to examine these relationships in a sample (N = 30) of adults aged 60 years and older. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms. Correlational analyses revealed a statistically significant relationship between central auditory processing and executive function. Statistically significant relationships were also observed between speed of processing and peripheral hearing as well as central auditory processing. No significant relationships were noted between depressive symptoms, hearing acuity and cognitive performance. While the correlation coefficients (r) for several of the hearing and cognitive performance measures were not statistically significant, medium effect sizes were detected, suggesting a moderate association may exist between these variables.

This grounded theory study investigated how registered nurses (RNs) managed problem-solving and decision-making in residential aged care facilities (nursing homes) in Western Australia. The outcome of the study was the substantive theory of situational positioning, the process used by the RN participants when they were trying to get things right .In-depth interviews were conducted with 25 purposefully selected registered nurses and nursing home management staff. The interviews were transcribed verbatim, and analysed using the constant comparative method. Other sources of data. guided by theoretical sampling. were selected documents such as government reports regarding aged care, and some field observations. Situational positioning was a process that involved physical. cognitive, emotional, and moral dimensions, and reflected how the RN participants acted and responded when dealing with situations at work. Situational positioning was conceptualised as occurring along two intersecting continua of behaviours, and these behaviours emerged from the data as four interrelated categories. Yielding and confronting represented the poles on a continuum of action-oriented behaviour, with being flexible and being rigid on a continuum that reflected more affective or attitudinal responses. The four categories that made up the positioning continua had both positive and negative meanings in relation to the actions and responses of the participants, depending on the particular situation. Yielding was a conceptual category that reflected participants' comments about stopping a particular action and trying something else or giving up completely and even leaving the situation. f he term confronting was used to describe participants' actions that were based on assertiveness that was seen as a constructive behaviour, or anger that tended to be non-productive. / Being flexible meant that the participants were responsive to changing situational variables, and this was usually seen as a desirable attribute of effective nursing practice in aged care. However, it could also mean being pliant and ready to compromise in order to get through situations when the participants realised that they would be unable to get things right. At the other end of the response axis, the term being rigid was defined as the opposite of being flexible, that is, having firmly fixed or set ways of responding. or a tendency to respond to situations in the same way in all circumstances. The basic psychosocial problem, being unable to get things right, had two properties. One property was temporal, in that the problem occurred when the participants were getting behind or running late because of having insufficient time. usually due to interruptions. The second property of the problem was more qualitative in that contextual and intervening conditions led the participants to feel that they were not doing things properly because of adverse conditions. Conditions that varied .situational positioning were those that led to the participants being unable to get things right, such as having insufficient time. working with unqualified carers. and trying to meet the differing expectations of various stakeholders. Situations that were easy for the participants to manage involved known routines and few, if any. interruptions. In those circumstances, si uational positioning was intuitive and the phases of recognising, prioritizing, and moving on were negotiated quickly. In more complex situations, or when significant interruptions occurred, the participants followed an alternative pathway, which involved recognising that something in the situation changed. then compromising. that is. choosing a new course of action. / Compromising required tolerance, as the participants adjusted their expectations of what could be achieved in the circumstances. Repositioning then occurred belore they moved on to the next task or to the end of their shifts. Moving on. the third phase in the process, involved persevering as they continued trying to get things right. The adverse conditions that prevailed in nursing homes during the time of this study impeded nursing practice and the delivery of consistently good standards of care for all residents. Situational positioning enabled the participants to persevere in their efforts to try to get things right, but their capacity to maintain the effort was eroded by the apparently unrelenting nature of the adverse conditions that existed in nursing homes. The main conclusion of this study was that the RN role in nursing homes in Western Australia was ill-defined, and inefficient in terms of best utilisation of nursing time. Recommendations included a review of the RN role in aged care and implementation of strategies that would enable aged care RNs to focus on their clinical roles.

This mailed survey of nurses in all (111) New South Wales aged care facilities with Huntingdon Disease affected residents, used a custom designed questionnaire in a triangulated exploratory design. It was undertaken by an HD specialist nurse into the previously un-researched field of the nursing challenges in that setting. Knowledge was sought, through descriptive and correlational analysis of fixed choice and open-ended questions, of the facts of the affected resident profile (N=63). Similarly, nursing opinions were obtained on the following unsatisfactory aspects of care provision, the impact of internal resources and the HD nursing role and its support. Results are discussed in some detail. Overt evidence of stigmatisation was not evident. Approximately 32 additional long stay HD beds are needed plus more equipment and education for the aged care facilities. The outreach model of support was strongly endorsed. / Master of Nursing (Hons)

The health care requirements of older people admitted to acute hospitals and their need for nursing care have been identified in current literature as problematic. Hospital organisations which are medically oriented and more focused on implementing programs directed by economics, efficiency and effectiveness may be unsupportive of nursing practices based on a professional value system. There is a need, therefore, to examine how health care structures that tend to promote cost containment and a technical imperative, impact on the professional capability of nurses to provide the standard of care required by acutely ill older hospitalised patients. The collected data, analysed thematically, indicates that the nurses were knowledgeable and potentially competent in providing the standard of technical and functional care required by older adults in hospital. However, although nurses articulated that they wanted to provide the quality of care needed by acutely ill older patients, they nevertheless admitted they were optionalising this care because of constraints in the health care system.While the nurses’ constructions revealed they believed technical tasks took up most of their time during shifts, it is evident during the observations that this was not the case. Through the use of Giddens’s (1984) Structuration Theory, a very different picture began to unfold about the incongruence about was said, and what was actually done. The significance of this study is that the incongruence found between the nurses’ knowledge and their actions has been revealed. / Doctor of Philosophy (PhD)