Class of 2015 Abstract / Objectives: The specific aim of the study was to examine the effects of a 30-minute educational intervention, developed and delivered by student pharmacists, on knowledge of hypertension and its management among community-dwelling older adults and their caregivers. The study also aimed to examine the helpfulness of the program and readiness of the participants to adopt healthier lifestyle practices afterward. Methods: This was a pre- and post-interventional study. At senior centers around the Phoenix metropolitan area, community-dwelling older adults (ages 60 or older) and family members or caregivers (ages 18 or older) were recruited to participate. Participants completed knowledge-based questionnaires prior to and after the educational program. The mean number of correct responses was calculated for pre- and post-program questionnaires, then compared using paired t-test. Results: A total of 77 individuals participated in the program with mean age of 72 and 67% female. The mean number of correct responses calculated for survey before the educational program was 3.03 and 5.46 for survey after the program, which was significantly different (p <0.01). 85% of participants reported the program to be helpful, and 84% participants were willing to adopt healthier lifestyle after attending the program. Conclusions: An intervention tailored to community-dwelling older adults, developed and delivered by student pharmacists, was found to improve awareness of hypertension and generated willingness to adopt healthier lifestyle among the participants.

Class of 2014 Abstract / Specific Aims: To assess older adults’ knowledge of medications associated with an increased risk of falls and to evaluate the impact of pharmacist counseling on knowledge of medication-related fall risk. Subjects: Community-dwelling adults 60 and older. Methods: Data were collected using an online questionnaire consisting of 15 knowledge-based items to determine awareness of medication-related fall risk, four items to determine pharmacist counseling experience, fall history, and number of medications taken, and two items to collect demographic information (age and gender). Main Results: Two hundred and six community-dwelling older adults (mean age = 69.07 years, SD = 5.59) participated in the study by completing all or part of the questionnaire. The number of older adults who reported having fallen within the last five years was 90 (43.7%). The knowledge-based portion of the questionnaire was completed in its entirety by 162 older adults (80 males, 81 females, one unreported gender; mean age = 68.7 years, SD = 5.12). One hundred and nineteen of 162 (73.5%) questionnaire respondents scored below 70% on the knowledge assessment (mean score 49.3%, SD = 26.8). The 12 respondents (7.6%) who reported having received counseling from a pharmacist regarding medication-related fall risk scored significantly higher on the knowledge assessment compared to the 145 respondents who did not (mean score 61.66% versus 48.09%, p = 0.01). Conclusion: A majority of community-dwelling older adults lacked knowledge of medications associated with an increased risk of falling. However, those who had been counseled by a pharmacist demonstrated greater awareness of medication-related fall risk. Thus, pharmacist counseling of older adults regarding medications and fall risk should be promoted.

Background and Rationale: Falls are among the most common problems faced by elderly persons. While the physical risk factors for falls are well established, the psychosocial aspects have been largely neglected. Moreover, studies exploring the responses to falls from the individuals’ perspectives in an immigrant population are virtually non-existent. The older Chinese immigrant population is substantial and growing in the Greater Toronto Area. The cultural and immigrant-related factors that influence their responses to and recovery after a fall are important considerations as health and social care professionals develop falls prevention strategies, and provide services and care. This dissertation explored the nature of immediate and subsequent responses of community-dwelling older Chinese immigrants after falling. Method: Focussed Ethnography, as guided by elements from Critical Social Theory, was used as the research methodology. Eighteen informants over 70 years of age, living in the community who had experienced a recent fall were interviewed using a semi-structured guide developed after a detailed literature review. Thematic analysis of transcribed interviews was conducted. Results: Four major themes related to responses to falling were drawn forth from the interview data: 1) Help-seeking decisions immediately after the fall, 2) Psychological impact of the fall, 3) Care and support networks, and 4) Learning from the fall. Discussion: The psychosocial responses supported a “blended” explanatory model of illness. Respondents appeared to adhere to both Western medical models and traditional Chinese explanatory model depending on the severity of the fall injuries. Also, the roots of Chinese culture in the blended traditions and philosophies of Confucianism, Taoism, and Buddhism appear to be the foundation for many of the beliefs and attitudes expressed in this study, and these beliefs and attitudes in turn influence how Chinese fallers experience falling. The wide range of psychosocial responses also illustrated the complexity of the Andersen’s Behavioural model for health services use and its potential to explain the different types of services an older Chinese immigrant may need post-fall. Conclusions: Findings from this study provided key, previously unexplored insights into the cultural and immigrant-related factors that influence the psychosocial experience, vulnerability and care-seeking behaviours of older Chinese immigrants following a fall.

Background and Rationale: Falls are among the most common problems faced by elderly persons. While the physical risk factors for falls are well established, the psychosocial aspects have been largely neglected. Moreover, studies exploring the responses to falls from the individuals’ perspectives in an immigrant population are virtually non-existent. The older Chinese immigrant population is substantial and growing in the Greater Toronto Area. The cultural and immigrant-related factors that influence their responses to and recovery after a fall are important considerations as health and social care professionals develop falls prevention strategies, and provide services and care. This dissertation explored the nature of immediate and subsequent responses of community-dwelling older Chinese immigrants after falling. Method: Focussed Ethnography, as guided by elements from Critical Social Theory, was used as the research methodology. Eighteen informants over 70 years of age, living in the community who had experienced a recent fall were interviewed using a semi-structured guide developed after a detailed literature review. Thematic analysis of transcribed interviews was conducted. Results: Four major themes related to responses to falling were drawn forth from the interview data: 1) Help-seeking decisions immediately after the fall, 2) Psychological impact of the fall, 3) Care and support networks, and 4) Learning from the fall. Discussion: The psychosocial responses supported a “blended” explanatory model of illness. Respondents appeared to adhere to both Western medical models and traditional Chinese explanatory model depending on the severity of the fall injuries. Also, the roots of Chinese culture in the blended traditions and philosophies of Confucianism, Taoism, and Buddhism appear to be the foundation for many of the beliefs and attitudes expressed in this study, and these beliefs and attitudes in turn influence how Chinese fallers experience falling. The wide range of psychosocial responses also illustrated the complexity of the Andersen’s Behavioural model for health services use and its potential to explain the different types of services an older Chinese immigrant may need post-fall. Conclusions: Findings from this study provided key, previously unexplored insights into the cultural and immigrant-related factors that influence the psychosocial experience, vulnerability and care-seeking behaviours of older Chinese immigrants following a fall.

Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief. Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease. Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT. Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III). Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.

No description available.

This study explored the emerging Self-Imposed Activity Limitation (SIAL) theory among community dwelling elders. This theory was examined using the proposed Aging Well Conceptual model which was guided by Baltes' Selection, Optimization with Compensation model, Markus and Nurius' Envisioned Possible Selves theory, Kuypers and Bengtson's Social Breakdown Syndrome model, Bandura's Self-Efficacy theory, and Rotter's Locus of Control theory. The objectives of this study were to explore the relationships among multiple variables in a hierarchical model and to examine the explanatory power of the SIAL variables in predicting elders' well-being.A correlational descriptive design with a causal modeling approach was used employing Structural Equation Modeling (SEM) techniques. The Aging Well model was tested through a secondary analysis of the National Survey of Midlife Development in the United States (MIDUS) database selecting respondents aged 65-74 years.Two research questions guided this study. Research question one, how well does the Aging Well model fit with empirical sample data, was explored. The Aging Well model statistically approximated the MIDUS data after theoretical and statistical modifications and explained 76% of the variance of elder's well-being. The mediating effects of SIAL variables were determined by nested alternative model testing. Research question two, are the proposition statements in the Aging Well model valid, and was demonstrated empirically by the expected patterns of correlation and covariance among most of the variables in the Aging Well model.SIAL as a composite factor had a large positive effect on elder's well-being. Elders' perceived constraints and perception of aging had no direct effect on well-being. The influences of these two factors on well-being were mediated by a common factor, SIAL. These findings supported the emerging SIAL theory by suggesting that the optimal use of SIAL would lead to adaptive outcomes promoting elders' well-being. In addition, SIAL mediated the effects of elders' sense of control and perception of aging on well-being. The full range of SIAL could not be examined due to limitations inherent in secondary data analysis.

This qualitative research study addressed the gap in the literature and lack of clinical guidelines and frameworks for health professionals as they assess and manage risk when balancing the safety and autonomy of community-dwelling older adults. Twelve health professionals were asked in individual interviews how they perceive, identify, assess and treat risk and how they negotiate the safety and autonomy of their clients. Informed by grounded theory methodology, the findings revealed what kinds of decisions health professionals made and how they made them within this clinical context. These findings from the perspective of the health professional contributed to the development of a definition of living at risk, a safety continuum and a conceptual/practice framework to help health professionals, including occupational therapists, make sound clinical decisions as they balance the autonomy and safety of their community-dwelling older adult clients.

Background: Although there is significant scholarly interest in defining the concept of successful aging, there are very few small-scale, in-depth qualitative studies examining the lived experience of women over 80 who self-identify as aging successfully. Aim: The aim of this study is to explore the lived experience of a small group of community-dwelling Jewish women over 80 in a single county in Northwestern Vermont who self-identify as aging successfully. Approach: This study has a phenomenological approach. Method: Phenomenological interviews were conducted with five women over 80 years of age. Interview content was analyzed, and shared themes were synthesized. Findings: Findings revealed the following shared themes: acknowledgement of extraordinary quality of life events and/or circumstances, extensive and ongoing social involvement with communities and/or individuals, and strong sense of self. Conclusions: The lived experiences of participants who self-identified as aging successfully were characterized by gratitude for the lives they led and continue to lead, extensive and ongoing communal and interpersonal social engagement, and high levels of self-esteem and self-knowledge. Implications for practice: Interventions focused on promoting gratitude, ongoing social engagement, and self-esteem/efficacy may improve individuals' chances of aging successfully; women over 80 respond positively given the opportunity to tell their story, and may benefit from affiliation with a religious community.

L’objectif de ce travail était d’étudier l’évolution des symptômes dépressifs (SD) chez 2590 sujets âgés français, issus de la population générale et suivis pendant 20 ans entre 1988 et 2008. Une méthode d’analyse du changement fondée sur l’identification de trajectoires individuelles de développement a été utilisée afin de tenir compte de l’hétérogénéité pressentie dans cette population. Les facteurs et évènements évolutifs associés aux trajectoires de SD ont été étudiés. Nous avons identifié cinq trajectoires d’évolution de SD entre 1988 et 2008 et trois trajectoires entre 65 et 104 ans. La majorité des individus ne présentait pas ou peu de SD au cours des 20 ans de suivi. Cependant, environ une personne sur dix suivait une trajectoire compatible avec un diagnostic de dépression chronique. Les antécédents psychiatriques, la polymédication, les comorbidités somatiques et la perte d’autonomie étaient des facteurs fortement prédictifs de dépression « émergente » ou « persistante ». Le veuvage apparaissait être un facteur protecteur d’appartenance à la trajectoire de dépression « persistante » pour les femmes uniquement. L’entrée en institution et le décès étaient plus fréquents dans les trajectoires les plus défavorables. Les trajectoires de SD étaient significativement associées aux trajectoires de consommation d’antidépresseur. Notre travail confirme l’hétérogénéité de l’évolution des symptômes dépressifs en population âgée. Il alerte sur la prévalence préoccupante de la chronicité et aide à déterminer des sujets à plus haut risque d’évolution défavorable qui pourraient faire l’objet d’actions de prévention. / The aim of this study was to investigate patterns of the course of depressive symptoms (DS) in 2590 community-dwelling older adults followed over a period of 20 years, between 1988 and 2008. Using a group-based trajectory method, we modelled the course of DS and examined associations between trajectory patterns and baseline socio-demographic and health variables, as well as outcomes. We identified five time-related trajectories between 1988 and 2008, and three age-related trajectories between 65 and 104 years old. A majority of participants experienced no or only mild DS. However, about one to ten belonged to high-level trajectories consistent with clinically relevant chronic depression. Psychiatric history, polypharmacy, somatic comorbidities and functional limitation were strongly associated with membership to increasing and persistently high trajectories. Being widowed seemed to be a protective factor for membership of this persistently high trajectory group only in women. Institutionalization and death were more prevalent in worse trajectories. Trajectories of DS and trajectories of antidepressant use were significantly associated. Our study confirmed heterogeneity of the evolution of DS in late-life and highlighted the problematic risk of chronicity. We identified several high-risk groups for later-life depression that can be easily detected and that are amenable to preventive intervention.