Nursing homes are an essential yet understudied provider of cancer-related care for those with complex health needs. Nine percent of nursing home residents have a cancer diagnosis at admission, and it is estimated that one-third of them experience pain on a daily basis. Although pain management is an essential component of disease treatment, few studies have evaluated analgesic medication use among adults with cancer in this setting. Use of opioids, which are the mainstay of pain management in older adults because of their effectiveness in controlling moderate to severe pain, may be significantly related to coverage by the Medicare Part D prescription drug benefit. However, little is known about Medicare Part D’s effects on opioid use in this patient population. A limited body of evidence also suggests that despite known risks of overdose and respiratory depression in opioid-naïve patients treated with long-acting opioids, use of these agents may be common in nursing homes. This dissertation examined access to appropriate and effective pain-related health care services among US nursing home residents, with a special focus on those with cancer. Objectives of this dissertation were to: 1) estimate the prevalence, and identify resident-level correlates, of pain and receipt of analgesic medications; 2) use a quasi-experimental research design to examine the relationship between implementation of Medicare Part D and changes in the use of fentanyl patches and other opioids; and 3) to estimate the prevalence, and identify resident-level correlates, of naïve initiation of long-acting opioids. Data on residents’ health status from the Resident Assessment Instrument/Minimum Data Set (versions 2.0 and 3.0) were linked with prescription drug transaction data from a nationwide long-term care pharmacy (January 2005–June 2007) and the Centers for Medicare and Medicaid Services (January–December 2011). From 2006 to 2007, more than 65% of residents of nursing homes throughout the US with cancer experienced pain (28.3% on a daily basis), among whom 13.5% reported severe pain. More than 17% of these residents who experienced daily pain received no analgesics (95% confidence interval [CI]: 16.0–19.1%), and treatment was negatively associated among those with advanced age, cognitive impairment, feeding tubes, and restraints. These findings coincided with changing patterns in opioid use among residents with cancer, including relatively abrupt 10% and 21% decreases in use of fentanyl patches and other strong opioids, respectively, after the 2006 implementation of Medicare Part D. In the years since Medicare Part D was introduced, some treatment practices in nursing homes have not been concordant with clinical guidelines for pain management among older adults. Among a contemporary population of long-stay nursing home residents with and without cancer, 10.0% (95% CI: 9.4–10.6%) of those who began receiving a long-acting opioid after nursing home admission had not previously received opioid therapy. Odds of naïve initiation of these potent opioids were increased among residents with terminal prognosis, functional impairment, feeding tubes, and cancer. This dissertation provides new evidence on pharmaceutical management of pain and on Medicare Part D’s impact on opioid use in nursing home residents. Results from this dissertation shed light on nursing home residents’ access to pain-related health care services and provide initial directions for targeted efforts to improve the quality of pain treatment in nursing homes.

The aging population in the U.S. is dramatically increasing; it is predicted that not only will individuals live longer but also that they will live with multiple chronic diseases that could require high levels of medical and social resources. While the aging population increases, the number of health care providers choosing to specialize in caring for the elderly is decreasing just as dramatically. Teams are believed to be a possible response to more efficiently use the providers available, take advantage of alternative provider types, and integrate a range of health and social services to meet patient needs more effectively. Interdisciplinary teams are the best practice in the care of older adults, who require both medical and social services. However, maintaining functional collaborative teams has been an ever-present challenge to health and social care organizations. Research has found that institutional support is critical for teams to benefit patients and organizations alike. This study examined the role of institutional context in supporting interdisciplinary teams (IDT) in the care of older adults through interviews of the management and staff of the Program for All-Inclusive Care of the Elderly (PACE) in six states. PACE organizations must commit to an interdisciplinary model of care consisting of 11 different disciplines from across the professional spectrum. The research question posed for this study was: What elements of institutional context support the use of interdisciplinary teams in the care of older adults? Due to the standardized team structure used, PACE was selected as the model to see how institutions at macro and micro levels support the work done by PACE teams and possibly highlight where support is still lacking. A case study approach drawing upon qualitative methods was used to examine policy-regulative, cultural-cognitive, normative, relational, and procedural elements of institutional context and the extent to which they support collaborative teamwork. Thirty-two interviews were conducted with administrators and team members from seven PACE programs across the country. For these PACE programs, five elements and 14 categories of support were identified by the interviewees. Policy and regulatory elements constrain and systematize behavior. PACE IDT experience these constraints and systems through regulatory body practices, resource allocation, and quality measurement. Cultural-cognitive elements mediate between an IDT's external environmrder to make sense of what is happening. PACE IDTs create meaning through their interactions with their external environments through interdependence, demographic characteristics, and organizational structure. Normative findings constrain behavior and confer the rights and duties of IDT members, which arise from organizational mission and values, leadership, and professient and the response of the IDT in oonal boundaries. Relational elements emphasize relationships among IDT members and team interaction with the organization's environment. Social constructs within the team affect role definition and communication, which support IDT practice. Procedural support standardizes practices to maintain highly functional teams. In order to support IDT practice, PACE organizations highlighted recruitment and retention, time and space, and training and education as the primary ways to support IDTs. These categories illustrate the complexity of supporting teams and actualizing teamwork in practice. These findings suggest that PACE is succeeding in supporting the IDT model and provides lessons for other organizations that wish to do the same.

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred and forty older adults residing in 14 assisted living facilities in the Portland, Oregon metropolitan area were interviewed about the frequency and types of social interactions they experienced with members of their facility-based social networks, as well as depression, mood, loneliness, self-esteem, and self-rated health. A 12-item, two-factor model of humor-related social exchanges was identified through confirmatory factor analysis, including both positive and negative humor-related social exchange factors. The newly developed scale displayed evidence of adequate reliability and validly in the current sample. Results indicated that both positive and negative humor-related exchanges were associated with various aspects of mental health, although negative humor-related exchanges appeared to be a stronger predictor of mental health than positive humor-related exchanges. Both positive and negative humor-related exchanges also served as mediators between resident and facility characteristics and indicators of mental health. Cultivating a better understanding of the relationships between humor-related social exchanges and mental health may be beneficial for researchers interested in the way humor impacts older adults' ability to cope with stress. This research may also be of value to long-term care providers who create interventions designed at improving residents' mental health and overall quality of life.

Contexte : Partout dans le monde, la population âgée en hébergement a été la plus lourdement affectée par la pandémie de COVID-19, du point de vue des infections et des décès. Or, ces mêmes personnes ont été exclues d’une grande partie de la littérature scientifique. Ce mémoire décrit l’évolution des éclosions dans 17 CHSLD publics de Montréal, dont certains ont été fortement atteints alors que d’autres ont été épargnés pendant la première vague (23 février au 11 juillet 2020), en cherchant à élucider les facteurs associés à l’incidence et à la létalité de la COVID-19. Méthodes : Des données institutionnelles ont été recueillies sur les 17 CHSLD du CIUSSS Centre-Sud-de-l'Île-de-Montréal et des données individuelles ont été obtenues grâce à une révision des 1197 dossiers de patients atteints de la COVID-19 en première vague. Dans l’analyse ARIMA, des séries chronologiques ont été construites pour les cas incidents bruts chez les résidents en CHSLD et dans la ville de Montréal, afin d’évaluer l’impact de deux interventions, soit le port généralisé du masque de procédure et le dépistage élargi des résidents et des employés. Dans l’analyse des infections par CHSLD, des modèles de régression de type binomial négatif ont été construits pour estimer l’effet des facteurs de risque institutionnels sur l’incidence de la COVID-19 chez les résidents. Dans l’analyse de surmortalité, les excès de décès durant la période de février à juillet ont été évalués avec des tests t et des ratios de taux entre l’année 2020 et la moyenne des quatre années précédentes (2016-2019). Enfin, pour l’analyse de mortalité dans la cohorte rétrospective de résidents atteints de la COVID-19, des modèles de régression logistique à effets mixtes ont été utilisés pour évaluer les facteurs institutionnels et les traitements associés à la mortalité dans les 30 jours suivant un diagnostic de COVID-19, en contrôlant pour les facteurs de risque individuels. Résultats : Dans l’analyse de série chronologique ARIMA, chaque augmentation d’un cas incident quotidien par 100 000 à Montréal était associée avec une augmentation de 0,051 (IC95% 0,044 à 0,058) fois l’incidence quotidienne en CHSLD la semaine suivante, chez les résidents à risque. De plus, en contrôlant pour la transmission communautaire, chaque palier d’intensification du dépistage était associé à une diminution de l’incidence de 11,8 fois (IC95% -15,1 à -8,5) dans les deux semaines suivantes, chez les résidents à risque. Dans le modèle explicatif des infections au niveau des CHSLD, la pénurie sévère d’infirmières auxiliaires (IRR 3,2; IC95% 1,4 à 7,2), la mauvaise performance aux audits ministériels (IRR 3,0; IC95% 1,1 à 7,8) et un score moyen d’autonomie plus faible (IRR 2,1; IC95% 1,4 à 3,1) étaient associés au taux d’incidence par centre. En revanche, la présence de zone chaude dédiée aux patients COVID-19 (IRR; 0,56 IC95% 0,34 à 0,92) était protectrice. Pour l’ensemble des 17 CHSLD avec 2670 lits, l’excès de décès de février à juillet 2020 était de 428 (IC95% 409 à 447). Comparé aux quatre années précédentes, il y a eu plus que le double (IRR 2,3; IC95% 2,1 à 2,5) de décès en 2020 pendant la période de la première vague. Pour 12 CHSLD qui ont vécu des éclosions importantes, les excès de décès en 2020 variaient de 5,2 à 41,9 décès par 100 lits, avec une surmortalité par rapport aux années précédentes allant de 1,9 à 3,8. Selon l’analyse de mortalité dans la cohorte rétrospective, les facteurs individuels associés à la mortalité dans les 30 jours suivant le diagnostic de COVID-19 étaient l’âge (OR 1,58; IC95% 1,35 à 1,85 par tranche additionnelle de 10 ans), le sexe masculin (OR 2,37; IC95% 1,70 à 3,32), la perte d’autonomie (OR 1,12; IC95% 1,05 à 1,20 pour chaque augmentation d’un point à l’Iso-SMAF), le niveau d’intervention médicale C (OR 3,43; IC95% 1,57 à 7,51) et D (OR 3,61; IC95% 1,47 à 8,89) comparé au niveau A, ainsi que les diagnostics de trouble neurocognitif (OR 1,54; IC95% 1,04 à 2,29) et d’insuffisance cardiaque (OR 2,36; IC95% 1,45 à 3,85). Le traitement avec une thromboprophylaxie (OR 0,42; IC95% 0,29 à 0,63) et l’infection tardive après le 20 avril 2020 (OR 0,46; IC95% 0,33 à 0,65) étaient associés à la survie à 30 jours. Pour les facteurs institutionnels, la pénurie sévère de 25% ou plus d’infirmières auxiliaires (OR 1,91; IC95% 1,14 à 3,21 par rapport à une pénurie légère < 15%) et la taille du centre (OR 1,77; IC95% 1,17 à 2,68 pour chaque 100 lits additionnels) étaient associés au décès dans les 30 jours. Conclusion : Ce mémoire a relevé plusieurs facteurs de risque modifiables au niveau institutionnel associés aux infections et aux décès COVID-19, dont le dépistage, l’adhérence aux directives ministérielles de prévention et contrôle des infections, la pénurie d’infirmières auxiliaires et le nombre de lits par centre. Ces enjeux cruciaux devront être au cœur des futures orientations et politiques touchant les centres d’hébergement, pour cette pandémie et au-delà. / Background: In the midst of the COVID-19 pandemic, the population of long-term care residents has been the hardest hit by infections and deaths all around the world. Yet, these same individuals have been excluded from vast segments of the scientific literature. This thesis describes the evolution of outbreaks in 17 public long-term care facilities (“CHSLD”) in Montreal, some of which were severely affected and others were relatively spared during the first wave (February 23 to July 12, 2020), in search of risk factors associated with COVID-19 cases and deaths. Methods: Institutional-level data on the 17 CHSLDs were collected from relevant administrative departments within the establishment (CIUSSS Centre-Sud-de-l'Île-de-Montréal), and individual-level data was obtained from the chart reviews of 1,197 first wave COVID-19 patients. For the ARIMA analysis, time series were built using the crude incidence rates among CHSLD residents and in the city of Montreal, in order to assess the impact of two interventions – introduction of the mask-wearing policy and generalized testing among residents and staff. For the analysis of facility-level infection rates, negative binomial regression models were built to estimate the effects of several institutional risk factors on incident cases. As for the excess mortality analysis, excess death and relative mortality were estimated using one-sample t-tests and rate ratio tests to compare 2020 deaths with average deaths in the previous four years (2016-2019), for the period of February to July. Lastly, for the survival analysis of the retrospective cohort, mixed-effects logistic regression models were used to identify institutional factors and treatments associated with 30-day mortality after a COVID-19 diagnosis, while controlling for individual risk factors. Results: In the ARIMA time series analysis, each additional case per 100,000 per day in Montreal was associated with a 0.051 (95%CI 0.044 to 0.058) increase in CHSLD daily incidence a week later, among at-risk residents. In addition, while controlling for community transmission, increased testing intensity was associated with a 11.8 (95%CI -15.1 to -8.5) decrease in CHSLD daily incidence two weeks later, among at-risk residents. In the negative binomial regression model for facility-level COVID-19 infections, poor performance on ministry audits (IRR 3.0 95%CI 1.1 to 7.8), severe shortage of auxiliary nurses (IRR 3.2 95%CI 1.4 to 7.2) and lower average autonomy scores (IRR 2.1 95%CI 1.4 to 3.1) were associated with incident cases, while the presence of a COVID-19 unit or “red zone” (IRR 0.56 95%CI 0.34 to 0.92) was inversely associated with infections. For the 17 CHSLDs, excess deaths from February to July 2020 was 428 (95%CI 409 to 447). Compared to the same period in the previous four years, 2020 mortality during the first wave was 2.3 (IRR 95%CI 2.1 to 2.5) times higher. For a subset of 12 facilities that experienced substantial outbreaks, excess deaths in 2020 varied from 5.2 to 41.9 deaths per 100 beds, with significant excess mortality between 1.9 and 3.8, relative to previous years. According to the mortality analysis by mixed-effects logistic regression, individual risk factors associated with 30-day mortality after a COVID-19 diagnosis were age (OR 1.58 95%CI 1.35 to 1.85 per additional 10 years), male sex (OR 2.37 95%CI 1.70 to 3.32), loss of autonomy (OR 1.12 95%CI 1.05 to 1.20 per unit increase of Iso-SMAF profile), C-level (OR 3.43 95%CI 1.57 to 7.51) or D-level (OR 3.61 95%CI 1.47 to 8.89) medical intervention compared to A-level, as well as being diagnosed with a neurocognitive disorder (OR 1.54 95%CI 1.04 to 2.29) or congestive heart failure (OR 2.36 95%CI 1.45 to 3.85). Treatment with thromboprophylaxis (OR 0.42 95%CI 0.29 to 0.63) and diagnosis after April 20, 2020 (OR 0.46 95%CI 0.33 to 0.65) were associated with 30-day survival. As for institutional risk factors, severe shortage of auxiliary nurses (OR 1.91 95%CI 1.14 to 3.21) and facility size (OR 1.77 95%CI 1.17 to 2.68 per 100 beds) increased the odds of dying within 30 days. Conclusion: This study identified several modifiable risk factors at the institutional level associated with COVID-19 infections and deaths, including testing strategies, adherence to ministry directives for infection prevention, auxiliary nurse shortages, and number of beds per facility. Future policies and regulations targeting long-term care facilities will need to tackle these critical issues, for this pandemic and beyond.

The purpose of this study is to examine the experiences and perspectives of need assessors working with mental illness in older adults. This will be studied to gain a deeper understanding of their work with mental illness in older adults and how they work to promote mental health amongst older adults. A qualitative interview study with six needs assessors was completed to fulfill the purpose of the study, and were later analyzed using thematic analysis. The study’s collected data were furthermore analyzed using two theoretical tools:human service organizations as well as ageism. The results of this study conclude that needs assessors experience their work with mental illness in older adults as indirect due to a lack of elaborate working methods to meet the needs of older adults with mental illness. The study’s results also show that needs assessors perceive mental illness in older adults as a sensitive topic to work with. Additionally, this study highlights that needs assessors feel restricted in their work to promote mental health in older adults as a result of organizational prerequisites in elderly care.

Background: Historically, patients with cancer have been perceived as poor candidates for ICU admission. General ICU admission criteria lists cancer patients as low priority in ICU admission depriving them of the care they rightfully deserve. The purpose of this literary synthesis was to examine ICU admission criteria, risk factors, and outcomes of ICU admission in relation to hematological and solid tumor cancers and discuss ways that practitioners and nurses can educate patients with cancer and their families on appropriateness of ICU care. Methods: A total of 768 articles were found in a literature search including all literature from 2005 to 2016 from all countries using the databases CINAHL Plus, MEDLINE, PsycINFO, and Academic Search Premier. These were further narrowed down based on relevancy by topic or reading abstracts. A total of 13 articles utilizing the inclusion and exclusion criteria of the literature search were included in the final literature synthesis. Results: In addition to general ICU admission criteria several other criteria and scores can be helpful in admitting patients with cancer to the ICU including cancer specific criteria, mortality predictor tools, performance status, and ICU trials. Mortality predictors, in combination with other patient characteristics, demonstrated effectiveness to predict outcomes in patients with cancer. Survival rates in hematological and solid tumor cancers have improved from the past, and lower prognostic scores can predict who will have better outcomes. Conclusion: Cancer specific criteria, mortality predictor tools, performance status, and ICU trials in addition to general ICU criteria should be used for admission of cancer patients into ICU. Practitioners and nurses should become familiar with the newest outcomes in patients with cancer to make collaborative informed decisions about ICU admission.

<p>The risk of fracture is higher in adults with type 2 diabetes compared to controls without type 2 diabetes, despite normal or higher than normal bone mineral density (BMD). In addition to BMD, bone strength depends on other factors such as structural and material <em>bone qualities</em>, which are not accounted for in BMD measurements. The objective was to determine whether structural and material <em>bone qualities</em> are different in adults with type 2 diabetes compared to controls without type 2 diabetes. First, a cross-sectional study was undertaken using MRI to investigate distal radius trabecular bone microarchitecture, a structural <em>bone quality.</em> In women with type 2 diabetes, trabecular bone holes were larger compared to controls, which is important because greater trabecular bone hole size is related to reduced bone strength. Next, a two year prospective study was conducted with the participants involved in the cross-sectional study to determine whether changes in trabecular bone microarchitecture are different in women with type 2 diabetes compared to controls. There was a greater increase in the number of trabecular bone holes in women with type 2 diabetes compared to controls, which provides early evidence of trabecularization of cortical bone in women with type 2 diabetes. In the third study, quantitative backscattered electron imaging (qBEI) was used to derive bone mineralization density distribution (BMDD) outcomes for bone samples from adults with and without type 2 diabetes to compare material <em>bone quality. </em>There was evidence of elevated bone calcium concentration and reduced mineralization heterogeneity in bone samples from adults with type 2 diabetes compared to controls, which may contribute to bone brittleness. In summary, differences in structural and material <em>bone qualities </em>identified in this body of work provide explanations for elevated fracture risk in adults with type 2 diabetes.</p> / Doctor of Science (PhD)

Text in German / Die gesellschaftliche Situation ändert sich stetig. Während früher alte Menschen zu Hause von ihren Familien gepflegt wurden, übernehmen heutzutage oft Altenpfleger diese schwere Aufgabe. Betrachtet man die Altenpflege, so lässt sich erkennen, dass die Pflege alter, kranker oder im Sterben liegender Menschen für die Mitarbeiter physisch und psychisch sehr belastend ist. Angesichts dieser Tatsache, besteht die Notwendigkeit ein differenziertes Personalentwicklungskonzept, das biblisch diakonische Grundprinzipien widerspiegelt, zu formulieren. Die vorliegende Arbeit zeigt deren Möglichkeiten und Potentiale auf. Sie untersucht und beschreibt entsprechende Prinzipien, unter anderem anhand des Ansatzes H.U.M.O.R. und des Modells „Pflege den Pflegenden". Diese Konzepte wurden im „Luise-Schleppe-Haus und Schloss", einer der traditionsreichsten Altenhilfeeinrichtungen Baden-Württembergs entwickelt. Die Darstellung und Untersuchung dieser Konzepte, sowie die Sichtung weiterführender Literatur eröffnet neue Perspektiven für die Personalentwicklung in der Altenhilfe. Der christlich ethische Aspekt von Führung wird berücksichtigt. Auf der Basis der erarbeiteten Prinzipien der Mitarbeiterentwicklung gibt die Masterarbeit Anregungen für die Praxis. Formerly elderly people were taken care of at home by their families. Nowadays this difficult task is often assigned to professional nurses. In closer analysis of their task it becomes evident that helping the very old, ill and dying people constitutes a physical and mental strain. This necessitates the development a differentiated concept of human resource development that reflects the fundamental Biblical diaconal principles. This dissertation analyses the opportunities and potentials of such a concept. It researches and describes appropriate principles, amongst others the approach of H.U.M.O.R. and the model of Care for Caregivers (Pflege den Pflegenden). These concepts were developed in the "Luise-Schleppe-Haus und Schloss", a geriatric facilities in Baden-Württemberg, Germany, of long standing. The analysis combined with further literature opens up new perspectives for the human resource development in the care for the elderly and the ethical aspects of leaderhship in this context. / Systematic Theology and Theological Ethics / M. Th. (Christian Leadership in Context)

Text in German / Die gesellschaftliche Situation ändert sich stetig. Während früher alte Menschen zu Hause von ihren Familien gepflegt wurden, übernehmen heutzutage oft Altenpfleger diese schwere Aufgabe. Betrachtet man die Altenpflege, so lässt sich erkennen, dass die Pflege alter, kranker oder im Sterben liegender Menschen für die Mitarbeiter physisch und psychisch sehr belastend ist. Angesichts dieser Tatsache, besteht die Notwendigkeit ein differenziertes Personalentwicklungskonzept, das biblisch diakonische Grundprinzipien widerspiegelt, zu formulieren. Die vorliegende Arbeit zeigt deren Möglichkeiten und Potentiale auf. Sie untersucht und beschreibt entsprechende Prinzipien, unter anderem anhand des Ansatzes H.U.M.O.R. und des Modells „Pflege den Pflegenden". Diese Konzepte wurden im „Luise-Schleppe-Haus und Schloss", einer der traditionsreichsten Altenhilfeeinrichtungen Baden-Württembergs entwickelt. Die Darstellung und Untersuchung dieser Konzepte, sowie die Sichtung weiterführender Literatur eröffnet neue Perspektiven für die Personalentwicklung in der Altenhilfe. Der christlich ethische Aspekt von Führung wird berücksichtigt. Auf der Basis der erarbeiteten Prinzipien der Mitarbeiterentwicklung gibt die Masterarbeit Anregungen für die Praxis. Formerly elderly people were taken care of at home by their families. Nowadays this difficult task is often assigned to professional nurses. In closer analysis of their task it becomes evident that helping the very old, ill and dying people constitutes a physical and mental strain. This necessitates the development a differentiated concept of human resource development that reflects the fundamental Biblical diaconal principles. This dissertation analyses the opportunities and potentials of such a concept. It researches and describes appropriate principles, amongst others the approach of H.U.M.O.R. and the model of Care for Caregivers (Pflege den Pflegenden). These concepts were developed in the "Luise-Schleppe-Haus und Schloss", a geriatric facilities in Baden-Württemberg, Germany, of long standing. The analysis combined with further literature opens up new perspectives for the human resource development in the care for the elderly and the ethical aspects of leaderhship in this context. / Systematic Theology and Theological Ethics / M. Th. (Christian Leadership in Context)

<p>Старење становништва је велики изазов са којим се суочава светска популација у XXI веку. Становништво Војводине спада у веома старо становништво, а процењује се да ће до средине овог века чак свака трећа особа бити старија од 60 година. Циљ овог рада је био да се процени здравље, разлике у здрављу и коришћење здравствене заштите, као и да се идентификују предиктори&nbsp; здравља и коришћења здравствене заштите код особа старости 65 и више година на територији Војводине. Истраживање представља део Истраживања здравља становништва Србије из 2013. године које је спровело Министарство здравља Републике Србије. Истраживањем је обухваћено 886 испитаника старости 65 и више година са територије Војводине. Инструмент истраживања су били упитници конструисани у складу са упитником Европског истраживања здравља, а подаци о телесној маси, телесној висини и крвном притиску су добијени мерењем. Резултати су показали да су имали већу шансу да процене своје здравље као лошије жене (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), сиромашни (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), испитаници са умереним до тешким ограничењима у обављању кућних активности (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), са присутним јаким болом (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), благим депресивним симптомима или депресивном епизодом (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), оболели од две или више хроничних болести (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) и испитаници са лошијом социјалном подршком (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Предиктори посете лекару опште медицине били су виши ниво образовања, боље материјално стање, веће издвајање из сопствених прихода за ванболничку здравствену заштиту и мултиморбидитет, док су чешће били хоспитализовани мушкарци, особе нижег нивоа образовања, испитаници који су процењивали своје здравље као лоше или веома лоше. Истраживање је потврдило да постоје значајне неједнакости у здрављу и коришћењу здравствене заштите код старих особа у Војводини, које је потребно смањити свеобухватним јавноздравственим политикама и интервенцијама.</p> / <p>Starenje stanovništva je veliki izazov sa kojim se suočava svetska populacija u XXI veku. Stanovništvo Vojvodine spada u veoma staro stanovništvo, a procenjuje se da će do sredine ovog veka čak svaka treća osoba biti starija od 60 godina. Cilj ovog rada je bio da se proceni zdravlje, razlike u zdravlju i korišćenje zdravstvene zaštite, kao i da se identifikuju prediktori&nbsp; zdravlja i korišćenja zdravstvene zaštite kod osoba starosti 65 i više godina na teritoriji Vojvodine. Istraživanje predstavlja deo Istraživanja zdravlja stanovništva Srbije iz 2013. godine koje je sprovelo Ministarstvo zdravlja Republike Srbije. Istraživanjem je obuhvaćeno 886 ispitanika starosti 65 i više godina sa teritorije Vojvodine. Instrument istraživanja su bili upitnici konstruisani u skladu sa upitnikom Evropskog istraživanja zdravlja, a podaci o telesnoj masi, telesnoj visini i krvnom pritisku su dobijeni merenjem. Rezultati su pokazali da su imali veću šansu da procene svoje zdravlje kao lošije žene (OR=2,14; 95%CI=[1,42-3,23]; p&lt;0,001), siromašni (OR=2,92; 95%CI=[1,18-7,20]; p=0,020), ispitanici sa umerenim do teškim ograničenjima u obavljanju kućnih aktivnosti (OR=3,33; 95%CI=[1,28-8,69]; p=0,014), sa prisutnim jakim bolom (OR=2,81; 95%CI=[1,20-6,60]; p=0,017), blagim depresivnim simptomima ili depresivnom epizodom (OR=8,90; 95%CI=[3,71-21,32]; p&lt;0,001), oboleli od dve ili više hroničnih bolesti (OR=13,25; 95%CI=[4,05-43,3]; p&lt;0,001) i ispitanici sa lošijom socijalnom podrškom (OR=3,00; 95%CI=[1,08-8,34]; p=0,035). Prediktori posete lekaru opšte medicine bili su viši nivo obrazovanja, bolje materijalno stanje, veće izdvajanje iz sopstvenih prihoda za vanbolničku zdravstvenu zaštitu i multimorbiditet, dok su češće bili hospitalizovani muškarci, osobe nižeg nivoa obrazovanja, ispitanici koji su procenjivali svoje zdravlje kao loše ili veoma loše. Istraživanje je potvrdilo da postoje značajne nejednakosti u zdravlju i korišćenju zdravstvene zaštite kod starih osoba u Vojvodini, koje je potrebno smanjiti sveobuhvatnim javnozdravstvenim politikama i intervencijama.</p> / <p>Aging is the great challenge of the XXI century. Population of Vojvodina is very old, and projections indicate that by 2050 one in three persons will be older than 60 years. The aim of this study was to evaluate health, health differences and health care utilization, as well as to indentify predictors of health and health care utilization in people aged 65 and over in Vojvodina. The study represents part of the National health survey Serbia conducted in 2013 by the Ministry of Health of Republic of Serbia. Study included 886 examinees aged 65 and over who were interviewed on the territory of Vojvodina. The instruments were questionnaires designed according to the European Health Interview Survey questionnaire, and data on body mass, body height and blood pressure were measured. Results showed that the highest odds of assessing their health as poor had women (OR=2.14; 95%CI=[1.42-3.23]; p&lt;0.001), participants who belonged to the poor class (OR=2.92; 95%CI=[1.18-7.20]; p=0.020), who had difficulties with instrumental activities of daily living (OR=3.33; 95%CI=[1.28-8.69]; p=0.014), with severe pain (OR=2.81; 95%CI=[1.20-6.60]; p=0.017), with mild depressive symptoms or depressive episode (OR=8.90; 95%CI=[3.71-21.32]; p&lt;0.001), with 2 or more chronic conditions (OR=13.25; 95%CI=[4.05-43.3]; p&lt;0.001) and with poor social support (OR=3.00; 95%CI=[1.08-8.34]; p=0.035). Predictors of visits to general practitioner were higher educational level, affiliation to advantage classes, more out of pocket payment for outpatients health care, and multimorbidity, while the highest odds of hospitalization had males, participants who had low level of education, who assessed their health as poor or very poor. This study confirmed that there are significant differences in health and health care utilization in elderly in Vojvodina, which need to be reduced by comprehensive public health policies and interventions.</p>