Déterminant d’un vieillissement actif et en santé, la mobilité permet aux aînés de maintenir et de développer des liens sociaux significatifs, et de demeurer intégrés dans leur communauté. Malgré ces bienfaits, les interventions offertes aux aînés visant à favoriser leurs déplacements restent rares et discontinues. Un accompagnement-citoyen personnalisé d’intégration communautaire (APIC) pourrait favoriser les déplacements et améliorer la perception des lieux des aînés en perte d’autonomie. Cette étude visait à : 1) vérifier les effets de l’APIC sur les déplacements et l’espace perçu des aînés en perte d’autonomie et 2) identifier les facilitateurs et les obstacles à l’utilisation de l’espace dans l’APIC. Un devis mixte incluant un dispositif pré-expérimental a été utilisé auprès de 16 participants (11 femmes) âgés entre 66 et 91 ans. Les déplacements ont été mesurés à l’aide du Life Space Assessment. Un entretien individuel semi-structuré d’environ 30 minutes a été réalisé 2 à 4 semaines après la fin de l’intervention. À la suite de l’APIC, les déplacements des participants se sont améliorés (p < 0,01). Selon les participants âgés, l’APIC constitue un facilitateur important qui a permis de découvrir des lieux de participation et d’améliorer leur capacité à se déplacer seul. L’APIC est une intervention prometteuse qui permet d’améliorer les déplacements et l’utilisation de l’espace d’aînés en perte d’autonomie.

The thesis applies a modification of the concept of landscape to embody physical settings, social behaviour and affixed meanings. The argument focuses on both how a specific environment was created as well as perceived on four Estonian islands from the late seventeenth century until the present. Islands have clear natural boundaries, and thus they comprise well-defined entities. Physical environment is seen as an important factor in the formation of home and identity. Island life in Estonia was on the background of complicated power relations dominated by foreign ruling classes less restricted, and historically the islanders had better opportunities for gaining a livelihood. They were thus part of a common Baltic Sea world often passed by in native Estonian research, which has concentrated on mainland farming traditions. Living conditions on the islands were drastically changed by Soviet occupation after the Second World War when they came to belong to the strictly regulated border area towards the West. The occupation is seen as a focal point of the thesis lending it a before and after perspective. The local variation was great and therefore island communities and landscapes are critically examined in a long-term perspective focusing on settlement history, the outward signs of belonging to a place (kinship, way of doing things, skills, dialect, humour, traditions) and on landscape biography. It is argued that constant change was accommodated in the mental picture, but an abrupt one caused an idealisation of national cultural values. The mythical elements are examined after first establishing the content of the islescapes of home and of popular islescapes of the 1930s. At present, people are in the process of renewing contacts and revising their islescapes of memory and imagination into possible futures.

Mobility, which includes life space and driving behaviors, is an important functional domain for older adults (e.g., Webber, Porter, & Menec, in press). Low mobility is associated with sensory, physical, and cognitive deficits (e.g., Anstey, Wood, Lord, & Walker, 2005). However, few studies have investigated how mobility changes over time. This dissertation contains three longitudinal articles that explored mobility changes, with an emphasis on driving and cognition, among community-dwelling older adults. The first paper investigated patterns of driving self-regulation (i.e., adjustment of driving behaviors) among control-group participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (N=548). Self-regulation was defined by driving space, frequency, and perceived difficulty. Growth mixture models revealed one subgroup of drivers ("Decreasers") that showed declines in their driving, and two subgroups that were stable over time. Relative to the stable groups, Decreasers showed significantly more depressive symptoms and lower reasoning, speed of processing (Useful Field of View Test [UFOV]), self-rated health, balance, and everyday functioning at baseline. The second paper examined mobility changes in ACTIVE participants with psychometrically defined mild cognitive impairment (MCI; N=304). Group differences in life space and driving (space, frequency, and difficulty) were evaluated using random effects models, which were adjusted for baseline demographics, health, depression, balance, attrition, and cognitive training participation. Relative to normal participants, participants with MCI showed reduced baseline mobility for all outcomes, as well as faster rates of decline for driving frequency and difficulty. Finally, the third paper examined three-year changes in mobility for control-group participants in the Staying Keen in Later Life (SKILL) study (N=370). Outcomes were life space and driving (space, frequency, and difficulty). Latent change models revealed significant correlations between: changes in life space and age; changes in driving frequency and complex reaction time (Road Sign Test); and changes in driving difficulty and age, gender, mental status, and complex reaction time (Road Sign Test). Taken together, the articles in this dissertation show that older adults exhibit distinct patterns of mobility over time, and that demographic, health, and cognitive factors are associated with these patterns.

This thesis deals with the influence of environment on quality of life of seniors living in residential care for elderly. The main source for it was professional Czech and foreign literature and other related updates. The introductory chapter presents definitions of important characteristics of old age and aging, science aimed at this group, supplements and concepts aimed at elderly citizens in the Czech Republic and abroad. The second chapter takes the task of meeting with theories of quality of life, in the context of meeting the needs of the individual. The third section summarizes the definitions of space and its importance in human life. The following factors and that the space in which people live influence. The fourth chapter deals with residential services and their quality. Also deals with the Social Services Quality Standards and Quality Mark project, which focuses on residential care. Research section is intended to evaluate the impact of environment for seniors in their quality of life. Tracks selected areas of significance for the respondents and also satisfaction with their fulfillment. Final summary of research on the basis of the findings suggests points that should be respected in residential care for the elderly.

Både i Sverige och internationellt är det brist på sjuksköterskor. Det behöver utbildas fler sjuksköterskor, men det finns också tendenser som visar att många sjuksköterskor väljer att byta yrke under sitt arbetsliv. Bristen på sjuksköterskor leder till ökad risk för vårdskador samt en sämre arbetsmiljö för den personal som stannar kvar. Med hjälp av en kvalitativ ansats är därför syftet med den här studien att analysera sjuksköterskors reflektioner kring deras beslut att byta yrke. Frågeställningarna som undersöks i studien är vilka faktorer sjuksköterskorna beskriver som avgörande för sitt karriärbyte, samt hur sjuksköterskorna beskriver sin egen beslutsprocess vid valet att byta yrke. I studien har sju sjuksköterskor som idag har en annan yrkestitel eller är studerande inom ett annat område inkluderats. Resultatet analyseras med hjälp av begreppen roller och beslutspunkt, hämtade från Life-span – Life-space theory, samt begreppen livstema, yrkespersonlighet och karriäranpassningsförmåga, hämtade från Career Construction theory. Det framkommer i studien att sjuksköterskorna har haft en lång beslutsprocess där de beskriver sig själva som aktörer för sitt eget beslut. Två orsaker till karriärbyte har varit behovet av förändring samt den kravfyllda yrkesrollen som inte alltid vägs upp av meningsfullheten i deras arbete. Ett yrke som upplevts spännande tidigare behöver inte nödvändigtvis ge samma stimulans ett antal år senare. Resultatet visar även att sjuksköterskorna upplever trygghet i att ha sin utbildning, vilket skapat mod till att pröva en annan bana.

The aging process is often coupled with major life changes such as retirement, death of friends and family members, and declines in physical and psychological functioning. Intuitively, any one or a conjunction of these events might be expected to lead to decreases in positive affect (PA) and increases in negative affect (NA). However, older adults tend to be emotionally positive and stable even late in life. Thus, it is possible that emotion-based strategies for coping with the challenges presented in later life can be used effectively by older adults, even amidst potential vulnerabilities in other domains. The design of effective interventions and technologies aimed at facilitating this coping process, will depend on understanding that emotions can influence health in different ways. Affect level and intraindividual variability (IIV) are independently related to distal factors such as personality and health-related outcomes such as immune functioning and mortality, among others. By nature, emotions are subject to daily fluctuations that cannot be captured by investigation of mean affect levels alone. Research on affect IIV has focused primarily on whether there are stability differences in younger and older adults. In general, older adults tend to be more stable, perhaps because the failure to regulate emotions is particularly detrimental for older adults’ physiological health. It is therefore important to understand how proximal factors in everyday life lead to intraindividual emotional changes. The primary goal of this study was to identify the factors occurring within older adults’ daily lives that predicted emotional deviations and to determine whether individuals differed in the types of factors that were emotionally-relevant. As such, it was imperative to employ a methodology that could differentiate the factors that evoked consistent emotional responses across all individuals from the factors whose impact on affect were person-dependent. Specifically, participants were given online surveys three times per day for 20 consecutive weekdays that included assessments of their current positive and negative emotional states and questions (at least once per day) about their stress, pain, sleep quality, life space, physical activity, and social activity. Multilevel modeling (MLM) was used to determine if there was significant affect IIV for these older adults and how much IIV could be explained by these proximal predictors. This analysis approach was used because it is well-suited for nested data (in this case, observations nested within-persons) and does not assume independence of observations (which is a concern when individuals receive repeated assessments). Additionally, MLM analyzes the complete dataset rather than complete cases (individuals), which allowed for comparison of fixed effects regression models and random effects regression models. Random effects models, which are the hallmark of MLM, enabled the analysis of potential individual differences in the within-person relationships between the predictors and affect. As expected, there was significant affect IIV in these older adults for both PA and NA. The predictors of PA and NA were analyzed first in isolation (referred to as “isolated models”) and then when controlling for the other proximal variables (referred to as “full models”). The random effects isolated models were generally better fitting than the fixed effects isolated models, indicating that the models that did not constrain individual predictor-affect slopes to be the same across persons (random) were more accurate representations of the observed data than models that constrained individuals’ slopes to be the same (fixed). Full fixed slopes and full random slopes models were built in stepwise fashion based on the results of the isolated models. Again, the random effects full models better fit the observed data than the fixed effects models for both PA and NA, providing strong evidence in favor of the hypothesis that a larger percentage of affect IIV would be explained when allowing individual differences in the within-person predictor-affect relationships. The full random models accounted for 32% of the PA IIV, and 45% of the NA IIV. These were both better fitting than their respective null models, indicating that overall, the proximal predictors accounted for significant proportions of the within-person PA and NA variance. Certain factors accounted for larger percentages of the IIV than others and in general, there were differences between the PA and NA model in terms of which factors led to emotional fluctuations. Subjective health accounted for the largest percentage of PA IIV and stress accounted for the largest percentage of NA IIV. Additionally, subjective health, life space, stress, and pain were significant unique predictors of PA, NA, or both. However, there were specific unique effects across both PA and NA, namely, the slope variances for stress and pain. Follow-up analyses were unable to account for these slope variances using person-level predictors. In essence, an individual’s emotional reactivity to pain and stress did not depend on his or her overall mean level of those factors, or of the other daily predictors. This provided further evidence that PA and NA should be treated as separable variables (e.g., it is possible for a daily event to decrease older adult’s positivity without necessarily increasing their negativity) but also highlighted factors that have pervasive influences on emotion regardless of valence, which is harmonious with models of affect that propose a dynamic relationship between PA and NA. The results from this study have theoretical and practical implications. Theories on emotional stability often focus on if and why older adults are more stable than younger adults. Findings of the present study both support and expand upon these theories by identifying within an older adult population, which proximal factors were likely to cause emotional deviations after partialling out the effects of other daily variables, including factors that were previously unstudied in this domain. The analysis methodology implemented in the present research allowed for direct investigation of whether certain individuals were more prone to the influences of these factors than others. These results are discussed in the context of coping and resiliency theories that posit individual differences in emotional responses to stimuli based on these capabilities. From a practical perspective, these results highlight that the design of interventions and technologies intended to provide older adults with effective skills and resources to maintain or improve their emotional well-being should be tailored to individuals’ affective profiles.

Objectif: Évaluer les défis de la mobilité chez les personnes âgées atteintes de dégénérescence maculaire reliée à l’âge (DMLA), de glaucome ou de dystrophie cornéenne de Fuchs et les comparer avec les personnes âgées n’ayant pas de maladie oculaire. Devis: Étude transversale de population hospitalière Participants: 253 participants (61 avec la DMLA, 45 avec la dystrophie cornéenne de Fuchs, 79 avec le glaucome et 68 contrôles) Méthodes: Nous avons recruté les patients parmi ceux qui se font soigner dans les cliniques d’ophtalmologie de l’Hôpital Maisonneuve-Rosemont (Montréal, Canada) de septembre 2009 à octobre 2010. Les patients atteints de la DMLA ou de la maladie de Fuchs ont une acuité visuelle inférieure à 20/40 dans les deux yeux, tandis que les patients avec du glaucome ont un champ visuel dans le pire oeil inférieur ou égal à -4dB. Les patients contrôles, qui ont été recrutés à partir des mêmes cliniques, ont une acuité visuelle et un champ visuel normaux. Nous avons colligé des données concernant la mobilité à partir des questionnaires (aire de mobilité et chutes) et des tests (test de l’équilibre monopodal, timed Up and Go (TUG) test). Pour mesurer la fonction visuelle nous avons mesuré l’acuité visuelle, la sensibilité au contraste et le champ visuel. Nous avons également révisé le dossier médical. Pour les analyses statistiques nous avons utilisé les régressions linéaire et logistique. Critères de jugement principaux: aire de mobilité, équilibre, test timed Up and Go, chutes Résultats: Les trois maladies oculaires ont été associées à des patrons différents de limitation de la mobilité. Les patients atteints de glaucome ont eu le type le plus sévère de restriction de mobilité; ils ont une aire de mobilité plus réduite, des scores plus bas au test TUG et ils sont plus enclins à avoir un équilibre faible et à faire plus de chutes que les contrôles (p < 0.05). De plus, comparativement aux contrôles, les patients ayant de la DMLA ou la dystrophie cornéenne de Fuchs ont eu une aire de mobilité réduite (p < 0.05). Les chutes n’ont pas été associées aux maladies oculaires dans cette étude. Conclusions: Nos résultats suggèrent que les maladies oculaires, et surtout le glaucome, limitent la mobilité chez les personnes âgées. De futures études sont nécessaires pour évaluer l’impact d’une mobilité restreinte chez cette population pour pouvoir envisager des interventions ciblées qui pourraient les aider à maintenir leur indépendance le plus longtemps possible. / Objective: To examine the extent of mobility limitations in patients with age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy as compared to a control group of older adults with good vision. Design: Cross-sectional hospital-based study Participants: 253 people (61 with AMD, 45 with Fuchs, 79 with glaucoma, and 68 controls) Methods: Patients were recruited from the ophthalmology clinic of Maisonneuve- Rosemont Hospital (Montreal, Canada) from September 2009 until October 2010. Patients with AMD and Fuchs had to have visual acuity in the better eye of worse than 20/40 while patients with glaucoma had to have visual field deficit in their worse eye of at least -4dB. Control patients who had normal visual acuity and visual field were recruited from the same clinic. Questionnaire (life space and falls) and performance-based (one-legged balance test, timed Up and Go (TUG) test) mobility data were collected, visual acuity, contrast sensitivity, and visual field were assessed, and the medical record was reviewed. Linear and logistic regression were used. Main Outcome Measures: Life space, balance, timed Up and Go, falls Results: The three eye diseases were associated with different patterns of mobility limitations. Patients with glaucoma had the most types of mobility limitations as they had reduced life space, had worse TUG scores, and were more likely to have poor balance than the control group (p < 0.05). Compared to controls, patients with AMD or Fuchs corneal dystrophy had reduced life space (p < 0.05). Falls were not related to eye disease in this study.Conclusions: Our results suggest that eye diseases, especially glaucoma, restrain the mobility of older people. It is important to further explore the impact of eye disease on mobility in this population in order to develop interventions that would help affected older adults maintain their independence.

Objectif: Évaluer les défis de la mobilité chez les personnes âgées atteintes de dégénérescence maculaire reliée à l’âge (DMLA), de glaucome ou de dystrophie cornéenne de Fuchs et les comparer avec les personnes âgées n’ayant pas de maladie oculaire. Devis: Étude transversale de population hospitalière Participants: 253 participants (61 avec la DMLA, 45 avec la dystrophie cornéenne de Fuchs, 79 avec le glaucome et 68 contrôles) Méthodes: Nous avons recruté les patients parmi ceux qui se font soigner dans les cliniques d’ophtalmologie de l’Hôpital Maisonneuve-Rosemont (Montréal, Canada) de septembre 2009 à octobre 2010. Les patients atteints de la DMLA ou de la maladie de Fuchs ont une acuité visuelle inférieure à 20/40 dans les deux yeux, tandis que les patients avec du glaucome ont un champ visuel dans le pire oeil inférieur ou égal à -4dB. Les patients contrôles, qui ont été recrutés à partir des mêmes cliniques, ont une acuité visuelle et un champ visuel normaux. Nous avons colligé des données concernant la mobilité à partir des questionnaires (aire de mobilité et chutes) et des tests (test de l’équilibre monopodal, timed Up and Go (TUG) test). Pour mesurer la fonction visuelle nous avons mesuré l’acuité visuelle, la sensibilité au contraste et le champ visuel. Nous avons également révisé le dossier médical. Pour les analyses statistiques nous avons utilisé les régressions linéaire et logistique. Critères de jugement principaux: aire de mobilité, équilibre, test timed Up and Go, chutes Résultats: Les trois maladies oculaires ont été associées à des patrons différents de limitation de la mobilité. Les patients atteints de glaucome ont eu le type le plus sévère de restriction de mobilité; ils ont une aire de mobilité plus réduite, des scores plus bas au test TUG et ils sont plus enclins à avoir un équilibre faible et à faire plus de chutes que les contrôles (p < 0.05). De plus, comparativement aux contrôles, les patients ayant de la DMLA ou la dystrophie cornéenne de Fuchs ont eu une aire de mobilité réduite (p < 0.05). Les chutes n’ont pas été associées aux maladies oculaires dans cette étude. Conclusions: Nos résultats suggèrent que les maladies oculaires, et surtout le glaucome, limitent la mobilité chez les personnes âgées. De futures études sont nécessaires pour évaluer l’impact d’une mobilité restreinte chez cette population pour pouvoir envisager des interventions ciblées qui pourraient les aider à maintenir leur indépendance le plus longtemps possible. / Objective: To examine the extent of mobility limitations in patients with age-related macular degeneration (AMD), glaucoma, or Fuchs corneal dystrophy as compared to a control group of older adults with good vision. Design: Cross-sectional hospital-based study Participants: 253 people (61 with AMD, 45 with Fuchs, 79 with glaucoma, and 68 controls) Methods: Patients were recruited from the ophthalmology clinic of Maisonneuve- Rosemont Hospital (Montreal, Canada) from September 2009 until October 2010. Patients with AMD and Fuchs had to have visual acuity in the better eye of worse than 20/40 while patients with glaucoma had to have visual field deficit in their worse eye of at least -4dB. Control patients who had normal visual acuity and visual field were recruited from the same clinic. Questionnaire (life space and falls) and performance-based (one-legged balance test, timed Up and Go (TUG) test) mobility data were collected, visual acuity, contrast sensitivity, and visual field were assessed, and the medical record was reviewed. Linear and logistic regression were used. Main Outcome Measures: Life space, balance, timed Up and Go, falls Results: The three eye diseases were associated with different patterns of mobility limitations. Patients with glaucoma had the most types of mobility limitations as they had reduced life space, had worse TUG scores, and were more likely to have poor balance than the control group (p < 0.05). Compared to controls, patients with AMD or Fuchs corneal dystrophy had reduced life space (p < 0.05). Falls were not related to eye disease in this study.Conclusions: Our results suggest that eye diseases, especially glaucoma, restrain the mobility of older people. It is important to further explore the impact of eye disease on mobility in this population in order to develop interventions that would help affected older adults maintain their independence.

Summaries in Afrikaans and English / Text in Afrikaans / Die doel van hierdie studie was om vas te stel hoe vaderlike werkloosheid die leefwereld van die adolessent beinvloed. In 'n poging om die adolessent se leefwereld te verstaan, was dit nodig om die adolessent-in-totaliteit aan te spreek. Daar is aangedui hoe emosionele trauma soos die skielike werkloosheid van die vader nie net die adolessent se fisieke-, kognitiewe-, affektiewe-, sosiale- en normatiewe wording rem nie, maar dat dit ook 'n negatiewe invloed op skolastiese prestasie het. Vaderlike werkloosheid het 'n besondere invloed op die relasies binne die gesin. Die adolessent se leefwereld, wat die Gestalt is van al die relasies wat hy/sy gevorm het, word beduidend deur die vader se werkloosheid geraak. Die empiriese studie toon dat die adolessent wie se vader werkloos geraak het, se betekenisgewing, belewing en betrokkenheid negatief is en derhalwe word sy selfaktualisering gerem en is hy uiteindelik op terapeutiese ingryping aangewese. / The aim of this study was to determine the effect of fathers unemployment on the adolescent's life world. In an attempt to understand the adolescent's life world, it was necessary to address the adolescent in totality. It has been shown how emotional trauma, such as the unexpected unemployment of the father, not only impairs the adolescent's physical-, cognitive-, affective-, social- and normative development but also has a negative influence on scholastic performance. The unemployment of a father has a particular influence on the relations within the family. The adolescent's life world, which is the Gestalt of all the relations that he or she formed, is also particularly influenced by the father's unemployment. The empirical research reveals that the adolescent who's father is unemployed is much more inclined to negative meaning, involvement and experience. Thus this adolescent is restraint on his way to self - actualisation and becomes receptive to therapeutic intervention. / Psychology of Education / M.Ed. (Psychology of Education)

O presente trabalho tem como objetivo caracterizar a relação conjugal, em termos de questões como as negociações ou a impossibilidade de negociação, conflitos e violência de gênero, como elementos intervenientes na saúde reprodutiva de mulheres de baixa renda. Para isto realizamos uma pesquisa de campo do tipo qualitativa, utilizando a técnica de história oral – temática com a qual obtivemos dezesseis depoimentos. A pesquisa foi desenvolvida na região da Zona Leste de São Paulo, em um posto de saúde do Modulo 14 - do PAS (Programa de Assistência a Saúde) - Ermelino Matarazzo. De posse deste material, procedemos análise de discurso. Procuramos articular na discussão as concepções de poder, sexualidade e gênero, partindo do pressuposto de que as pautas de negociação e de processos de negociação ou a impossibilidade de sua realização são passíveis de serem desvelados nos discursos das mulheres e, por conseguinte, as estratégias utilizadas e os objetos da negociação entre os pares. O Espaço de Vida, profundamente marcado por inúmeras desigualdades sociais e de gênero – determinando uma baixa qualidade de vida e propiciando vivências caracterizadas muito mais pela ausência do que pela presença de diálogos e negociações entre os pares, com inúmeras violências, inclusive a conjugal –, intervém no processo reprodutivo. O casamento é idealizado como um espaço de vivências afetivas, compartilhadas com o parceiro, filhos, família. Há situações em que os direitos das mulheres são profundamente desrespeitados, inclusive nos seus direitos reprodutivos, acarretando prejuízos à saúde da mulher em geral e à sua saúde reprodutiva. Reproduzindo-se uma forma de socialização conjugal em que a mulher encontra-se sobrecarregada com trabalho dentro e fora de casa, numa relação de subordinação e dominação histórica, senão tradicional, hierárquica e desigual. / The present paper aims at characterizing the connubial relationship in terms of questions concerned with gender negotiation - or the impossibility of it -, conflicts and, violence as intervening elements in the reproductive health of low-income women. With this target in mind, a field-research, of the qualitative type, was carried out using the oral-thematic history technique with which 16 statements were obtained. The research was developed at the Eastward Area of São Paulo city, State of São Paulo, Brazil, on the Module 14 health post belonging to the Ermelindo Matarazzo PAS (Program for Health Assistance). With this material in hand, the analysis of the women’s discourse was proceeded. In the paper’s Discussion there is an attempt to articulate conceptions of power, sexuality and, gender starting from the supposition that either the agenda or the processes of negotiation, or even the impossibility of it, are able to be disclosed within the women’s discourses and, as a consequence, the strategies used in, and the objects of, negotiation between the couples. The Life Space -- deeply marked by innumerable social and gender inequalities, determining a low-quality of life and propitiating life experiences which characterize themselves much more by the absence than the presence of dialogues and negotiations between the couples, with innumerable acts of violence, including the connubial ones -- intervenes in the reproductive process. Marriage is idealized as a space for living affectionate life experiences, shared with the partner, children and, family. There are circumstances in which the women’s rights are profoundly disrespected, including in their reproductive rights, causing damages to the woman’s health, in general, and to her reproductive health, in particular, depicting a form of connubial socialization in which the woman finds herself overloaded with the work carried out both inside and outside home, in a relationship characterized by historical subordination and domination, which if not traditional, it is surely hierarchical and unequal.