It’s like the sun and the tide. The aim of this study was to understand the meaning of ‘being aged’ through the everyday experiences of those who are aged. Philosophically, this interpretive study was informed by hermeneutics and interpretive phenomenology. The writings of two twentieth-century philosophers, Hans-Georg Gadamer and Martin Heidegger, guided the study’s design and research methods. The phenomenon of interest is ‘being aged;’ a thing which is ordinarily taken-for-granted in the everyday. However, much is already spoken and empirically ‘known’ about the phenomenon by those who are not yet aged. Methodologically the study’s design sought to ‘put aside’ those voices and listen in closely to what elders themselves had to say about being in their everyday lives. Individual research conversations were conducted with fifteen participants; four Maori elders aged 71 to 93 and eleven non-Maori elders aged 80 to 97 years. All were living in private residences on Auckland’s North Shore and recruited by way of the general electoral roll. The conversations were focused on gathering the stories of particular everyday events as well as the person’s reflections on aging. Anecdotes drawn from the conversations formed the research text. Hermeneutics informed the interpretive engagement with this text. As a non-Maori researcher, cultural integrity of the text and the interpretations was enhanced through partnership with a Maori advisor. Dwelling hermeneutically with the anecdotal text was a way of listening to the spoken and unspoken words. Four overarching notions were illuminated and form the study’s findings. They are my interpretive descriptions of the ordinary ways of ‘being in the everyday,’ the experiences of ‘being with others’ in advanced age, the announcing of being aged in the uncomfortableness of ‘experiencing the unaccustomed’ and how ‘aging just is’ there in an everyday way. Reflecting phenomenologically on the findings, the meaning of being aged is in its ordinariness. My thesis is that being in the ordinary everyday in advanced age both conceals and reveals the phenomenon of being aged.

This diploma thesis is theoretical and is dedicated to old age and ageing. The aim of this diploma thesis is to summarize existing knowledge of old age and to view this final stage of human life from different perspectives and in various context. It is based on periodization of human life. It deals with the process of ageing and its progress, it lists definitions and theories on ageing and also discusses possible premises of longevity. It attempts to define old age and lists myths and prejudices associated with old age. It describes old age from different perspectives of multiple science fields, such as philosophy, biology, medicine, psychiatry, psychology, demography, sociology and social work. It depicts science fields concerned with old age and points out selected aspects of life that can influence elderly person, such as financial situation, housing situation, education, leisure activies, interpersonal relations. It also mentions possible crisis situations during old age, violence against elderly people and system of care of elderly people in the Czech republic. It explains the importance of adaptation during old age and outlines possible image of end of life. At the end of the thesis a set of recommendations for happy old age is included.

Alzheimer’s disease (AD) is a neurodegenerative disease and the major cause of dementia, affecting more than 50 million people worldwide. Chronic pain is long-lasting, persistent pain that affects more than 1.5 billion of the world population. Overlapping and heterogenous symptoms of AD and chronic pain conditions complicate their diagnosis, emphasizing the need for more specific biomarkers to improve the diagnosis and understand the disease mechanisms. To characterize disease pathology of AD, we measured the protein changes in the temporal neocortex region of the brain of AD subjects using mass spectrometry (MS). We found proteins involved in exo-endocytic and extracellular vesicle functions displaying altered levels in the AD brain, potentially resulting in neuronal dysfunction and cell death in AD. To detect novel biomarkers for AD, we used MS to analyze cerebrospinal fluid (CSF) of AD patients and found decreased levels of eight proteins compared to controls, potentially indicating abnormal activity of complement system in AD. By integrating new proteomics markers with absolute levels of Aβ42, total tau (t-tau) and p-tau in CSF, we improved the prediction accuracy from 83% to 92% of early diagnosis of AD. We found increased levels of chitinase-3-like protein 1 (CH3L1) and decreased levels of neurosecretory protein VGF (VGF) in AD compared to controls. By exploring the CSF proteome of neuropathic pain patients before and after successful spinal cord stimulation (SCS) treatment, we found altered levels of twelve proteins, involved in neuroprotection, synaptic plasticity, nociceptive signaling and immune regulation. To detect biomarkers for diagnosing a chronic pain state known as fibromyalgia (FM), we analyzed the CSF of FM patients using MS. We found altered levels of four proteins, representing novel biomarkers for diagnosing FM. These proteins are involved in inflammatory mechanisms, energy metabolism and neuropeptide signaling. Finally, to facilitate fast and robust large-scale omics data handling, we developed an e-infrastructure. We demonstrated that the e-infrastructure provides high scalability, flexibility and it can be applied in virtually any fields including proteomics. This thesis demonstrates that proteomics is a promising approach for gaining deeper insight into mechanisms of nervous system disorders and find biomarkers for diagnosis of such diseases.

In this thesis, "Stages of social work with clients with Alzheimer's disease", I focused on the analysis of the most effective stages of social work. I found out that most respondents prefer a domestic informal care, corresponding to the stages of provided social work and unconditional acceptance of the patient. The sick person requires a sensitive holistic approach, accepting his individuality and ensuring dignity in all stages of the disease. The thesis was structured on the theoretical part, based on the findings of scientific literature dealing with the symptomatology and processes of Alzheimer's disease, characterized by basic treatment and care approaches. The theoretical part is followed by an own joint investigation, divided in a qualitative and a quantitative approach. The qualitative approach is based on a detailed case study which uses the methods of observation and interviews. Anonymous questionnaires were used for the quantitative method. The obtained data were summarized and analyzed. Due to the lack of data I concluded that the considered results can be obtained as irrelevant.

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.

Dans les milieux de soins, il importe d’assurer la qualité de l’ensemble des services offerts, incluant lors de la fin de vie. À cet effet, un rôle clé des infirmières et infirmiers oeuvrant en centre d’hébergement (CHSLD) est de favoriser l’implication des proches dans les soins de fin de vie, ce qui peut contribuer, entre autres, au soulagement d’une possible souffrance pour eux ou les personnes âgées. Selon Andershed et Ternestedt (2001), l’implication des proches prend plusieurs formes : recevoir de l’information (savoir), être présent (être) et effectuer des tâches ou soins (faire). Cependant, peu d’études sur la fin de vie en CHSLD abordent l’implication des proches dans d’autres contextes que la planification des soins et la prise de décisions. Considérant ce manque de connaissances, le but de l’étude était d’explorer les perceptions de proches, en plus d’infirmières ou d’infirmiers, sur l’implication des proches dans les soins de fin de vie d’une personne âgée vivant en CHSLD. Pour répondre à ce but, une étude de cas qualitative instrumentale a été réalisée. Les données ont été collectées auprès de 4 infirmières ou infirmiers et 3 proches, par l’entremise d’entrevues semi-structurées individuelles, ainsi qu’un journal de bord et la documentation du milieu. L’analyse thématique présente l’étendue de l’implication des proches, les souhaits d’implication des proches et quelques stratégies favorisant cette implication. Ces résultats peuvent servir de pistes d’amélioration dans les pratiques en CHSLD, en plus de sensibiliser les professionnels de la santé aux réalités des proches lors de la fin de vie. / In health care settings, it’s imperative that quality of all services is ensured, including end-of-life (EoL) care. A key role of nurses working in long-term care homes (LTCH) is to promote the involvement of relatives in EoL care to, among others, help relieve a possible suffering of relatives or older adults. Based on Andershed and Ternestedt’s (2001) theory, relatives’ involvement can be described in three categories: their knowledge (to know), their presence (to be) and their participation in tasks or care (to do). However, few studies address relatives’ involvement in LTCH in other aspects than decision-making and care planning. Considering this knowledge gap, we conducted a qualitative case study exploring relatives’ and nurses’ perceptions of relatives’ involvement in this context. Data was collected from a sample of 4 nurses and 3 relatives using individual semi-structured interviews, a reflexive journal and relevant documents from the LTCH. Applying thematic analysis, results showed the scope of relatives’ involvement during the EoL, how relatives wished to be involved, and facilitating strategies to involve relatives in care. These results can guide improvement in LTCH practices and raise awareness in health care professionals of the experience of relatives during the agony phase.

<p>Scams and fraud have become a significant problem for the American population within the past few years. While victims range from young to older adults, it is the seniors who are the major targets. In 2018 the Federal Trade Commission reported that senior citizens aged 60 years and above formed 35% of all the scam victims it recorded. According to the U.S Senate Committee on aging, scams like the grandparent scam, IRS impersonation scam, romance scam; have become popular. Even at this level of notoriety, most victims are usually unaware of it entirely or how its perpetrators commit these crimes. Being aware of the situation is a critical step towards curbing this problem. This thesis project uses User-Centered Design (UCD) to understand, conceptualize, and prototype a solution to promote social interaction while improving the cognitive abilities of seniors and creating awareness about fraud. The design requirements and direction were formed through multivariate research methods like literature review, user interviews, and focus group sessions. The proposed solution is Puppy valley, an app-mediated trivia board game that has a physical wheel and mobile application and uses narratives inspired by real fraud cases to create activities for users to play with. After the research and design, the game was evaluated by five experts, and refinements within the scope of the study were made based on the insights from the evaluation.</p>

The most characteristic feature of the demographic development in the Czech Republic and other developed countries is population ageing. The aim of the thesis "The process and rate of disability among seniors" was to determine the extent to which disability interferes with the lives of the seniors and to map the development, progress and conditions of the pension system. After an introductory overview of basic concepts, a part of the thesis deals with a theoretical analysis of the European framework of social security of seniors and another part is concerned with the reform of disability pensions in the Czech Republic. The focus is also on the forms of care for disabled pensioners. The empirical part analyzes the areas related to the development of population structure, administrative agenda, overview of pensions according to the WHO diagnosis groups, total overview of disability pensions, the development of the structure of pensions, financing of pension administration, and the average age of retired people. The economic side is also included, where pensions are compared with average salary and also the economic activity of seniors. The research is quantitative and confirms the current global phenomenon of population ageing as one of the most important problems of developed countries. With this, old-age...

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Background: A landmark study suggested that wide excision of intermediate-thickness melanoma with sentinel lymph node biopsy (SLNB) and subsequent completion lymph node dissection (CLND) for regional disease may improve prognostication and disease-free survival (DFS) compared with those undergoing wide excision alone. However, these benefits were relatively small and not associated with an improvement in disease-specific survival (DSS). It remains unknown if SLNB and subsequent treatments are beneficial in elderly patients who have a decreased overall (OS) due to other causes. Methods: Adults ≥ 70 years of age, who underwent surgical intervention for intermediate-thickness cutaneous melanoma from 2000-2013 were identified from a prospectively-maintained database. Clinicopathologic variables measured included age, gender, anatomic site, histologic type, tumor thickness, ulceration, receipt and result of SLNB, completion of CLND, OS, and DFS. Results: Ninety-one patients underwent excision of an intermediate-thickness melanoma. Forty-nine patients (54%) received a SLNB. Seven of these biopsies (14%) were positive, and five patients went on to receive CLND. Five-year OS was 41% in patients who did not receive SLNB and 52% in patients who did receive SLNB (p=0.11). DFS was similar between groups independent of receipt of SLNB. Conclusion: Among elderly patients with intermediate-thickness melanoma, patients who received SLNB had similar 5-year OS and DFS compared with those who did not receive SLNB. Routine SLNB for intermediate-thickness melanoma patients may not significantly change outcomes for this age group, and clinical decision-making should consider individual patient comorbidities and goals of care.