Les transformations politiques, familiales, religieuses, économiques et spatiales amènent à rompre avec les évidences entretenues sur les sociétés africaines comme celles de care au profit des personnes âgées au nom du respect social des âges. Ce travail déconstruit les représentations sociales de la vieillesse en montrant d’une part que les catégories de la vieillesse sont les produits des politiques publiques et d’autre part que les vieillesses sont hétérogènes, contextuelles et dynamiques. A partir d’études de cas élargis, cette thèse explore les expériences du vieillir à partir des formes de prise en charge des personnes vieillissantes dans la capitale Ouagadougou (Burkina Faso).Une ethnographie au sein des familles, dans une unité de soins spécialisé dans un centre hospitalier universitaire et dans un centre d’accueil de femmes accusées de sorcellerie permet de décrypter les relations complexes de prise en charge entre le niveau micro et macro sociale. Cette thèse est une contribution à une anthropologie du care de la vieillesse. / The political, family, religious, economic and spatial lead to break with evidence maintained on African societies like those in care for the elderly in the name of social respect of ages. This work deconstructs social representations of old age by showing both on the on hand, that the categories of old age are the product of public policies and on the other the old ages are heterogeneous, dynamic and contextual. From a broader the case studies, this thesis explores the experiences from old forms of care for elderly in the capital, Ouagadougou (Burkina Faso). An ethnography within families, in a special care unit in a university hospital and a reception center for women accused of witchcraft allows to decrypt the complex relationships of care between the micro and macro social level. This thesis is a contribution to the anthropology of care in old age.

Bakgrund: Antalet personer med demenssjukdom ökar i Sverige och i övriga världen. Sjukdomen har stor påverkan på den drabbade personens liv, livskvalitet och autonomi. Det finns ännu ingen behandling som botar sjukdomen, men det finns mycket att göra för att öka livskvaliteten och stödja personer med demenssjukdom. Generellt sett har utevistelse visat sig ha stor betydelse för personers välmående. Men beroende på den ofta begränsade utemiljöns tillgänglighet och tidsbrist hos omvårdnadspersonalen så kommer många personer med demenssjukdom mer sällan ut än de som självständigt kan sörja för sin utevistelse. Därför är det av vikt att beskriva kunskap om utevistelse för personer med demenssjukdom boende på vårdhem. Syfte: Syfte är att sammanställa kunskap om utevistelsens betydelse för personer med demenssjukdom boende på vårdhem. Metod: En litteraturöversikt grundad på 13 vårdvetenskapliga artiklar, av kvantitativ och kvalitativ ansats. Resultat: Utevistelse i olika typer av trädgårdar, aktiviteter utomhus och att vistas ute i dagsljus har positiva effekter på personer med demenssjukdom, som ökat välbefinnande, minskat behov av läkemedel, ökad funktionell och kognitiv förmåga. Omvårdnadspersonal och anhöriga har kunskap i att utevistelse kan påverka personer med demenssjukdom positivt, och det är viktigt att möjliggöra utevistelse och erbjuda aktiviteter utomhus som är individuellt anpassade efter behov och förmåga. Slutsats: För personer med demenssjukdom ansågs utevistelsen som positivt, samt en bidragande faktor till att personer med demenssjukdom kände ökad livskvalitet. Aktiviteterna bör vara individanpassade för störst effekt på deras välbefinnande. / Background : The number of people with dementia is increasing in Sweden and the rest of the world. The disease has major impact on life itself, quality of life and autonomy for the affected person. There is still no treatment that cures the disease, but much can be done to increase the quality of life and support for people with dementia. In general, outdoor stay has proven to be of great importance to well-being. However, due to the often restricted outdoor environment's availability and lack of time from the healthcare professionals, many people with dementia rarely outweigh those who can independently provide for their own ability for outdoor stay. Therefore, it is important to describe the knowledge of outdoor stay for people with dementia living at nursing homes. Aim: The purpose is to put together knowledge about the meaning of outdoor stay for people with dementia living at nursing homes. Method: A literature review based on 13 scientific articles, quantitative and qualitative. Result: Outdoor stay in the form of different types of gardens, outdoor activities and exposure of daylight have positive effects on persons with dementia disease, as increased well-being and physical and cognitive function, and need of medication. Health care professionals and family members have knowledge about positive effects of outdoor stay for people with dementia disease, and it is important to make outdoor stay possible and offer activities outdoors that are individually adapted by need and ability. Conclusions: For people with dementia outdoor stay had positive results and as a contributing factor to people with dementia disease feeling increased quality of life. The outdoor activities should be individually adapted to the greatest effect on their well-being.

Elder bullying is on the rise and occurs in many contexts such as senior living communities and nursing homes, causing concern for the well-being of the residents by families, staff, themselves, and society in general. Although research has been limited, it does reveal that resident-to-resident bullying in nursing homes is a problem warranting further scholarly attention. The purpose of this study was to investigate the experiences of certified nursing assistants (CNAs) regarding resident-to-resident bullying in nursing homes. The theory of reasoned action and the theory of reflective equilibrium provided a conceptual lens from which to explore and describe the importance of the CNAs' attitudes and behavior when recognizing, observing, and addressing bullying incidences. A phenomenological research design was employed. Using open-ended questions, 10 CNAs were individually interviewed. One major discovery of the study was that 100% of the CNAs interviewed indicated that they experienced resident-to-resident bullying and that it was a major problem in the nursing home. The findings of this study presented many possibilities for positive social change across all levels, from individuals and families to nursing home organizations and society as a whole, but most importantly, it increased awareness about bullying across nursing homes as the ultimate goal was for the improvement on the quality of life experienced by residents in nursing homes.

The purpose of this qualitative case study was to examine the experiences and perceptions of African American women who reside in a nursing home and to understand African American women's decisions for admitting to the facility. Social Learning Theory was applied to answer the question of how African American women's experiences and perceptions toward long-term care influence healthcare decisions and admission to a nursing home. Eleven participants interviewed in the study were at least 60 years old, admitted into the facility within the past two years and who had not previously resided in a nursing home. Yin's five step approach to data analysis, NVivo and Microsoft Office to gather data from African American women who live in a nursing home. Participants in this study described their perceptions of nursing homes as places they never thought they would reside in and expressed that African American families traditionally "took care of their own." As a result, participants stated nursing homes were not an option normally considered within their families. Decisions to admit to a nursing home were based on family work schedules which resulted in lack of supervision at home, increased nursing care, and financial reasons. Cultural competence was an important factor in helping them adjust to a nursing home environment despite cultural norms. This research can contribute to social change by providing awareness and identifying health behaviors and cultural beliefs regarding the use of long-term care facilities by African American women despite cultural norms. The findings of this study can also create positive social change movement in nursing homes to deliver resident-centered care and empowering staff.

The prescription rate of antipsychotics in patients with dementia varies between 20% and 50% for the common and troubling neuropsychiatric symptoms experienced by patients with dementia. The use of these antipsychotic medications has been linked with increased risk of morbidity and mortality due to associated Parkinsonism, over sedation, gait disturbances, cognitive decline, and cardiovascular adverse events. The purpose of this project was to assess whether development of an evidence-based clinical practice guideline (CPG) for a long-term care facility would increase awareness about issues that govern the safe use of antipsychotic medications. The conceptual framework for the project was Watson's model of caring. The Fineout-Overholt tool was used to rank and score information retrieved following an extensive literature review. An expert panel made up of 2 medical doctors and 4 nurse practitioners had 100% agreement that objectives were clear; content was relevant and easy to understand; the CPG was well-organized and easy to follow; and knowledge learned would be used in practice. From 66.6% to 83.3% agreed that the CGP led to an improved understanding of dementia, neuropsychiatric symptoms, medication adverse events, and nonpharmacologic interventions. The expert panel agreed to launch the CPG upon implementation of an educational program for frontline nursing staff and a behavioral log to track occurrence and frequency of behaviors and the use of nonpharmacologic interventions and their effectiveness in managing behaviors. Safe implementation of this CPG might be adapted to other long-term facilities to optimize dementia care, which would bring about a positive social change.

<p>The aim of this study was to describe and analyse the constructions and</p><p>interplay of gender, ethnicity and sexuality between female and male careworkers</p><p>and residents in a nursing home. To explore this from a qualitative</p><p>everyday life’s approach, material was collected through participating observations,</p><p>interviews, and informal conversation with careworkers and residents.</p><p>The result points out that historical patterns of gender and caring related</p><p>to this context still matter and affect both careworkers and residents. For</p><p>example, female careworkers talked about the concept of caring as a genuine</p><p>female experience, while male careworkers, who were in a minority, instead</p><p>talked about caring in more gender-neutral words. The result also indicates</p><p>that a larger number of male careworkers not necessarily leads to a higher</p><p>grade of gender equality. Instead, the presence of male careworkers made the</p><p>traditional gender-power order more visible.</p><p>When analyzing outcomes of the interplay of gender, ethnicity and sexuality,</p><p>it was obvious that this was a complicated process. On one hand this</p><p>interplay of different categories seemed to affect female and male careworkers</p><p>in a similar way. On the other hand the interplay of gender, ethnicity and</p><p>sexuality can confront female and male careworkers with different types of</p><p>dilemmas. Therefore, an attempt to understand the position and experience</p><p>of being a careworker with non-Swedish background or being a nonheterosexual</p><p>careworker must include a gender-perspective.</p><p>A main result from the study was that the careworkers supported the residents</p><p>to perform their social gender-identity through the daily interactions.</p><p>These interactions were foremost influenced by the careworkers’ own expectations</p><p>about older women’s and older men’s needs and behaviour. The four</p><p>gender-constellations that occurred in the care-interactions also differed</p><p>from each other with regard to what careworkers and residents talked about,</p><p>and how they talked and acted. Even if the outcome from different types of</p><p>gendered meetings differed, there were also some similarities. It was obvious</p><p>that both female and male careworkers seemed to think and talk about the</p><p>female residents as more dependent and vulnerable than male residents. To</p><p>conclude, traditional norms and a gender-power order that influences society</p><p>also affects careworkers and residents in the nursing home.</p><p> </p>

<p>Hip fractures are the most serious consequence of osteoporosis, and are one important cause of morbidity and mortality among the elderly. Prophylactic treatment for hip fractures are now available. Early detection of individuals with increased risk for hip fractures is therefor of great interest. A subset of non-institutionalised patients with a first hip fracture (cases;n=l18) and controls (n=263), aged 65-85 years, underwent dual X-ray absorptiometry (DXA) of the femoral neck, quantitative ultrasound (QUS) of the heel and phalanges and radiographic absorptiometry (RA) of the phalanges. The entire cohort was followed for approximately four years or to death. In women, DXA of the proximal femur and QUS of the heel showed a high predictive value for an incident first hip fracture, adjusted odds ratio (OR) 3.6 (95% confidence interval (CI) 2.4-5.5) and 3.4 (95%CI 2.2-5.0) respectively. The association was even stronger in men, but only for DXA of the proximal femu,r with an adjusted OR of4.8 (95%CI 2.3-9.9). Bone densitometry at non-weight-bearing sites, QUS and RA of the phalanges did not discriminate female cases from controls, but proved capable of separating male cases from controls. The risk of death was higher in cases than in controls, with a multivariate rate ratio (RR) of 3.4 (95%CI 1.7-7.0). There was no significant association between bone density and mortality. </p><p>Nursing home residents underwent QUS of the heel and phalanges. Almost all of the female residents and 51% of the male residents were, if the WHO-criterion for osteoporosis was applied, osteoporotic as assessed by heel and finger QUS. The QUS values were approximately 1.5 SD lower than expected for age and gender. </p><p>In this randomised controlled intervention study we evaluated the effect of external hip protectors in nursing home residents; 302 residents were allocated to wear such protectors and 442 were controls. External hip protectors were found to be effective in preventing hip fractures in nursing home residents, with an adjusted relative risk for hip fracture of 0.33 (CI 0.11 - 1.00). </p>

Hip fractures are the most serious consequence of osteoporosis, and are one important cause of morbidity and mortality among the elderly. Prophylactic treatment for hip fractures are now available. Early detection of individuals with increased risk for hip fractures is therefor of great interest. A subset of non-institutionalised patients with a first hip fracture (cases;n=l18) and controls (n=263), aged 65-85 years, underwent dual X-ray absorptiometry (DXA) of the femoral neck, quantitative ultrasound (QUS) of the heel and phalanges and radiographic absorptiometry (RA) of the phalanges. The entire cohort was followed for approximately four years or to death. In women, DXA of the proximal femur and QUS of the heel showed a high predictive value for an incident first hip fracture, adjusted odds ratio (OR) 3.6 (95% confidence interval (CI) 2.4-5.5) and 3.4 (95%CI 2.2-5.0) respectively. The association was even stronger in men, but only for DXA of the proximal femu,r with an adjusted OR of4.8 (95%CI 2.3-9.9). Bone densitometry at non-weight-bearing sites, QUS and RA of the phalanges did not discriminate female cases from controls, but proved capable of separating male cases from controls. The risk of death was higher in cases than in controls, with a multivariate rate ratio (RR) of 3.4 (95%CI 1.7-7.0). There was no significant association between bone density and mortality. Nursing home residents underwent QUS of the heel and phalanges. Almost all of the female residents and 51% of the male residents were, if the WHO-criterion for osteoporosis was applied, osteoporotic as assessed by heel and finger QUS. The QUS values were approximately 1.5 SD lower than expected for age and gender. In this randomised controlled intervention study we evaluated the effect of external hip protectors in nursing home residents; 302 residents were allocated to wear such protectors and 442 were controls. External hip protectors were found to be effective in preventing hip fractures in nursing home residents, with an adjusted relative risk for hip fracture of 0.33 (CI 0.11 - 1.00).

The aim of this study was to describe and analyse the constructions and interplay of gender, ethnicity and sexuality between female and male careworkers and residents in a nursing home. To explore this from a qualitative everyday life’s approach, material was collected through participating observations, interviews, and informal conversation with careworkers and residents. The result points out that historical patterns of gender and caring related to this context still matter and affect both careworkers and residents. For example, female careworkers talked about the concept of caring as a genuine female experience, while male careworkers, who were in a minority, instead talked about caring in more gender-neutral words. The result also indicates that a larger number of male careworkers not necessarily leads to a higher grade of gender equality. Instead, the presence of male careworkers made the traditional gender-power order more visible. When analyzing outcomes of the interplay of gender, ethnicity and sexuality, it was obvious that this was a complicated process. On one hand this interplay of different categories seemed to affect female and male careworkers in a similar way. On the other hand the interplay of gender, ethnicity and sexuality can confront female and male careworkers with different types of dilemmas. Therefore, an attempt to understand the position and experience of being a careworker with non-Swedish background or being a nonheterosexual careworker must include a gender-perspective. A main result from the study was that the careworkers supported the residents to perform their social gender-identity through the daily interactions. These interactions were foremost influenced by the careworkers’ own expectations about older women’s and older men’s needs and behaviour. The four gender-constellations that occurred in the care-interactions also differed from each other with regard to what careworkers and residents talked about, and how they talked and acted. Even if the outcome from different types of gendered meetings differed, there were also some similarities. It was obvious that both female and male careworkers seemed to think and talk about the female residents as more dependent and vulnerable than male residents. To conclude, traditional norms and a gender-power order that influences society also affects careworkers and residents in the nursing home.

Hjärtsvikt är en av Sveriges största folksjukdomar och en vanlig orsak till sjukhusvistelse. Kvalificerad professionell vård i hemmet kan minska antalet inneliggande vårddygn för den hjärtsviktssjuke. Lyfts inte hjärtsviktssjuka personers behov av stödjande insatser fram finns risk för att professionella vårdare i hemmet inte uppmärksammar den sjukes behov av psykosocialt stöd. Syftet med litteraturstudien var att beskriva behovet av psykosocialt stöd för den hjärtsviktssjuke personen som vårdas i hemmet. Systematisk litteraturstudie valdes där 19 artiklar analyserades genom kvalitativ innehållsanalys. Det framkom två huvudkategorier; professionella stödet och det informella stödet. Resultatet beskriver behovet av stödjande insatser i form av psykosocialt stöd den hjärtsviktssjuke erfar i hemmet. Då den professionella vården gjorde en helhetsbedömning av den hjärtsviktssjuke uppmärksammades psykosociala behov hos den sjuke. Genom att stärka den inneboende förmågan med stödjande insatser kunde den sjuke hantera de psykiska symtom som hjärtsvikt medförde. För det professionella stödet var delaktighet av största vikt, delaktighet ökade känslan av att bemästra sjukdomssituationen och stärkte värdigheten hos den sjuke. Litterturstudien riktar sig främst till distriktsköterskor i kommunal hemsjukvård och är överförbar på personer med andra palliativa sjukdomar. Vidare forskning för att få en helhetsbild av den hjärtsviktssjukes vård i hemmet skulle vara att undersöka hur atienternas copingförmåga påverkar deras psykosociala välbefinnande. / Heart failure is one of the most common diseases and a major cause of hospitalization in Sweden. Professional health care provided at home might decrease the number of days of hospitalization for the heart failure patient. If not the heart failure patient´s need for support takes into consideration, there is a risk that professional caregivers in the home do not pay attention to the patient`s need of psychosocial support. The purpose of this study was to describe the heart failure patient's need for psychosocial support while being cared for in the home. A systematic literature review was chosen, 19 articles where selected and analyzed by qualitative content analysis. Two main categories revealed: professional support and informal support. Results of the study describe the supportive services in the form of psychosocial support on heart failure patient experience in the home. The professional care made a holistic assessment of the patient and they noticed psycho-social needs. By enhancing the inherent ability with supportive services, the patient could cope with the mental symptoms of heart failure. For the professional support the involvement of the supporting effort was of paramount importance. If the heart failure patient felt participating in the care, the patients feeling of mastering the disease situation and strengthening of the dignity increased. The literature study caters mainly to district nurses in municipal home care and is transferable to persons with other palliative diseases. Further research is needed to gain an overall picture of the heart failure patient's home care would be to examine how patients' coping, affect their psychosocial well-being.