Récits du vieillir « actif » et de la citoyenneté au quotidien : l’expérience des femmes aînées au Québec

Taken as a policy framework, active aging ranks high on most supranational bodies’ agenda. The new political economy of aging portrays “active” citizenship amongst seniors as a key challenge for the years to come. Our research focuses on, first, elderly women’s everyday ‘active’ practices, their meaning and purpose, in the context of Quebec’s active aging policy framework; and second, their day-to-day practical citizenship experiences. Informed by discourse analysis and a narrative approach, the life stories of women 60 to 70 years of age allowed for the identification of a plethora of distinctive old age activity figures. More specifically, four activity figures were identified by which respondents materialize their routine active practices, namely: (1) paid work; (2) voluntary and civic engagement; (3) physical activity; and (4) caregiving. Set against Quebec’s active aging policy framework, these patterns and set of practices that underpin them are clearly in tune with government’s dominant perspectives. Respondents’ narratives also show that active aging connotes a range of ‘ordinary’ activities of daily living, accomplished within people’s private worlds and places of proximity. Despite nuances, tensions and opposition found in dominant public discourse, as well as in active aging practices, a form of counter-discourse does not emerge from respondents’ narratives. To be active is normally the antithesis of immobility and dependence. Thus, to see oneself as active in old age draws on normative, positive assumptions about old age quite difficult to refute; nevertheless, discourses also raise identity and relational issues. In this respect, social inclusion issues cut across all active aging practices described by respondents. Moreover, a range of individual aims and quests underpin activity pattern. Such quests express respondents’ subjective interactions with their social environment; including their actions’ meaning and sense of social inclusiveness in old age. A first quest relates to personal identity and social integration to the world; a second one concerns giving; a third centers on the search for authenticity; whereas the fourth one is connected to a desire for freedom. It is through the objectivising of active practices and related existential pursuits that elderly woman recognize themselves as active citizens, rooted in the community, and variously contributing to society. Accordingly, ‘active’ citizenship experiences are articulated in a dialogic manner between the dimensions of ‘doing’, ‘active’ social practices, and ‘being’ in relation to others, within a context of interdependence. A proposed typology allows for the modeling of four ‘active’ citizenship figures. Overall, despite the role played by power relations and social inequality in structuring aging experiences, in everyday life ‘old age citizenship’ appears as a relational process, embedded in a set of social relations and practices involving individuals, families and communities, whereby elderly women are able to express a sense of agency within their social world.

Roads to Health in Nigeria – Understanding the Intersection of Culture and Healing

The most important attribute for which we all aspire as human beings is good health because it enables us to undertake different forms of activities of daily living. The emergence of scientific knowledge in Western societies has enabled us to explore and define several parameters of “health” by drawing boundaries around factors that are known to impact the achievement of good health. For example, the World Health Organization defined health by taking physical and psychological factors into consideration.

Falls and the Social Isolation of Older Adults in the National Health and Aging Trends Study

Thesis (Ph.D.)--University of Washington, 2016-08

IntelliChair: a non-intrusive sitting posture and sitting activity recognition system

Current Ambient Intelligence and Intelligent Environment research focuses on the interpretation of a subject’s behaviour at the activity level by logging the Activity of Daily Living (ADL) such as eating, cooking, etc. In general, the sensors employed (e.g. PIR sensors, contact sensors) provide low resolution information. Meanwhile, the expansion of ubiquitous computing allows researchers to gather additional information from different types of sensor which is possible to improve activity analysis. Based on the previous research about sitting posture detection, this research attempts to further analyses human sitting activity. The aim of this research is to use non-intrusive low cost pressure sensor embedded chair system to recognize a subject’s activity by using their detected postures. There are three steps for this research, the first step is to find a hardware solution for low cost sitting posture detection, second step is to find a suitable strategy of sitting posture detection and the last step is to correlate the time-ordered sitting posture sequences with sitting activity. The author initiated a prototype type of sensing system called IntelliChair for sitting posture detection. Two experiments are proceeded in order to determine the hardware architecture of IntelliChair system. The prototype looks at the sensor selection and integration of various sensor and indicates the best for a low cost, non-intrusive system. Subsequently, this research implements signal process theory to explore the frequency feature of sitting posture, for the purpose of determining a suitable sampling rate for IntelliChair system. For second and third step, ten subjects are recruited for the sitting posture data and sitting activity data collection. The former dataset is collected byasking subjects to perform certain pre-defined sitting postures on IntelliChair and it is used for posture recognition experiment. The latter dataset is collected by asking the subjects to perform their normal sitting activity routine on IntelliChair for four hours, and the dataset is used for activity modelling and recognition experiment. For the posture recognition experiment, two Support Vector Machine (SVM) based classifiers are trained (one for spine postures and the other one for leg postures), and their performance evaluated. Hidden Markov Model is utilized for sitting activity modelling and recognition in order to establish the selected sitting activities from sitting posture sequences.2. After experimenting with possible sensors, Force Sensing Resistor (FSR) is selected as the pressure sensing unit for IntelliChair. Eight FSRs are mounted on the seat and back of a chair to gather haptic (i.e., touch-based) posture information. Furthermore, the research explores the possibility of using alternative non-intrusive sensing technology (i.e. vision based Kinect Sensor from Microsoft) and find out the Kinect sensor is not reliable for sitting posture detection due to the joint drifting problem. A suitable sampling rate for IntelliChair is determined according to the experiment result which is 6 Hz. The posture classification performance shows that the SVM based classifier is robust to “familiar” subject data (accuracy is 99.8% with spine postures and 99.9% with leg postures). When dealing with “unfamiliar” subject data, the accuracy is 80.7% for spine posture classification and 42.3% for leg posture classification. The result of activity recognition achieves 41.27% accuracy among four selected activities (i.e. relax, play game, working with PC and watching video). The result of this thesis shows that different individual body characteristics and sitting habits influence both sitting posture and sitting activity recognition. In this case, it suggests that IntelliChair is suitable for individual usage but a training stage is required.

Viver com úlcera crónica nos membros inferiores: análise qualitativa de narrações significativas de pessoas idosas

O envelhecimento populacional é uma realidade mundial que altera a sociedade de forma complexa, implicando a necessidade de criação de estratégias de adaptação a esta realidade. A população idosa portuguesa apresenta também um aumento exponencial, e este fenómeno está frequentemente associado à perda de capacidades e dependência e ao aumento da incidência de patologias crónicas, como por exemplo as úlceras crónicas nos membros inferiores. Esta realidade verifica-se através de uma maior procura de cuidados de saúde e também no aumento dos encargos para a família e segurança social. Assim, a aquisição de conhecimentos sobre as implicações da úlcera crónica nos membros inferiores permite, aos profissionais de saúde, melhorar a prestação de cuidados às pessoas idosas, possibilitando a gestão eficaz de recursos e a melhoria da qualidade de vida dos utentes. Neste contexto, emergiu o nosso estudo que tem como objetivo conhecer as principais implicações da presença de uma úlcera crónica, nos membros inferiores, no quotidiano de pessoas idosas. A metodologia utilizada foi qualitativa, com um tipo de estudo exploratório-descritivo, em que foram realizadas 16 entrevistas a pessoas idosas portadoras de úlcera crónica nos membros inferiores e posteriormente analisadas as narrações de vivências ou experiências significativas dos participantes, utilizando as etapas metodológicas da análise de conteúdo segundo Bardin (2011). Os resultados encontrados foram incluídos em três áreas temáticas: Sentimentos e preocupações vividos com o aparecimento e desenvolvimento da úlcera crónica, Alterações no quotidiano das pessoas idosas com úlcera crónica e a Rede de apoio da pessoa idosa com úlcera crónica. A primeira área temática demostrou que as pessoas idosas apresentam sentimentos negativos de tristeza e dor em relação às suas vivências com a úlcera crónica, e receios futuros relacionados com a incerteza da evolução da úlcera, verificando-se alguma ambivalência entre a esperança e o desespero. As alterações no quotidiano verificaram-se na mobilidade física prejudicada, na interferência em atividades de vida diária e através da necessidade de tratamento. Na mobilidade física prejudicada foi o caminhar o mais mencionado pelos participantes e na interferência em atividades de vida diária foram as atividades domésticas, sociais e de lazer. A terceira área temática incluiu a rede de apoio da pessoa idosa com úlcera crónica identificando a família, a instituição e o convivente significativo como o principal apoio dos participantes. A família apresentou um papel de destaque, através do apoio prestado pelo cônjuge e pelos filhos. A realização deste estudo proporcionou conhecer melhor a realidade das pessoas idosas com úlceras crónicas nos membros inferiores, os seus sentimentos, dificuldades e/ou incapacidades, permitindo aos profissionais de saúde aumentar os conhecimentos e elaborar estratégias para auxiliar no seu dia-a-dia, ambicionando-se uma melhoria na prestação de cuidados às pessoas idosas, famílias e sociedade.

Exercit@rt mobile : monitorização da reabilitação respiratória na DPOC

A prevalência estimada da Doença Pulmonar Obstrutiva Crónica (DPOC) em Portugal é de 14,2% para indivíduos com idade superior a 45 anos (cerca de 800.000 indivíduos), sendo mais prevalente no sexo masculino (Observatório Nacional das Doenças Respiratórias, 2014). Com o aparecimento de soluções baseadas em novas modalidades de eHealth e mHealth surgiram novas formas de acompanhamento e monitorização das doenças crónicas, nomeadamente da DPOC. É neste contexto que foi desenvolvida a aplicação mobile Exercit@rt, em parceria com a Escola Superior de Saúde da Universidade de Aveiro e em continuidade com outros estudos do MCMM anteriormente desenvolvidos. A aplicação permite monitorizar, em tempo real, através da utilização de um oxímetro Bluetooth, os níveis de batimento cardíaco e saturação de oxigénio dos pacientes com DPOC. Com esta aplicação os pacientes podem realizar diversos exercícios de fisioterapia respiratória assim como atividades físicas de vida diária que podem ser monitorizadas, georreferenciadas e avaliadas. Para além do desenvolvimento da aplicação mobile, a presente investigação integrou ainda uma etapa de validação que contou com a participação de dez pacientes com doenças do foro respiratório – cinco utilizadores que utilizam/têm smartphone (UTS) e cinco utilizadores não utilizam/não têm smartphone (NUNTS). A cada um destes foram propostas tarefas a realizar na aplicação mobile, estando previsto que a aplicação estivesse apta para qualquer participante. A totalidade dos participantes reconheceu a utilidade da aplicação no controlo da sua doença.

Avaliação funcional do idoso em contexto do Centro de Dia

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Enfermagem

Conhecimento dos Cuidadores Informais no cuidar do seu familiar idoso dependente

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em Enfermagem

Is quality of life measurement likely to be a proxy for health needs assessment in patients with coronary artery disease?

BACKGROUND: The identification of patients' health needs is pivotal in optimising the quality of health care, increasing patient satisfaction and directing resource allocation. Health needs are complex and not so easily evaluated as health-related quality of life (HRQL), which is becoming increasingly accepted as a means of providing a more global, patient-orientated assessment of the outcome of health care interventions than the simple medical model. The potential of HRQL as a surrogate measure of healthcare needs has not been evaluated. OBJECTIVES AND METHOD: A generic (Short Form-12; SF-12) and a disease-specific questionnaire (Seattle Angina Questionnaire; SAQ) were tested for their potential to predict health needs in patients with acute coronary disease. A wide range of healthcare needs were determined using a questionnaire specifically developed for this purpose. RESULTS: With the exception of information needs, healthcare needs were highly correlated with health-related quality of life. Patients with limited enjoyment of personal interests, weak financial situation, greater dependency on others to access health services, and dissatisfaction with accommodation reported poorer HRQL (SF-12: p < 0.001; SAQ: p < 0.01). Difficulties with mobility, aids to daily living and activities requiring assistance from someone else were strongly associated with both generic and disease-specific questionnaires (SF-12: r = 0.46-0.55, p < 0.01; SAQ: r = 0.53-0.65, p < 0.001). Variables relating to quality of care and health services were more highly correlated with SAQ components (r = 0.33-0.59) than with SF-12 (r = 0.07-0.33). Overall, the disease-specific Seattle Angina Questionnaire was superior to the generic Short Form-12 in detecting healthcare needs in patients with coronary disease. Receiver-operator curves supported the sensitivity of HRQL tools in detecting health needs. CONCLUSION: Healthcare needs are complex and developing suitable questionnaires to measure these is difficult and time-consuming. Without a satisfactory means of measuring these needs, the extent to which disease impacts on health will continue to be underestimated. Further investigation on larger populations is warranted but HRQL tools appear to be a reasonable proxy for healthcare needs, as they identify the majority of needs in patients with coronary disease, an observation not previously reported in this patient group

Caregivers' experiences and coping strategies relating to patient's subjective treatment-related cognitive impairment following Haematopoietic Stem Cell Transplant (HSCT)

The treatments involved in cancers of the blood and bone marrow can be physically and psychologically challenging and be associated with adverse secondary effects, including cognitive impairment. The incidence and severity of treatment-related cognitive impairment varies widely, however it can significantly impact quality of life by interfering with patients’ activities of daily living, relationships and future plans. It can also pose challenges for the patients’ caregivers, an area which has received comparatively less research attention. The aim of this study was to investigate caregivers’ experiences of treatment-related cognitive impairment in patients who have undergone Haematopoietic Stem Cell Transplant (HSCT); how they coped, both practically and emotionally, and what supports they believe could help them. Participants were caregivers to individuals who had undergone HSCT within the past 20 years and who had reported cognitive changes at the HSCT Late Effects Clinic, Beatson West of Scotland Cancer Centre. Five participants completed a single semi-structured interview. The data was then analysed using Interpretative Phenomenological Analysis (IPA). Results of this analysis illustrated four super-ordinate themes: noticing change; managing expectations, managing personal feelings and commitment. Findings from the current study highlighted the importance of caregiver education regarding post HSCT cognitive and behavioural changes and providing caregiver emotional support. Future research should explore the mutual needs of both care recipient and caregiver.

Avaliação da memória em portugueses com idade superior a 50 anos: Validação e dados normativos para o CVLT-9 e para os subtestes reprodução visual e faces da WMS – III

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Récits du vieillir « actif » et de la citoyenneté au quotidien : l’expérience des femmes aînées au Québec

Taken as a policy framework, active aging ranks high on most supranational bodies’ agenda. The new political economy of aging portrays “active” citizenship amongst seniors as a key challenge for the years to come. Our research focuses on, first, elderly women’s everyday ‘active’ practices, their meaning and purpose, in the context of Quebec’s active aging policy framework; and second, their day-to-day practical citizenship experiences. Informed by discourse analysis and a narrative approach, the life stories of women 60 to 70 years of age allowed for the identification of a plethora of distinctive old age activity figures. More specifically, four activity figures were identified by which respondents materialize their routine active practices, namely: (1) paid work; (2) voluntary and civic engagement; (3) physical activity; and (4) caregiving. Set against Quebec’s active aging policy framework, these patterns and set of practices that underpin them are clearly in tune with government’s dominant perspectives. Respondents’ narratives also show that active aging connotes a range of ‘ordinary’ activities of daily living, accomplished within people’s private worlds and places of proximity. Despite nuances, tensions and opposition found in dominant public discourse, as well as in active aging practices, a form of counter-discourse does not emerge from respondents’ narratives. To be active is normally the antithesis of immobility and dependence. Thus, to see oneself as active in old age draws on normative, positive assumptions about old age quite difficult to refute; nevertheless, discourses also raise identity and relational issues. In this respect, social inclusion issues cut across all active aging practices described by respondents. Moreover, a range of individual aims and quests underpin activity pattern. Such quests express respondents’ subjective interactions with their social environment; including their actions’ meaning and sense of social inclusiveness in old age. A first quest relates to personal identity and social integration to the world; a second one concerns giving; a third centers on the search for authenticity; whereas the fourth one is connected to a desire for freedom. It is through the objectivising of active practices and related existential pursuits that elderly woman recognize themselves as active citizens, rooted in the community, and variously contributing to society. Accordingly, ‘active’ citizenship experiences are articulated in a dialogic manner between the dimensions of ‘doing’, ‘active’ social practices, and ‘being’ in relation to others, within a context of interdependence. A proposed typology allows for the modeling of four ‘active’ citizenship figures. Overall, despite the role played by power relations and social inequality in structuring aging experiences, in everyday life ‘old age citizenship’ appears as a relational process, embedded in a set of social relations and practices involving individuals, families and communities, whereby elderly women are able to express a sense of agency within their social world.

Quality of life after first-ever stroke: An interviewbased study from Blantyre, Malawi

Background In post-stroke patients, impairment of quality of life (QOL) has been associated with functional impairment, age, anxiety, depression, and fatigue. Good social support, higher education, and better socioeconomic status are associated with better QOL among stroke survivors. In Africa, studies from Nigeria and Tanzania have reported on post-stroke QOL. Aim The aim of this study was to describe QOL more than six months after first-ever stroke in Malawi. Methods This was an interview-based study about a stroke-surviving cohort. Adult patients were interviewed six or twelve months after their first ever stroke. HIV status, modified stroke severity scale (mNIHSS) score, and brain scan results were recorded during the acute phase of stroke. At the time of the interviews, the modified Rankin scale (mRS) was used to assess functional outcome. The interviews applied the Newcastle Stroke-specific Quality of Life Measure (NEWSQOL). All the data were analysed using Statview™: the X2 test compared proportions, Student’s t-test compared means for normally distributed data, and the Kruskal-Wallis test was used for nonparametric data. Results Eighty-one patients were followed up at least six months after the acute stroke. Twenty-five stroke patients (ten women) were interviewed with the NEWSQOL questionnaire. Good functional outcome (lower mRS score) was positively associated with better QOL in the domains of activities of daily living (ADL)/self-care (p = 0.0024) and communication (p = 0.031). Women scored worse in the fatigue (p = 0.0081) and cognition (p = 0.048) domains. Older age was associated with worse QOL in the ADL (p = 0.0122) domain. Seven patients were HIV-seroreactive. HIV infection did not affect post-stroke QOL. Conclusion In Malawi, within specific domains, QOL after stroke appeared to be related to patients’ age, sex, and functional recovery in this small sample of patients.

Prevalence of surgical wound infection after surgery for breast cancer: systematic review

One of the known risk factors for abuse and neglect of the elderly is the decrease in functionat capacity, contributíng to self care dependency of instrumental actívities of daily living and basic activities of daily Itving (OMS, 2015). Methods: Cross-sectional study with non probabilistíc sample of 333 elderly, performed in a hospital, homes and day centers for the elderly. The data collectíon protocol tncluded socio-demographic data, Questíons to elicit Elder Abuse (Carney, Kahan B Paris, 2003 adap. By Ferreira Alves & Sousa, 2005), scale of instrumental actívi - ties of daily living Lawton and Brody and Katz index to assess the levei of independence in actívities of daily living. Objectives: To evaluate the assodation between abuse and neglect in the elderly, instrumental actívitíes of daily living and levei of independence in actívitíes of daily living. Results: Emotional abuse is signifícantty correlated with the levei of independence in activities of daity Uving (p = 0. 000), older peopie with less independence tend to have higher leveis of emotional abuse. The total abuse is signtficantly correlated with the leveis of independence in activittes of daily living (p = 0. 002), less independent elderty tend to suffer greater abuse and neglect. There were no statistically significant associations between abuse and neglect and instrumental activities of daily l1v1ng. Conclusions: The less independent elderly are more vulnerable to situatíons of abuse and neglect, being more exposed to emotional abuse. These results point to the need for health professionals/ nurses develop prevention interventions, including strategies to support carers and early screentng tn less independent elderly. Keywords: Elder abuse. Negligence. Nursing care. Frail elderly. PREVALENCE OF SURGICAL WOUND INFECTION AFTER SURGERY FOR BREAST CÂNCER: SYSTEMATIC REVIEW C. Amaral3, C. Teixeira"'1', F. Sousa'', C. Antãoa "Polythecnic Institute o f Bragança, Bragança, Portugal; bEPI Unit, Public Health Institute, University of Porto, Portugal. Contact details: catarinaisabeln.amaraliSsmaU.com Introduction: Breast câncer is one of the most common mahgnant pathology in European countries, as Portugal, where annual inddence is around 90 new cases per 100,000 women. Breast surgery is the usual treatment for this pathology, however such procedure can be complicated by the infection of surgical site. Objectives: To know the prevalence and determtnants of surgtcal wound infection after breast surgery. Methods: We conducted a systematic review by searching of the Web of Sdence electronic database for articles published over the last s1x years 1n developed countries. Over three hundred dtatíons were obtained and after excludtng citations with reasons, fíve artícles met our inclusion criteria and were included in the present review. Results: Prevalence of surgical wound infection varied across studies between 0. 1% and 12. 5%. Bilateral mastectomy is assodated with higher prevalence of wound infectíon than unilateral mastectomy (3. 6% vs 3, 3%), lumpectomy with immediate breast reconstruction (IBR) is related with higher frequency of wound infectíon than surgery with no IBR (0, 5% vs 0, 1%), also, mastectomy with IBR is associated with higher prevalence of wound infectíon than mastectomy wtth no IBR (1, 5% vs 0, 3%) and breast surgery followed by axiltary lymph nade dissectíon is related with higher prevalence of wound infection than surgical procedures wtth no axillary lymph node dissection (2, 82% vs 1, 66%). Conclusions: Nurses that provide post-operatíve care to women after breast surgery should be aware about risk of wound tnfectíon, partícularly after more invasive procedures.

Immigration experience of Latin American working women in Alicante, Spain: an ethnographic study

Objective: to describe the experience of Latin American working women regarding immigration, taking into account the expectations and conditions in which this process takes place. Method: ethnographic qualitative study. Data collection was performed by means of semi-structured interviews with 24 Latin American immigrant women in Spain. The information collected was triangulated through two focal groups. Results: the expectations of migrant women focus on improving family living conditions. Social support is essential for their settling and to perform daily life activities. They declare they have adapted to the settlement country, although they live with stress. They perceive they have greater sexual freedom and power with their partners but keep greater responsibility in childcare, combining that with the role of working woman. Conclusions: migrant women play a key role in the survival of households, they build and create new meanings about being a woman, their understanding of life, their social and couple relationships. Such importance is shaped by their expectations and the conditions in which the migration process takes place, as well as their work integration.