SAMMANFATTNING   Sveriges befolkning blir allt äldre och antalet personer över 80 år ökar. Många vill bo kvar hemma men äldre med stora hjälpbehov flyttar till äldreboende. Syftet med studien var att belysa äldres uppfattningar om att vara äldre och deras syn på äldreboende. Vidare hur de ser på att själva bo på ett äldreboende och deras syn på att diskutera en framtida flytt till äldreboende med anhöriga eller vårdpersonal. Studien genomfördes med en kvalitativ ansats och intervjuer gjordes. Analysen av intervjumaterialet skedde med en kvalitativ manifest innehållsanalys. Resultatet visade att de äldre inte såg sig själva som äldre trots de förändringar åldrandet medfört. De äldre hade både en positiv och negativ syn på äldreboende som de grundade på erfarenheter från två äldreboenden. De ville bo kvar hemma och en flytt till äldreboende var ännu ingen aktuell fråga. Men en anledning till att i framtiden flytta till äldreboende skulle vara att inte längre kunna sköta sin hygien. De flesta informanterna hade inte diskuterat en framtida flytt till äldreboende med någon, men upplevde ändå att deras anhöriga kände till deras vilja. Flera såg det som positivt att bli kontaktade av vården och få information om äldreboende och hemtjänst. Resultatet antyder att det kan vara av vikt att veta hur äldre ser på äldreboende och hur de vill ha det den dagen deras hjälpbehov ökar.

<p>SAMMANFATTNING</p><p> </p><p>Sveriges befolkning blir allt äldre och antalet personer över 80 år ökar. Många vill bo kvar hemma men äldre med stora hjälpbehov flyttar till äldreboende. Syftet med studien var att belysa äldres uppfattningar om att vara äldre och deras syn på äldreboende. Vidare hur de ser på att själva bo på ett äldreboende och deras syn på att diskutera en framtida flytt till äldreboende med anhöriga eller vårdpersonal. Studien genomfördes med en kvalitativ ansats och intervjuer gjordes. Analysen av intervjumaterialet skedde med en kvalitativ manifest innehållsanalys. Resultatet visade att de äldre inte såg sig själva som äldre trots de förändringar åldrandet medfört. De äldre hade både en positiv och negativ syn på äldreboende som de grundade på erfarenheter från två äldreboenden. De ville bo kvar hemma och en flytt till äldreboende var ännu ingen aktuell fråga. Men en anledning till att i framtiden flytta till äldreboende skulle vara att inte längre kunna sköta sin hygien. De flesta informanterna hade inte diskuterat en framtida flytt till äldreboende med någon, men upplevde ändå att deras anhöriga kände till deras vilja. Flera såg det som positivt att bli kontaktade av vården och få information om äldreboende och hemtjänst. Resultatet antyder att det kan vara av vikt att veta hur äldre ser på äldreboende och hur de vill ha det den dagen deras hjälpbehov ökar. <em></em></p><p> </p><p> </p><p> </p>

Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years. Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders. This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006. The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation. Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder. Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common. In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

In the last decades our knowledge concerning cardiovascular risk factors has grown rapidly through results from longitudinal studies. However, despite new treatment, in Western countries coronary heart disease remains the leading cause of death and stroke is still the leading cause of severe disability. The studies reported in these papers examine the relationships between stroke/transient ischaemic attack (TIA) and a number of different factors measured on two different occasions in men born in Uppsala 1920-1924 and are epidemiological in their character. The findings indicate that in addition to already established risk factors, indices of an unhealthy dietary fat intake and high serum lipoprotein(a) are independent predictors of stroke/TIA. Among different glucometabolic variables a low insulin sensitivity index derived from the euglycaemic insulin clamp and proinsulin carries a high predictive value for later stroke, independently of diabetes. Moreover, cognitive test performance measured with Trail Making Test B at age 70 is a strong and independent predictor of brain infarction, indicating that the risk is already increased in the subclinical phase of milder cognitive dysfunction. Performance at a pre-stroke Trail Making Test is also of predictive value for mortality after first-ever stroke/TIA, but none of the studied pre-stroke variables or cognitive tests was found to be related to dependency after an event. In summary these studies provide further knowledge about predictors of stroke and of mortality after first-ever stroke. They also indicate the possible importance of new markers of risk, such as the level of lipoprotein(a), profile of fatty acids in the diet, low insulin sensitivity derived from clamp investigations, level of proinsulin, and cognitive performance measured with Trail Making Tests.

Population ageing has been posed as a problem for contemporary governing in relation to the allocation and consumption of finite health care resources, in particular acute hospital care. This thesis explores how nursing practice is a key resource in the management of this ???problem???. Employing Foucault???s concept of governmentality, nursing practice is examined as a form of social government that is central to the regulation of hospital care to older people. A governmentality approach enables consideration of the relationship between the macro political context of governing, as embodied in prevailing political rationalities, and their outworking beyond the arenas of formal government in the micro practices of nurses. Specifically, in this research, it reveals how contemporary entrepreneurial rationalities of governing work at a distance to discursively shape the local practices of nurses in the regulation of hospital care to older people. Discourse analysis of interview texts, literature and documents revealed how enterprise rationality was invested in the discourses circulating in the study site, highlighting the power relationships and subject positions available to registered nurses and outcomes produced in the regulation of hospital care to older people. The analysis details how registered nurses activated a range of technologies and practices as they engaged with enterprise discourses, constituting nursing practice as an activity aimed at making up older people as dischargeable subjects. It shows how enterprise is both a practice and way of thinking that directs us toward a particular truth of hospital, hence nursing, care of older people. The thesis illustrates how changes in the ways of governing hospitals have actively transformed the meaning and practice of nursing in the provision of hospital care to older people. It shows how the values and practices that make entrepreneurial modes of government possible penetrate each layer of an organisation and can create new mentalities or ways of thinking. This was evident in this research whereby an entrepreneurial mode of governance had re-imagined the social practice of nursing as a form of the economic, such that neither recovery, nor health, but discharge assumed pre-eminence as the focus and aim of hospital care for older people and hence the goal of nursing practice. These findings suggest that hospital care of older people has become a political and economic, rather than therapeutic concern. Furthermore, nursing interventions in the hospital care of older people have become administrative rather than therapeutic, with nursing practice focused on individual older people only insofar as they are constituted as part of a population at risk of delayed discharge. The thesis contends that nurses are implicated in the politics of health care in new and different ways amid entrepreneurial rationalities of governing that promote an ethos of risk management, individualism and responsibilisation in relation to health. It argues that the replacement of an ethos of nursing as care based on client need with an ethos of nursing as risk management substitutes the therapeutic intent and practices of nursing with the technical intent of managing risk. In so doing, the thesis illustrates dangers and possibilities arising from the re-framing of health care through entrepreneurial modes of governance. It enables a critically informed consideration of what kind of practice acute care nursing could be into the future and how nurses and others can take action to positively contribute to the futures of older people they provide care to. / Thesis (PhD)--University of South Australia, 2010

Background Creutzfeldt–Jakob disease is a rare and rapidly fatal neurodegenerative disease. Since clinicians may see only very few cases during their professional career, it is important to be familiar with the clinical presentation and progression, to perform appropriate investigations, and allow for quick diagnosis. Case presentation A 73-year-old British Caucasian woman presented with acute confusion of 2 weeks’ duration on a background of low mood following a recent bereavement. Her symptoms included behavioral change, visual hallucinations, vertigo, and recent falls. She was mildly confused, with left-sided hyperreflexia, a wide-based gait, and intention tremor in her left upper limb. Initial blood tests, computed tomography, and magnetic resonance imaging of her brain showed no significant abnormality. Following admission, she had rapid cognitive decline and developed florid and progressive neurological signs; a diagnosis of prion disease was suspected. A lumbar puncture was performed; cerebrospinal fluid was positive for 14–3-3 protein, real-time quaking-induced conversion, and raised levels of s-100b proteins were detected. An electroencephalogram showed bilateral periodic triphasic waves on a slow background. The diagnosis of probable Creutzfeldt–Jakob disease was made. Conclusions This case report highlights key features in the initial presentation and clinical development of a rare but invariably rapidly progressive and fatal disease. It emphasizes the importance of considering a unifying diagnosis for multifaceted clinical presentations. Although it is very rare, Creutzfeldt–Jakob disease should be considered a diagnosis for a mixed neuropsychiatric presentation, particularly with rapid progressive cognitive decline and development of neurological signs. However, to avoid overlooking early signal change on magnetic resonance imaging, it is important to take diffusion-weighted magnetic resonance imaging for all patients with neuropsychological symptoms. Importantly, early diagnosis also ensures the arrangement of suitable contamination control measures to minimize the risk of infection to health care professionals and other patients.

Cette thèse, référée à une approche psychodynamique, se propose d’explorer etd’interroger les processus psychiques impliqués dans la création de chanson(s), parl’association de deux volets différents et complémentaires : d’une part, par le biais de rencontres avec des auteur(e)s-compositeur(rice)s-interprètes s’exprimant à propos de leur travail de création artistique de chanson(s) (étude théorico-clinique) ; et, d’autre part, à travers l’initiation d’un atelier thérapeutique hebdomadaire de création de chanson(s), l’atelier « créachan(t)son(s) », avec des personnes âgées valides vivant en institution (recherche-action). Elle s’inscrit ainsi dans une démarche oeuvrant pour une application pratique des recherches dansles domaines de la psychologie clinique et des psychothérapies à médiation(s) artistique(s). En référence aux écrits de Grimbert (1996, 2002) et à l’aune du modèle théorico-clinique du Moi-Peau développé par Anzieu (1985), cette recherche met en lumière la mobilisation des différentes fonctions du Moi-Peau à travers la création artistique comme la création artthérapeutique de chanson(s). Tout en soulignant la multidimensionnalité intrinsèque et singulière du médiateur qu’est la chanson. Il en résulte de multiples perspectives d’avenir : autant dans le domaine de la recherche, par les nécessaires enrichissements d’un corpus théorique afférent à la création artistique de chanson(s) qui reste à découvrir et à construire ; que dans le champ de la pratique clinique, par l’initiation de propositions alternatives originales et pertinentes quant à l’accompagnement psychothérapeutique des sujets âgés résidant en EHPAD, la création artthérapeutique de chanson(s) en constituant résolument une.Des considérations donc d’importance, pour le présent comme pour l’avenir. / This thesis, based on a psychodynamic approach, will explore and ask the psychicprocesses involved in songwriting, through two different but complementary sections. On the one hand, through the exploration of the very act of creating by means of meeting singerssongwriters while trying to explain the creative process (theoretical-clinical research) ; on the other hand through the practice of weekly songwriting music therapy sessions with elderly people living in nursing home (practice research). This thesis is part of a global approach which works for a practical application of the researches in clinical psychology and art-psychotherapy domains. In reference to Grimbert (1996, 2002) and to the Skin-Ego theoretical-clinical model developed by Anzieu (1985), this research highlights the different uses of the Skin-Ego functions through artistic creation and art-therapeutic creation, and emphases the singular and intrinsic multidimensionality aspects of the song media. It brings also future prospects. In the research domain, it shows the needs to complement the dedicated songwriting theoretical corpus and in the clinical practical domain, it opens original and alternative possibilities of therapeutic way to care for the elderly people living in nursing home ; therapeutic songwriting being definitively one of them.

Introdução: A perda dentária e o edentulismo podem afetar de maneira significativa a saúde bucal e a saúde geral, a qualidade de vida, e a nutrição de idosos. A cárie e a perda dentária têm sido descritas como o resultado de processos que envolvem elementos biológicos, nas superfícies dentárias, e de uma combinação de fatores comportamentais e sociais. Além disso, o contexto histórico no qual os indivíduos estão inseridos influencia seus comportamentos e percepções em relação à saúde bucal. Uma compreensão acerca de comportamentos de saúde demanda a utilização de métodos que permitam explorar a realidade subjetiva destes fatores. Objetivo: Os objetivos deste estudo de métodos quantitativo e qualitativo foram avaliar a associação entre fatores demográficos, socioeconômicos, comportamentais e de saúde e a incidência de Cárie Coronária, Cárie Radicular, e Perda Dentária na amostra estudada, e realizar entrevistas de grupo focal com membros desta amostra para explorar suas percepções acerca da perda dentária. Métodos: Um estudo de coorte foi conduzido com uma amostra aleatória simples de indivíduos com 60 anos ou mais em Carlos Barbosa, RS, entre 2004 e 2008. Entrevistas e exames bucais foram conduzidos com 388 indivíduos dentados na linha de base, e com 273 participantes no seguimento. A incidência de perdas dentárias, cáries coronárias e radiculares e suas associações com variáveis da linha de base foram modeladas com o uso de regressão binomial negativa. Em um segundo momento, informações de natureza qualitativa foram produzidas através de uma séria de oito entrevistas de grupo focal envolvendo 41 idosos, selecionados dos participantes do seguimento do estudo. As discussões de grupo foram moderadas pelo autor, foram gravadas, codificadas e analisadas através do uso da Teoria Fundamentada em Dados. Resultados: Foi observado no modelo multivariável que, ser mais velho; do sexo masculino; viver em área rural; ser casado; ter menor escolaridade; ser fumante; e estar insatisfeito com os serviços de saúde acessados, estiveram associados com a incidência perdas dentárias. Entre as variáveis clínicas, o uso de próteses parciais removíveis e o índice de sangramento gengival foram preditores, enquanto maior taxa de fluxo salivar foi um fator protetor para o desfecho. Com relação às cáries coronárias, no modelo multivariável final foi observado que, ser mais velho; do sexo masculino; viver em área rural; e ser fumante, estiveram associados à sua incidência. Entre as variáveis clínicas, o uso de próteses parciais removíveis foi um preditor, enquanto maior taxa de fluxo salivar foi um fator de proteção para este desfecho. No modelo multivariável final tendo como desfecho a densidade de incidência de cáries radiculares, ser mais velho; viver em área rural; e escovar os dentes com frequência menor do que diária, foram preditores; ao passo que a única variável clínica associada ao desfecho foi uma maior taxa de fluxo salivar, como fator de proteção. No segmento qualitativo, as respostas dos participantes permitiram concluir que as perdas dentárias estiveram relacionadas com a falta de programas de saúde bucal; normas sociais (incluindo valores relativos ao gênero); nível limitado de informações de saúde; e reduzidas acessibilidade e disponibilidade de serviços odontológicos. Contextos de vulnerabilidade social e programática tiveram um papel fundamental no desenvolvimento de normas e valores sociais e comportamentos individuais que resultaram em extrações dentárias. Conclusão: Estes achados são importantes, porque compreender as relações causais entre práticas individuais como higiene bucal, hábito de fumar, e procura por cuidados odontológicos preventivos, e perdas dentárias, não elucida as razões para as pessoas assumirem tais comportamentos. / Introduction: Tooth loss and edentulism may have a negative impact in the oral and general health, in the quality of life, and nutrition of the elderly. Dental caries and tooth loss have been described as results of processes involving biologic factors, on the surfaces of the teeth, and of a combination of behavioral and social factors. Furthermore, the historical context in which people are placed influences their behaviors and perceptions towards oral health. The understanding of health behaviors requires the use of methods which allow for the exploration of the subjective reality of those factors. Objective: The objectives of this study using quantitative and qualitative methods were to evaluate the association between demographic, socioeconomic, behavioral and health factors and the incidence of tooth loss, coronal and root caries in the studied sample. Also, to carry on focus groups interviews with members from the sample to explore their perceptions about tooth loss. Methods: A cohort study was conducted with a simple random sample of subjects 60 years old or older in Carlos Barbosa city, southern Brazil, between the years of 2004 and 2008. Interviews and oral examinations were conducted with 388 dentate subjects at baseline, and 273 participants at follow-up. The incidence of tooth loss, coronal and root caries and their association with baseline variables were modeled with the use of negative binomial regression. Following the quantitative part of the study, information of qualitative nature was obtained through a series of eight focus groups, involving 41 participants, purposefully selected from those participating in the follow-up. The focus groups discussions’ were moderated by the author, were recorded, coded and analyzed through the use of Grounded Theory. Results: In the multivariate model it was observed that, older age; male gender; living in a rural area; being married; less schooling; being a current smoker; and being dissatisfied with the health services accessed, were associated with the incidence of tooth loss. Among clinical variables, the use of removable partial dentures, and the gingival bleeding index were predictors, whereas higher stimulated saliva flow rate showed a protective effect for the outcome. With regards to the incidence of coronal caries, in the multivariate model it was found that, older age; male gender; living in a rural area; and being a current smoker, were associated with the outcome. Among clinical variables, the use of removable partial dentures was a predictor, whereas a higher stimulated saliva flow was a protective factor for the outcome. In the final model, for the outcome defined as the incidence density of new root caries, it was observed that, older age; living in a rural area; and brushing less than daily were predictors, whereas a higher stimulated saliva flow rate showed a protective effect for the outcome. With regards to the qualitative part of the study, the answers of the participants allowed for the conclusion that tooth extractions had been related, in the past, with the lack of oral health problems; social norms (including social values related to gender); low level of health information; and limited accessibility and availability of dental services. Contexts of social and programmatic vulnerability played a major role in the development of social norms and individual behaviors which resulted in tooth extractions. Conclusion: These findings are important, because understanding the causal relations between individual behaviors such as oral hygiene, smoking, and the pursuing of preventive dental care, do not elucidate why people engage in such behaviors.

Introdução: A perda dentária e o edentulismo podem afetar de maneira significativa a saúde bucal e a saúde geral, a qualidade de vida, e a nutrição de idosos. A cárie e a perda dentária têm sido descritas como o resultado de processos que envolvem elementos biológicos, nas superfícies dentárias, e de uma combinação de fatores comportamentais e sociais. Além disso, o contexto histórico no qual os indivíduos estão inseridos influencia seus comportamentos e percepções em relação à saúde bucal. Uma compreensão acerca de comportamentos de saúde demanda a utilização de métodos que permitam explorar a realidade subjetiva destes fatores. Objetivo: Os objetivos deste estudo de métodos quantitativo e qualitativo foram avaliar a associação entre fatores demográficos, socioeconômicos, comportamentais e de saúde e a incidência de Cárie Coronária, Cárie Radicular, e Perda Dentária na amostra estudada, e realizar entrevistas de grupo focal com membros desta amostra para explorar suas percepções acerca da perda dentária. Métodos: Um estudo de coorte foi conduzido com uma amostra aleatória simples de indivíduos com 60 anos ou mais em Carlos Barbosa, RS, entre 2004 e 2008. Entrevistas e exames bucais foram conduzidos com 388 indivíduos dentados na linha de base, e com 273 participantes no seguimento. A incidência de perdas dentárias, cáries coronárias e radiculares e suas associações com variáveis da linha de base foram modeladas com o uso de regressão binomial negativa. Em um segundo momento, informações de natureza qualitativa foram produzidas através de uma séria de oito entrevistas de grupo focal envolvendo 41 idosos, selecionados dos participantes do seguimento do estudo. As discussões de grupo foram moderadas pelo autor, foram gravadas, codificadas e analisadas através do uso da Teoria Fundamentada em Dados. Resultados: Foi observado no modelo multivariável que, ser mais velho; do sexo masculino; viver em área rural; ser casado; ter menor escolaridade; ser fumante; e estar insatisfeito com os serviços de saúde acessados, estiveram associados com a incidência perdas dentárias. Entre as variáveis clínicas, o uso de próteses parciais removíveis e o índice de sangramento gengival foram preditores, enquanto maior taxa de fluxo salivar foi um fator protetor para o desfecho. Com relação às cáries coronárias, no modelo multivariável final foi observado que, ser mais velho; do sexo masculino; viver em área rural; e ser fumante, estiveram associados à sua incidência. Entre as variáveis clínicas, o uso de próteses parciais removíveis foi um preditor, enquanto maior taxa de fluxo salivar foi um fator de proteção para este desfecho. No modelo multivariável final tendo como desfecho a densidade de incidência de cáries radiculares, ser mais velho; viver em área rural; e escovar os dentes com frequência menor do que diária, foram preditores; ao passo que a única variável clínica associada ao desfecho foi uma maior taxa de fluxo salivar, como fator de proteção. No segmento qualitativo, as respostas dos participantes permitiram concluir que as perdas dentárias estiveram relacionadas com a falta de programas de saúde bucal; normas sociais (incluindo valores relativos ao gênero); nível limitado de informações de saúde; e reduzidas acessibilidade e disponibilidade de serviços odontológicos. Contextos de vulnerabilidade social e programática tiveram um papel fundamental no desenvolvimento de normas e valores sociais e comportamentos individuais que resultaram em extrações dentárias. Conclusão: Estes achados são importantes, porque compreender as relações causais entre práticas individuais como higiene bucal, hábito de fumar, e procura por cuidados odontológicos preventivos, e perdas dentárias, não elucida as razões para as pessoas assumirem tais comportamentos. / Introduction: Tooth loss and edentulism may have a negative impact in the oral and general health, in the quality of life, and nutrition of the elderly. Dental caries and tooth loss have been described as results of processes involving biologic factors, on the surfaces of the teeth, and of a combination of behavioral and social factors. Furthermore, the historical context in which people are placed influences their behaviors and perceptions towards oral health. The understanding of health behaviors requires the use of methods which allow for the exploration of the subjective reality of those factors. Objective: The objectives of this study using quantitative and qualitative methods were to evaluate the association between demographic, socioeconomic, behavioral and health factors and the incidence of tooth loss, coronal and root caries in the studied sample. Also, to carry on focus groups interviews with members from the sample to explore their perceptions about tooth loss. Methods: A cohort study was conducted with a simple random sample of subjects 60 years old or older in Carlos Barbosa city, southern Brazil, between the years of 2004 and 2008. Interviews and oral examinations were conducted with 388 dentate subjects at baseline, and 273 participants at follow-up. The incidence of tooth loss, coronal and root caries and their association with baseline variables were modeled with the use of negative binomial regression. Following the quantitative part of the study, information of qualitative nature was obtained through a series of eight focus groups, involving 41 participants, purposefully selected from those participating in the follow-up. The focus groups discussions’ were moderated by the author, were recorded, coded and analyzed through the use of Grounded Theory. Results: In the multivariate model it was observed that, older age; male gender; living in a rural area; being married; less schooling; being a current smoker; and being dissatisfied with the health services accessed, were associated with the incidence of tooth loss. Among clinical variables, the use of removable partial dentures, and the gingival bleeding index were predictors, whereas higher stimulated saliva flow rate showed a protective effect for the outcome. With regards to the incidence of coronal caries, in the multivariate model it was found that, older age; male gender; living in a rural area; and being a current smoker, were associated with the outcome. Among clinical variables, the use of removable partial dentures was a predictor, whereas a higher stimulated saliva flow was a protective factor for the outcome. In the final model, for the outcome defined as the incidence density of new root caries, it was observed that, older age; living in a rural area; and brushing less than daily were predictors, whereas a higher stimulated saliva flow rate showed a protective effect for the outcome. With regards to the qualitative part of the study, the answers of the participants allowed for the conclusion that tooth extractions had been related, in the past, with the lack of oral health problems; social norms (including social values related to gender); low level of health information; and limited accessibility and availability of dental services. Contexts of social and programmatic vulnerability played a major role in the development of social norms and individual behaviors which resulted in tooth extractions. Conclusion: These findings are important, because understanding the causal relations between individual behaviors such as oral hygiene, smoking, and the pursuing of preventive dental care, do not elucidate why people engage in such behaviors.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2018-03-06T15:34:37Z No. of bitstreams: 1 Carolina Guedes de Brito Montoya.pdf: 1893462 bytes, checksum: 8998cf8a19a4196e8e4d7a33d90ade6a (MD5) / Made available in DSpace on 2018-03-06T15:34:37Z (GMT). No. of bitstreams: 1 Carolina Guedes de Brito Montoya.pdf: 1893462 bytes, checksum: 8998cf8a19a4196e8e4d7a33d90ade6a (MD5) Previous issue date: 2017 / Mestrado Profissional em Enfermagem Assistencial / Objetivos: descrever o perfil sóciodemográfico e de saúde e os impactos objetivos da sobrecarga, em cuidadores de idosos; analisar os impactos objetivos da sobrecarga em cuidadores de idosos que podem interferir no cuidado do idoso e o autocuidado do cuidador; elaborar uma tecnologia educacional a partir dos déficits identificados na escala de sobrecarga a partir das demandas dos cuidadores. Método: pesquisa descritiva, transversal. Respeitados os critérios de inclusão e exclusão participaram do estudo 50 cuidadores de idosos que participam de todas as atividades do Programa EASIC/UFF. Foram identificados no EASIC da Universidade Federal Fluminense as pessoas que já trabalham como cuidador ou são cuidadores familiares. Após a identificação destes cuidadores e aprovação pelo comitê de ética em pesquisa foi realizado contato para convite à participação no estudo. Como campo de pesquisa, foram utilizadas as dependências do Centro de Atenção à Saúde do Idoso e seus Cuidadores CASIC/UFF, em Niterói, RJ. A produção de dados ocorreu de setembro a outubro de 2016, e de abril a junho de 2017. Os dados sóciodemográficos e clínicos e os escores obtidos da escala de sobrecarga de Zarit foram organizados e tabulados em planilhas no Microsoft Excel e submetidos à análise descritiva. Resultados: Com relação aos aspectos sociodemográficos percebeu-se que dos 50 cuidadores da amostra, 90% são mulheres; 34% dos cuidadores têm de 52 a 61 anos; 30% tem ensino médio completo; 36% possuem uma renda familiar mensal de 1 a 2 salários mínimos; e 78% são cuidadores familiares. Da escala Zarit, de sobrecarga vivida pelo cuidador foi possível identificar que 42% dos cuidadores apresentavam grau moderado de sobrecarga. Como produto elaborou-se um manual com orientações de enfermagem ao cuidador de idosos. Conclusão: pode-se concluir que o cuidado ao idoso pode levar à sobrecarga moderada a saúde dos cuidadores resultando na diminuição da sua qualidade de vida. Destaca-se a relevância do produto desta pesquisa que constitui uma importante estratégia de educação em saúde, fornecendo orientações direcionadas à realidade dos cuidadores de idosos. O trabalho contribui com a enfermagem gerontológica e para a produção da tecnologia educacional direcionada aos cuidadores / Objectives: to describe the sociodemographic and health profile and the objective impacts of overload in caregivers of the elderly; analyze the objective impacts of overloading on caregivers of the elderly that may interfere with the care of the elderly and caregiver self-care; to elaborate an educational technology from the deficits identified in the scale of overload from the demands of the caregivers. Method: descriptive, cross-sectional research. In compliance with the inclusion and exclusion criteria, 50 elderly caregivers participating in all activities of the EASIC / UFF Program participated in the study. People who already work as caregivers or are family caregivers were identified in the EASIC of the Federal University of Fluminense. After the identification of these caregivers and approval by the research ethics committee, contact was made to invite the study participation. As a research field, the facilities of the Center for Health Care of the Elderly and their Caretakers CASIC / UFF, in Niterói, RJ, were used. Data production occurred from September to October 2016 and from April to June 2017. The sociodemographic and clinical data and scores obtained from the Zarit overload scale were organized and tabulated in spreadsheets in Microsoft Excel and subjected to descriptive analysis. Results: Regarding the sociodemographic aspects, it was noticed that of the 50 caregivers of the sample, 90% are women; 34% of caregivers are 52 to 61 years old; 30% have completed high school; 36% have a monthly family income of 1 to 2 minimum wages; and 78% are family caregivers. From the Zarit scale, of overload experienced by the caregiver, it was possible to identify that 42% of the caregivers presented moderate degree of overload. As a product, a manual with nursing orientations was developed for caregivers of the elderly. Conclusion: it can be concluded that care for the elderly can lead to a moderate burden on caregivers' health, resulting in a reduction in their quality of life. It is important to highlight the relevance of the product of this research, which is an important strategy for health education, providing orientations directed to the reality of caregivers of the elderly. The work contributes to gerontological nursing and to the production of educational technology directed to caregivers