Doctor of Philosophy / School of Family Studies and Human Services / Maurice M. MacDonald / This dissertation consists of three studies exploring the relationship between cognitive abilities, health, and wealth related variables among the elderly. For all three studies, the life cycle hypotheses provided the basis of the theoretical framework and utilized data from the 2000 through 2010 panels of the Health and Retirement Study (HRS). The first study compared the cognitive abilities of non-married households with the cognitive abilities of married households in order to examine the effect of marital status on household wealth. The second study examines the relationship of two aspects of cognitive ability (fluid intelligence and crystallized intelligence) and wealth for couples married to the same spouse for all HRS panels for 2000 to 2010. The third study examines the relationship of cognitive ability, emotional health, physical health, and wealth for couples married to the same spouse for all HRS panels for 2000 to 2010. Results identified significant associations among marital status, cognitive abilities, and health with wealth. These findings contribute to the field of financial planning by providing useful information about how marital status, cognitive functioning, and health affect the household wealth of the elderly. Financial service practitioners, regulators, researchers, and caregivers can apply these findings to develop approaches to assist the elderly manage their household wealth.

As our population ages, the proportion of frail elderly people requiring assisted accommodation in aged care facilities is increasing. This population is at high risk of falls and fractures, which bring significant morbidity and mortality. The prevalence of osteoporosis also increases with age, but there have been few studies of bone density in residents of hostels and nursing homes. This thesis looked at the prevalence of osteoporosis and falls in elderly people in residential care, to define the size of the problem and identify risk factors for low bone density and falling, with particular reference to vitamin D levels. Two thousand and five men and women aged between 65 and 104 years were enrolled in the Falls and Fracture Risk in the Elderly Epidemiology (FREE) study between 1999 and 2003. The key findings from analysis of this population were firstly, that quantitative ultrasound (QUS) measures were higher in men than women independent of age, and that in men there was no significant decline in either BUA or VOS, but in women BUA declined by over 3% per decade and VOS by 1% per decade. Both ultrasound machines used in the study were shown to be reliable, with precision unaffected by advanced age. QUS was found to be sensitive to longitudinal change even in this frail elderly cohort. Vitamin D deficiency was found in the majority of elderly aged care facility residents but supplementation conferred higher serum 25-OH-vitamin D levels. Vitamin D levels were not shown to be related to BUA, VOS or the risk of falling in this population. Serum parathyroid hormone might be important in determining future falls risk. In summary, the results of this thesis give an important insight into the prevalence of osteoporosis and falls in the frail elderly, and how these might be predicted. Future study of prospective fracture rates in this group will then be able to assess relative risk factors for osteoporotic fracture, and identify those individuals who might benefit from directed fracture prevention strategies.

<p>ABSTRACT Introduction: This study is based on Aantonovskys SOC-theory; Sense of Coherence. SOC can be described as a theory which describes how a person experience her existence and the theory is based on three key expressions; comprehensibility, manageability and meaningfulness. Aim: The aim of the study is to examine a group of elderly (>80 years) men and women who live alone to investigate how many percent of the group that estimate a high value of SOC. The study aims to investigate which factors contribute to the fact that a person achieve a high value of SOC and increase the understanding about how these factors concretely can appear in a persons life. Methods: Questionnaire (SOC scale) and Interviews. Results: Out of 59 questionnaires, 10 were answered completely. The 10 answers were represented equally of 50 % women and 50% men. Three persons out of ten (30%) estimated a high SOC (>160p). From the answered questionnaires, the 6 representatives with the highest estimated SOC were chosen for participating in interviews. The chosen people hade an estimated SOC-value between 132 and 177 points. The content from the interviews were analyzed and seven different subcategories were found consisting of common factors that had contributed to a high value of SOC. The subcategories were; relations, childhood, belief, conditions, career, occupation and experiences. Afterwards the subcategories were re-established to the three key-expressions; comprehensibility, manageability and meaningfulness. Conclusions: The number of answered questionnaires in the investigation was unexpected very low and therefore the result is only to be applied as an example of the meaning that the procedure have for the result. However the result from the interviews is to be considered as possible to transmit into the work with elderly in healthcare. The result shows how factors that contribute to good health can be expressed in elderly peoples life. This makes it easier for the nurse to take care of and illuminate these factors and to work from a salutogenetic perspective.</p>

ABSTRACT Introduction: This study is based on Aantonovskys SOC-theory; Sense of Coherence. SOC can be described as a theory which describes how a person experience her existence and the theory is based on three key expressions; comprehensibility, manageability and meaningfulness. Aim: The aim of the study is to examine a group of elderly (&gt;80 years) men and women who live alone to investigate how many percent of the group that estimate a high value of SOC. The study aims to investigate which factors contribute to the fact that a person achieve a high value of SOC and increase the understanding about how these factors concretely can appear in a persons life. Methods: Questionnaire (SOC scale) and Interviews. Results: Out of 59 questionnaires, 10 were answered completely. The 10 answers were represented equally of 50 % women and 50% men. Three persons out of ten (30%) estimated a high SOC (&gt;160p). From the answered questionnaires, the 6 representatives with the highest estimated SOC were chosen for participating in interviews. The chosen people hade an estimated SOC-value between 132 and 177 points. The content from the interviews were analyzed and seven different subcategories were found consisting of common factors that had contributed to a high value of SOC. The subcategories were; relations, childhood, belief, conditions, career, occupation and experiences. Afterwards the subcategories were re-established to the three key-expressions; comprehensibility, manageability and meaningfulness. Conclusions: The number of answered questionnaires in the investigation was unexpected very low and therefore the result is only to be applied as an example of the meaning that the procedure have for the result. However the result from the interviews is to be considered as possible to transmit into the work with elderly in healthcare. The result shows how factors that contribute to good health can be expressed in elderly peoples life. This makes it easier for the nurse to take care of and illuminate these factors and to work from a salutogenetic perspective.

Elderly people comprise the highest proportion of television viewers. Elderly people often struggle with new technology and reject it due to complexity. We propose a system to help people keep up with certain new technologies, such as IPTV and social networks with reduced efforts. We specifically propose a system to integrate IPTV with Twitter, a social networking website with an aid of a mobile phone. The system uses speech to text technology on mobile phone, as input to reduce the difficulty involved in the interaction with Twitter, while viewing television. As speech is a more convenient and natural way of expression than text, we anticipate that people from other age groups can also benefit from the system.

The study of victimization among the elderly crosses multiple disciplines. A large body of research focuses on identifying the nature of and risk factors for elder abuse, while theory has remained relatively underdeveloped in the elder abuse literature. In comparison, the criminological literature is characterized by a plethora of theoretically-driven studies that explore the causes of crime and victimization. Criminology, however, is heavily focused on crimes committed by and against younger individuals. The current study filled a gap in both bodies of work by using the lifestyles/routine activities theoretical (L/RAT) framework, a widely-used criminological perspective, to understand victimization risk among a sample of 1,257 younger and older adults. Using multivariate logistic regression models, it was found that age was a significant predictor of victimization risk. Consistent with findings from the criminological literature, victimization risk generally declines with age. Findings also suggested that the effects of L/RAT variables vary across offense type, as well as across the lifecourse. Implications for theoretical development, policy, and practice are discussed, as well as directions for future research.

The purpose of this thesis was to investigate how spirituality and religion could serve as a protective factor for depressed elderly (65 and older) who are victims of abuse. The review was carried out using scientific articles found through searches of various scientific databases with no limitation date.   Results found no studies which investigated that relationship across developed countries and especially not in the European context. However, the review gave some indications that spirituality might serve as an asset for depressed elderly. In addition the study found that professionals working with abused elderly should encourage them to be involved in spiritual actions and discussions. Studies on what role spirituality can influence and improve coping strategies across abused elderly are urgently needed in order to improve interventions aimed to curb the ever growing problem of elderly abuse.

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As the average age of the population in the United States gets older each year, the problem of depression has been recognized as a chronic problem that affects the quality of life and mental health of many of our nation's elderly. Widowed females, who represent the largest segment of older adults, are particularly at risk for suffering from depression in their elder years. One of the primary difficulties in treating depression in this population is lack of understanding of the factors that contribute to its etiology, in the context of an environment which restricts development of social relationships and limits resources for treatment of depression symptoms. This study examined the reported levels of interpersonal intimacy, depression and the personality characteristics of introversion or extroversion, and examined the relationship between the three factors. Results indicated that, with this study sample (N=99), 23.2% of the sample met cut-off scores indicating depression. Overall, the participants reported being satisfied with their current level of intimacy in relationships; however those who also reported being depressed were less likely to be satisfied. Likewise, those participants who were depressed were more likely to be in the introvert group of personality characteristics. There was no significant relationship established between satisfaction with intimacy and the personality traits. The study showed that the variables examined, including some demographic variables, were correlated, but more work and a larger sample is needed to allow the variables to be used for the purpose of prediction of depression or satisfaction with intimacy in this population.

Research Objectives : Studies indicated that influenza vaccination is a cost-effective clinical prevention for elderly persons. Higher influenza vaccination rate will reduce disease threat and related health care utilizations in a health care system. From 2001, Taiwan provided free influenza vaccine for all of its elderly persons. Nevertheless, the influenza vaccination rate was lower than the expected goal and less than 50%. Therefore, this study aims to evaluate the key factors which affect elderly persons receiving influenza vaccination in Taiwan. Study Design : This is a retrospective study using national representative data from year 2000 to 2004. The vaccination information was linked with outpatient and inpatient records in individual level. The data was also linked with medical institution¡¦s characteristics. We modified Health Belief Model and threat-responsiveness theory to hypothesize previous experiences on vaccination and medical utilization were important factors affecting individual¡¦ s probability of receiving influenza vaccination. Population-based descriptive analysis was conducted to assess the demography characteristics, health status, and health care utilizations. We tested the significance by t-test and Chi-Square test. Moreover, we applied multivariate logistic regression to analyze the associations between controlled factors and the probability of receiving influenza vaccination. Population Studied : People aged 65 years and older were drawn from Taiwan¡¦s national health insurance database from 2000 to 2004. The total sample size is 23,023 elderly persons. Principle Finding: The study results indicated that the most important factor affect elderly persons continue to receive influenza vaccination is whether the person had received influenza vaccination during last flu season or not. Elderly persons who had received influenza vaccination in last flu season were significantly seven times more likely to receive influenza vaccination in this year (OR: 7.66 [95%CI:7.34-8.00]). Other key affecting factors include age, health status, flu-related inpatient and outpatient utilizations in last year, locations of receiving influenza vaccination, and the health care organizations¡¦ levels. Conclusion : This research combines Health Belief Model and threat-responsiveness theory as framework to analyze the national dataset of four year¡¦s elderly influenza vaccination rate change in Taiwan. We found that lagged effects such as vaccination status and flu-related health care use in previous flu season significantly affect the volition of influenza vaccination. Therefore, further research on how to adopt this critical finding and promote higher vaccination rate are in great needs. Implications for Policy, Delivery or Practice: Free coverage and easy access does not guarantee high influenza vaccination rate in Taiwan, even it is under universal health insurance program. This study provides empirical investigations on key factors that might affect the elderly persons¡¦ intention to receive influenza vaccination. Elderly persons¡¦ responses to regular clinical prevention and disease threat were positively associated with probability of having influenza vaccination. By focusing on the major factors and conducting related promotion programs, effective prevention policy can be reinforced. Moreover, this study result could serve as valuable reference for other countries which also has or plans to have free influenza vaccination policy, particularly for those countries also with national health insurance program.