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The aim of the thesis was to investigate factors influencing ICT use by older-adults. A selection of psycho-social, socio-demographic and health determinants were investigated with Internet use. Data were collected through questionnaires (Studies I-III) and interviews (Study IV). Univariate and multivariate analyses were conducted, investigating Internet use as a dichotomous variable, with the aforementioned factors. The results indicated that psycho-social determinants did not affect older-adults’ Internet use (Study I). Scoring higher on the personality traits openness and extraversion did not affect whether the older adults started to use the Internet (Study II). However, well-being increased for some frail older-adults when using the tablet computer and connected to the Internet (Study IV). Some socio-demographic determinants affected Internet use. Being younger in age was a strong contributing factor in all four studies whether the older-adult would use the Internet. Higher education influenced Internet use (Study I & III), correlated with living in a rural or urban setting (Study III); yet education was not influencing whether they would start to use the Internet. Living alone was correlated with Internet use, especially if the older-adult lived in an urban setting (Study III). Functional disability and household economy did not affect Internet use. Finally, the health determinants on Internet use were quite strong. Normal cognitive functioning influenced whether older-adults would start to use the Internet (Study II). The older-adult living in an urban environment, would use the Internet if they had normal cognitive functioning (Study III). It was noted also from Study IV that the learning to use the Tablet PC and Skype took longer for older people and more repetition was needed. Being frail was a strong factor whether the older-adult would use the Internet. They would not want to learn or try to use the technology if they were too ill (Study IV). The findings show only a small increase (7.7%) in Internet use by older-adults over time. The indicators of non-use are: higher in age, lower educated, living alone or rurally, lower cognition and frailty. There are two different profiles of rural and urban Internet users. These determinants along with an understanding of the use of technology, and a good support system, are a few pillars in ICT adoption by older-adults. As ICT continues to develop as a means to provide better health care, it will be important to take into account the abovementioned indicators. In certain cases Internet use is not a given, which continues to exclude older-adults. Part of healthy aging is social participation; therefore being connected and included in the digital society is important. Alternative and not only one design solutions should be explored in health care and by organisations, so as to cater to the heterogeneity of the aging population.

Background: Physical activity (PA) is a health protective behaviour that is critical in the reduction of most major chronic diseases. It also provides the participant with psychological benefits. Despite its well-established health benefits, PA engagement is low in the adult population. Women over the age of 60 are the least physically active segment and thus an important target for behaviour change interventions. Objective: The purpose of this mixed methods feasibility study was to explore the feasibility of six-week Self-Determination Theory (SDT)-based dance and walking programs for older women. Design: This was a parallel, randomized controlled trial with three groups: dance, walking, and wait-list control. This study included the sequential collection of quantitative then qualitative data (sequential explanatory design). Setting: This study was conducted in Victoria, BC. Participants: Participants were community-dwelling, English-speaking women aged 55-70 years who were not meeting PA guidelines. Methods: Data were collected at baseline and two endpoints: post-intervention at six weeks and follow-up at 12 weeks. The primary outcomes were feasibility measures: recruitment, intervention adherence, retention, and satisfaction. Survey data included self-reported PA (Godin Leisure Time Exercise Questionnaire) and measures of behavioural regulations and psychological needs (SDT constructs) using validated tools (Behavioural Regulations in Exercise Questionnaire-2 and Psychological Need Satisfaction in Exercise Scale). Qualitative data were collected in the form of open- and close-ended program evaluation questions and during focus group interviews, both occurring at post-intervention (six weeks). Results: The feasibility measures suggest that it is feasible to recruit and retain participants and that they were generally satisfied with the programs. Thirty-five of 37 randomized participants completed the study (mean age ± SD = 62.8 ± 4.8), representing a 39% recruitment rate and 95% retention rate. Both programs were highly attended. Exploratory effect sizes for the quantitative measures were promising for conducting a larger-scale trial. Emergent themes highlighted the importance of the leadership component of the group-based PA programs. Conclusion: This study had high protocol adherence, promising effect sizes, program evaluation satisfaction, and a recreation centre took on the dance program; these factors provide a foundation for expanding this feasibility trial to a full-scale study. / Graduate / 2017-12-01

Many factors detrimental to healthy aging have been proposed including depression, stress, cognitive decline, and telomere shortening. Of specific interest are the genetic factors that may contribute to these factors and subsequently lead to accelerated telomere shortening and aging, namely the Bcl1, 5-HT, DRD2, and ApoE polymorphisms. We sought to: 1) further clarify the role of depression, stress tolerance, and cognitive decline in aging by examining the effect of associated polymorphisms (Bcl1, 5-HT, DRD2, and ApoE) on telomere length in two samples of older adults and 2) determine the difference in absolute telomere length between the two groups. We examined two samples of older adults: participants in a competitive, athletic event (N=220; mean age=66.8 years) and a sample of community-dwelling older adults (N=208; mean age=69.1 years). Participants completed a questionnaire with demographic information and provided a saliva sample. The Bcl1, 5-HT, DRD2, and ApoE polymorphisms were determined using PCR and Taqman assays. Telomere length was determined using qPCR analysis. The community-dwelling group had significantly shorter telomere lengths than the athletic group (t=-4.82, p< .0001). Additionally, for males in the athletic group, the L/S genotype of the 5-HT polymorphism was associated with longer telomere length. In males in the community-dwelling group, the GC genotype of the Bcl1 polymorphism was associated with shorter telomere length. In females in the athletic group, the GC and GG genotypes of the Bcl1 polymorphism were associated with shorter telomere length with the opposite being true for females in the community-dwelling group: the GC genotype of the Bcl1 polymorphism predicted longer telomere length. Exercising nearly everyday and the length of exercise were associated with telomere length in both groups. Our results indicate that competitive athletic activity in older age is associated with increased telomere length, longer periods of exercise at one time may contribute to longer telomere length, and the Bcl1 and 5-HT polymorphisms are associated with telomere length in older adults.

The orofacial area stands apart from other body systems in that it possesses a unique performance anatomy whereby oral musculature inserts directly into the underlying cutaneous skin, allowing for the generation of complex three-dimensional deformations of the orofacial system. This anatomical substrate provides for the tight temporal synchrony between self-generated cutaneous somatosensation and oromotor control during functional behaviors in this region and provides the necessary feedback needed to learn and maintain skilled orofacial behaviors. The Directions into Velocity of Articulators (DIVA) model highlights the importance of the bidirectional relationship between sensation and production in the orofacial region in children learning speech. This relationship has not been as well-established in the adult orofacial system. The purpose of this observational study was to begin assessing the perception-action relationship in healthy adults and to describe how this relationship may be altered as a function of healthy aging. This study was designed to determine the correspondence between orofacial cutaneous perception using vibrotactile detection thresholds (VDT) and low-level static and dynamic force control tasks in three representative age cohorts. Correlational relationships among measures of somatosensory capacity and low-level skilled orofacial force control were determined for 60 adults (19-84 years). Significant correlational relationships were identified using non-parametric Spearman’s correlations with an alpha at 0.1 between the 5 Hz test probe and several 0.5 N low-level force control assessments in the static and slow ramp-and-hold condition. These findings indicate that as vibrotactile detection thresholds increase (labial sensation decreases), ability to maintain a low-level force endpoint decreases. Group data was analyzed using non-parametric Kruskal-Wallis tests and identified significant differences between the 5 Hz test frequency probe and various 0.5 N skilled force assessments for group variables such as age, pure tone hearing assessments, sex, speech usage and smoking history. Future studies will begin the processing of modeling this complex multivariate relationship in healthy individuals before moving to a disordered population.

A major demographic shift is projected to begin in 2011 due to the retirement of those born between 1946 and 1965, or the post-World War II baby boomer generation. Due to this trend, it is pertinent for Canadian communities to concentrate on creating ‘senior-friendly’ spaces, infrastructure and support services. One such initiative throughout British Columbia is the establishment of 18 designated Senior Community Parks (SCPs) across the province in 2008. This case-study research project, taking place in Oak Bay, British Columbia on the grounds of the Henderson Recreation Centre (HRC), examines park visitation levels, types of utilization and effectiveness of park accessibility, and infrastructure. A mixed methods approach was employed combining seven park observations, sixty-five quantitative questionnaires completed by patrons of the Henderson Recreation Centre, and 16 qualitative interviews with community-dwelling older adults between the ages of sixty-one and eighty and with six staff members of the HRC. Results indicate steady but low park visitation amounts as only 55 total people were seen during observations. Almost all persons were observed walking or jogging and only one person was seen using the equipment within the park. Quantitative data revealed under-utilization of the park and a wide discrepancy between the number persons aware of the SCP (90.8%) and those that visit more than once a month (38.5%). Qualitative interviews uncovered aspects of the park favored by participants (chip trail, park upkeep, exercise opportunities) and those that require improvement (exercise equipment, awareness). Two infrastructural shortcomings were identified; signage and equipment stations. Based on results, the ineffectiveness of the outdoor exercise equipment and awareness of the SCP need to be investigated further. / Graduate

Using a basic interpretive qualitative research design, this study explores adult musicians’ reflections of participation in wind band as a health promoting activity. Five male participants between the ages of 58 and 76 participated in semi-structured interviews and provided basic demographic information. Data were analyzed thematically and findings represented evocatively. Elements of a wind ensemble were used as a metaphor to provide a rich way of presenting the data as fundamentally tied to the specific act of making music in a wind ensemble. The three main components of the metaphor and the main themes they present are: Instrumentation: Defining Roles (Purpose), Sound: Making Meaning (Physical and Emotional Well-being), and Performance: Extending Self (Challenge, Accomplishment and Connection). The current findings contribute to furthering knowledge and research in the area of music making and health, especially wind ensemble playing participation and healthy aging. Implications for both practice and future research are identified.

ABSTRACT Title ”Trying to stay healthy as long as possible and being in motion” Titel ”Försöka hålla sig frisk så länge som möjligt och vara i rörelse” Author Martina Skoglund Institute Institution For Health Science Tutor Konstantin Kougiomtzis Date 2014-06-05 No. of pages 39 Keywords Elder, Health, Healthy aging, Physical activity, SOC Summary Background: Thanks to advances in healthcare recent decades life expectancy have increased steadily. In order not to put pressure on the healthcare service we as a society need to think in terms of salutogenetic and health promotion. Research has shown that physical activity has great effects to healthy aging. Objectives: The purpose of this study was to see what older individuals believe health and physical activity to be, and with the help of questions about SOC interconnect these with healthy aging. Method: To gain knowledge in this area the qualitative method was selected, it provides a deeper understanding. A hand-picked selection was applied and eight individuals were selected for interviews. Result: They define health with good food, exercise, to feel good and having no diseases. Physical activity is moving your body in different ways. They believe circuit training to be a great way to be physically active, with exercises that target the entire body, and your part of a group who can draw strength from each other. Respondents generally have relatively high SOC, high on manageability and meaningfulness and lower comprehensibility. Conclusion: Based on the results and studying of literature the conclusion can be drawn that in order to grow old in a strong and healthy way, physical activity in group are recommended.

The human brain changes in a complex and heterogeneous way throughout life, the normal aging process is associated to significant alterations in the axonal connections. In this study, we evaluated the age-related changes in physical parameters associated with the brain white and gray matter integrity in healthy subjects, as well as the possible correlation between them in specific tracts. Structural images (1 mm isotropic) and diffusion weighted images (2 mm isotropic, b = 1000 s /mm2) of 158 healthy individuals aged between 18 and 83 years were retrospectively collected at the Clinics Hospital of Ribeirao Preto, after their acquisition in a 3T MR scanner. From the structural images, the cortical thickness was estimated and the age effect was evaluated in several regions based on the Atlas of Destrieux. The diffusion-weighted images were processed to characterize the intravoxel diffusion using two models: diffusion tensor (DT) and constrained spherical deconvolution (CSD). Fractional anisotropy (FA) and apparent density of fiber (AFD) maps were estimated and used in statistical group analysis between the three groups separated by age. The most relevant brain tracts were segmented by three procedures: manually, automatically with a specific tool and based on automatic segmented cortical regions. Physical parameters of diffusion (anisotropy and diffusivities) were evaluated in the segmented tracts to determine the age-related changes. The connectome analysis based on two cortical parcellations was performed to evaluate the age effect on characteristic structural brain network parameters. The tract-cortical relationship was evaluated considering the anisotropy of each tract and the thickness of the cortical areas at the end of the corresponding tract. Further analysis was performed to evaluate a possible association of structural and functional connectivity in the corpus callosum (CC). There was significant cortical thinning in 88.5% of the regions during life (p <0.05, corrected for multiple comparisons); the frontal region was the most affected in the initial aging (after 40 years), and the occipital and temporal regions in the elderly (after 60 years). Similarly, the group analysis demonstrated a global pattern of reduction of FA and AFD in the white matter, with a higher rate of degradation of integrity from the sixth decade of life. The manual selection of tracts from the DT model proved to be the most reliable methodology in the precise definition of the tracts for our data. Following this methodology, analysis of anisotropy and diffusion parameters also indicated degeneration of white matter in normal aging in all studied brain tracts and corroborated to the antero-posterior gradient of degeneration in the CC. Fornix was the most affected tract bilaterally, with a 3.5% reduction and an increase of 4% per decade in these parameters, respectively; followed by CC. In the evaluation of the age effect on the connectome estimates, regardless of diffusion model and cortical atlas, there was a decrease in global efficiency, number of connections and local efficiency with aging, mainly in the prefrontal, temporal and parietal and its connections. In the tract-cortical analysis, cortical regions connected by tracts demonstrated similar thinning patterns for the majority of tracts, and a significant relation between mean cortical thinning rate and FA/MD alteration rates were found. In all evaluated tracts, age was the main effect controlling diffusion parameters alterations; there were no direct correlations with cortical thickness for the majority of tracts. Only for the fornix, the values of FA and MD showed significant correlation with the cortical thickness of the subcallosal gyrus in both hemispheres during aging (p <0.05 corrected). For the other tracts, CC, Inferior Longitudinal Fasciculus, Uncinated Fasciculus, Inferior Fronto-occipital Fasciculus, Corticospinal Tract, Cingulum and Arcuate Fasciculus, age was the main effect controlling alterations in the parameters, but there were no direct correlations between FA and MD and cortical thickness during the aging process. / O cérebro humano muda de forma complexa e heterogênea ao longo da vida, o processo de envelhecimento normal tem associado significativas alterações nas conexões axonais. Neste estudo, avaliamos as mudanças relacionadas à idade em parâmetros físicos associados à integridade das substâncias branca e cinzenta cerebral em sujeitos saudáveis, assim como a possivel correlação entre eles em tratos específicos. Imagens estruturais (1 mm isotrópica) e imagens ponderadas em difusão (2 mm isotrópica e b=1000 s/mm2) de 158 indivíduos saudáveis entre 18 a 83 anos foram coletadas retrospectivamente no Hospital das Clinícas de Ribeirão Preto, após sua aquisição em aparelho de ressonância magnética de 3 Teslas. A partir das imagens estruturais, a espessura cortical foi estimada e o efeito de idade nela foi avaliado em diversas regiões tomando com base o atlas de Destrieux. As imagens ponderadas em difusão foram processadas para caracterizar a difusão intravoxel utilizando dois modelos: tensor de difusão (DT) e deconvolução esférica restrita (CSD). Mapas de anisotropia fracionada (FA) e densidade aparente da fibra (AFD) foram estimados e usados em analise estatistica de três grupos separados por faixa etária. Os tratos cerebrais mais relevantes foram segmentados por tres procedimentos: manualmente, automaticamente com uma ferramenta especifica e com base em regiões corticais automaticante segmentadas. Parâmetros físicos de difusão (anisotropia e difusibilide) foram avaliados nos tratos segmentados para determinar as alterações relacionadas à idade. A análise de conectoma baseada em dois parcelamentos corticais foi realizada para avaliar também o efeito da idade em parâmetros caracteristicos da rede estrutural cerebral. A relação trato-cortical foi avaliada considerando a anisotropia de cada trato e as espessuras das áreas corticais nas extremidades do trato correspondente. Uma análise adicional foi realizada para avaliar uma possivel associação de onetividades estrutural e funcional no corpo caloso (CC). Houve afinamento cortical significativo em 88,5% das regiões durante a vida (p <0,05, corrigido); a região frontal foi a mais afetada no envelhecimento inicial (após 40 anos), e as regiões occipital e temporal nos idosos (após 60 anos). Similarmente, a análise de grupo demonstrou um padrão global de redução de FA e AFD na substância branca, com uma maior taxa de degradação de integridade a partir da sexta década de vida. A seleção manual de tratos baseada no modelo de DT mostrou-se a metodologia mais confiavél na precisa definição dos tratos nos nossos dados. Seguindo essa metodologia, a análise dos parâmetros de anistropia e difusão também indicou degeneração de substância branca no envelhecimento normal em todos os tratos cerebrais estudados e corroborou o gradiente ântero-posterior de degeneração no CC. O fornix foi o trato mais afetado bilatreamente com redução de 3.5% e aumento de 4% por década nesses parâmetros, respectivamente; seguido do CC. Na avaliação do efeito da idade nas estimativas do conectoma, independentemente do modelo de difusão e do atlas cortical usado, houve uma diminuição da eficiência global com o envelhececimento, do número de conexões e da eficiência local, principalmente nas regiões pré-frontal, temporal e parietal e suas conexões. Nas análises trato-corticais, as regiões corticais conectadas por tratos mostraram padrões de afinamento similares para a maioria dos tratos, e uma correlação significativa entre a taxa média de afinamento cortical e as taxas de alteração de FA e difusibilidade média (MD) foram encontradas. Em todos os tratos avaliados, a idade foi o principal efeito controlando das alterações dos parâmetros de difusão; não houve correlações diretas com espessura cortical para a maioria dos tratos. Somente para o fornix, os valores de FA e MD mostraram correlação com a espessura cortical do giro subcalosal (parcelamento de Destrieux) em ambos os hemisférios durante o envelhecimento (p <0,05 corrigido). Para os outros tratos, CC, fascículo longitudinal inferior, fascículo uncinado, fascículo occipitofrontal inferior, trato cortico-espinal, parte cingulada do cíngulo e fascículo arqueado, a idade foi o principal efeito no controle das alterações dos parâmetros, mas não houve correlações diretas entre FA e MD e espessura cortical durante o processo de envelhecimento

INTRODUÇÃO: Fatores genéticos estão associados a fenótipos do envelhecimento como a longevidade e algumas doenças relacionadas à idade, mas a identificação dos genes envolvidos no fenótipo complexo do envelhecimento permanece um desafio. Estudos de associação genômica ampla (GWAS), têm apontado o gene da Apolipoproteína E (APOE) como o único associado de maneira consistente à longevidade e alguns fenótipos do envelhecimento. Até o momento, entretanto, a associação do gene APOE com fenótipos alternativos como o envelhecimento saudável (ES), não tem sido demonstrada de maneira consistente. OBJETIVOS: determinar a influência do polimorfismo do APOE na variação de índices prognósticos do envelhecimento (multimorbidade, funcionalidade e acúmulo de déficits) em dez anos. MÉTODOS: estudo longitudinal de coorte retrospectiva de 125 idosos independentes inicialmente para atividades de vida diária (ABVD e AIVD), de um ambulatório assistencial em um hospital escola, em São Paulo. Na avaliação inicial, foram identificados o polimorfismo do gene APOE (alelos E2, E3 e E4), variável preditora primária, e algumas variáveis epigenéticas (clínicas, sociodemográficas e hábitos de vida). No seguimento, avaliações anuais de prontuários foram realizadas para identificar associações com perdas de envelhecimento fisiológico (índice de acúmulo de déficits, DI), ganho de multimorbidade (Cumulative Illness Rating Scale for Geriatrics, CIRS-G e Charlson comorbidity index, CCI) e dependência em ABVD/AIVD, e morte, em dez anos. Curvas de Kaplan-Meier e modelos de regressão de Cox foram utilizados para associações dos fatores genéticos e epigenéticos com piora funcional e morte, e de regressão linear múltipla para associações com os índices CIRS-G, CCI e DI. RESULTADOS: 125 participantes da avaliação inicial, idade média de 74,9 anos, 76,8% mulheres, e 81,6% brancos. A média do CIRS-G foi de 10,24. A distribuição dos alelos: E2 10%, E3 50,8%, e E4 39,2%. A presença de E2 e E4 em relação ao grupo controle E3/E3 não foram preditoras de piora nos índices prognósticos do envelhecimento. Alguns fatores epigenéticos apresentaram associações com desfechos em dez anos. Maior acúmulo de déficits: idade mais elevada p < 0,001; sedentarismo p=0,02; tabagismo p=0,02. Maior dependência em ABVD: idade mais elevada p=0,002; sexo masculino p=0,01; pontuação maior no CIRS-G p=0,02; sedentarismo p=0,02. Maior dependência para AIVD: idade mais elevada p < 0,001; sexo masculinop=0,01; sedentarismo p=0,02. Mortalidade: idade mais elevada p=0,002, pontuações maiores CCI p=0,001. Atividades metabólicas (beta=-4,37; p=0.003) e morar sozinho (beta=-2,28; p=0.005) foram associados com níveis mais baixos de CIRS-G em 10 anos, e etilismo (beta=1,78; p=0.04) com níveis mais altos de CIRS-G. CONCLUSÕES: O polimorfismo do gene APOE não influenciou o prognóstico do envelhecimento. O ganho inesperado de acúmulo de déficits apresentou associação com alguns preditores epigenéticos em idosos ambulatoriais (idade >= 80 anos, sedentarismo e tabagismo). A idade >=80 anos, sexo masculino e sedentarismo, foram associados a perda em dez anos de funcionalidade para ABVD e AIVD. Atividades metabólicas e morar sozinho foram associados a menor multimorbidade em dez anos. Mortalidade em dez anos foi associada a idade >= 80 anos e alta multimorbidade através do CCI / BACKGROUND: While genetic factors are linked to longevity and agerelated diseases, the identification of genes responsible for different aging phenotypes remains unclear. Previous studies, including the genome-wide association studies (GWAS), have indicated that Apolipoprotein E (APOE) gene is associated with longevity and other aging phenotypes. However, little is still known on the association of the APOE gene with healthy aging. OBJECTIVES: To determine the influence of the APOE gene polymorphism on the variation of aging prognostic indices (functionality, multimorbidity, and accumulation of deficits) over 10 years. METHODS: A retrospective cohort study comprising 125 older adults who were independent in activities of daily living (ADL and IADL) at baseline. Participants were evaluated at an ambulatory setting from an academical medical center at the University of Sao Paulo Medical School. Baseline assessment included the identification of the APOE gene polymorphism (alleles E2, E3, and E4), which was the primary predictor, and other epigenetic variables such as sociodemographic factors, multimorbidity, and behavior measures. Annual follow-up evaluations over 10 years were conducted to identify dependencies in ADL and IADL, multimorbidity, and death using the hospital medical charts. A cumulative deficit index was computed using the patients\" multimorbidity and functionality every year. Kaplan-Meier curves and Cox proportional hazard models were used to associate the genetic and epigenetic factors with time to dependence in ADL and IADL and death. Multiple linear regression models examined the association of risk factors with the scores of the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Charlson comorbidity index, and deficit index at 10 years. RESULTS: Participants had a mean age of 74.9 years; 76.8% were female, and 81.6% white. The mean score in CIRS-G was 10.2 points. The distribution of the alleles of APOE was 10% for E2, 50.8% E3, and 39.2% E4. Compared to the allele E3/E3 (control group), the presence of allele E2 did not predict dependence in ADL and IADL. The presence of allele E4 did not predict any outcome. Some epigenetic risk factors were associated with the outcomes over 10 years. For significant increase in deficit index: older age, p < 0,001; sedentarism, p=0,02; tobacco consumption p=0,02 .For dependence in ADL: older age, p=0.002; men p=0,01 ; higher scores in the CIRS-G, p=0.02; sedentarism, p=0.02. For dependence in IADL: older age, p < 0.001; men p=0,01 ; sedentarism, p=0.02 For mortality: older age, p=0,002; higher score in the Charlson comorbidity index, p=0.001. While metabolic activities (beta=-4,37; p=0.003) and living alone (beta=-2,28; p=0.005) were associated with a lower score in the CIRS-G at 10 years of follow-up, alcohol consumption (beta=1,78; p=0.04) was associated with higher scores in this index. CONCLUSIONS: The APOE gene polymorphism did not influence the prognosis of aging. Older age, sedentarism and tobacco consumption were associated with a significant increase in deficit index. Older age, men and sedentarism were predictors of functional loss. Metabolic activities and living alone were associated with a lower score in the CIRS-G at 10 years of follow-up. Older age and multimorbidity at baseline were predictors of mortality