Growth in the number of people living to very old age and progress in health care technology are creating important new challenges for our society. Among them is modern medicine's ability to extend some people's lives beyond the point where they are capable of making decisions or expressing their needs and desires, resulting in the very complex problem of knowing when to allow a person to die. In part, advance directives were created to solve this problem. Texas has been busy developing changes to existing state laws in an effort to create more "user-friendly" directives. This paper explores the history of advance directives, and discusses the details and nuances of the Texas Advance Directives Act of 1999.
North Dakota is faced with the challenge of meeting the needs of its growing population of elderly persons aging with a developmental disability. The challenge of creating new service models presents itself to professionals in the fields of Aging and Developmental Disabilities. Traditionally, the aging person with a developmental disability has been sent to nursing homes or grouped into community programs with younger persons with developmental disability. North Dakota is looking toward the future of caring for this special population through integration with elderly without disabilities.
Assisted living, the fastest growing segment of the senior housing industry, allows individuals to remain as independent as they prefer and still receive necessary services. However, assisted living residences exist primarily to serve those seniors who can pay for the services from their own savings/income. We are facing a critical need for housing options for both the current senior generation and the soon-to-be-retired baby boomers. How will access to assisted living be opened to all types of payors? How will states fund the growth of assisted living? The purpose of this paper is to discuss opportunities for expansion that will make assisted living an affordable option for the low- and moderate-income elderly.
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.
This study was a qualitative examination of social, economic, political, and cultural dilemmas that face Peruvian survivors of the Communist Shining Path Revolution, an internal armed conflict that cut a swath of terror and destruction during the years 1980-2000, with a reported loss of 69,000 residents either killed or considered “disappeared.” The conflict affected primarily poor, uneducated Andean campesinos and townspeople in the highland areas of the Ayacucho District. In this study, I looked closely at the responsibilities of both government and NGOs in the facilitation of readjustment during and after times of instability. In addition, specific challenges the elderly, women and campesinos face in a post-conflict world are analyzed and possible social policies are discerned that might be developed to better implement the transition to a new form of community. Ideas that emerged from this research may assist policy shapers in other less developed countries involved in similar conflicts by examining how Peru dealt with its own issues. Methodology included participant observation and interviews with long-term Ayacuchan residents who stayed-in-place during war time, along with migrants who went to live in shantytowns in more urban areas. The government-mandated Truth and Reconciliation Commission report serves as a framework as it outlined those ultimately deemed responsible and detailed what those affected may expect in the way of appropriate reparations and compensation in the future. Much emphasis is given to the emerging role of women and how ensuing shifts of gender specific cultural roles may affect familial and communal bonds in small-scale societies.
Disaster or emergency situations have the potential for serious impact on the safety and security of both residents and staff in a nursing home. Furthermore, federal and state laws require that all nursing facilities be prepared in case of an emergency or disaster. The first part of this document is an introduction and rationale for the development of a nursing home disaster plan. The second part is a procedure manual developed for a nursing home in Oklahoma, outlining emergency actions and recovery procedures for various types of disasters, followed by a list of emergency telephone contacts of key personnel and services both inside and outside the nursing facility.
For a workplace to be successful, it needs to have a higher morale, thus leading to higher quality of care for residents. For a workplace to be successful in empowerment, it must have developed strong teams, and everyone must work as a team and respect one another. The research for this paper focused on many issues. The most important part of my research came from a study of the nursing assistants at Jennings Hall (JH) in Garfield, Ohio. From the data received, I concluded that the two biggest problems in many nursing homes are lack of respect and lack of team-centered attitude.
Although humor is a generally accepted part of everyday life for humans, its existence, importance, and positive influence on older persons are often underestimated. The purposes of this study are to determine whether humor is a normal experience for nursing home residents, enhancing their activities of daily living, and whether it plays a role in contributing to their psychological well-being. The study includes a discussion of research on humor, particularly as it relates to the elderly and the aging process; analysis and comparisons based on interviews with residents on the subject of humor and review of their psychological state as evaluated by the MDS 2.0 nursing facility assessment; individual case studies, and anecdotes illustrating the beneficial contributions humor brings to the lives of nursing home residents.
Widespread concern about the rapid growth of Medicare spending in recent years initiated a legislative response that resulted in the Balanced Budget Act of 1997. The effects of the BBA were far reaching and created shock waves throughout the health care industry. This study presents background information on the history of the Medicare home health benefit, enumerates specific provisions and goals of the BBA of 1997, examines how the BBA has changed the delivery of Medicare home health services, and proposes survival strategies for home health care providers.
The focus of this research study is glycemic control in the presence of multiple morbidities and polypharmacy in homebound individuals with Type 2 diabetes aged 65 years and older. The research method is a quantitative retrospective cohort study of discharged patients of a nonprofit community-based home health agency from January 1, 2010, to December 31, 2011, using OASIS data. Glycemic control is assessed using the hA1C laboratory test following the recommendation of the American Diabetes Association. The study documents a moderate significant association between glycemic control, polypharmacy and comorbid conditions, indicating that homebound individuals with Type 2 diabetes aged 65 years and older are less likely to have optimal glycemic control in the presence of multiple morbidities and polypharmacy. There continues to be a need for scientific research in this population cohort; and the dose-response association between antidiabetic therapy interventions designed to lower blood glucose levels in the presence of chronic disease and polypharmacy.
The long-term care administrator profession is one that is both new and evolving. The unique historical perspective of this health profession is brief in the number of years it encompasses and crucial in understanding the current issues facing the profession. Administrator experiences provide a point of reference regarding the profession's structural problems. Ethical considerations play a dynamic role in administrators' daily jobs as well as their continued licensure. The significance of the profession's ongoing problems at the state and national level causes the need for alternatives to the current system. A combination of these alternatives must be embraced to assist in the recruitment and retention of long-term care administrators.
Elder abuse first received national attention in 1980, as the subject of a congressional investigation. Now, 20 years later, establishing successful strategies of identification, subsequent intervention, and prevention of abuse is of paramount importance; but progress toward this goal is hindered by lack of consensus as to the definition of elder abuse, and the use of vague, confusing, and sometimes contradictory terms in its discussion. In this paper, both social research and professional approaches and legal approaches to the definition of elder abuse are surveyed, as are definitions formulated for the National Elder Abuse Incidence Study conducted by the National Center on Elder Abuse. The continuing need for a universal or standard definition is emphasized.
This dissertation examined the impact of Medicare Plan D on medication compliance in Medicare beneficiaries at University of Texas Health Center at Tyler, TX. Data were collected before and after the implementation of Plan D. The impacts of various types of benefits, such as private insurance, employer insurance and pharmacy assistance programs were evaluated in terms of impact on drug compliance. Medication compliance was found to increase in those respondents without Plan D. Plan D was found to be a predictor of those who spent less on basics in order to buy medications. Although compliance increased in general, these increases could not be attributed to the acquisition of a Plan D policy.
Loneliness is a significant problem for older adults and can lead to negative health and social outcomes. Having a companion pet is beginning to be recognized as a way loneliness can be reduced for older persons. The purpose of this descriptive study was to determine the effect of pets on the level of loneliness in persons 60 years old or older who live alone and independently in a large metropolitan community in the North Central Texas area. Using a non-random snowball sample of older individuals (N = 252), who met the study criteria, each subject was administered the researcher-developed demographic data survey instrument containing the following variables: (a) pets - having a pet/wanting a pet, (b) age, (c) gender, (d) marital status, (e) living alone, (f) losses within the last six months, (g) interactions with family members, (h) interactions with others outside of the family, (i) highest educational level achieved, (j) employment or volunteer involvement in the community, (k) religious participation, and (l) self perceived health status. The UCLA Loneliness Scale Version 3 was used to obtain the loneliness scores. Prediction of loneliness and relationship with the independent variables was tested using frequency, correlation, analysis of variance (ANOVA), and multivariate analysis using ordinary least-squares (OLS) regression analysis. The findings from this study showed that those older adults living alone who did not have a pet but would like to have a companion pet had higher levels of loneliness (p<0.05). Other findings suggested that older adults' loneliness was less if they had moderate religious participation and interactions with others (p< 0.05). Future studies are needed to examine the effects that pets have on feelings of loneliness and the ability of older individuals to cope effectively with those feelings.
Federal and state regulations require that licensed long-term care facilities have policies for every resident-related topic. Long-term care administrators must plan, implement, and evaluate resident care policies that can be easily personalized to the needs of the specific facility's population. Part 1 of this paper is an overview of resident policies, covering admission, physician services, transfers and discharges, nursing services, restraints, abuse and neglect, pharmaceutical services, dietary services, clinical records, therapeutic recreation services, and social services. Part 2 presents the policies themselves, ready for use by Texas long-term care administrators as part of their facility's administrative policy manual.
The graying of America will have implications for all areas of society, especially the delivery of long-term care services. Many older individuals are aging in place, a phenomenon that is apparent at Dickinson Place, a church-sponsored low-income housing property for the elderly in Dallas, Texas, where the average age of residents has risen from 65 in the early 1970s to 78 in 1999. This change has prompted the board of directors to review the facility's mission, its physical plant, and the services it provides for strategic planning purposes, to ensure that Dickinson Place can continue to meet the needs of its residents both now and in the future.
The purpose of this study is two-fold: (1) to examine the correlation between frequency of sexual activity and general happiness among older Americans and (2) to examine the correlation between frequency of sexual activity and marital happiness among older married Americans. This study employed quantitative data drawn from the 2004-2008 General Social Surveys. Two samples were used. The first sample included all respondents 65 years of age and older with valid responses for the dependent, independent, and control variables. The second sample was a subset of the first and included only the married respondents. Both bivariate cross-tabulations and binary logistic regression analyses were conducted. As expected, the data support a positive association between sexual activity and general happiness in both the total elder sample and the married elder sample (p < 0.05). Also, as expected, the data support a positive association between frequency of sexual activity and marital happiness in the married elder sample (p < 0.05). Even with the introduction of control variables, frequency of sexual activity was found to be a significant predictor of both general and marital happiness (p < 0.05). This study suggests that sexual activity does indeed contribute the happiness and well-being of older Americans.
The effects of teamwork in a long-term care setting were explored, and four key elements of teamwork in the long-term care facility were discovered. These elements--clarity of purpose, clear communication, well-defined decision-making procedures, and participative leadership--are presented in detail. The literature reviewed as well as observations from personal participation in a case study show that employing the teamwork concept in a nursing home environment significantly enhances the quality of life for the residents of such facilities.
Tuberculosis in the nursing home is an ever-growing problem for the health care community. The incidence of tuberculosis in the United States has risen alarmingly since 1982, and high-population environments such as nursing homes are among the places where it is most prevalent. The first part of this document is an introduction to the current concerns faced by nursing home infection control personnel. It includes information about the history, symptoms, and epidemiology of the disease, as well as other topics. The second part is a policy and procedure manual that contains a basic guide to methodical testing for tuberculosis, steps for dealing with active cases of the disease, and suggestions for education of nursing home health care workers.
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