Identifying depressive symptoms in community-dwelling elders has been problematic, due to a lack of resources and training for health clinicians. Previous researchers have indicated that older adults who engage in physical activities can prevent, or mitigate depression, but no model has included this variable in conjunction with factors such as lifestyle or sociodemographic characteristics. In this study, a predictive design was used with a regression analysis. The purpose of this quantitative study was to investigate the relationship between depressive symptoms and the different factors identified in the literature as significant contributors to its prevalence among older community-dwelling adults. Erikson's theory of psychosocial development, Beck's cognitive model of depression, and the learned helplessness model were used as the theoretical foundations to determine whether lifestyle activities, perceived social support, sociodemographic variables, and comorbidities can predict depressive symptoms. The sample consisted of 156 older adults who were 60 years of age and older and living in Northern Louisiana. Pearson correlation analysis and multiple regression analyses were used to investigate whether (a) daily lifestyle activities, (b) community setting (rural or urban), (c) gender, (d) perceived social support, (e) marital status, and (f) comorbidities can predict depressive symptoms. The 2 primary predictors of depression among older adults were low activity levels and low perceived social support. Positive social implications include improving counselors' and mental health practitioners' knowledge of the ways to lessen the depressive symptoms experienced by the elderly population.

Aging may bring mental and/or physical decline. There may come a point when a loved one needs long-term care in a nursing home. The purpose of this phenomenological study was to examine the community dwelling spouses' emotional state. A study was conducted with 10 individuals (5 men and 5 women) who had a spouse in long-term nursing care. Inclusion criteria was to be at least 65-years old, have been married at least 30 years, and reside alone in his or her own home. The social emotional selectivity theory and the construct of boundary ambiguity were applied to view the epoch. Data were collected with audio recorded interviews and coded as to major idea in each response. Five themes evolved from the responses: reduction of friends, ease or difficulty with change, companionship, vows are forever, and why. The community-dwelling spouse tended to be sad, anxious, and angry. Loss of companionship, increased isolation due to reduction of friends prior to placement, concern about the well-being of his or her spouse, and feelings of 'why did this happen to me?' were common themes by the community dwelling spouse. Wives who did all household chores prior to their husband's institutionalization were more able to accept the placement of their spouse than were husbands who had depended on their wives. There is a need for treatment for the community-dwelling spouse by nursing home staff, friends, and family. Nursing homes can encourage support through community-dwelling support groups and mealtime with their institutionalized spouses. Children of community-dwelling spouse can provide support through contacting their parents frequently, clergy, and friends of the church through visiting the community-dwelling spouse after placement of their spouse.

The unprecedented increase in the number of older adults is expected to increase the burden of osteoporosis on the individual and society. Blacks have been understudied in osteoporosis prevention education research. Although the risk of osteoporosis is low in this population, its consequences are significant. This study employs a two-group experimental design (experimental and wait-list control groups) to evaluate the effect of an osteoporosis education on two osteoporosis prevention behaviors (OPBs) – calcium intake (CI) and physical activity (PA), in a group of community-dwelling Black older adults, 50 years and older resident in South Florida. A final sample of 110 (mean age 70.15 years), 90% female and 10% male completed a battery of questionnaires at two assessment periods. The experimental group participated in six weekly education program sessions immediately following baseline assessment, and the wait-list control group received the education following end of program assessment by all participants. The weekly educational sessions were conducted in social settings (church or senior center) employing constructs of the Revised Health Belief Model. The sessions focused on improving CI; osteoporosis knowledge (OKT), self-efficacy (SE), health beliefs (HB) and PA. Findings revealed significantly greater increase in reported CI (M = 556 mg, Wilks’ λ = .47, F(1,108)=122.97, p< .001, η2=.53), OKT (p< .001), and SE (p< .001) among participants in the experimental compared to the wait-list control group. There was no significant difference between the two groups for PA and most of the HB subscales. OKT and SE were the best predictors of CI, while perceived barrier was a predominant factor predicting PA. Over the study period, a change in SE was the only variable related to changes in both OPBs. Attrition rate was lower than expected, which can be attributed to the settings utilized for the study. These findings support the importance of utilizing a familiar social setting. These results suggested the effectiveness of a program offered in multiple short sessions among this underserved minority population to improve OKT and SE resulting in a change in OPBs (increase in CI). However, there is need to explore alternative strategies to improve PA in this population group.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第18201号 / 人健博第18号 / 新制||人健||2(附属図書館) / 31059 / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 二木 淑子, 教授 坪山 直生, 教授 桂 敏樹 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

This thesis includes three manuscripts with an overarching objective to improve understanding of behavioural risk factors for falling in community-dwelling older adults. The first manuscript presented in Chapter two, presents a protocol for a scoping review. The objective of this scoping review was to highlight the current methods used to identify fall-related risk-taking behaviours in community-dwelling older adults, and to identify factors that might contribute to these behaviours. The second manuscript (Chapter three) presents the results of the scoping review written in the format for publication. The review identified older adults are generally aware of their own falls risk and engage in protective behaviours to reduce their risk of falling. Older adults engaged in risk-taking behaviours based on the potential benefits outweighing perceived risk of the behaviours. An individual’s abilities, self-perception, personal values, and the environment likely influence the perception of risk which contributes to risk-taking behaviours. The third manuscript (Chapter four) includes the analysis of clinical data from a community-based multi-component fall prevention program – the Building Balance Program. Individuals who participated in this six-week fall prevention program improved in balance ability, lower extremity muscle strength, mobility, and reduced fear of falling from baseline. Fear of falling (FoF) was the highest amongst the youngest participants despite having better physical function at the outset of the Program. This suggests that in addition to physical function, other factors, like psychological and social factors may be involved with FoF. / Thesis / Master of Health Sciences (MSc) / Falling is very common for older adults. Falling can lead to injuries and long-term side effects like fear of falling. Community-based exercise programs are a cost-effective way to help large groups of older adults reduce their risk of falling. Exercise programs can reduce older adults’ risk of falling by improving their balance and muscle strength. But exercise might not be enough to prevent falling in older adults. Falls can happen for various reasons, such as the activities or behaviours in which the individual participates. This thesis includes two studies presented in three papers aimed to better understand behavioural components which may be associated with falls. The results of this research suggest there is a psychological and social component involved with falling. The findings from this thesis highlight the importance of a holistic approach to and may help to inform the development of comprehensive interventions for fall prevention.

Bakgrund: Upplevelsen av ensamhet kan vara skadlig och kan leda till psykisk ohälsa och fysisk sjukdom. Som sjuksköterska är det viktigt att ha god kunskap om ensamhet och desskonsekvenser för att uppmärksamma äldre personer som är i risk för ohälsa och för attkunna ge adekvat stöd till dessa personer Syfte: Syftet med studien var att beskriva hemmaboende äldres upplevelser av ensamhet. Metod: En litteraturstudie baserad på åtta kvalitativa artiklar genomfördes.Databassökning gjordes i Cinahl, PubMed och PsycINFO. Analysen baserades på Fribergsfemstegsmodell. Resultat: Analysen gav fyra huvudkategorier och elva underkategorier,huvudkategorierna var: ”Orsaker till ensamhet”, ”Känslouttryck relaterade till ensamhet”,”Att hantera ensamhet” och ”Betydelsen av anhöriga och vänner”. Konklusion: Förlust av livskamrat och vänner samt förlust av funktioner är bidragandeorsaker till ensamhet. Hopplöshet, rädsla, obetydlighet och ledsamhet är framträdande vidensamhet. Aktiviteter samt att socialisera med andra kan göra det lättare att hanterasituationen. Ensamhet kan upplevas negativt men även som en frihet för vissa personer.Acceptans är en viktig hanteringsstrategi. Resultatet av denna studie kan bidra med enökad förståelse för ensamhet hos äldre personer som sjuksköterskor och annanvårdpersonal kan ha nytta av. / Background: The experience of loneliness can be harmful and can lead to mental andphysical illness. As a nurse it is important to have good knowledge of loneliness and itsconsequences in order to draw attention to older people who are at risk of illness and to beable to provide adequate support to these people. Aim: The aim of the study was to describe the community-dwelling elderly's experiencesof loneliness. Methods: A literature study based on eight qualitative studies. Database search wasconducted in Cinahl, PubMed and PsycINFO. The analysis was based on Friberg's five-stepmodel. Results: The analysis yielded four main categories and eleven subcategories. The maincategories were: "Causes of loneliness", "Emotional expressions related to loneliness","Managing loneliness" and "The importance of relatives and friends”. Conclusion: Loss of life partner and friends as well as loss of functions are contributingcauses of loneliness. Hopelessness, fear, insignificance and sadness are prominent inloneliness. Activities and socializing with others can make it easier to cope with thesesituations. Loneliness can be a negative experience but can also be seen as a freedom forsome people. Acceptance is an important coping strategy. The results of this study cancontribute to an increased understanding of loneliness in older people that nurses andother health care personnel can benefit from.

Background: Fear of falling has significant adverse physical and psychological effects for the community-dwelling older adult. Objective: The purpose of this study was to assess fear of falling in community-dwelling older adults and explore participant perceptions of fear of falling assessments and interventions. Methods: A mixed methods case study was utilized to gain an in-depth understanding of older adults' perceptions. It consisted of quantitative data collection by objective measures and qualitative data collection by four individual in-depth interviews. A sample of four community-dwelling adults aged 65 years and older and living in Orlando, Florida, completed the study in their home environment. To combine quantitative and qualitative data for each participant, a case-specific analysis was used, resulting in narratives with a storytelling approach aiming to explore each participant independently. This was followed by a cross-case analysis to gain a more comprehensive understanding of the participants in relation to one another. Results: Four themes emerged: 1) Feedback from an objective measure is valuable; 2) Family experiences with fear of falling drive personal interventions; 3) Fundamental assessments for fear of falling are missing, and 4) Fluctuating definitions of "fear" contribute to difficulty in assessments and interventions. Conclusion: Clear perceptual themes developed to provide a comprehensive understanding of community-dwelling older adults' perceptions of fear of falling assessments and interventions. Future research is needed to determine how to best combine feedback-oriented assessments with established interventions, such as exercise. Standardization of a subjective measure for fear of falling to use in combination with objective measures is also needed. Keywords: assessment, intervention, fear of falling, older adults, community-dwelling, mixed methods

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No description available.

Bakgrund: Fall är vanligt förekommande hos äldre personer och har stora konsekvenser för både individen och samhället. Fallförebyggande multifaktoriella interventioner rekommenderas för äldre personer som bor hemma men det saknas stark evidens för vilka kombinationer av fallpreventiva interventioner som är effektiva. För att få en bättre bild av fördelarna med att inkludera andra interventioner tillsammans med träning är det av vikt att undersöka kombinationen av patientutbildning tillsammans med träning hos hemmaboende äldre. Syfte: Att undersöka effekten av patientutbildning i kombination med träning på antalet fall hos hemmaboende äldre samt redovisa innehållet i patientutbildningarna och träningsinterventionerna. Metod: En systematisk litteraturstudie där sökningen genomfördes i PubMed. Åtta RCT-studier valdes ut. Studiernas kvalitet granskades med PEDro-skalan och tillförlitligheten av det sammanvägda resultatet bedömdes utifrån GRADEstud.   Resultat: Åtta studierna inkluderades med totalt 1557 deltagare där den lägsta medelåldern var 71 år. Fem studier sammanvägdes. Alla studier innehöll patientutbildning och träning, dock varierade komponenterna i interventionerna. Kontrollgrupperna innehöll ingen intervention, sedvanlig vård eller icke fallpreventiva interventioner. Jämfört med kontrollgruppen hade interventionsgruppen ingen effekt av patientutbildning i kombination med träning på antalet fall. De fem studier som sammanvägdes hade bra kvalitet (6-8 poäng) enligt PEDro-skalan medan det sammanvägda resultatet hade låg tillförlitlighet enligt GRADEstud. Konklusion: Patientutbildning i kombination med träning visade ingen fallreducerande effekt på hemmaboende äldre och innehållet i interventionerna skilde sig åt i samtliga studier. Fler framtida studier behövs då tillförlitligheten av det sammanvägda resultatet bedömdes vara låg. / Background: Falling is common among older people and has severe consequences for both the individual and the society. Multifactorial interventions are recommended for community-dwelling elderly, although there is a lack of strong evidence for which combinations of fall preventive interventions that are effective. To get a better picture of the benefits of including other interventions together with exercise it is of most importance to investigate the combination of patient education together with exercise for community-dwelling elderly.   Aim: To investigate the effect of patient education in combination with exercise on the number of falls amongst community-dwelling elderly, and to present the content in the patient education and the exercise interventions.  Method: A systematic literature study was carried out in PubMed. Eight RCT-studies were chosen. The quality was assessed using the PEDro-scale and the combined reliability of the studies was assessed using GRADEstud.  Results: Out of the eight studies five of them were combined with a total of 1557 participants and the lowest average age was 71 years. All of the studies contained patient education and exercise, although the components in the interventions varied. The control groups contained; no intervention, usual care or non-fall preventive interventions. No effects of the patient education in combination with exercise was demonstrated on the number of falls in comparison to the control groups. The five studies that were combined had good quality (6-8 points) according to the PEDro-scale while the combined result had low reliability according to GRADEstud.  Conclusion: Patient education in combination with exercise had no fall reducing effect on community-dwelling elderly and the content in the interventions varied in all the studies. More future studies are needed since the reliability in this study was low.