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The accessibility, predictors, and use of health care and social services among developmentally disabled elderly adults in Canada were examined using a nationally representative social survey. The first research hypothesis is that the independent variables will contribute significantly to the prediction of the dependent variables. A second hypothesis is that the slope of any given independent variable will not equal zero. The results of this research show that the illness (need) variables are the most predictive correlate of the utilization of health care and social services. The predisposing variables have secondary explanatory power, with the enabling variables accounting for the least amount of variance. The hypotheses were tested by step-wise multiple regression analysis using SPSS-X.

Bakgrund: Polyfarmaci hos äldre är ett av vårdens stora problemområden. Många äldre patienter är missnöjda med det höga antalet tabletter de konsumerar. Polyfarmaci kan leda till negativa konsekvenser som exempelvis fall, konfusion och sjukhusinläggningar. Sjuksköterskan har en viktig roll i det förebyggande arbetet för konsekvenserna av polyfarmaci.Syfte: Syftet var att beskriva sjuksköterskans erfarenheter av att förebygga konsekvenser av polyfarmaci hos äldre patienter.Metod: En litteraturöversikt genomfördes med induktiv ansats och kvalitativ design. Litteraturöversikten inkluderade tolv vetenskapliga artiklar publicerade mellan 2011–2021. Data inhämtades från databaserna CINAHL och MEDLINE. Innehållsanalysen genomfördes med Fribergs metod.Resultat: Första huvudkategorin blev läkemedelsgenomgångar med underkategorierna uppdaterad läkemedelslista och att ändra rutiner för förskrivning av läkemedel. Andra huvudkategorin blev multiprofessionellt arbete. Tredje huvudkategorin blev farmakologisk kunskap vars underkategorier blev vikten av att ha goda kliniska kunskaper och välinformerade patienter.Slutsats: Polyfarmaci är ett komplext problem som i många fall inte kan undvikas. Däremot kan det förebyggas med hjälp av läkemedelsgenomgångar, multiprofessionellt arbete och sjuksköterskans farmakologiska kunskap.

I performed a secondary analysis of existing data and determined that when interacting with physicians during primary care visits for chronic illness treatment, patients using opioids are less likely to continue presenting concerns designed to reinforce their social and emotional uniqueness during the second half of primary care visits when physicians provide empathic support of their concerns in the first half of visits.

The number of Canadian seniors with 2 or more chronic health conditions living into their late 90s or older has never been greater. As such, concerns have been raised that the Canadian healthcare system will be unable to meet the growing healthcare needs of the aging population. In this project, an Advanced Practice Nursing needs assessment was used to identify the impact that caring for a senior has on caregivers' stress levels, and what resources caregivers need to in order to cope with their role. Guided by Neuman's system model theory and Rogers' diffusion of innovation model, a convenience sampling technique was used to gather a sample of caregivers who provide services to seniors age 65 years and older. A total of 33 individuals were sampled; however, valid data were present for only 25 respondents in the quantitative investigation and 27 respondents in the qualitative investigation. Quantitative data were gathered on demographic variables, a caregiver's overall level of stress, and a caregiver's burden. Qualitative data were gathered on what resources would help a caregiver feel less stressed. Nonparametric statistics were used to analyze the quantitative data, and the qualitative data were subjected to a content analysis. Quantitative results revealed that as the respondents got older, their caregiver burden and stress increased; the data also revealed that more educated respondents had less caregiver burden and less stress. Analysis of the qualitative data found that the caregivers wanted more support, more information on how to be a better caregiver, more respite care, and more help from both the Community Care Access Centers and the government. It is expected that the findings of this project can be used as a basis for planning and allocating services for caregivers.

Managing diabetes in the geriatric long-term care population can be challenging, yet important because diabetes is a chronic, progressive disease. The purpose of this project was to identify clinical practice guidelines for managing Type 2 diabetes in geriatric veterans and to develop a class to educate providers on diabetes management in the geriatric long-term care population at a community living and rehabilitation center. The practice focused question asked if providing education to providers about the clinical practice guidelines for managing Type 2 diabetes in geriatric long-term care veterans would improve knowledge as measured by a pre- and posttest. The project was based on the stage theory of organizational change and focused on the goal of improving diabetes management in the long-term care geriatric population by using clinical practice guidelines. The American Medical Directors Association's and Diabetes Association's updated clinical practice guidelines and systematic review literature on diabetes provided the evidence to support the educational project. A pretest, posttest, and summative evaluation were used to evaluate the project. A paired t test was used to compare the pretest and posttest scores for all participants. Posttest results showed a significant improvement in provider knowledge compared to pretest scores (t = -4.416, df = 12, p < .01). Participant evaluation of the program showed that the goals and objectives were met, content was understandable, and presentation was professional. The findings of the project may be beneficial at the organizational level to promote positive social change by improved management of diabetes in the geriatric long-term care population, thus potentially decreasing unwanted side effects and improving geriatric veteran health.

Bakgrund Majoriteten av de personer som vårdas av ambulanssjukvården är över 65 år. Under 2020-talet kommer den äldre befolkningen fortsätta att öka. Detta har gjort att efterfrågan på ambulanssjukvård och akutsjukvård vuxit och kommer att växa. Ambulanssjukvårdspersonal behöver därför ha bred kompetens även inom äldreperspektivet för att kunna bemöta och hantera detta.  Syfte  Syftet med studien var att belysa upplevelsen av omhändertagandet vid ambulanssjukvård hos äldre personer boende på särskilt boende.  Metod Studien har en kvalitativ ansats och baseras på intervjuer om äldre personers upplevelser och analyserades med en manifest och latent innehållsanalys.  Resultat I studiens resultat visades temat: Skapandet av en relation mellan patient och ambulanssjukvård är prioriterad i en akut vårdsituation med kategorierna: Professionellt vårdande ambulanssjukvård, Personcentrerat omhändertagande och Bemötandet var centralt i en utsatt situation.  Slutsats  De äldre personerna i den här studien beskriver att de kände sig sedda och upplevde att ambulanssjukvården var säker, korrekt och enligt regelboken. Ett gott bemötande och tydlig information ökar förtroendet för ambulanssjukvårdspersonalen. / Background  The majority of the people cared for by the ambulance service are over 65 years old. During the 2020s, the elderly population will continue to increase. This has meant that the demand for ambulance and emergency medical care has grown and will continue to grow. Ambulance healthcare personnel therefore need to have broad competence also within the perspective of the elderly in order to be able to meet and manage this.  Aim  The aim of the study was to shed light on the experience of care in ambulance care among elderly people living in nursing homes.  Method  The study has a qualitative approach and is based on interviews about the experiences of older people and was analyzed with a manifest and latent content analysis.  Results  In the results of the study, the theme: The creation of a relationship between patient and ambulance care is prioritized in an emergency care situation was shown with the categories: Professional care ambulance care, Person-centred care and The treatment was central in a vulnerable situation.  Conclusions  The older people in this study describe that they felt seen and experienced that the ambulance medical care was safe, correct and according to the rule book. Good treatment and clear information increase trust in the ambulance medical staff.

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...

Objective:To describe the prevalence and impact of vestibular dysfunction and nonspecific dizziness diagnoses and explore their associations with traumatic brain injury (TBI) severity, mechanism, and postconcussive comorbidities among post-9/11 veterans. Setting:Administrative medical record data from the US Departments of Defense and Veterans Affairs (VA). Participants:Post-9/11 veterans with at least 3 years of VA care. Design:Cross-sectional, retrospective, observational study. Main measures:International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for TBI, vestibular dysfunction, dizziness, and other commonly associated postconcussive conditions; Neurobehavioral Symptom Inventory. Results:Of the 570 248 post-9/11 veterans in this sample, 0.45% had a diagnosis of vestibular dysfunction and 2.57% had nonspecific dizziness. Those with either condition were more likely to have evidence of TBI (57.11% vs 28.51%) and reported more disruption from neurobehavioral symptoms. Blast and nonblast injuries were associated with greater symptom disruption, particularly in combination. Conclusions:There was a consistent, significant association between TBI and vestibular dysfunction or nonspecific dizziness, after controlling for sociodemographic factors, injury mechanism, and comorbid conditions. Given that most deployed post-9/11 veterans report blast and/or nonblast injuries, the need for prompt identification and management of these conditions and symptoms is clear.

Objective:The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods:In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results:There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed and falls after the onset of the UVH predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-based Balance Confidence (ABC) scale and Dynamic Gait Index (DGI) scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of DGI scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions:Therapists may use these findings for patient education or the need for adjunct therapy such as counseling. Impact:Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR, which will help therapists create better predictive models.