Excessive abdominal obesity, coupled with a decline in muscle mass and physical function that is exacerbated by sedentary living, contributes substantively to the disease and disability common to our aging population. The Senior Study, a randomized controlled trial designed to investigate the health benefits associated with performing resistance exercise (RE), aerobic exercise (AE), or a combination of both exercise modalities (RAE) for six months in the absence of caloric restriction, was conducted on otherwise healthy but abdominally obese, sedentary men (n=57) and women (n=79) between the ages of 60 and 80. The purpose of the first manuscript (Chapter 3) was to compare the effects of exercise modality on visceral obesity and insulin resistance in the Senior Study. All exercise groups significantly reduced total abdominal and visceral fat (P<0.05) and waist circumference (P<0.001), which measure explained 30% of the variance in total abdominal fat changes (P<0.001). AE and RAE improved insulin sensitivity (P<0.05), but the RE group did not (P>0.1). The greatest insulin sensitivity increase was observed within the RAE group (48% increase, P<0.001). The purpose of the second manuscript (Chapter 4) was to evaluate the effects of exercise modality on cardiorespiratory and functional fitness in the Senior Study. AE and RAE increased cardiorespiratory fitness (P<0.001), whereas RE did not (P>0.1). All exercise groups improved functional fitness performance (P<0.001), but age- and sex-specific percentile ranking improvement within RAE was greater than AE (P<0.01). RE and RAE significantly increased skeletal muscle (P<0.01), predominantly in the upper body, while AE did not (P=1.0). AE and RAE reduced total fat (P<0.001). Both fat loss and muscle gain were independent predictors of improvements in functional fitness (P<0.05). The findings from these studies demonstrate conclusively that a combined resistance and aerobic exercise program without caloric restriction is an optimal strategy for the therapeutic reduction of health risk in abdominally obese men and women. While each exercise modality offers distinct benefits and remains a viable option for needs-based exercise prescription, the combination was associated with the greater simultaneous improvements to body composition, insulin resistance, and cardiorespiratory and functional fitness than either resistance or aerobic exercise alone. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2007-09-13 13:21:31.772

Background: It has been reported that the ratio of limb fat to trunk fat (LF/TF) is associated with markers of cardiometabolic risk in elderly men and women. However, it is unknown if LF/TF is associated with cardiometabolic risk beyond that explained by LF and TF independently. Objective: To determine if LF/TF is associated with markers of cardiometabolic risk in elderly men and women after control for LF and TF. A secondary objective was to examine the independent associations of LF and TF with markers of cardiometabolic risk. Methods: Subjects included abdominally obese men (n=58) and women (n=78) between 60 and 80 years of age. Regional adiposity was quantified using magnetic resonance imaging. Insulin resistance, fasting glucose, HDL-cholesterol, plasma triglycerides and adiponectin were determined. Regression analyses and partial correlations were used to assess the independent associations between variables. Results: After control for potential confounders, TF was positively associated with fasting glucose, insulin resistance and plasma triglycerides, and negatively associated with HDL-cholesterol (p<0.05). These associations were strengthened after further control for LF (p<0.05). LF was not associated with any marker of cardiometabolic risk after control for potential confounders (p>0.05). However, after further control for TF, LF was positively associated with HDL-cholesterol and negatively associated with plasma triglycerides (p<0.05). Plasma adiponectin was independently associated with both LF and TF in elderly women (p<0.05) but was not independently associated with either depot in elderly men (p>0.05). LF/TF was not associated with any marker of cardiometabolic risk after control for LF and TF. Conclusions: These results suggest that it is the absolute, rather than relative amounts of LF and TF which have the greatest influence on cardiometabolic risk in elderly men and women. Further, these results suggest that the associations between plasma adiponectin and regional adiposity are significantly influenced by sex in elderly men and women. / Thesis (Master, Kinesiology & Health Studies) -- Queen's University, 2008-12-05 16:08:10.868

Family members are in an optimal position to identify changes in behaviour of loved ones suffering from delirium. To date there are no known studies on educational interventions specifically targeting families of the elderly related to delirium outside of the hospital setting. Using the Knowledge to Action Process, families became involved in the development of a knowledge translation product related to delirium. It was found from two focus groups that participants’ knowledge of delirium was limited. Also, it was determined that participants were most interested in receiving an educational session in a group setting. The education session was developed using feedback from the focus groups as well as evidence based resources. The focus for the education session was on prevention and identification of delirium. There were a total of seven education sessions held and 16 eligible participants. In each session a pre and post-test for delirium knowledge was given to the participants. There was a significant increase in scores on the post-test following the session. Participants were also given a post session questionnaire to evaluate the education session. Overall the session was well received; participants were often interested in learning more about delirium. Half of the participants felt they would be able to identify delirium in someone close to them. The majority of participants thought that it is important for other families of the elderly to receive a similar session on delirium. Four to six weeks following the education session, semi-structured telephone interviews were conducted with five participants from the second phase in order to receive further feedback on the intervention. Most participants were able to recall information related to risk factors and signs of delirium. Three participants stated that the education sessions should be longer in order to provide more time for discussion. Participants still thought they would be able to recognize delirium as long as they were close to the person experiencing it. Since the education session none of the participants had witnessed anyone who was delirious. / Thesis (Master, Nursing) -- Queen's University, 2010-09-03 12:50:12.792

Hypothesis. We hypothesized that contrary to "normal aging," frail elderly women would have a heightened resting energy expenditure per kg fat free mass (REE/kg FFM) and thermic effect of food (TEF) response. / Methods. 13 healthy (H) [X +/- SEM: 81.4 +/- 1.1 yr] and 9 frail elderly women (F) [84.7 +/- 1.6 yr], free from acute conditions underwent REE and TEF measurements (liquid standard mixed meal: 720 kcal, 58% carbohydrate, 14% protein, 28% fat) using ventilated hood indirect calorimetry. Anthropometric and body composition measurements, thyroid hormones, cortisol, cytokines and catecholamine concentrations, and physical activity (PASE) and mobility ("time up and go" TUG) scores were related to the results obtained. / Results. H had a faster TUG: 10.2 +/- 1.6 vs. 21.0 +/- 9.3 s (p=0.001), greater PASE score: 179.2 +/- 116.1 vs. 47.1 +/- 26.2 (p=0.003), greater triiodothyronine [T3]: 5.1 +/- 0.6 vs. 4.3 +/- 0.4 rhomol/L (p=0.003) and lower cortisol concentrations: 351.1 +/- 19.9 vs. 474.5 +/- 43.6 nmol/L (p=0.011). In H vs. F: REE/kg FFM was 1044 +/- 20.4, 1021 +/- 23.7 kcal/day (NS) and TEF response as expressed as % of REE was 18.4 +/- 5.6, 19.5 +/- 4.2 (NS). The time course of glucose (p=0.043) and insulin from 90 minutes onwards (P=0.013) suggested insulin resistance in F. REE was positively correlated with FFM, percent body fat and [T3] (r>0.499, p<0.021). / Conclusion. REE/kg FFM and TEF response was not different between H and F and thus the greater prevalence of malnutrition in F, cannot be explained by these parameters.

We assessed the nutritional status and physical function of 121 women (79.4 +/- 6.6 y, 26.8 +/- 5.6 kg/m2) and 61 men (78.6 +/- 8.3 y, 26.6 +/- 4.7 kg/m2) participating in the Geriatric Day Hospital. According to a composite index of malnutrition, 19% of them were found malnourished whereas the Mini-Nutritional Assessment, a validated nutritional screening tool, found that 56% of the elderly were malnourished or at risk for malnutrition. Malnourished persons, as determined by the composite index, had a lower lean body mass (LBM) by bioelectrical impedance analysis compared with the well-nourished group (40.5 +/- 9.7 vs. 42.0 +/- 8.7 kg, p = 0.0001). LBM correlated significantly with handgrip strength (r = 0.34, p = 0.0001) but not with gait speed (r = 0.04, p = 0.27). There were no significant differences between nutritional states for any of the two tests of physical function. The score of the MNA, correlated with gait speed (r = 0.24, p = 0.02) but the performance at the physical tests was not different according to the nutritional status defined by this tool. We conclude that malnutrition is relatively prevalent among frail persons participating in the Geriatric Day Hospital and that malnutrition is one among many other factors that contribute to their low level of physical performance. As such, a nutritional intervention may be of benefit in improving the physical function of frail elderly persons who are malnourished.

Syfte: Att kartlägga likheter och skillnader i åtgärder och hjälpmedel mot dehydrering hos äldre i teori och praktik. Metod: Initialt utfördes litteraturstudier via universitetsbibliotekets söktjänst OneSearch. Tre intervjuer utfördes på undersköterskor på gruppboende, demensboende och hemtjänst. Dessa erbjuder en inblick i den praktiska verksamheten. Resultat: Följande faktorer av betydelse för att förebygga eller motverka dehydrering identifierades samstämmigt i litteratur och vid intervjuer: (1) kunskap om den äldre via dokumentation, (2) anpassning av tillvägagångssätt vid servering av dryck efter den äldres preferenser och tillstånd, (3) hemtrevlig miljö med sociala interaktioner, (4) bedömning av vätskeintag, väskebalans och riskfaktorer via uppmärksamhet, vätskeregistrering och med hjälp av flera andra yrkesgrupper samt med hänsyn till den äldres historik, (5) påminnelser (särskilt vid demens) och en stor mängd lättabsorberade drycker som intas succesivt vid diarré och kräkningar, (6) lättanvända och specialutformade hjälpmedel. Följande metoder särskilde sig: (1) utbildning för vårdare; begränsad på de undersökta platserna, (2) tekniska hjälpmedel och sväljterapi (kostmodifieringar, anpassade huvudpositioner, sväljträning) vid dysfagi; kostmodifieringar används på de undersökta platserna, (3) färgsättning av koppar och kannor, vilket visats kunna ha betydelse för intag. Slutsats: Skillnader fanns gällande utbildning och användning av sväljterapi, tekniska hjälpmedel och infusioner. Utbildning av personalen, mer frekvent vätskeregistrering och fullständig sväljterapi utgör förbättringsmöjligheter. Vissa av dessa åtgärder kräver ökade resurser och/eller tydliga riktlinjer. Acceptans för tekniska hjälpmedel är inte en självklarhet. Undersökningar gällande möjligheterna i att med färgval och design av dryckeskärl stimulera de äldre att dricka mer kan vara värt att undersöka vidare. Intervjuerna syftade främst till att ge en inblick i den praktiska verksamheten och generaliserbarheten av erhållna resultat är begränsad. De flesta åtgärder som har identifierats är ”mjuka” till sin karaktär. Det är svårt att få en klar bild av olika metoders effektivitet. Några av metoderna som har utvärderats med goda resultat vid dysfagi och som därför kan förbättra vätskeintaget är sväljterapi och stimulering av sväljmuskulatur. / Objective: To identify similarities and differences in methods and aids used to prevent dehydraton in the elderly as identified from the scientific literature and from interviews with caretakers. Method: Literature studies was performed through the University Library search service ”OneSearch” and further from references in key papers. Three interviews were conducted on nursing assistants in two retirement homes and home care services, to offer some insight into the practical activities. Results : The following factors were identified as important in both literature and interviews: (1) knowledge of the elderly through documentation, (2) adapted approach when serving drinks after the elderly person's preferences and condition, (3) a homely environment with social interactions, (4) assessments of fluid intake, fluid balance and risk factors through attention, fluid registration and with the help of several other professional groups, and given the history of the elderly, (5) reminders for dementia and a accessibility of large amount of easily absorbed beverages consumed gradually during diarrhea and vomiting, (6) easy-to-use and specially designed drinking aids. For the following factors differences were obeserved between literature survey and interviews: (1) education for caregivers; limited to the investigated sites, (2) technical aids and swallowing therapy (dietary modifications, adapted head positions, swallowing training) in dysphagia; diet modification is used at the investigated sites (3) the importance of cup and jug colours; blue cups used in practice, no support in literature. Conclusions: Differences were found in terms of education and the use of swallowing therapy, assistive technology and infusions. Education, more frequent fluid registration and a complete swallowing therapy are improvement opportunites, some of them requires extra resources and/or clear guidelines. Acceptance of technical aids is not self-evident. Investigation of the effect of cup color and design that can encourage the elderly to drink could potentially be a way forward. The results of the interviews are not generalizable because they only aimed to give an insight into the practical activities. Most of the strategies that have been identified are "soft" in nature. It is difficult to get a clear picture of the efficiency of different methods. Methods that have been evaluated with good results in dysphagia and therefore offer potential to improve liquid intake, are swallowing therapy and stimulation of swallowing musculature.

Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems. Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems. Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study. Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure. Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.

Bakgrund: Trycksår är ett stort problem inom vården. De uppstår lätt bland äldre patienter och medför lidande för dem. En av sjuksköterskans uppgifter är att identifiera patienternas behov av förebyggande omvårdnadsinsatser. Det finns många insatser för trycksårsprevention, som exempelvis riskbedömning, lägesändring och tryckavlastande underlag. Trots det råder osäkerhet kring hur dessa preventionsinsatser bör användas. Denna litteraturstudie fokuserar på att beskriva evidensbaserade trycksårsförebyggande insatser för äldre för att underlätta sjuksköterskans val av hjälpmedel samt minska förekomsten av trycksår bland äldre patienter. Syfte: Att beskriva evidensbaserade trycksårsförebyggande insatser för äldre patienter. Metod: Detta är en litteraturstudie innehållande tio kvantitativa artiklar. Resultat: Trycksårsincidensen kan minskas genom användning av riskbedömningsinstrument i kombination med sjuksköterskans kliniska bedömning. Viskoelastisk madrass, luftalternerande madrass samt överdrag har visats ha bra effekt som tryckavlastande preventionsinsatser. Lägesändring var tredje timme under natten minskar trycksårsincidensen, detta gör även lägesändring var fjärde timme i kombination med tryckavlastande viskoelastisk madrass. Dessutom kan trycksår på hälar undvikas om en kilformad viskoelastisk kudde eller ett avlastande hälskydd används. Tryckavlastande rullstolsdynor har visat sig minska trycksårsincidensen. Slutsats: Riskbedömningsinstrument bör kombineras med sjuksköterskans kliniska bedömning, och utifrån det resultat som erhålls kan trycksårsförebyggande insats väljas, som till exempel luftalternerande alternativt viskoelastisk madrass eller tryckavlastande rullstolsdyna. Lägesändring har visat minskad trycksårsincidens, men det råder osäkerhet om vilket intervall som bör användas och därför behövs mer forskning inom detta område. Det finns tydligt evidens för att en kilformad kudde eller ett hälskydd ger minskad trycksårsincidens. / Background: Pressure ulcers are a major problem in health care. They easily occur among elderly patients, and cause suffering for them. One task of being a nurse is to identify the patients' needs of prevention. Many pressure ulcer preventions exist, such as risk assessment, repositioning and support surfaces. Despite this, there is uncertainty about how these preventive measures should be used. This work focuses on describing evidence-based pressure ulcer prevention for the elderly to facilitate nurses' choices regarding the application of their resources, as well as reduce the incidence of pressure ulcers among elderly patients. Aim: To describe evidence-based pressure ulcer prevention in elderly patients. Method: A literature review containing ten quantitative articles. Results: Pressure ulcer incidence can be reduced by use of assessment instruments in combination with the nurse's clinical judgment. Viscoelastic mattress, air alternating mattress and cover have been shown to be effective as pressure ulcer prevention. Repositioning every three hours during the night reduces the incidence of pressure ulcers, and so does repositioning every four hours in combination with a pressure-relieving viscoelastic mattress. Additionally, pressure ulcers on heels can be avoided if a wedge-shaped viscoelastic cushion or a heel guard is used. Pressure relieving wheelchair cushions have been shown to reduce the incidence of pressure ulcers. Conclusion: Risk assessment instruments should be combined with the nurse's clinical assessment, and based on the results obtained pressure ulcer prevention efforts can be selected, such as air alternating or viscoelastic mattress, or pressure relieving wheelchair cushion. Repositioning have shown reduced pressure ulcer incidence, but there is uncertainty about the interval that should be used, and therefore more research is needed in this area. There is clear evidence that a wedge-shaped pillow or a heel guard provides reduced pressure ulcer incidence.

It is inevitable that as a person ages they will encounter different physical and cognitive impairments as well as dynamic social issues. We started this project under the assumption that autonomous driving would greatly benefit the fastest growing population in developed countries, the elderly. However, the larger question at hand was how are older drivers going to interact with future automated driving systems? It was through the qualitative research we conducted that we were able to uncover the answer to this question; older drivers are not willing to give up “control” to autonomous cars. As interaction designers, we need to define what type of interactions need to occur in these future automated driving systems, so older drivers still feel independent and in control when driving. Lawrence D. Burns, former Vice president of Research and Development at General Motors and author of Reinventing the Automobile Personal Urban Mobility for the 21st Century talks about two driving factors that will shape the future of the automobile. These factors are energy and connectivity (Burns et al., 2010). We would add a third one, which is control. If we address these three factors we might be able to bridge the gap between how we drive today and how we will drive in the future and thus create more cohesive future automated driving systems.

Äldres delaktighet och inflytande i äldreomsorgen beskriver Socialdepartementet som bristfällig. För att öka äldres delaktighet tillsattes ett verktyg, genomförandeplaner. I den här uppsatsen ställer vi oss frågorna: Hur upplever personal äldres delaktighet på äldreboenden samt vad fyller genomförandeplaner för funktion för äldres delaktighet? Utifrån sex intervjuer med personal på äldreboenden visar resultatet att personalen upplever äldres delaktighet som framåtskridande och betydelsefull inom äldreomsorgen. Personalens syn på genomförandeplaner är att det är ett krångligt men bra verktyg för att öka äldres delaktighet. Slutsatser vi argumenterar för är att äldres delaktighet kan gynnas eller missgynnas av: Personalens förhållningssätt och hur de arbetar, huruvida de äldre är engagerade till att vara delaktiga och om de kan vara delaktiga. Studien visar att genomförandeplaner som verktyg för äldres delaktighet fungerar och ger positiva resultat. Faktorer som kan främja eller begränsa delaktigheten via genomförandeplaner är: kontaktmannaskapet, äldre och personalens förståelse för frågorna och genomförandeplansprocessen. / Elderly people’s participation and involvement in elderly care are according to the Ministry of Health and Social Affairs inadequate. To increase elderly people’s participation, a tool for documentation for implementation was made. In this study we ask ourselves: How does staff experience elderly people’s participation in nursing homes and which function does the documentation for implementation have on elderly people’s participation? On the basis of six interviews with staff in nursing homes the result shows that staff experience that elderly people’s participation is in progress and is very important in elderly care. The staff’s view on the documentation for implementation is that it is complicated. However, they feel that it is a good tool for increasing elderly people’s participation. We argue that elderly people’s involvement can be advantaged or disadvantaged by: How the employee acts and works, if the elderly are committed and if they can be involved. We argue that the documentation for implementation, as a tool for elderly people’s participation, give positive results. Factors that can promote or limit the participation in the documentation for implementation are: the contact person and elderly and employees comprehension about the questions and the process.