RESUMEN
Risk is a multifaceted and complex concept that mediates quality of life through the balance between risk taking and risk avoidance. Society expects older adults to identify and manage their personal risks yet little is known about the meaning of risk in their daily lives and how they balance the tensions between taking and avoiding risks. Therefore the purpose of this study was to explore how older adults construe risk. A qualitative exploratory study that incorporated photovoice methodology was used. Seventeen older adults, over a weeklong period, took pictures and kept a log of the places, spaces, events, activities, or situations that best represented risk. Subsequently, they participated in a follow-up individual interview. Older adults viewed risk both positively and negatively, judging the saliency of a risk according to criteria that related both to the risk itself and to personal characteristics. Although risk was avoided in specific situations, risk taking was participants' primary approach to risk, which assumed three forms: adaptive, opportunistic, and/or unjustifiable. Contrary to societal views, older adults view risk as constructive and personally relevant, and as something to be taken and need to be supported in risk taking rather than risk avoidance.
Asunto(s)
Envejecimiento/psicología , Formación de Concepto , Reducción del Daño , Fotograbar , Asunción de Riesgos , Accidentes por Caídas/prevención & control , Adaptación Psicológica , Anciano , Actitud Frente a la Salud , Características Culturales , Negación en Psicología , Emociones , Femenino , Estado de Salud , Humanos , Individualidad , Masculino , Características de la Residencia , Medio Social , Responsabilidad Social , Valores SocialesRESUMEN
BACKGROUND: Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. OBJECTIVE: This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long-term care (LTC) facilities. METHODS: We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health-related services. RESULTS: The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. CONCLUSIONS: Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector.
Asunto(s)
Cuidado Dental para Ancianos/economía , Anciano Frágil , Hogares para Ancianos/economía , Cuidados a Largo Plazo/economía , Anciano , Cuidado Dental para Ancianos/organización & administración , Organización de la Financiación , Hogares para Ancianos/organización & administración , Humanos , Cuidados a Largo Plazo/organización & administración , Evaluación de Necesidades , Recursos HumanosRESUMEN
PURPOSE: The aim of this study is to determine if more males than females are admitted to adult intensive care units (ICUs). MATERIALS AND METHODS: In 9 tertiary and community hospitals in British Columbia, Canada, we expressed the number of patients admitted to hospital and to ICU from 1998 to 2008 as a proportion of the population of the main regions served by these hospitals, and for ICU patients in 1 tertiary hospital, as a proportion of the hospital population. Patients not residing in the region of this tertiary hospital or whose addresses were unknown and admissions for sex-specific diagnoses were excluded from the main analyses. Male proportion was divided by female proportion for age groups by decade. Multivariate regression was used to determine the association between sex and admission to ICU after adjustment for confounders. RESULTS: Normalized male-to-female ratio of ICU admissions to the 9 hospitals was greater than 1. In the tertiary hospital analyzed in more detail, the male-to-female ratio for admissions to hospital or to ICU, normalized to the population in the community or hospital, respectively, was greater than 1 for all age groups, and this ratio increased with age. After adjustment for covariates, males and females less than 80 years of age were roughly equally likely to be admitted to ICU from hospital, but in patients aged 80 or older, men were much more likely than women to be admitted (odds ratio, 2.14; 95% confidence interval, 1.56-2.94). CONCLUSION: More men than women are admitted to ICUs; this difference is especially prominent in elderly patients.