Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. Project 2 examined the association between care environments and apathy in persons with dementia. Project 3 tested the accuracy of ActiGraph and activPALTM activity monitors in measuring weight-bearing activities among persons with previous diabetic foot ulcers. Methods: The PEAR consists of environment (PEAR-Environment) and apathy (PEAR-Apathy) subscales. The validity and reliability of the PEAR was examined through video observation of 24 participants. Project 2 selected 40 participants with dementia in order to examine the association between apathy and environmental stimulation, ambiance, crowding, staff familiarity, and light and sound. Study procedures involved video observation and data extraction. Project 3 enrolled 31 participants to test the accuracy of ActiGraph and activPALTM in measuring number of steps taken and duration of walking, standing, sitting, and lying. Results: The PEAR-Environment subscale had significant but fair correlation with the Crowding Index (Ρ=.27, p<.01), suggesting fair validity. The PEAR-Apathy highly correlated with the Passivity in Dementia Scale (ρ=.81) and Neuropsychiatry Inventory (NPI)-Apathy subscale (ρ=.266), and moderately correlated with the NPI-Depression subscale (ρ=.46), indicating good convergent validity and moderate discriminate validity. The PEAR also demonstrated good internal consistency (Cronbach's Α= .84 -.85) and moderate to good inter-rater (Weighted Kappa=.47-.94) and intra-rater (Weighted Kappa=.47-.94) reliability. Project 2 revealed that stimulation clarity and strength were significantly associated with a low apathy level (p<.001). An increase of 1 point on stimulation clarity and strength corresponded to a decrease on apathy score of 1.3 and 1.9 points, respectively. Project 3 revealed that ActiGraph had widely varied accuracy in measuring duration of standing, walking, sitting, and lying (0-100%) and in measuring number of steps taken (43-81%). In contrast, activPALTM showed consistently high accuracy in measuring duration of standing, walking, sitting, and lying (97-100%) and in measuring number of steps of taken (91-99%). Discussion: The PEAR is a valid and reliable measure of care environment and apathy in long-term care residents with dementia. Care environments that contain clear and sufficiently strong environmental stimulation are significantly associated with lower apathy levels, providing a foundation for interventions targeting apathy. ActivPALTM is a valid tool to measure weight-bearing activity in persons with diabetes in order to examine the role of weight-bearing activity in foot ulceration. This monitor may also be useful as a supplemental measure for apathy in persons with dementia.

The aging of the nation in the coming decades will contribute to an increased demand for long-term care. Given this trend, it is becoming increasingly important to understand utilization of services along the continuum of care and to determine factors that influence the provision of quality care. These insights are needed to reduce national expenditures on long-term care and to maximize independence and well-being among older adults. The purpose of the present dissertation was to explore factors that influence the utilization and quality of long-term care by conducting three separate studies. The first study examined risk of nursing home (NH) placement in a frail sample of older adults receiving publicly-funded long-term care in two settings: home and community-based services (HCBS) or assisted living (AL). Specifically, it explored whether these settings of care modify the relationship between dementia and NH placement. The second study examined NH organizational characteristics and job characteristics of staff in relation to turnover of nursing assistants (NAs) in a nationally representative sample of NHs. Using the same sample, the final study examined the presence of employment-based benefits of NAs and explored the relationship between NH organizational characteristics and the availability of staff benefits. Findings from this dissertation can contribute to a greater understanding of the use of long-term care services and the retention of staff to provide quality care. In the first study, AL was associated with longer time to NH placement for individuals with dementia when compared to HCBS. In the second study, the provision of competitive wages and benefits, involvement of NAs in resident care planning, and high levels of nurse staffing were associated with lower NA turnover, which may be important for quality of NH care. In the final study, for-profit ownership and high Medicaid occupancy were negatively associated with NA benefits whereas facility size, chain membership, occupancy level, union involvement, and education of the NH administrator were positively associated with benefits offered to these staff. Collectively, the findings from this dissertation may have important implications for policy makers, providers, and consumers of long-term care.

Many older couples face the dilemma of one of them developing an illness that results in their ability to cope with everyday living activities. The well spouse may struggle for many years with an increasing workload, both physical and mental. Ultimately, there may come a time, when nursing home placement becomes necessary. The aim of this research was to find out what the experience was like for the wife, with a husband who is ill and faces placement in a nursing home, and to determine whether nurses could do more to help them to cope with this difficult situation. Following ethics approval, nine wives were interviewed over a period of two years. Each of the experience was unique, but there were some common problems that many of the wives mentioned. Loneliness was considered by most of the wives as being extremely upsetting, even when they were living with other people, for example their children. The absence of their partner and long term confident was noticed particularly in the evening when, in the past, they had sat down together and watched television. Other reactions included guilt, grief, depression and a change in the husband/wife relationship. Many of the wives seemed to accept the situation, realising that they could no longer cope with their husband at home, they were also healthier than they had been when their husband was at home. This research has highlighted some important points when a wife finds herself in the situation of having to place her husband in a nursing home, although nurses are unable to assist with many of the effects on the wife of the placement, it is helpful to know that the friendliness of the staff, the care of the patient and the cleanliness and homeliness of the nursing home are helpful at this time / Master of Nursing (Hons)

<p>Syftet med denna deskriptiva litteraturstudie var att beskriva vilken inverkan sällskapsdjur har på äldre personers hälsa och välbefinnande. Totalt 18 vetenskapliga artiklar inkluderades dessa återfanns i databaserna Cinahl, Science Direct och Academic Search Elite samt via andra artiklars referenslistor. Studierna som gjorts om djurens inverkan på äldre personer som bor i det egna hemmet genomfördes med enkäter och intervjuer. Resultatet visade att djurägarna var mindre missnöjda med sin sociala och emotionella situation än de som inte ägde djur. Hos hemmaboende personer med Alzheimers sjukdom visade det sig att interaktioner med sällskapsdjur minskade humör- och psykomotoriska störningar såsom aggression, hyperaktivitet, hallucinationer och känslor av oro. Även en påverkan på den fysiska hälsan hos djurägare återfanns då de fick mer motion än vad icke djurägare fick. Djurägarnas ADL förmåga bibehölls i större utsträckning över tid i jämförelse med de äldre som inte ägde något djur. De flesta studier som gjorts om sällskapsdjurens påverkan på äldre personer inom äldreomsorgen har varit av experimentell karaktär. Sällskapsdjuren hade flera effekter på de äldre; det sociala samspelet och de verbala interaktionerna ökade, känslan av depression och ensamhet minskade. En klar fysisk förbättring kunde påvisas i form av minskade muskelspänningar och trötthet, ökat nutritionsintag och lägre blodtryck. Bland äldre dementa personer påvisades en markant minskning av oro och aggressivitet då de deltog i djurterapi.</p> / <p>The aim of this descriptive literature review was to describe the impact of pets on the health and well being of elderly persons. A total of 18 studies were included which were found in Cinahl, Science Direct and Academic Search Elite and from other article references. Questionnaires and interviews were used to asses the impact of pets on elderly persons living at home. The result showed that pet owners were more satisfied with the social and emotional situation compared to non-pet owners. Persons with Alzheimer’s disease living at home and interacted with pets showed a lesser degree of aggression, hyperactivity, hallucinations and anxiety than non-pet owners. Pets also had an influence on the physical health of the pet owners. They took longer walks more frequently than non-pet owners. Pet owners preserved their ADL to a greater extent compared to non-pet owners. Most studies exploring the impact of pets on elderly living in nursing homes were experimental. Pets had several effects on the elderly; the social connection and the verbal interactions increased, depression and loneliness decreased. Pets also affected the physical condition of the elderly; they had less muscle tensions and fatigue, higher nutritional intake and lower blood pressure. Among the elderly with dementia the anxiety and aggression decreased when they participated in animal assisted therapy.</p>

<p>Aim: The overall aim of this thesis was to deepen the understanding of nursing care for seriously ill patients on the edge of life in intensive care unit (ICU) and nursing home when questions were raised whether to withhold or withdraw curative treatment. Method: All studies were conducted in a qualitative frame of reference with interviews of nurses in two contexts in Norway; group interviews of 14 nurses in an ICU (study I, III), and individual interviews of 14 nurses in two nursing homes (study II, IV). Data were analysed with interpretative phenomenology (I, III, IV) and phenomenography (II). Findings: The nurses’ descriptions of the patients on the edge of life were interpreted as ‘being in a twilight zone’, a state between living and dying. The patients’ situation were understood to be very burdensome as they were mostly ‘voiceless’ and unable to call for, or refuse help and totally surrendered to other people’s devices. Their state was strained by extensive suffering; pains and bodily afflictions, loneliness, confusion and without control and dignity (I). Their need for nursing care was comprehensive (I, II) with an overall need for dignity (II), which included having the needs for preparedness, human relationship, comfort and safety met (II). The patients’ inabilities to express themselves clearly involved major challenges for nursing care (I - IV). Good nursing care was described as caring for the individual patient based on his/her situation and needs. The nurses experienced themselves to be of imperative importance for the patient’s living or dying (III, IV) and their interpretation of the patient’s condition was crucial (III). Their commitment and drive to help was high, they knew what good nursing care was for the patients (I - IV), and they were proud when they succeeded in their care (III, IV). An outstanding finding was the nurses’ experiences of ambiguity of both certainty and uncertainty. Being certain mostly seemed to concern nursing care related to the patient’s needs and situation (I, II), and uncertainty to what was ‘right’ to do with regards to withholding or withdrawing treatment (III, IV). They often experienced loneliness, too much responsibility, a vulnerable professional pride, and being pulled between opposite poles when they struggled to give good nursing care (I - IV), but too often they failed (II, IV). This demanding situation sometimes led to the nurses’ use of several self-protecting strategies. Whether the patients could receive good nursing care or not did not only depend on the single nurse, but was also anchored in opportunities and hindrances on a relational and an organisational level (I – IV). There were many congruities in patterns in the experiences of ICU - and nursing - home - nurses with regards to the situation and needs of patients on the edge of life, and good nursing care. Congruities were also found regarding being a nurse when caring for these patients, and nurses’ opportunities and hindrances for carrying out good nursing care. Conclusion: This thesis shows that nursing care was experienced as being of crucial importance to the patients on the edge of life, and the nurses knew very well what good nursing care was for them. However, the nurses’ opportunities to perform good nursing care depended on several preconditions and were restricted by hindrances on different levels, which have to be overcome in order to fulfil patients’ needs and nurses’ ambitions of giving good nursing care. As such, this thesis highlights a wide-ranging understanding of nursing care for these patients, which should challenge individual nurses, but also other health care workers, leaders and politicians.</p>

<p><strong>SAMMANFATTNING</strong></p><p><strong>Syfte: </strong>Syftet<strong> </strong>med studien<strong> </strong>var att undersöka vilka uppfattningar äldre vårdtagare på vårdboende hade om kvalitet i samband med måltider med avseende på aspekterna produkten, rummet och mötet.</p><p><strong>Metod: </strong>Studien är av deskriptiv design och bygger på kvalitativa intervjuer. Urvalet var målmedvetet och undersökningsgruppen bestod av nio äldre vårdtagare på vårdboenden. Intervjuerna analyserades med en kvalitativ analysmetod.</p><p><strong>Resultat: </strong>I resultatet framkom att det var viktigt att maten smakade som förväntat, tillagades på rätt sätt av kompetent kökspersonal samt var nylagad med ett aptitligt utseende. Viktigt var att få välja exempelvis portionsstorlek och dryck. Måltidsmiljön skulle vara trivsam, ren och stressfri. Vårdtagarna ville få möjlighet att välja matrum. Personalen påverkade måltidsupplevelsen och viktigt var en trevlig, omtänksam samt hjälpsam personal. Sällskap ansågs viktigt och att själv få välja mellan att äta med eller utan sällskap.</p><p><strong>Slutsats: </strong>Vårdtagarna i studien hade varierande uppfattningar om vad som ansågs vara kvalitet gällande måltider. Däremot uttryckte alla vårdtagarna i studien att det var viktigt att bli tillfrågad och ges möjlighet att påverka sin egen måltid. Detta visar vikten av att vårdpersonal strävar efter att möta individens egna önskemål under måltiden för att optimera upplevelsen av kvalitet vid måltiden.</p> / <p><strong>ABSTRACT</strong></p><p><strong>The purpose: </strong>The purpose<strong> </strong>of the study was to investigate what older people living in nursing homes consider to be quality at meals regarding the aspects the product, the room and the meeting.</p><p><strong>Method: </strong>The study has a descriptive design and is based on qualitative interviews. The sampling was purposive and the interviewees consisted of nine elderly nursing home residents. The interviews were analysed with a qualitative analysis.</p><p><strong>Results: </strong>The result showed that it was important that the food was fresh with an appetizing appearance, tasted as expected and was cooked in the right way by competent kitchen staff. To be able to choose for example the beverage and the size of the portion was important. The surroundings at meals should be pleasant, clean and free from stress. The nursing home residents wanted the option to choose dining room. The staff affected the experience of the meal and a pleasant, considerate and helpful staff was important. Company was of importance and also the option to choose between eating with company or alone.</p><p><strong>Conclusion:</strong> The opinions of quality regarding meals differed among the participating nursing home residents. However all the informants in the study expressed that it was important to be asked and given the possibility to influence one's meal.<strong> </strong>This shows that it is important that the nursing staff show respect for individual desires to optimize the experience of quality at meals.<strong> </strong></p>

Graduation date: 2004

The overall objective of this research was to analyze the effect of ownership status on 1) quality of care delivered, 2) the cost of nursing homes in the United States and 3) wages to Registered Nurses. The model developed here uses a two stage least squares technique to correct for observed endogeneity problems. Results show that a model which includes ownership classification interactively with all independent variables, performs better than a model which simply uses dummies to proxy for ownership status. Nonprofit homes were found to have higher direct patient care expenditures than profit homes. Non-profits were also found to have a more specialized nursing force. Both of these results suggest that non-profits may actually provide a higher quality of care than for profit enterprises. No support was found for the hypothesis that nonprofits have more philanthropic wage policies. / Graduation date: 1996

Thesis (Ph. D.)--Ohio State University, 1982. / Includes vita. Includes bibliographical references (leaves 124-126). Available online via OhioLINK's ETD Center.

The general aim was to explore factors influencing the normal variation and measurement of body temperature. Additional aims were to study morbidity, mortality and the clinical presentation of pneumonia and predictors for survival in elderly nursing-home residents. Two hundred and thirty seven non-febrile nursing home residents (aged 66-99 years) and 87 healthy adults (aged 19-59 years) were included. In elderly individuals, the morning ear and rectal body temperature was measured at baseline and pneumonia and survival was observed at one- two and three-year. In healthy adults the rectal, ear, oral and axillary temperature were measured simultaneously on one morning and repeated measurements were performed in three subjects. Overall, the range of normal body temperature was wider then traditionally stated. In elderly nursinghome residents, functional and cognitive impairment and BMI &lt; 20 were related to a lower body temperature and medication with analgesics to a higher. Compared to adults &lt; 60 years elderly persons had a higher average ear and a lower rectal temperature. Men and postmenopausal women &lt; 60 years had lower body temperature than premenopausal women. The repeated measurements showed a wide individual variability irrespective of the site of measurement, and that replicated measurements do not improve accuracy. When comparing the rectal temperature with oral, ear and axillary readings the average difference was &gt; 0.5°C with a wide individual variation. The yearly incidence of nursing-home acquired pneumonia varied between 6.9% and 13.7%. Functional impairment, chronic obstructive pulmonary disease (COPD) and male sex were related to a higher risk of acquiring pneumonia and presenting non-specific symptoms were common. Age and functional impairment predicted mortality, irrespective of gender, while cerebral vascular insult, a lower body mass index and malnutrition in women and heart disease, COPD, medication with sedatives and mortality rate index in men were gender specific predictors. Surviving women had a higher baseline body temperature than non-surviving, while no such difference was found in men. When assessing body temperature, it is important to consider the site of measurement, technical design, operator technique, age and gender and, in elderly nursing-home residents, physical and cognitive impairment, body constitution and medication with analgesics. The best approach is to use an unadjusted mode, without adjusting to another site. To prevent a delayed diagnosis of pneumonia, one should be aware of a low baseline body temperature and lack of specific clinical symptoms in elderly nursing-home residents. Preserving and/or improving functional, cognitive, nutritional status and preventing agitation and confusion would improve survival in nursing-home residents.