480 resultados para frail elders


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De Ishtar discusses ways in which Whites could develop research epistemologies and methodologies which responded to and reflected those being developed by Indigenous researchers across Australia and around the world. She details her own explorations in developing a methodology which enabled her to work in collaboration with a group of Indigenous women elders from Western Australia's Great Sandy Desert. She stresses that if collaborative research with Indigenous women is to be possible, White feminists must learn how to do research which is culturally unobtrusive, and that means taking responsibility for their own cultural practices, attitudes and values.

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We present optical, near-IR, and radio follow-up of 16 Swift bursts, including our discovery of nine afterglows and a redshift determination for three. These observations, supplemented by data from the literature, provide an afterglow recovery rate of 52% in the optical/near-IR, much higher than in previous missions (BeppoSAX, HETE-2, INTEGRAL, and IPN). The optical/near-IR afterglows of Swift events are on average 1.8 mag fainter at t = 12 hr than those of previous missions. The X-ray afterglows are similarly fainter than those of pre-Swift bursts. In the radio the limiting factor is the VLA threshold, and the detection rate for Swift bursts is similar to that for past missions. The redshift distribution of pre-Swift bursts peaked at z similar to 1, whereas the six Swift bursts with measured redshifts are distributed evenly between 0.7 and 3.2. From these results we conclude that ( 1) the pre-Swift distributions were biased in favor of bright events and low-redshift events, ( 2) the higher sensitivity and accurate positions of Swift result in a better representation of the true burst redshift and brightness distributions ( which are higher and dimmer, respectively), and (3) similar to 10% of the bursts are optically dark, as a result of a high redshift and/or dust extinction. We remark that the apparent lack of low-redshift, low-luminosity Swift bursts and the lower event rate than prelaunch estimates ( 90 vs. 150 per year) are the result of a threshold that is similar to that of BATSE. In view of these inferences, afterglow observers may find it advisable to make significant changes in follow-up strategies of Swift events. The faintness of the afterglows means that large telescopes should be employed as soon as the burst is localized. Sensitive observations in RIz and near-IR bands will be needed to discriminate between a typical z similar to 2 burst with modest extinction and a high-redshift event. Radio observations will be profitable for a small fraction (similar to 10%) of events. Finally, we suggest that a search for bright host galaxies in untriggered BAT localizations may increase the chance of finding nearby low-luminosity GRBs.

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Com esse trabalho, visamos discutir a tentativa de estabelecer um equilíbrio entre o ser humano e natureza na área rural de Judá, pouco antes do reinado de Josias (640-609 a.C.). Nesse caso, pode-se perguntar: seria o mandamento de Deuteronômio 5,12-15 um discurso ecológico? A partir dos estudos de Frank Crüsemann e Haroldo Reimer se admite que partes das leis veterotestamentárias eram destinadas ao assim chamado grupo povo da terra de Judá, visando à manutenção de seu poder. O grupo teria assumido a liderança em Judá mediante um golpe político e, articulando-se, desde então, numa política de aliança para se conservar no poder, mesmo não o assumindo diretamente. Nesse contexto de política de alianças deve-se procurar a implementação do mandamento de Deuteronômio 5,12-15. Ele teria sido escrito por anciãos, um grupo junto ao qual o povo da terra teria se aliado para que ordenassem sentenças jurídicas para a acomodação social. Nesse caso, inicialmente o portão da cidade, espaço oficial para discussões, reclamações e propostas de intermediações, deve ter sido o lugar de elaboração de sentenças jurídicas sobre a utilização de técnicas na agricultura. Sendo elas posteriormente levadas ao tribunal do templo para passar pelas mãos dos sacerdotes, outro braço da coalizão. O uso dos animais de porte, cujo peso prejudicava as pequenas propriedades de terra de Judá, deve ter sido um motivo de incessantes conflitos entre pequenos e grandes proprietários de terra. Ressaltamos assim que apenas os homens mais abastados de Judá tinham acesso a esses animais. Esta solução, segundo se entende, liga o rodízio de culturas ao descanso do campo pertencente ao povo da terra de Judá. Liga-se o termo sábado com a vida da elite rural judaíta do período do reinado de Josias. Uma saída encontrada pelas elites de Judá, a qual nos leva a ponderar uma situação similar que ocorre na América Latina, diante da globalização. Se o texto Deuteronômio 5,12-15 é uma ponderação das elites hegemônicas de Judá que buscam o equilíbrio entre ser o humano e a natureza (ecologia), o discurso ecológico contemporâneo poderá ter neste texto um importante interlocutor. Esse discurso pode ocultar interesses econômicos, completamente diferentes, pois se trata de uma estratégia dominadora e não libertadora, objetivando-se, sobretudo, a reprodução social. O Brasil e os demais países da América Latina vêm sofrendo, há algum tempo, com essa distância entre a elite e o resto da sociedade. Nossas elites utilizam-se, há tempos, do discurso ecológico para se manterem no poder dessas sociedades. Por exemplo, vemos nos noticiários uma quantidade de programas e manchetes ligadas à destruição da natureza. Isso é interessante porque, após terem eles mesmo destruído a natureza, passam agora a defendê-la; controlando as reservas naturais, garantindo sua produtividade e seu status quo no sistema econômico atual.(AU)

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Esse trabalho busca analisar o sistema educacional na tribo Ticuna, localizada na região do Alto Solimões, estado do Amazonas, onde estou há 21 anos em contato permanente com os índios Ticuna. Com o passar dos anos tenho observado que a cada dia, e de forma mais intensa, a manutenção de sua cultura vem sofrendo com o processo de influência da cultura não índia. Nesse trabalho realiza-se um levantamento histórico referente à possível existência de duas correntes educacionais entre os professores Ticuna. Uma considera importante um ensino bilíngue, o estudo dos mitos e costumes para preservação da cultura; a outra acredita que é inócuo estudar os mitos e outros aspectos culturais, que podem ser apreendidos no dia a dia, defendem que os índios precisam de uma educação igual a dos não indígenas, para competir no mercado em condições de igualdade. Inicialmente propõe-se uma busca histórica sobre o processo educacional relacionado à cultura Ticuna fora da escola, procurando verificar as relações entre o que é transmitido pela escola e o que se evidencia no cotidiano Ticuna. Em seguida, realiza-se uma análise de como se processa a educação implantada no meio Ticuna sob o título Educação Indígena . Destacam-se os fatores que influenciaram a fundação da escola, sua localização e aspectos relacionados ao meio físico, econômico, social e cultural, bem como, o ambiente humano e de aprendizagem, dados esses que subsidiam o objetivo proposto para este trabalho. Procura-se verificar se a educação desenvolvida na escola indígena cumpre o papel de estar constantemente buscando alternativas para uma educação que seja apropriada à sobrevivência da cultura Ticuna, uma educação adequada à realidade cultural. A pesquisa baseia-se em levantamento de dados através de documentos, como também em entrevistas com lideranças, professores e idosos da Tribo Ticuna; também na observação direta, com anotações feitas em caderno de campo. O processo de assimilação e influência da cultura não índia predomina na região do Alto Solimões e tem esmagado a cultura Ticuna, fazendo com que muitos já não queiram mais pescar, caçar ou viver como produtores ou coletores. É necessário buscar alternativas educacionais para a escola indígena Ticuna, em uma educação que seja apropriada para a sobrevivência de sua cultura e ao mesmo tempo minimize o preconceito enfrentado por esse povo. As lideranças e professores Ticuna esperam que a escola ajude na preservação e valorização de sua cultura. O prejuízo causado à educação cultural dos índios Ticuna é grande, a maioria dos jovens e crianças não são conhecedores dos significados dos rituais religiosos, mitos, lendas e crenças. Muitas vezes sabem até realizar o ritual, mas parece mais uma imitação de gestos, que se desvincula do seu real sentido. Espera-se que ao final dessa pesquisa sejamos capazes de utilizar o material desenvolvido para reflexão e que ela talvez possa servir como ponto de partida para os professores Ticuna na elaboração de diretrizes e desenvolvimento de um novo paradigma educacional que valorize mais a cultura.

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OBJECTIVE: To explore the association between use of sedative drugs and frailty. DESIGN: Cross-sectional study. SETTING: First wave of The Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of the community-dwelling population aged 50 years or older in Ireland. PARTICIPANTS: Participants were 1642 men and 1804 women aged 65 years or older. MEASUREMENTS: Regular use of sedative drugs determined according to the sedative load (SL) model, frailty phenotype status, and frailty deficit index (FI) score assessed using validated, established protocols. RESULTS: Overall, 19% of the participants took sedative drugs, most frequently hypnotics and antidepressants. Sedative drug use was at 46% for frail, 23% for prefrail, and 9% for nonfrail participants. After adjustment for covariates, SL was positively associated with being prefrail (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.11-1.46) and frail (OR 1.30; 95% CI 1.02-1.64). Advancing age but not sex remained significant (P < .001). After adjustment for covariates, the association between SL and the FI was also significant at P ≤ .001 (β = 1.77; 95% CI 1.13-2.42). CONCLUSION: Higher SL was positively associated with phenotype frailty and the FI. This suggests that careful consideration must be given when prescribing sedatives to frail older adults, who are most vulnerable to adverse drug reactions and adverse health outcomes.

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REVIEW QUESTION / OBJECTIVE : The objective of this review is to identify the effectiveness of the interventions in preventing progression of pre-frailty and frailty in older adults. More specifically, the review questions are: - What is the effectiveness of interventions in preventing or reducing frailty in older adults? - How does effectiveness vary with degree of frailty? - Are there factors that influence the effectiveness of interventions? - What is the economic feasibility of interventions for pre-frailty and frailty? INCLUSION CRITERIA : Types of participants This review will consider studies that include older adults (female and male) aged 65 years and over, explicitly identified as pre-frail or frail by the researchers or associated medical professionals according to a pre-specified scale or index, and who have received health care and support services in any type of setting (primary care, nursing homes, hospitals). This review will exclude studies that: - Include participants who have been selected because they have one specific illness - Consider people with a terminal diagnosis only. - Types of intervention(s)/phenomena of interest: The clinical/medical component of the review will consider studies that evaluate any type of interventions to prevent the progression of pre-frailty and frailty in older adults. These interventions will include, but will not be limited to, physical activity, multifactorial intervention, psychosocial intervention, health and social care provision, and cognitive, nutrition or medication/medical maintenance and adherence focused interventions. The economic component of the review will consider studies that have performed any type of health economic analysis of ...

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To demonstrate the extent of elder malnutrition risk in this country, a meta analysis of 30 studies that used the Nutrition Screening Initiative's "DETERMINE Your Nutritional Health Checklist" was conducted. The studies were divided into three categories: Elder Populations in Healthcare Related Systems (HS), Elder Meal Program Participants (MP), and General Community Residing Elder Population (GC). HS was sub-divided into Hospital Inpatient/Clinic Outpatient and Long Term Care/Home Care. The MP population were identified as Congregate or Home Delivered meal participants. Overall, results indicate that 63% of elders are at moderate (32%) or high (31 %) risk of malnutrition. Home Delivered Meal Participants and Hospital Inpatient/Clinic Outpatients are most likely to be at high risk of malnutrition (49.5% and 49.1%, respectively). Individuals least likely to be at high malnutrition risk are the General Community Residing Elder Population (17.5%) and Congregate Meal Participants (22.5%).

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The frailty syndrome is a geriatric medical condition of vulnerability resulting in the decline of physiological reserves, characterized by high-risk consequences as falls, disability, hospitalization, institutionalization and death. Although the presence of comorbidities is not always accompanied by fragility, this presence could also indicate an increased risk of adverse health events, taking the elderly to a greater likelihood of becoming brittle due to the physical limitations that may occur with emergence of diseases, which are strongly predictive of Fragility Syndrome. This study aimed to assess the prevalence of frailty syndrome in the elderly and associated factors. The specific objectives were to identify the prevalence of frailty syndrome in the elderly and their associations with demographic, economic, health, functional and psychological; identify the reasons for the prevalence of frailty syndrome with the demographic profile, health problems, use of legal drugs and problems with sleep of older people. The study was cross-sectional and composed of 385 elderly aged 65 or more. Multivariate Poisson regression models were used to check conditions associated with fragility and determine the prevalence ratio (α = 0.05). The prevalence of fragility was 8.7% and pre-fragility of 50.4%. Fragile and pre-frail elderly presented, bigger and increasing prevalence ratio for marital status, difficulty in performing instrumental activities of daily living, old age, involuntary loss of stool, depression and negative affect. Elderly people who do not work have a higher prevalence of fragility, as well as those who reported having had a stroke / stroke / ischemia, those who suffered falls in the last 12 months and those with sleep problems. It is considered that the results, together with other available in the literature, can contribute to the understanding of the fragility epidemiology and also in the implementation of specific programs aimed at reducing the prevalence of frailty, optimizing the quality of life. It is suggested that future programs have special attention to the profiles of elderly people who have not yet developed fragility, i.e., pre-fragile. This could prevent the elderly from becoming frail.

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The focus of this study is to draw attention to the intergenerational family’s lifestyles and their various ways of cohabitation, in special to those families which are made by individuals of different generations, these families being constituted of, two or more individuals, or, two or more smaller families, which live under the same roof and have the elderly person as referential in their cohabitation. In those types of families, as for their ways of organization, it is interesting to note that the researches and productions done by inner architects and inner designers do not include this type of family arrangement because their studies do not cover this kind of structuralization nor was this type of organization put together with any of the ways of cohabitation. Therefore there is a theoretical concept void which is propositional, interventional and does not relate to the empirical reality. In observation to these remarks, the research starts a theoretic challenge of deconstruct or reconstruct our modern only habitational template, which is used today in all families configurations which out any regards to where this template will be used, unfitting to the intergenerational families who have elders. This study is then meant to give an differential analysis of the various domestic space’s templates in regards to the new families formats, their basic and special necessities, the home identities of those families which indicates the differential gap in housing and lifestyle from the higher social classes in comparison to the lower social classes. The interdisciplinary method was chosen in order to describe arrangements found in the lifestyles and the ways of cohabitation of the intergenerational families, this method is used for its knowledge base that better articulates the procedure method and the inductive reflexive approach made possible after an qualitative research. In order to accomplish that, an geographical space which tow real possibilities was selected, that is, the space where the people of great social and anthropological proximity are concentrated and the people which are the researcher kinships and friends, in between those are the habitants of Capim Macio’s, Candelária’s, Tirol’s and Petrópolis’s, neighborhoods, located in the south west zone of her home city Natal. It has been noticed that, meanwhile these intergenerational spaces do not claim their said spaces, because of their habits, necessities and relations in between generations and gender, their arrangements of said space are extremely creative. That means that alterations in the concepts of planning, construction and utilization of built spaces are imperative.

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The focus of this study is to draw attention to the intergenerational family’s lifestyles and their various ways of cohabitation, in special to those families which are made by individuals of different generations, these families being constituted of, two or more individuals, or, two or more smaller families, which live under the same roof and have the elderly person as referential in their cohabitation. In those types of families, as for their ways of organization, it is interesting to note that the researches and productions done by inner architects and inner designers do not include this type of family arrangement because their studies do not cover this kind of structuralization nor was this type of organization put together with any of the ways of cohabitation. Therefore there is a theoretical concept void which is propositional, interventional and does not relate to the empirical reality. In observation to these remarks, the research starts a theoretic challenge of deconstruct or reconstruct our modern only habitational template, which is used today in all families configurations which out any regards to where this template will be used, unfitting to the intergenerational families who have elders. This study is then meant to give an differential analysis of the various domestic space’s templates in regards to the new families formats, their basic and special necessities, the home identities of those families which indicates the differential gap in housing and lifestyle from the higher social classes in comparison to the lower social classes. The interdisciplinary method was chosen in order to describe arrangements found in the lifestyles and the ways of cohabitation of the intergenerational families, this method is used for its knowledge base that better articulates the procedure method and the inductive reflexive approach made possible after an qualitative research. In order to accomplish that, an geographical space which tow real possibilities was selected, that is, the space where the people of great social and anthropological proximity are concentrated and the people which are the researcher kinships and friends, in between those are the habitants of Capim Macio’s, Candelária’s, Tirol’s and Petrópolis’s, neighborhoods, located in the south west zone of her home city Natal. It has been noticed that, meanwhile these intergenerational spaces do not claim their said spaces, because of their habits, necessities and relations in between generations and gender, their arrangements of said space are extremely creative. That means that alterations in the concepts of planning, construction and utilization of built spaces are imperative.

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Teaching Portuguese language in Brazilian public schools is still limited mostly to studying decontextualized text fragments, memorizing classifications and cult of grammar rules. Considering the language as a social, cultural practice which emerges from the intersubjective interaction, we sought to propose an educational intervention that prioritizes the retextualization processes from speech to the writing of memoirs as a textual genre, so as to contribute for improving learner’s discursive performances. Therefore, paying attention to these concerns and in attempt to contribute for improving the teaching of Portuguese language in elementary school, we chose as privileged locus a 9th grade class from a state school in Bento Fernandes, RN. The corpus is formed by texts produced and retextualized by students from the elders’ oral reports within local community. We sought thus to understand what memory is, its importance for registering local spoken language and culture, as much as to carry out didactic actions that favor students’ learning in the activities of textual production. In light of the theoretical overviews about linguistic-discursive relations, based on Marcuschi’s (1993, 1997, 2001, 2002, 2006, 2008, 2010) conception of oralitiy-writing continuum and the debates proposed by Antunes (2003, 2014), Alves Filho (2011), Koch (2012) and Bakhtin (1992, 2011), we aimed to understand, by analyzing the retextualized memoirs, how these practices complement each other within the process of orality and writing. As for the proposal of didactic sequences, the study has been oriented by Dolz and Scheneuely (2004); as for the memoirs, by the guidelines of Coracine and Ghiraldelo (2011) and Le Goff (2010, 2013). In this way, this work followed the action-research methodology in a qualitative approach, considering the teacher (researcher) as an active agent involved in the process of knowledge production in his own educational practice, so as to interfere in the mediation, knowledge production and its dissemination in classroom context, which is the privileged locus for constructing and transforming process. There is much to be research within the area of retextualization. Yet we verified that this educational intervention, based on discursive operators of retextualization, has been proven viable as an efficient path so that we teachers can work the peculiarities of usages and functions of textual genres in oral and written modalities of a language, without grasping both as a dichotomy. This accredited us to strengthen a discourse that undoes many myths still present in that order, especially the one that causes more damage for the learners of Portuguese language – that writing is a representation of speech.

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Funding: This study was conducted as part of the TRiaDS programme of implementation research which is funded by NHS Education for Scotland (NES). The Health Services Research Unit which is funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates supported the study. The funder had no influence over the design, conduct, analysis and write up of the study.

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The VUE study is funded by the National Institute for Health Research Health Technology Assessment programme (project number 11/129/183).

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The restructuring of English social care services in the last three decades, as services are provided through a shifting collage of state, for-profit and non-profit organisations, exemplifies many of the themes of governance (Bevir, 2013). As well as institutional changes, there have been a new set of elite narratives about citizen behaviours and contributions, undergirded by modernist social science insights into the wellbeing benefits of ‘self-management’ (Mol, 2008). In this article, we particularly focus on the ways in which a narrative of personalisation has been deployed in older people’s social care services. Personalisation is based on an espoused aspiration of empowerment and autonomy through universal implementation to all users of social care (encapsulated in the Making it Real campaign [Think Local, Act Personal (TLAP), no date)], which leaves unproblematised the ever increasing residualisation of older adult social care and the abjection of the frail (Higgs and Gilleard, 2015). In this narrative of universal personalisation, older people are paradoxically positioned as ‘the unexceptional exception’; ‘unexceptional’ in the sense that, as the majority user group, they are rhetorically included in this promised transformation of adult social care; but ‘the exception’ in the sense that frail older adults are persistently placed beyond its reach. It is this paradoxical positioning of older adult social care users as the unexceptional exception and its ideological function that we seek to explain in this article.

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The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this "fat and frail" population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient's nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.