Maintaining dynamic balance during walking is a major challenge in many patient populations including older adults and post-stroke hemiparetic subjects. To maintain dynamic balance, whole-body angular-momentum has to be regulated through proper foot placement and generation of the ground-reaction-forces. Thus, the overall goal of this research was to understand the mechanisms and adaptations used to maintain dynamic balance during walking by analyzing whole-body angular-momentum, foot placement and ground-reaction-forces in older adults and post-stroke subjects. The analysis of healthy older adults showed that they regulated their frontal-plane angular-momentum poorly compared to the younger adults. This was mainly related to the increased step width, which when combined with the dominant vertical ground-reaction-force, created a higher destabilizing external moment during single-leg stance. The results also suggested that exercise programs targeting appropriate foot placement and lower extremity muscle strengthening, particularly of the ankle plantarflexors and hip abductors, may enhance balance control in older adults. During post-stroke hemiparetic walking, ankle-foot-orthosis and locomotor therapy are used in an effort to improve the overall mobility. However, the analyses of healthy subjects walking with and without a solid ankle-foot-orthosis showed that they can restrict ankle plantarflexor output and limit the successful regulation of angular-momentum and generation of forward propulsion. Thus, the prescription of solid ankle-foot-orthosis should be carefully considered. The analysis of hemiparetic subjects walking pre- and post-therapy showed that locomotor training did not improve dynamic balance. However, for those subjects who achieved a clinically meaningful improvement in their self-selected walking speed, their change in speed was correlated with improved dynamic balance. Also, improved balance was associated with narrower mediolateral paretic foot placement, longer anterior nonparetic steps, higher braking ground-reaction-force peaks and impulses, higher (lower) propulsive ground-reaction-force peaks and impulses from the paretic (nonparetic) leg, and higher vertical ground-reaction-force impulses from both legs during the late stance. Further, simulation analyses of hemiparetic walking highlighted the importance of ankle plantarflexors, knee extensors and hip abductors in maintaining balance and revealed the existence of compensatory mechanisms due to the paretic leg muscle weakness. Collectively, these studies showed the importance of ankle plantarflexors and hip abductors in maintaining dynamic balance. / text

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The purpose of this dissertation is to identify how can a focus on the ethical notion of dignity and respect for autonomy help to improve health care for elderly people in Islamic countries. An ethic for aging relies on the principle that the losses of age do not detract from a person’s essential autonomy. Thus, care should be provided without assuming that older people are different from those of other ages. It is possible to determine that ethical values are similar in Islamic cultures as well as, Western countries. But these values are often neglected when people face the need to provide health care to the elderly people. This dissertation provides a critical evaluation of the current view and application of the ethical concepts of dignity and respect for autonomy in Islamic countries including the ethical challenges that elderly people encounter in health care. The study focuses on three parts; first it will provide a general introduction to the bioethics in Islamic countries and its relation to Islamic law (Sharia). The argument is that human dignity does exist in the Islamic religion; however, the application and the functions of the concept in elderly health care are disregarded, due to the cultural understanding and interpretations of the concept. This have led health care providers and societies in Islamic countries to miss the momentum of implementing a strong old-age health and social support system that can maintain elderly people dignity and respect for autonomy, and meet their health care needs. The outcomes mandate further examination towards building greater consciousness of treatment and healing, towards the intellectual and cultural adjustment of health practices. The second part presents the applications of both concepts in Western countries, including their functions and meaning. The arguments characterize the notions of dignity regardless of age. It will identify how dignity is associated with respect for autonomy; thus, dignity and respect for autonomy should be a core value in health care practice. The third part analyses the differences and the deficiencies of the application of both ethical concepts to elderly health care in Islamic countries versus Western countries. The arguments will demonstrate how the application of the ethical principle of respect for autonomy in Islamic countries fails to acknowledge Beauchamp and Childress's principle of respect for autonomy. The analysis will help on understanding the major opportunities for and barriers to successful shift in the Islamic countries in regards to elderly health care and the overall process of aging. The challenge is to make sure that all health care providers have the capabilities to convey appropriate care and treatment with respect and appreciation to the elderly individuals’ dignity. It will suggest adopting several advantageous approaches that arose in the West and worldwide, and modifying it according to Islamic culture to improve elderly health care. The results justifies that the notions of dignity and respect for autonomy can help to improve elderly health care in Islamic countries. Concluding that in Islamic countries, a considerable measure of research, education, and preparation are all needed in the sphere of geriatrics to meet today’s health challenges associated with the increasing of elderly population. A need for adopting a fresh perception on an analytical gerontology and a respected devoted approach that aims to comprehend ageing process and requirements to change for the better. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

The purpose of this study was to examine the impact of (a) respondent age, (b) age and gender of perpetrator and victim, and (c) history of experienced violence on perceptions of elder abuse. Two-hundred and one (N = 201) middle-aged adults and 422 college students were assessed. Measures included adaptations of the Severity of Violence Against Women Scale and Elder Abuse Attitudes and Behavioral Intentions Scale-Revised. Middle-aged respondents viewed psychological behaviors more harshly than young. Middle-aged females and young males were less tolerant of middle-aged perpetrators. While past performance of elder abuse was predictive of future elder abuse, history of childhood abuse was not. Exploratory analyses examined middle-aged respondents' judgments of abusive behaviors and perceptions based on age of perpetrator. Middle-aged and young adults' willingness to respond to dimensions of quality, severity, and reportability were also examined.

The primary purpose of this study was to examine the correlation between depression and the personal characteristics of Asians who are 50 years or older. The secondary objective was to determine whether Asians 50 years or older living in the United States are more likely to be depressed than other ethnicities. The information for this study was secured from the National Health Interview Survey, spanning the years 2001 to 2010. In this study, I utilized the SAS-Callable SUDAAN statistical system. Multivariate regression was used to predict and determine significant correlations. The results indicated that Asians 50 and older living in the U.S. and who experience functional limitations, poor vision, hypertension, poor health, not married, and unemployed in previous year were in general more prone to depression. Furthermore, the study indicated that Asian elderly living the U.S. showed lower rates of depression than all non- Asian ethnicities. However when controlled for personal characteristics only Whites and Hispanics had higher depression incidences than Asian elderly. Recommendations for future studies include: conducting more micro and macro studies of Asian elders, such as in-depth case studies for each ethnicity, longitudinal studies of various Asian subgroups, and studies of Asian elderly with hypertension who have committed suicide.

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<p>Benzodiazepines are drugs used to treat insomnia and anxiety. This group of drugs should be prescribed with the duty of care to the elderly because of it´s negative effects. Life expectancy is increasing because of the progress of drug development. Aging brings physical and psychological changes leading to changes in pharmacokinetic and pharmacodynamic features. Drug treatment is becoming increasingly widespread and contributes to the increasing number of interactions and complications for the elderly. The aim of the study was to illuminate the consequences of long-term use of benzodiazepines in the elderly. The study was conducted as a literature review based on 14 scientific articles that were analyzed. The result showed that the theme benzodiazepine use among the elderly could be divided into three categories; consequences out of long-term use, benzodiazepine users experiences and the nursing perspective. The category of impact out of long-term use of benzodiazepines revealed three sub-categories: physical consequences, psychological consequences and social consequences. Information and education to the elderly patients is important to make the elderly aware of the negative effects that may arise out of a long-term use of benzodiazepines. It is essential that nurses already in their basic education acquire more knowledge about benzodiazepine use among elderly in order to address these problems in the nursing care.</p>

Thesis (M. Soc. Sc.)--University of Hong Kong, 2006.