Statement of problem. This thesis applied established criteria for evaluation of a screening program to assess the population health impacts of extending population-based breast cancer screening to Canadian women aged 70 to 79. Methods. Experimental evidence was systematically reviewed, complemented by analyses of Canadian data for incidence, mortality, screening participation and treatment patterns for women aged 70 to 79. The MISCAN micro-simulation model was adapted to the Canadian population to assess benefits and harms. Results. Compared to stopping at age 69 and depending upon the level of screening participation and sojourn time, continuing to screen women aged 70 to 79 resulted in an estimated 530 to 547 false positive mammograms per 10,000 screens, 20 to 40 additional biopsies, 10 to 25 "extra" cancers, and 12.2 to 13.7 prevented cancer deaths, while 30 fewer women will be diagnosed with stage T2+ cancer. About 110 life-years will be gained per 10,000 screens, with 210 to 440 life-years lived in lead-time. Quality adjustment of life-years gained reduced the benefit by up to 31% to 48% with a 5% discount factor for shorter vs longer sojoum times respectively. Between 733 and 821 screens will be needed to avert one breast cancer death, with an overall gain in life expectancy of about 4 days per screen. Overall, an estimated 459 breast cancer deaths can be prevented per year in Canada if the national target level of 70% screening participation is reached. Conclusion. Overall, results indicate favourable population health impacts of extending breast cancer screening to screen women aged 70 to 79. More work is needed to discern the sojourn time and the costs associated with the benefits.

Guided by the Theory of planned Behavior (TPB), this study was an exploratory investigation of attitudinal, normative, and perceptual determinants of exercise behavior among community residing older adults who reported difficulties in performing one or more activities of daily living. The objectives of this study were: (1) to determine the relationship between various components of the TPB model and exercise behavior in a sample of community-dwelling physically frail older adults aged 65 and over, and (2) to examine the differences between "low actives" and "high actives" with respect to the TPB variables and selected sociodemographic and health-related characteristics. This descriptive comparative study involved two phases: (1) instrument development to measure the TPB constructs and pilot testing on a purposive sample of 10 seniors; and (2) a cross-sectional survey of a convenience sample of 99 community-dwelling seniors in the Ottawa-Carleton Region. Subjects were recruited from a variety of community settings, using both direct (in-person) and indirect (key informant) approaches. Data were collected through interviewer-administered questionnaires. (Abstract shortened by UMI.)

Older persons who suffer from health problems leading to functional impairment are at risk for developing depression. Moreover, the combination of functional impairment and depression creates a complex situation requiring special treatment consideration. A successful intervention must address issues unique to late-life depression and must do so in the context of physical disability caused by serious health problems. The purpose of this work was to create a community-based intervention program that would address the needs of this special population of older persons. An intervention based on behavioural principles and on an empirically validated model, Lewinsohn's (1986) Control Your Depression , was modified to suit the needs of this population. The modifications included three distinctive features. First, the program was designed to be readable and relevant to the life circumstances of older adults with special physical impediments. Second, the aim of the program was to deliver this intervention in a self-administered, minimal-contact format, in order to facilitate access to this under-serviced population. Third, the program was adapted to be delivered by non-mental health professionals---in this case, home-care nurses---who were in a health-care delivery role with older individuals. These three elements were combined to create an efficacious model of service delivery that was able to overcome barriers to access, make use of existing community resources, address special issues of functional impairment, and that was deliverable with minimal supervision. This model was tested in three separate series, each with two participants. A multiple-baseline design allowed a data-driven refinement of the model, and was also well-suited for behavioural analysis. In Series A, we tested the feasibility of the model. Results indicated that the program is feasible, and especially highlighted the role of reinstating pleasant activities in alleviating depression in these participants. Series B further examined the role of pleasant activities. Results confirmed the initial findings that reinstating pleasant activities is a pivotal part of the treatment for this population. Some adjustments were added to produce a finalized model in Series C, with positive results. Overall, these three series of studies indicated that the model is feasible, deliverable, and efficacious in reducing depression in older participants. In addition, results showed a positive impact on participants' functional ability, especially in the areas where the impairment is reversible, such as social functioning and activities of daily living. This model has implications for future applications that encourage the development of alternative models of intervention capable of meeting the unique needs of special populations.

Les femmes aînées de 65 ans et plus constituent le segment de la population qui présente le plus de problèmes de santé et qui est le moins actif physiquement. Or, la pratique de l'activité physique est un élément important dans la promotion de la santé. De plus, il est démontré que l'activité physique chez les aînées réduit les risques de cardiopathie et d'ostéoporose, accroît l'énergie et la mobilité, améliore l'autonomie et l'estime de soi et favorise, dans le contexte d'une pratique collective, la construction d'un réseau de soutien social et la conservation d'une identité culturelle. La présente étude porte sur la place de l'activité physique dans le vécu de femmes âgées immigrantes d'origine portugaise. Des éléments théoriques empruntés de la perspective socioculturelle développée par Pierre Bourdieu ont été utilisés, notamment les concepts d'habitus corporel et de logique sociale. La méthode de recherche privilégiée est qualitative et repose sur l'analyse des transcriptions d'entrevues semi-dirigées réalisées auprès d'une dizaine de femmes aînées immigrantes d'origine portugaise âgées entre 65 et 75 ans provenant de la région d'Ottawa. (Abstract shortened by UMI.)

Many risk factors for falls among seniors are modifiable with appropriate interventions. Educational strategies to improve the use of mobility aids have been an important component of some fall prevention programs. However, literature and clinical observations point to poor acceptance of these devices by seniors. Guided by the Theory of Planned Behavior (TPB), this study was an exploratory investigation of attitudinal, normative, and perceptual determinants of cane use among community-residing older adults. The objectives were: (1) to develop valid and reliable measures of TPB constructs as they relate to the use of canes in fall prevention; (2) to determine relationships between various components of the model and cane use behaviors in a sample of community-dwelling older adults aged 65 and over; and, (3) to examine the differences between "cane-users" and "non-users" with respect to the TPB variables and selected sociodemographic and health-related characteristics. This descriptive comparative study involved two phases: (1) instrument development and pilot testing on a purposive sample of 10 seniors; and, (2) a cross-sectional survey of a convenience sample of 98 community-dwelling seniors in Ottawa-Carleton. Subjects were recruited from a variety of community settings, using both direct and indirect approaches. Data were collected through self- and interviewer-administered techniques. The findings provided some evidence for the validity and reliability of the instrument and confirmed the utility of the TPB in its application to a new domain of behavior. "Cane-users" were significantly older, reported greater mobility difficulties, and had more negative evaluations of their activity level compared to "non-users". However, the two groups did not significantly differ with respect to other sociodemographic characteristics, fall history and frequency, and self-rated health. There were significant differences between "cane-users" and "non-users" on all components of the TPB model, even after stratifying the sample by age and mobility level. (Abstract shortened by UMI.)

This exploratory study investigated the relationships among the provision of care, physical and emotional health, and exercise and socialization among spousal caregivers of older adults with cancer. The Pender Health Promotion Model formed the conceptual framework for the study. Face to face interviews were conducted with sixty spousal caregivers of elderly individuals with cancer who were being cared for in their home. Findings indicated that the majority of respondents participated in health promoting activities (exercise and socialization) both prior to and following spouses' diagnosis of cancer. There was, however a decline in participation in all forms of physical exercise inquired about, particularly those requiring absence from the home, following spouses' diagnosis. With respect to socialization, face to face interactions with family, friends and others remained unchanged, however, social outings declined dramatically. Caregivers perceived their overall health to have declined since their spouse's diagnosis of cancer. Caregivers provided a substantial amount of assistance to their spouse in the form of personal and instrumental activities of daily living. This study also examined the strength of the major variables as predictors of participation in health promoting activity as hypothesized by the Pender model. Correlational analysis revealed a significant relationship between engagement in exercise and self rated health. Indeed, the greatest predictor of health-promoting activity was prior levels of participation in exercise and socialization, which is not identified as an important predictor of health-promoting activity in the Pender Health Promotion Model. Consequently, alterations to the Pender Model were proposed. (Abstract shortened by UMI.)

Reminiscence has been identified as an important contributor to adaptation in later life by gerontologists (e.g., Birren, 1991), developmental theorists (e.g., Erikson, 1980), and clinical practitioners (e.g., Haight, 1991). Despite its wide acceptance as a therapeutic intervention, little is known about how, and for whom, reminiscence acts to produce therapeutic gains. To understand and to evaluate the therapeutic value of reminiscence for a specific clinical problem, contemporary cognitive theories of depression were integrated with reminiscence theory to develop a model that: (a) identifies the key therapeutic content of two types of reminiscence theory to interventions (integrative and instrumental); and, (b) elucidates the cognitive and emotional change processes evoked in participants of reminiscence therapy that can treat depression. Based on this model, standardized integrative and instrumental reminiscence interventions were developed and implemented with 26 older adults with moderate to severe depression. Using a clinical intervention single case study replication design, results support the utility of the model developed to explain how reminiscence contributes to the treatment of depression. In the Integrative group, constructive reappraisal of initial interpretations and emotional reactions to past self-defining events led to an improvement in self-esteem, purpose, and personal meaning, and a decline in hopelessness and internal, stable, and global attributions for the causes of negative events. In the Instrumental group, memories were used to remove emotional and cognitive barriers to coping by normalizing stress, identifying important needs at stake in current coping, providing evidence of successful past coping, and identifying appropriate coping strategies. As a result, self-esteem, life control, and problem-focused coping increased, and appraisals of stressors as threatening and unchangeable, and escape-avoidance coping decreased. Evaluation of the effectiveness of integrative and instrumental reminiscence interventions demonstrated greater clinically significant improvement in symptoms of depression in the Integrative and Instrumental groups compared with the Active Socialization Control group. In the Integrative group, 58% of clients demonstrated clinically significant improvement at post-test, yielding an effect size (ES) of.86. At follow-up, 100% of Integrative subjects improved clinically (ES =.96). In the Instrumental group, 56% of clients demonstrated clinically significant improvement at post-test (ES =.81) and 88% improved at three-month follow-up (ES =.89).

<p> The purpose of this project was to create a plan for a sustainable and accessible transportation service that will be available to members of a Beacon Hill-type Village in Long Beach, California. Specifically, the goals of this project were to analyze the existing literature on the transportation needs and options for older adults, examine current transportation services available in Long Beach, California, and develop the tools necessary for a Long Beach Village Transportation Program including a volunteer drivers&rsquo; manual, a plan to recruit volunteer drivers, and policies and procedures for the Long Beach Village office. A brochure for members to advertise the transportation program and an evaluation tool for members and drivers of the Long Beach Village to assess the effectiveness of the program were also included.</p>

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No description available.