This project explored the values considered by elderly people, their younger relatives, and health professionals in decisions about residential long - term care, aiming to contribute to the literature on prospectively held values. The mixed methods design utilised a medical record review of 60 frail elderly hospital patients, a stratified survey of 3,015 adults in the South Australian community, and interviews with 36 stakeholders ( 10 elderly people, 10 younger relatives, and 18 health professionals ). The medical record review confirmed that the hospital patients and their outcomes resembled those described internationally. It was used to develop a hypothetical vignette, used in the later studies. Survey responses suggested that when considering a hypothetical long - term care decision, community members put the elderly person ' s physical health and safety first. Situational variables ( the elderly person ' s autonomy, environmental adaptation, and caregiver burden ) appeared secondary, albeit less so with increasing age of the respondent. Thematic analysis of the interviews demonstrated that elderly stakeholders considering a hypothetical decision were more likely to mention autonomy values, and less likely to mention safety values, than were relatives or health professionals. However, elderly stakeholders were also more likely to suggest restrictive solutions, such as residential placement and proxy decision - making. This finding raised methodological issues concerning ' third person ' vignettes, in that respondents might be responding as proxy decision - makers, rather than as if the hypothetical decision applied to themselves. The project confirmed that, in this context, prospectively held values resembled the retrospectively described values identified by McCullough, Wilson, Teasdale, Kolpakchi and Shelly ( 1993 ). Hence, the retrospective literature could be applied. The project supported the importance and complexity of psychosocial predisposing factors when applying the Andersen Behavioral Model ( Andersen, 1995 ) to long - term care decisions. Additionally, the Ecological Theory of Aging ( Nahemow, 2000 ) and the MacArthur Model of Successful Aging ( Andrews, Clark, & Luszcz, 2002 ) were found to be relevant to long - term care decisions for individuals and populations. It was concluded that both clinically, and at a policy level, discussions of long - term care could be more effective if they focussed on maintenance of elderly people ' s autonomy and control, rather than on their physical health and safety. / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2006.

This project explored the values considered by elderly people, their younger relatives, and health professionals in decisions about residential long - term care, aiming to contribute to the literature on prospectively held values. The mixed methods design utilised a medical record review of 60 frail elderly hospital patients, a stratified survey of 3,015 adults in the South Australian community, and interviews with 36 stakeholders ( 10 elderly people, 10 younger relatives, and 18 health professionals ). The medical record review confirmed that the hospital patients and their outcomes resembled those described internationally. It was used to develop a hypothetical vignette, used in the later studies. Survey responses suggested that when considering a hypothetical long - term care decision, community members put the elderly person ' s physical health and safety first. Situational variables ( the elderly person ' s autonomy, environmental adaptation, and caregiver burden ) appeared secondary, albeit less so with increasing age of the respondent. Thematic analysis of the interviews demonstrated that elderly stakeholders considering a hypothetical decision were more likely to mention autonomy values, and less likely to mention safety values, than were relatives or health professionals. However, elderly stakeholders were also more likely to suggest restrictive solutions, such as residential placement and proxy decision - making. This finding raised methodological issues concerning ' third person ' vignettes, in that respondents might be responding as proxy decision - makers, rather than as if the hypothetical decision applied to themselves. The project confirmed that, in this context, prospectively held values resembled the retrospectively described values identified by McCullough, Wilson, Teasdale, Kolpakchi and Shelly ( 1993 ). Hence, the retrospective literature could be applied. The project supported the importance and complexity of psychosocial predisposing factors when applying the Andersen Behavioral Model ( Andersen, 1995 ) to long - term care decisions. Additionally, the Ecological Theory of Aging ( Nahemow, 2000 ) and the MacArthur Model of Successful Aging ( Andrews, Clark, & Luszcz, 2002 ) were found to be relevant to long - term care decisions for individuals and populations. It was concluded that both clinically, and at a policy level, discussions of long - term care could be more effective if they focussed on maintenance of elderly people ' s autonomy and control, rather than on their physical health and safety. / Thesis (Ph.D.) -- University of Adelaide, School of Psychology, 2006.

Ageing is a process that starts from the moment of conception. It is accompanied by gradual impairment of body functions rendering the elderly less active socially as well as physically as a result of organ failure and compromised immunity system, leading to physical illness that may cause pain as well as mental illness such as dementia. In the United Kingdom majority of elderly people suffers from dementia and are cared for by nurses in the nursing homes. Patients with dementia experience pain as a result of other co- morbidities such as arthritis, but may be undiagnosed and therefore under-treated due to change in their behaviour. Inability to express pain causes concern to the nurse who provides care to the patient. Although some consequences of ineffective pain management have been evaluated, the question of nurses' opinions of pain experience in patients who suffer from dementia has, according to the extensive literature search done by the researcher, not been investigated. The purpose of this study is to describe and explore nurses' opinion of pain in patients suffering from dementia. The researcher adopted a qualitative approach to capture the participants' experiences and opinions of the nurses. A non-experimental qualitative research approach which is exploratory-descriptive and contextual in nature guided the researcher to explore and describe the nurses' opinion of pain in patients who suffer from dementia. Structured interviews and focus group discussions were conducted with seven participants involved in elderly care delivery. Biographical data were analysed and presented using descriptive statistics. The program for qualitative data analysis guided the process of categorizing and coding the data. / Health Studies / M.A. (Health Studies)

Bakgrund: Demens förekommer i många former och yttras på olika sätt i ett degenerativt förlopp. Globalt lider 55 miljoner människor av denna sjukdom. En majoritet av befolkningen blir alltmer äldre och behovet av omsorg ökar med avsaknad av tillräckligt med platser på särskilda boenden. Omsorgen sköts mer i det ordinära boendet med involvering av anhöriga vars tillvaro belastas och välbefinnande successivt försämras. Syfte: Belysa anhörigas upplevelser tiden efter att deras demenssjuke familjemedlem flyttat till särskilt boende. Metod: En litteraturöversikt av enbart kvalitativ forskning. Sökning av artiklar genomfördes i databaserna Cinahl och MedLine. En manifest kvalitativ innehållsanalys valdes av de 13 artiklar som ingick. Det analyserade materialet baserades på intervjuer. Resultat: Analysen av de anhörigas upplevelser resulterade i 3 teman. ”Emotionell belastning”, ”En ökad finansiell utmaning” och ”En harmonisk tillvaro”. I dessa teman framkommer ökad ensamhet, sorg, skuldkänslor, oroat samvete samt ekonomiska svårigheter. Slutsats: Tiden efter den närstående residerat i ny boendeform befinner sig anhöriga i en omvälvande fas i livet med stor omställning. En ofta redan tumult och svårt belastad tillvaro, övergår i ett skede med nya emotionellasvårigheter. / Background: Dementia manifests itself in different ways in the degenerative process. Globally, 55 million people suffer from this disease. A majority of the population is getting older and the need for care increases with the lack of nursing home facilities. Homebased care of dementia is more prevalent. Informal caregivers are commonly involved in care which gradually decreases their well-being. Aim: Elucidate informal caregivers’ experiences after nursing home admission of their relative with dementia. Method: A literature review of qualitative research. Articles were searched in the databases Cinahl and MedLine. A manifest qualitative content analysis was selected of the 13 articles that were included. The analyzed data was based on interviews. Results: The analysis of the relatives' experiences resulted in 3 themes. "Emotional burden", "An increased financial challenge" and "A harmonious existence". These themes identified increased loneliness, grief, guilt, troubled conscience and financial difficulties. Conclusion: Relatives are in an upheaval phase in life with major adjustment after their family member with dementia resides in the nursing home. An often already tumultuous and heavily burdened existence transitions into a stage with new emotional difficulties.

Repeatedly, researchers have reported on the health benefits resulting from social support (Cohen-Mansfield, 2000; Lee, 1985; & Siebert & Mutran, 1999). Despite this testimony, social support eludes a clear definition and has been predicted to decline with debility and aging. Additionally, institutionalization and medicalization may potentiate this decline. The purpose of this qualitative study was to describe the characteristics of social support, and the influencing factors of social support in a nursing home environment. The settings for this research were two central Florida nursing homes that differed according to the diversity of their populations. Observations and staff questionnaires were analyzed in order to answer the following research questions: (a) How is social support manifested in elderly nursing home populations? (b) How do staff behaviors influence social support among elderly nursing home residents? (c) How do nursing home policies influence social support among elderly nursing home residents? (d) How do economic differences influence social support among elderly nursing home populations? Collected data from observations, and questionnaires, were sorted and coded according to emerging patterns and themes. The analysis of these data contributed to answers to the research questions. Manifestations of social support within this environ were very limited. Residents exchanged greetings, occasionally looked after their roommates' needs, or assisted them down a hall in a wheelchair. Although infrequently observed, reciprocal resident tasks appeared to have significant resident value. Staff behaviors and facility policies appeared to be determined by governmental mandates and resulted in resident dependency. Economic differences appeared to be essentially aesthetic and had limited impact on residents and social support. The exception was the impact that economics seemed to have on resident demographics and levels of cognition. A greater health care provider understanding of the manifestations of social support and the sociopolitical and economic influences of social support in elderly nursing home populations can positively impact future policy, education, and the lives of elderly individuals.

Bakgrund: Demenssjukdom är vanligt förekommande i samhället och leder till att den drabbade slutligen blir beroende av hjälp från andra. Anhörigvårdare står för en stor del av omvårdnaden men när omvårdnadsbehovet blir ohanterligt, sker ofta en flytt till särskilt boende.  Syfte: Att beskriva anhörigvårdares upplevelser när en person med demenssjukdom, som de vårdat, flyttar från det egna hemmet till ett särskilt boende. Metod: Litteraturöversikt där strukturerade sökningar gjorts i databaserna Cinahl och PsycINFO för att hitta relevanta kvalitativa vetenskapliga artiklar som svarar mot syftet. Analys har gjorts i flera steg, resultatet har slutligen sammanställts och sorterats in i olika huvud- och underrubriker. Resultat: Anhörigvårdare kan uppleva transitionen på olika sätt; känna frihet, sorg, saknad, skuld, skam och lättnadskänsla. Anhörigvårdare känner sig överväldigade av vårdtyngden i hemmet. Beslutet om flytt upplevs underlättas om stöd och stöttning från omgivningen finns. Det framkom att anhörigvårdare kan uppleva bristande kommunikation, information och stöttning från vårdpersonal på särskilt boende. Slutsats: Sjuksköterskan kan genom att stärka och stödja närstående bidra till minskad risk för ohälsa, orsakad av vårdtyngd och psykisk stress. Utifrån detta tydliggörs vikten av att se och uppmärksamma anhörigas upplevelser av transitionen när personen med demens flyttar till särskilt boende. / Background: Dementia is common in society and eventually leads to the person with dementia to become reliant on help from others. Family caregivers account for a large portion of the care, but when the need for care increases, a move to a nursing home is common. Aim: To describe family caregivers experiences when a person with dementia, whom they have cared for, moves to a nursing home. Method: A literature review. Structured searches were done using the databases Cinahl and PsycINFO to find relevant qualitative articles that answer the aim. The analysis was made in several steps, the result was sorted into main- and subcategories. Results: Family caregivers can experience the transition in many different ways; feel freedom, grief, loss, guilt, shame and relief. They feel overwhelmed by the burden of care at home. The decision to move the person with dementia can be eased by support from other people. Family caregivers can experience a lack of communication, information and support from the nursing home staff. Conclusion: The nurse can help decrease the risk of worsening health for the caregiver caused by caregiver burden and stress, by supporting the family caregiver. This shows the importance of acknowledging the family caregivers experiences of the transition when the person with dementia moves to a nursing home.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

The aim of the study is, based on the staff’s perspective, to describe and analyse the existential needs of elderly in end-of-life living in nursing homes. The aim was also to examine how the staff perceive working with elderly in end-of-life care. Three qualitative focus groups were conducted by interviewing nursing home staff. The analysis is based on Weisman’s the appropriate death, Tornstam’s gerotranscendence and Hasenfeld’s human service organizations. The main findings were that the term ‘existential needs’ is described as wide and hard to define. Uneasiness and anxiety were common in the end-of-life and it was hard for the staff to meet the existential needs. The staff also described that the “little things” matter, such as holding one’s hand, as well as being present with the elderly. The relationship between the elderly and the staff was vital in order for the elderly to have as good an end-of-life and death experience as possible. The staff felt sorrow when the elderly had passed away and had little time to grieve. In difference to earlier research the staff did not request further education nor tutoring, however they wanted more time to grieve and process the deaths of the elderly.

Syfte. Syftet med studien var att undersöka samband mellan nedstämdhet och kön, ålder, kommunikationssvårigheter, smärta, sömnsvårigheter samt beteende- och psykiska symtom bland vårdtagare på särskilt boende.   Bakgrund. Depression tillhör de stora folksjukdomarna. Den drabbar människor i alla åldrar och är en del i den ökande psykiska ohälsan hos befolkningen i Sverige. Uppskattningsvis 20-25 % av de äldre på särskilda boenden lider av depressiva symtom. Omvårdnadspersonal visar sig ha brister i att identifiera depressiva symtom hos äldre personer vilket medför sämre behandlingsprognoser än om de upptäcks tidigare. Design. Studien genomfördes som en tvärsnittsstudie. Metod. Enkätstudie där vårdtagare (n=575) på särskilt boende i Umeå skattades av personal angående förekomst av olika fysiska och psykiska symtom. Statistikprogrammet SPSS användes för att beräkna samband mellan olika faktorer och nedstämdhet. Resultat. Tre faktorer var oberoende associerat med nedstämdhet; smärta, insomningssvårigheter och psykiska symtom. Nedstämda äldre var dessutom mer benägna att ha problem att äta, vara vaken nattetid samt ha beteendesymtom. De var även skattade som mer psykiskt vårdtunga av vårdare. Konklusion. Studien visar att hos nedstämda på äldreboende finns ofta ytterligare problematik i form av smärta, insomningsproblem och psykiska symtom. Dessa faktorer är värda att ta i beaktande vid val av behandling mot nedstämdhet.

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