Thesis (M. Med. Sc.)--University of Hong Kong, 200.

This thesis explores the contrasting experience of the discharge of older people from hospital on a Care of the Elderly Unit and Medical/Surgical Unit in a District General Hospital in North Wales. It comprises both the results of a Fourth Generation evaluation (Guba and Lincoln, 1989) and the later development of a substantive grounded theory of the discharge process (Charmaz, 2000). Both elements of the thesis were informed by a constructivist approach to research and the presentation and style of the thesis reflects this orientation. Data were collected from all the main stakeholder groups (members of the multidisciplinary team, patients and carers, members of the primary health care team) using a variety of methods including semi-structured interviews, documentary analysis and periods of observation. These data were then fed into a series of hermeneutic cycles in an effort to reach consensus about desired change. Barriers to both consensus and change were identified and explored largely in terms of the threat they posed to traditional medical power bases. The subsequent theory suggested that the differences between the Units could be explained largely in terms of the orientations on the ward, one of which 'processed patients' with an emphasis on pace (speed of throughput) while the other 'processed people' with more recognition of the complex needs of older individuals. In both Units the role of the nurse was significant and comprised a number of key processes: pushing; fixing; informing and brokering. The ways in which these processes interact are considered and their impact on the discharge process described. The quality of the thesis is considered on a number of criteria and the extent to which the results can be recontextualised is addressed. Finally, implications for policy and practice in the light of recent developments are discussed.

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No description available.

In I960, the Junior League of Vancouver undertook a three-year exploratory program of recreation and visiting activities in selected residential institutions for the aged. The project had been suggested by the Committee on the Welfare of the Aged, a subdivision of the Social Planning Section of the Community Chest and Councils of Greater Vancouver, who were aware of the dearth of diversional resources in these institutions. The Research Department of the Community Chest and Councils of Greater Vancouver was asked by the Advisory Committee to the Junior League Senior Citizens Project to undertake an evaluative study of the program. The present study, a self-contained segment within the broad Research Department evaluation, is designed to test two related hypotheses, (a) that the level of participation in a group recreation program will be positively related to the level of previous participation in group activity, and (b) that the level of participation in a group recreation program will be inversely related to the degree of hearing" impairment. Case material as well as statistical recording is assembled to examine these questions. 34 residents of Taylor Manor, a city-owned and operated boarding home for dependent older men and women, constituted the study sample. There is strong statistical support for the first section of the hypothesis. For the second section, the data are not of statistical significance, possibly because of the limited sample size. However, examination of related factors indicates the question of a relationship between program response and impaired hearing should be considered an open one. Social Contacts is the only other variable identified which seems to have a statistically significant relationship to program response. There was inadequate statistical evidence to support the belief that the program had measurable effect upon attitudes and behaviour of Taylor Manor residents, although subjective observations and trends evident in graphs indicate the program did have positive effect upon a number of participants. A larger population with a matched control sample would be necessary before stronger conclusions could be drawn on whether program participation improved attitudes and behaviour. Some implications for community planning are drawn, and suggestions are made for future research. The possibilities of program development are discussed under four headings: community education, recruitment and training of community volunteers, programming and continuing assessment. / Arts, Faculty of / Social Work, School of / Graduate

A major concern of community planning is the integrated use of land and its implications upon people. This statement leads to the central hypothesis of this thesis: that the planned location of senior citizens' housing developments in the urban area should be based upon adequate knowledge of the needs and preferences of the elderly in regard to the total community. In an attempt to gain a total perspective, a survey of five per cent of the self contained dwelling units, specifically designed for the elderly in the city of Vancouver, is undertaken. Using multivariate contingency tabulations (MVTAB) and the statistical package for social sciences (SPSS) programs, four principal variables, age, length of residence in the housing project, satisfaction with the proximity to facilities, and frequency of their use are correlated with the locational importance attributed to these selected facilities by the respondents. The results of this study indicate that more than one half of the respondents are displeased with the location of their present living quarters. Also, decisions in locating residences for the elderly must be based upon the examination of a number of facilities used by this age group, as opposed to the identification of a single facility frequented most regularly. These findings may contribute toward a more knowledgeable approach in the future site planning of housing accommodation for the aged. / Applied Science, Faculty of / Community and Regional Planning (SCARP), School of / Graduate

Depression is not a normal part of aging; despite this, 15-17% of older adults have symptoms of depression (Lakkis & Mahmassani, 2015). Depression in older adults not only negatively impacts quality of life, but also negatively impacts co-morbid disease progression (Gallagher et al., 2016; Oza, Patel, & Baptist, 2016; Sinnige et al., 2013; Song et al., 2014). Depression treatment improves co-morbid disease outcomes (Bogner et al., 2016; Wood et al., 2015). Arizona has a large population of older adults and the number of older adult is projected to increase 174% by the year 2050 (Arizona Department of Health Services, n.d.). The majority of depressed patients seek treatment in the primary care setting (Lakkis & Mahmassani, 2015; Samuels et al., 2015). Arizona has over five thousand nurse practitioners working in primary care (Arizona Department of Health Services, 2014b). The purpose of this project was to determine the treatment practices of nurse practitioners caring for older adults with depression in southern Arizona. A needs assessment, using a self-administered survey, was conducted to determine how southern Arizona nurse practitioners self-identify their ability to recognize and treat older adult depression. Results revealed that southern Arizona nurse practitioners have barriers to recognition and treatment of depression in older adults. Barriers to the recognition of depression in older adults included the older adult patient’s medical complaint, limited appointment times in the primary care setting, and limited experience as a nurse practitioner. Treatment barriers identified by survey results included the older adult patient’s attitude toward depression, financial status, and ability to participate in depression treatment. The majority of these barriers are consistent with evidence established in previous studies. The ability of the older adult to participate in depression treatment was a barrier identified in the results not found in the synthesis of evidence. This project supports existing evidence regarding barriers to the recognition and treatment of older adult depression in the primary care setting. Further research is indicated to evaluate if removing the identified barriers will increase the nurse practitioners’ ability to recognize and treat depression in the older adult.

"Older people are beautiful!" "Older people are beautiful images of God!" Even though contemporary western society is powerfully shaped both by the visual and by an increasingly ageing demographic, the above statements are rare and counter-cultural. Yet they are statements totally true to my own experience as a minister with special responsibility for older people. I am drawn to wondering how the beauty of older people can be highlighted in ways that our culture will see and engage with; and therefore begin to own, and even possibly celebrate, the ageing process. In the first part of my thesis I aim to discover why our society does not see beauty in age, or even perceive age itself. I begin with a historical study of western artistic expressions of beauty, tracing a reoccurring and influential strand of classical symmetry and perfection. A social analysis of our contemporary culture of youth is followed by an overview of the church's attitudes towards ageing. All three studies reveal a picture of deeply rooted ageism in society. Alongside these discoveries, an alternative perspective and antidote to ageism is offered through an inclusive reader response to Paul's description of the Body of Christ in 1 Corinthians 12. My discoveries inform my choice of research methodology - the ways in which I endeavour to uncover new perceptions of older people and forms of expression that honour and include them. Thus embracing them as part of the Body of Christ. Participant observation, the inclusive tool favoured by social anthropology suits the aesthetic and subjective nature of my research. Older people themselves are my research participants. Group situations, where they play with clay and comment upon portraits and landscapes, enable them to express their perceptions of what is beautiful and so reflect a perceptible beauty of their own. A biblical structure allows the participants' thoughts about beauty to become expressions of their own particular spirituality. This uncovering of an embodied spirituality of older people as vital and beautiful is offered as a counterpoint to a culture that renders older people invisible. I discover that there is much that older people can offer younger generations through their laughter and tears, their interpersonal relationships and their intrepid journeying through the unknown territory of ageing itself. A search for and reflection upon theological perspectives and art images that resonate with these discoveries and illuminate older people as beautiful images of God forms the final part of my thesis.

Planners for British Columbia's aging population are beginning to contemplate the difficult problem of ensuring the future adequacy of supportive programs for the elderly in the key areas of health, income, and housing. It now appears that these programs may well be squeezed between increased demand resulting from a rapid rise projected in the number and proportion of older people early in the next century, and lower rates of provincial and national growth foreseen by most economists. This descriptive study draws on available relevant information (much of it included in tables, figures, and appendices) to explore the problem from its origins in previous policy development to the situation at the present time. From this perspective the implications of current demographic, economic, and political/bureaucratic trends for programs for the elderly are assessed in both the national and international contexts. After a consideration of the roles of philosophy and ideology in social theory, a wide range of social gerontological theories are examined using a sociological scheme which classifies them according to four major paradigms in order to determine their abilities to describe accurately the information presented, and to prescribe useful policy alternatives. It is concluded that a theoretical approach which advocates radical change from a structural perspective is both most valid and most productive as a paradigm for planning for the aging population. A description of the relationship of planning to social change, and a systems analysis of the process of public policy making together introduce a discussion of strategies based upon the selected planning paradigm. Once the approaches used in planning for the elderly in the past are critically reviewed, the outline of a radical structural plan for the aging population is described, and then a strategy for its implementation over the next two or three decades is presented. The report concludes with a brief summary, and a number of specific recommendations for action by the appropriate public authorities, including several suggestions for enhancing the capacity for policy and program research in this field. One important recommendation is for the early establishment in British Columbia of an inter-departmental agency on aging to co-ordinate information and planning for the province's elderly. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Reminiscence is a complex phenomenon which is theorized in contemporary gerontological literature to serve adaptive functions in successful aging. This study explores the relationship between reminiscence (as measured using the Reminiscence Survey) and one criterion of adaptation: global self-esteem (as measured by the Total P score of the Tennessee Self Concept Scale) in a sample of 40 older volunteers who range in age from 55 years to 95 years and who still live independently in the community. Significant positive correlations were found between the Reminiscence Survey measures and the Total P scores of the TSCS. As well, life-reviewers reported significantly more uses, triggers, and outcomes of reminiscence and had significantly higher self-concept scores than did non-life-reviewers. These findings serve to demonstrate the positive relationship between the pervasiveness of reminiscence and the positivity of self-conception. Implications for the constructive use of reminiscence as a therapeutic intervention strategy in counselling older adults are discussed. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate