Browsing by Author "Ferreira, Monica"

Now showing 1 - 7 of 7
  • Thumbnail Image
    Item
    Open Access
    Geriatric Medicine in South Africa - a Cinderella subspecialty?
    (2007) Ferreira, Monica
    Population ageing is a worldwide phenomenon and follows a decline in birth and death rates. Longevity and a greater number of people living to an advanced age are a major achievement for humankind. However, a consequence of the demographic shift is an escalating demand for health care as a result of increases in chronic and age-specific diseases and disabilities. The transition is more rapid in developing countries, which also have fewer resources than the developed countries to meet the challenges of an ageing population.
  • Thumbnail Image
    Item
    Open Access
    Language and dementia in bilingual settings : evidence from two case studies
    (2004) Beckett, Tracy; Young, Douglas; Ferreira, Monica; Makoni, Sinfree
    This study used qualitative methodology for an analysis of the conversations of two communication-impaired bilingual elders diagnosed with a mild/moderate stage of Alzheimers's disease (AD). The aim of the study was to investigate the linguistic consequences of cognitive decline on language in English-Afrikaans co-ordinate bilinguals with AD by monitoring the changes in these linguistic outcomes after three months, and to see whether the two languaes are affected by AD in a comparable way. The impact of conversational disorders on clinicians and caregivers needs to be investigated to determine the full impact of a communication disorder such as AD from the perspective of the impaired speaker and the conversational partner, to functionally improve communication, self-esteem and psychosocial well-being. The results are based on observations and audio recordings of conversations with two participants. The results are presented broadly to demonstrate the participants' typical linguistic behaviour and reveal linguistic behaviour as a continuum that includes elements of both languages. Wide use of L1q in conversation domains that were allocated to the L2 was noted. The results show that the severity of AD and language proficiency are major contributing factors for language mixing. As the disease progressed, the conversational partner carried the cognitive responsibility for upholding/maintaining the conversation. Emerging from the study is an enhanced awareness of the need to combine studies in bilingualism with studies in ageing, since research of this nature is still in its infancy in applied language studies and applied linguistics in Africa.
  • Thumbnail Image
    Item
    Open Access
    Management of older patients presenting after a fall - an accident and emergency department audit
    (2006) Kalula, Sebastiana Zimba; De Villiers,Linda; Ross, Kathleen; Ferreira, Monica
    Background. It is common for older patients to present to accident and emergency (AE) departments after a fall. Management should include assessment and treatment of the injuries and assessment and correction of underlying risk factors in order to prevent recurrent falls. Objectives. To determine management of older patients presenting after a fall to the AE department of Groote Schuur Hospital in Cape Town, South Africa. Method. Hospital records were reviewed for a random sample of 100 patients aged 65 years and older presenting to the AE department after a fall, between December 2001 and May 2002. Results. The mean age of the sample was 78.6 years (range 65 - 98 years); 72% of subjects were female. History of a previous fall, and history of drug or alcohol intake, were recorded in less than 20% of cases. Blood pressure and pulse rate were recorded in approximately 90% of cases, and pulse rhythm and postural blood pressure in 2%. Examination of the musculoskeletal system was done in 86% of cases and that of other systems in less than 50%; cognitive assessment was conducted in less than 30%. Radiological investigations were performed in 89% of cases, glucose and haemoglobin in 32%, renal profile and electrocardiogram in 5%, and urinalysis in 4%. Three-quarters of the patients were referred for further management: 52% to orthopaedic surgery, 12% to other surgical subspecialties, 6% to the general medical department, and 6% to other hospitals and clinics. No referrals were made to geriatric medicine, physiotherapy or occupational therapy Conclusions. In managing elderly patients after a fall, the AE department focused on injuries sustained. Little effort was made to establish and manage risk factors, hence to prevent recurrent falls. Guidelines are needed for the management of such patients in AE departments.
  • Thumbnail Image
    Item
    Open Access
    A preliminary study of a correlation between scores on a 6-item cognitive impairment test and a modified Bristol Activities of Daily Living Scale obtained from older women in Khayelitsha
    (2001) Brodrick, Kathleen; Ferreira, Monica; Watson, Ruth
    The absence of culturally appropriate assessment tools for the measurement of cognition and activities of daily living in an older black African population living in South Africa was the reason for embarking on the study. The purpose of the study was to develop culturally appropriate screening tools for dementia in a South African, Xhosa speaking urban black population. The aim of the study was to determine a correlation between the scores on a six item cognitive test ( 6CIT) (Brooke and Bullock 1999), and a modified Bristol Activities of Daily Living Scale (BADL) (Bucks, Ashworth, Wilcock and Siegfried 1996), in order to assess the usefulness of the cognitive test as a screening tool for dementia in black older women. A random sample of women (N=92) was drawn in an urban area (Khayelitsha) near to Cape Town, South Africa. Data were gathered with the use of three instruments. Background information was obtained from the subjects. The 6CIT was administered to the subjects. The BADL, an informant-based scale, was administered to the primary carers. The instruments were modified for local use and translated into Xhosa, the home language of the majority of residents in Khayelitsha. The results of the study showed a correlation between the scores on the two measurement instruments (r =.49745) at a 95% confidence interval. The instruments were found to be culturally appropriate for the black African older population. However, low education was a confounding factor for the cognitive test and cut-off scores, used in previous studies to detect the possible presence of early dementia, were found to be too low for this population. The modified BADL scale showed that none of the subjects were fully dependent on their carers for the performance of activities of daily living. Recommendations are that the instruments, 6CIT and modified BADL, which have been shown to be easily administered by community health workers be further validated and translated into other black South African languages. Easy to administer screening tools for dementia should be developed for detection of the disease in the population so that provision is made by health authorities and occupational therapists for treatment plans to minimise the detrimental effects of the disease on the individuals, their families and communities.
  • Thumbnail Image
    Item
    Open Access
    Risk factors for falls in older adults in a South African Urban Community
    (BioMed Central, 2016-02-24) Kalula, Sebastiana Zimba; Ferreira, Monica; Swingler, George H; Badri, Motasim
    Background: Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries. Methods: A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors. Results: Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls. Conclusion: Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting.
  • Thumbnail Image
    Item
    Open Access
  • Thumbnail Image
    Item
    Open Access
    Stroke outcomes in a socio-economically disadvantaged urban community
    (2011) De Villiers, Linda; Badri, Motasim; Ferreira, Monica; Bryer, Alan
    AIMS: To determine survival, disability and functional outcomes of stroke patients following their discharge from an acute stroke unit in an urban community with limited rehabilitative resources. METHODS: Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded. RESULTS: The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months. CONCLUSION: Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes.