Malnutrition is prevalent in the geriatric population, as is age-related decline in skeletal muscle mass. Research indicates that nearly forty percent of older adults in skilled nursing facilities across the nation are undernourished, with over half experiencing protein-energy malnutrition (PEM). Effects include a gradual loss of mass, strength and function. Concurrently, studies indicate optimal protein-energy intake increases the quality and length of life, and mortality may be reduced by supplementation in this group. However, as protein needs increase, skilled nursing facilities struggle to meet patient protein needs as appetite, amino acid metabolism, chewing, and swallowing capacity decline. Nutrient-dense foods are essential in promoting geriatric health with an emphasis on protein. Fortification of foods is a common, cost-effective approach to enhance nutritional health in this setting, as increasing the volume of food intake is not always a viable solution. The aim of this research was to create a functional food, fortifying a food item that is eaten as a part of a typical diet. Researchers modified a biscuit recipe to increase the protein and calorie content of this popular southern food and compared the acceptance among a sample of adults (n=97) during a blind trial, and the effects of adding two different protein powders, a whey protein modular or instant dry milk powder, on nutrient composition. Analysis of Variance and post hoc testing indicated a statistically significant effect when adding protein sources on acceptability, texture, and flavor (P<0.05). Participants rated the flavor and overall acceptance of the milk fortified protein biscuit highest among variations, with the texture of the control and milk variations most similar, the whey variation was poorly accepted. Results suggest the addition of instant dry milk powder to a popular biscuit recipe may be a cost-effective method of improving its nutrient composition, while maintaining acceptability.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Bakgrund: Aggression mot vårdare är ett bestående problem inom vården. Vid vård- ochomsorgboende har var femte vårdare utsatts för hot och våld av brukarna. En vanlig orsaktill aggressivt beteende är en bakomliggande kognitiv svikt, vilket är vanligt förekommandeinom äldrevården. Syfte: Studiens syfte var att belysa vårdares erfarenhet att vårda aggressiva brukare ochhur det påverkar bemötandet. Metod: En sekundäranalys genomfördes baserat på semistrukturerade interjuver med 20vuxna kvinnor, anställda på sjukhem som varit exponerade för en våldsam situation. Enkvalitativ innehållsanalys med en induktiv ansats nyttjades. Resultat: Analysen av intervjuerna resulterade i fyra huvudkategorier: Försöka hanteravåldet, Bli ursäktande, Resignera och Vända sig till arbetsgruppen. Resultatet visade attvårdarna skapade egna uppfattningar om brukarnas beteenden och spred dessa tillarbetsgruppen. Dessa uppfattningar lede till formulerandet av avdelningsnormer kring hurspecifika brukare skulle hanteras och bemötas. Vårdarna hade vant sig med brukarnasaggression, således hade våldet normaliserats. Konklusion: Betydelsen av att kontinuerligt exponeras för aggressivt beteende kanpotentiellt leda till att vårdarna utvecklar compassion fatigue till brukaren och yrket samtnegligerar brukarnas psykosociala behov. När dessa interjuver genomfördes varpersoncentread vård inte den vedertagna normen, men ur ett historiskt perspektiv kan detmöjligen skådas en framväxt av detta tankesätt. / Background: Aggression against caregivers is a persistent problem within the healthcare. Especially regarding care and nursing homes, with one out five employees having beenexposed to threats and violence from residents. A common underlaying cause foraggressive behaviour is the presence of cognitive impairment, commonly present innursing homes. Aim: of the study was to illustrate caregivers experience to care foraggressive residents and how it effects encounters. Method: A secondary analysis was conducted based upon semi structured interviews with20 adult women, employed at a nursing home and having been exposed to a violentsituation. A qualitative content analysis with an inductive approach was used. Results: Analysis of the interviews produced four main categories: Attempting to managethe violence, Excusing, Compile and Discussion with colleagues. It was found thatcaregivers possessed interpersonal perceptions about residents, which were shared amongand between colleagues. In turn this led to formation of norms and conducts concerningcertain residents. Caregivers had grown accustomed to the aggressive behaviour, thusnormalizing the violence. Conclusion: The effect of prolonged exposure to aggressive behaviour could potentiallyresult in development of compassion fatigue and neglect towards residents.Retrospectively the historic emergence of person-centred care could possibly be observedin the data.

Background and Purpose: The adverse effects of drugs may influence results on tests of mobility and balance, but the drug-specific impact is not identified when using these tests. We propose that a quantitative drug index (QDI) will assist in assessing fall risk based on these tests, when combined with other fall risk variables. Methods: Fifty-seven community-dwelling older adults who could walk independently on a treadmill and had Mini-Mental State Examination (MMSE) scores equal to or greater than 24 participated. Mobility and balance outcome measures included the Balance Evaluation Systems Test (BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) and cognitive dual task TUG (TUGc). Fall history, current drug list, and Activity-Specific Balance Confidence (ABC) scale scores were also collected. Body mass index (BMI) was calculated. The QDI was derived from the drug list for each individual, and based on fall-related drug adverse effects. Multiple linear regression analyses were conducted using age, BMI, and QDI as predictor variables for determining mobility and balance test scores, and ABC scale scores. Subsequently, participants were divided into (QDI = 0) low-impact drug group (LIDG) and (QDI > 0) high-impact drug group (HIDG) for Mann-Whitney 2-group comparisons. Results: Age, BMI, and QDI were all significant (P <.001) independent variables in multiple regression analyses for mobility and balance test scores, but not for the ABC scale. Separately, the 2 group comparisons for the BESTest, BBS, TUG, and TUGc demonstrated that HIDG scored significantly (P <.05) worse on these tests compared with the LIDG. Drug counts were also significantly higher for the HIDG than for the LIDG. In contrast, age, BMI, MMSE, and reported falls in the last 12 months were not significantly different between groups. Conclusion: Age, BMI, and QDI - all contributed independently to the mobility and balance test scores examined, and may provide health care professionals a screening tool to determine whether additional mobility and balance testing is required. In addition, the QDI is a more precise marker of adverse effects of drugs compared with drug counts, as the latter does not quantitate the influence of drugs on physiologic function.

Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the goal of early communication to the interdisciplinary team. The project aims are as follows: a) to integrate the “Preparing for Caring” screening tool into the electronic health record, b) for nursing to provide education to the caregiver and assist with identification of needs during the inpatient stay, c) for nursing and the interdisciplinary team to collaborate with the caregiver during the inpatient stay to prepare for discharge, d) to provide education of resources available within the community upon discharge, and e) to include discussion of caregiver presence during the daily interdisciplinary team meeting. Program outcome measures will include use of aggregate data reports to determine the percentage of compliance for screening conduction, case review of identified caregivers, discharge education, and provision of a resource list upon discharge. Specified outcomes are being measured weekly during the implementation phase. As a result of the above, it will be determined if identification and subsequent intervention for informal family caregivers reduces readmission rate to an inpatient facility and the caregiver’s overall sense of burden in providing care upon discharge. Expected outcomes will be reduction in 30-day readmission to the inpatient geropsychiatry unit due to caregiver distress.

El Hospital Geriátrico, busca ser un modelo de hospital que satisfaga y atienda íntegramente las necesidades de las personas adultas mayores, esto debido a que en la actualidad los hospitales a nivel nacional no cuentan con el sistema de atención dirigido a este tipo de la población. Los hospitales geriátricos existentes, no cuentan con la categorización adecuada, ni con el equipamiento necesario para brindar una buena atención. Por otro lado existen centros de día y centros de rehabilitación que atienden al adulto mayor, pero estos tienen deficiencias ya que han sido adecuados de construcciones ya existentes. Hay que tener en cuenta que la población adulta mayor necesita un cuidado especializado e íntegro, por lo cual es importantísimo que sea atendido por un médico geriatra, que lo derive a las áreas correspondientes. El hospital, será público, permitiendo así que una mayor cantidad de adultos sean atendidos. El estar situado en la cuidad, se propone como reto arquitectónico que el hospital sea una edificación que tenga relación con el espacio urbano, generando así espacios integradores que pueden ayudar a la rehabilitación de los pacientes, sin dejar de lado la seguridad y privacidad que necesita el mismo. / The Geriatric Hospital, seeks to be a model of hospital that fully meets and meets the needs of older adults, this because currently hospitals nationwide do not have the system of care for this type of population. Existing geriatric hospitals do not have the appropriate categorization, nor the necessary equipment to provide good care. On the other hand there are day centers and rehabilitation centers that serve the elderly, but these have deficiencies since they have been adequate for existing buildings. It must be taken into account that the elderly population needs specialized and complete care, which is why it is very important that it be attended by a geriatrician, who refers them to the corresponding areas. The hospital will be public, thus allowing more adults to be treated. Being located in the city, it is proposed as an architectural challenge that the hospital be a building that is related to the urban space, thus generating integrative spaces that can help the rehabilitation of patients, without neglecting the security and privacy that you need the same. / Tesis

No description available.

Late-life depression is a major public health concern, associated with poor health outcomes, including doubling of dementia risk. Psychiatric evaluation is impractical in large epidemiological studies, which instead typically rely on self/informant reports, which are subject to various biases (stigma, recall). Few studies have addressed level of agreement between sources. This study examined associations between these sources and assessed whether subject and informant variables moderated these associations. In a population-based study of dementia in Cache County, Utah (2002-5), 1,480 subjects completed an in-depth clinical assessment (CA). Major depression was assessed via the self-report Patient Health Questionnaire-9 (PHQ-9) and informant-rated Neuropsychiatric Inventory (NPI-CA). One hundred forty-eight subjects with cognitive impairment also completed a psychiatrist’s examination, including the self-report Geriatric Depression Scale (GDS), the informant-rated NPI (NPI-MD), and the physician’s clinical rating (PCR). Bivariate correlations were modest: NPI-CA versus PHQ-9 (r = .26), NPI-MD versus GDS (r = .20), GDS versus PCR (r = .22), NPI-MD versus PCR (r = .45). Kappa statistics and logistic regression models indicated that the NPI-CA predicted the PHQ-9 moderately (ϰ = .08, p <.001; OR = 3.1, 95% CI: 1.5 to 6.1). Results also indicated that the GDS did not significantly predict the PCR (ϰ = .10, p > .05; 95% CI: 0.7 to 11.2) nor the NPI-MD (ϰ = .01, p > .05; 95% CI: 0.6 to 6.3), and that the NPI-MD predicted the PCR moderately well (ϰ = .35, p < .001; OR= 11.1, 95% CI: 2.6 to 48.3). CA-NPI predicted the PHQ-9 for cognitively normal subjects (ϰ = .13, p < .001; OR = 10.1, 95% CI: 1.9 to 52.6) but not for subjects with mild impairment (ϰ = .01, p > .05; 95% CI: 0.4 to 4.3) nor dementia (ϰ = .14, p > .05; 95% CI: 0.9 to 7.8). No other variables moderated these associations. Results suggest the importance of cognitive assessment when measuring late-life depression via self-report.

This dissertation reports on the evolution of an observation instrument designed to examine a series of dyadic interactions between service providers and elderly clients. The encounters took place in the physical context of the client's home and under the auspices of two different kinds of urban service agencies. Staff members and elderly clients of In-home Nursing and Interaction agencies participated in the study. The coding system (Service Provider/Client Dyadic Interaction Coding System or SP/CDICS), is comprised of 28 carefully defined and described behavioral categories. The categories were developed through literature reviews and a series of preliminary observations conducted in agencies similar to but not included among the sampled agencies. A majority of the defined behavioral categories require moderate levels of observer judgment. A Field Manual was developed to train the five observers who collected the data. This was supplemented with a videotape constructed to further assist observers in the learning and subsequent use of the code, particularly with non-verbal and paralinquistic aspects of the behaviors. Fifty-one service providers and 147 clients comprised the sample of observed dyads. The coded observational data were examined in the expectation that there would be recurrent patterns of behavior. Factor analysis resulted in the delineation of ten client and five service provider behavioral patterns that appear to be interpersonally meaningful. The derived service provider and client behavioral factors were correlated with other measurements available on the same population. These included several service provider personality and attitude measures as well as observer and client evaluations of the encounter. The comparisons, in general, tended to confirm the interpretations given to the described factors, further supporting an assumption that the SP/CDICS is a useful and valid instrument.

The National Organization for Women use assertion training as a part of its strategy to overcome the oppression of women in our society. Certainly another group of people who suffer from oppression are the elderly. When a person in our society reaches age 65, he or she may suddenly be perceived as of decreased worth and may face forced retirement and quite often may have to adjust to a lifestyle of poverty. If an elderly person's physical health begins to wane, a nursing home may suddenly become the day to day environment he or she must accept. The therapists in the Residential Care Program, which offers mental health services to residents of nursing homes, at Elahan Mental Health Clinic and Center for Family Living in Vancouver, Washington realized that assertion training might be one way to help their elderly clients gain more control over their live and thus implemented an assertion training program. The following is an evaluation of that module which was introduced as part of the Elderly Day Treatment Program in 1977.