ERA

Chronicity

The mission of the Chronicity Areas of Excellence (AoE) is to advance and disseminate knowledge and to influence public policy related to living well with chronic health concerns.
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  1. Orchestrating Care: Nursing practice with hospitalized older adults [Download]

    Title: Orchestrating Care: Nursing practice with hospitalized older adults
    Creator: DAHLKE, S
    Description: Background: The increased incidence of health challenges with aging means that nurses are increasingly caring for older adults, often in hospital settings. Research about the complexity of nursing practice with this population remains limited. Objective: To seek an explanation of nursing practice with hospitalized older adults. Methods: Design. A grounded theory study guided by symbolic interactionism was used to explore nursing practice with hospitalized older adults from a nursing perspective. Glaserian grounded theory methods were used to develop a mid-range theory after analysis of 375 hours of participant observation, 35 interviews with 24 participants, and review of selected documents. Results: The theory of Orchestrating Care was developed to explain how nurses are continuously trying to manage their work environments by understanding the status of the patients on their unit, mobilizing the assistance of others, and stretching available resources to resolve their problem of providing their older patients with what they perceived as “good care” while sustaining themselves as “good” nurses. They described their practice environments as hard and under-resourced. Orchestrating care is comprised of two subprocesses - building synergy and minimizing strain. These two processes both facilitated and constrained each other and nurses’ abilities to orchestrate care. Conclusions: Although system issues presented serious constraints to nursing practice, the ways in which nurses were making meaning of their work environment both aided them in managing their challenges and served to constrain their agency.
    Subjects: OLDER PEOPLE, HOSPITAL, NURSING
    Date Created: 2017
  2. Simultaneous temporal trends in dementia incidence and prevalence, 2005–2013: A population-based retrospective cohort study in Saskatchewan, Canada [Download]

    Title: Simultaneous temporal trends in dementia incidence and prevalence, 2005–2013: A population-based retrospective cohort study in Saskatchewan, Canada
    Creator: Kosteniuk, J. G.
    Description: Background: Original studies published over the last decade regarding time trends in dementia report mixed results. The aims of the present study were to use linked administrative health data for the province of Saskatchewan for the period 2005/2006 to 2012/2013 to: (1) examine simultaneous temporal trends in annual age- and sex-specific dementia incidence and prevalence among individuals aged 45 and older, and (2) stratify the changes in incidence over time by database of identification. Methods: Using a population-based retrospective cohort study design, data were extracted from seven provincial administrative health databases linked by a unique anonymized identification number. Individuals 45 years and older at first identification of dementia between April 1, 2005 and March 31, 2013 were included, based on case definition criteria met within any one of four administrative health databases (hospital, physician, prescription drug, and long-term care). Results: Between 2005/2006 and 2012/2013, the 12-month age-standardized incidence rate of dementia declined significantly by 11.07% and the 12-month age-standardized prevalence increased significantly by 30.54%. The number of incident cases decreased from 3,389 to 3,270 and the number of prevalent cases increased from 8,795 to 13,012. Incidence rate reductions were observed in every database of identification. Conclusions: We observed a simultaneous trend of decreasing incidence and increasing prevalence of dementia over a relatively short 8-year time period from 2005/2006 to 2012/2013. These trends indicate that the average survival time of dementia is lengthening. Continued observation of these time trends is warranted given the short study period.
    Subjects: Dementia, Diagnosis, Epidemiology, Physician, Hospital, Long-Term Care, Prescription Drug, Administrative Data
    Date Created: 2015/11/25
  3. Re-examining the boundaries of the normal in aging. [Download]

    Title: Re-examining the boundaries of the normal in aging.
    Creator: O’Rourke, Hannah
    Description: Textbooks and policy documents tend to present the boundary between normal and abnormal ageing as natural and clearly demarcated. In this study, we trouble the notion of natural and clearly demarcated boundaries between normal and abnormal ageing by considering how these boundaries have been established and maintained in present-day Western contexts. We draw on both Canguilhem’s discussion of the normal and the abnormal and Foucault’s emphasis on the role of the sociohistorical context in the social practice of boundary generation. In doing so, we critically examine common conceptualizations of normal and abnormal ageing, including those found in antiageing science, successful ageing and healthy ageing policy discourses and in health education textbooks. We argue that the growing emphasis on ‘healthy’ ageing both reflects and shapes the societal views of those individuals who are not able to remain disease-free and represents a kind of mystification of ageing where ageing without functional or cognitive decline is instituted as the norm. Awareness of the role that the social context plays in shaping definitions of normal and abnormal ageing encourages critical consideration of the effects that Western conceptualizations of normal ageing may have for older adults who continue to age with cognitive or functional decline.
    Subjects: ageism, norms, ageing, successful ageing, healthy ageing, normal
  4. Patient education in the contemporary management of coronary heart disease (Protocol) [Download]

    Title: Patient education in the contemporary management of coronary heart disease (Protocol)
    Creator: Brown J
    Subjects: Economics, Coronary heart disease, Rehabilitation
  5. Women with heart failure are at high psychosocial risk: a Systematic review of how sex and gender influence heart failure self-care [Download]

    Title: Women with heart failure are at high psychosocial risk: a Systematic review of how sex and gender influence heart failure self-care
    Creator: Thomas JR
    Subjects: Women, Sex Factors, Heart Failure, Self Care
    Date Created: 2011
  6. Mortality due to cervical Cancer, 1996-2011, Santa Catarina, Brazil [Download]

    Title: Mortality due to cervical Cancer, 1996-2011, Santa Catarina, Brazil
    Creator: Hegadoren, Kathleen M.
    Description: Population-based quantitative study. This study's objectives were to examine the influence of regions, age, and time on cervical cancer mortality. We analyzed cervical cancer mortality rates in the State of Santa Catarina, Brazil between 1996 and 2011. Data were obtained from the Mortality Information System from the Brazilian Ministry of Health in 2013. Data were analyzed based on descriptive epidemiology. Cervical cancer mortality rates ranged from 3.6 to 5.0/100,000 women. Rates were higher among older women, with the highest rates after the age of 70. Women's awareness regarding the importance of the Pap smear test in their health checkups may differ across ages and regions of residence. The frequency of Pap smears should change due to the trend of mortality rates observed over time.
    Subjects: Uterine cervical neoplasms, Cause of death, Neoplasms
    Date Created: 2014
  7. Reliability and validity of the attitudes to ageing questionnaire for Canadian and Norwegian older adults. [Download]

    Title: Reliability and validity of the attitudes to ageing questionnaire for Canadian and Norwegian older adults.
    Creator: Kalfoss, M.
    Description: The aim of this study was to examine the reliability and validity of the Attitudes to Ageing Questionnaire (AAQ), a new scale designed for cross-cultural comparisons of older adults. There are currently very few measures intended to measure the attitudes of older adults to their own ageing. The instrument was designed as part of a larger study to develop a measure of quality of life (QOL) of older adults and to assess factors related to QOL; it was hypothesized that attitudes to ageing would be related to QOL. Canadian (n = 202) and Norwegian (n = 490) data were used. In both study samples, a series of correlation analyses indicated that item scores correlated most strongly with their parent subscales (r=0.42–0.79; p < 0.01). Acceptable internal consistency was shown (Cronbach’s alpha of 0.70 or greater for all subscales). In a confirmatory factor analyses (CFA), all 24 items in the AAQ were retained (p < 0.001); the observed lack of goodness of fit and residual covariance patterns provided empirical support, in part, for the construct validity of the AAQ. Patterns of correlations of the AAQ subscales with WHOQOL-OLD facets, WHOQOL-BREF domains, a global QoL item and GDS scores provided evidence of convergent and divergent validity. Nonsignificant correlations were found between psychological growth and two facets of the WHOQOL-OLD in the Canadian sample. Subscale scores also significantly discriminated between healthy and unhealthy groups. Further validation of the scale among older people, across countries, is recommended.
    Subjects: validity, reliability, attitudes to ageing questionnaire, ageing, measurement
    Date Created: 2010
  8. Treating tobacco addiction as a chronic medical condition. [Download]

    Title: Treating tobacco addiction as a chronic medical condition.
    Creator: Els, C.
    Description: Tobacco consumption remains the leading preventable cause of death, disease and disability. Nicotine is the chemical compound sustaining tobacco addiction, a lethal chronic disease, and the major cause of other prevalent chronic diseases. The downward trend of prevalence rates in Canada appears to have levelled with smoking rates hovering at 18%. Of those individuals who currently smoke, 70% would like to stop and half will try to quit at least once this year. But unless provided with evidence-based and multimodal treatment, only 3-5% of individuals who try will be abstinent six months later. International standards recommend treatment that includes offering combinations of counselling and pharmacotherapy for every individual wanting to quit. But unlike other chronic diseases, most individuals with tobacco addiction are often precluded from treatment because prevailing ideologies frame their disease as a “lifestyle choice”. This profound misinterpretation of a chronic disease poses a significant barrier to effective tobacco control and a major contributor to unsustainable growth in excess health spending across Canada. Our existing tobacco control paradigm will likely not yield the desired health outcomes and costs savings until policy and clinical practice are aligned with scientific evidence. Furthermore, an urgent need is identified to incorporate an increased level of vigilance for depression and other neuropsychiatric issues has been identified. This manuscript outlines the health professional’s legal duty to treat and introduces a single algorithmic approach to achieve such. This integrated and unified approach is aimed at defragmenting current approaches by crossing disciplines and levels of care. This guide for safe and effective treatment delivery may be particularly appropriate to resource- scarce settings.
    Subjects: smoking cessation, mental health, tobacco addiction
    Date Created: 2010
  9. Nursing educators: The view from here. [Download]

    Title: Nursing educators: The view from here.
    Creator: Bowen, D.
    Subjects: community-university relations, nursing faculty, nursing education
    Date Created: 2010
  10. The Background and tenets of critical realism [Download]

    Title: The Background and tenets of critical realism
    Creator: Clark AM
    Subjects: Critical realism
    Date Created: 2009