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

Nutrition can be viewed as a modifiable factor related to maintaining and preserving health in older adults. Previous studies have found that nutritional factors can influence cognitive abilities, however few studies have examined macronutrients and micronutrients as they relate to cognitive functioning. Research has yet to examine the mechanisms related to nutrition, cognition and aging in an older adult population from a holistic and interactive perspective. This dissertation examined three research questions to better understand the relationship between age, nutrition, cognition, and inflammatory biomarkers. First, is nutrition related to cognition beyond demographic factors? Do individual nutrients serve as mediators? Second, are inflammatory biomarkers significant mediators to cognitive performance? Third, do nutrients and inflammatory markers interact as moderators to cognitive performance? This study examined 1,317 adults 60 years and older from the National Health and Nutrition Examination Survey III (NHANES III). Macronutrients were collected from a retrospective 24-hour dietary recall, micronutrient values were obtained from blood serum/plasma for vitamin C, vitamin D, vitamin E, homocysteine, iron, folate, and inflammatory biomarkers values were obtained from blood serum/plasma for C-reactive protein, fibrinogen, and ferritin. Cognition was measured by 6 tasks: immediate and delayed word recall, immediate and delayed story recall, orientation, and digit subtraction. All tasks were then combined to form a global cognitive measure. Results for question one found that after controlling for age, sex, education, and total calorie intake, higher intake of polyunsaturated fat was related to better global cognition and delayed story recall score (std β= .08, p= .028, std β= .08, p=.04 respectively). Greater than 28% of calories from carbohydrate indicated worse global cognition and delayed story recall (std β= -.013, p= .028, and std β= -.158, p= .01). Higher intake of saturated fat and protein were related to worse digit subtraction scores (std β= -.160, p= .02, std β= -.064, p= .02). Higher serum vitamin C, D, and folate levels were related to better global cognition and digit subtraction. Additionally, higher serum vitamin C and D were associated with better orientation score, and folate was related to better immediate and delayed story recall. Building from these relationships, individual mediation models found that serum vitamin C, vitamin D, folate, and ferritin were significant mediators between age and the previously mentioned cognitive tasks. Results for question two examined mediation between inflammatory markers and cognition and found that higher fibrinogen was related to worse global cognition and digit subtraction. Higher ferritin was associated with better delayed word recall. Question three investigated the moderating relationship between age, nutrients, and biomarkers, and results found that folate and fibrinogen were significant moderators. Higher serum folate was related to better global cognition and immediate story recall. Ferritin values below 1.2 and above 3.2g/l indicated worse digit subtraction performance. Evidence for a dose-dependent relationship was confirmed. Results from this project demonstrated that select nutrients (polyunsaturated fat, vitamin C, D, and folate), and inflammatory markers (ferritin and fibrinogen) were associated with cognitive performance across various cognitive domains. Consuming a diet rich in healthy fatty acids, and antioxidants may be beneficial for cognitive health. Future studies should continue to examine the underlying mechanisms connected to maintaining, preserving, and protecting cognitive abilities in older adults.

The discourse of older healthy adults is commonly described as lengthy and off-topic and thought to be associated with a general cognitive decline that occurs in healthy aging. This study investigated the overall decline in attention associated with healthy aging and its relationship to instances of off-topic speech (OTS) in a constrained and unconstrained language production task. Ninety cognitively healthy adults participated and comprised three age cohorts (40 – 75+). Participants completed cognitive measures of attention and two discourse tasks that included recounting personal events and describing a procedure. Older adults exhibited poorer scores on measures of selective and shifting attention, and elderly adults produced more OTS as compared to middle-aged (40s) and older (60s) adults in the unconstrained task only. Poorer scores of shifting attention were significantly correlated with more OTS in the older adults (60s) only. Overall, a marked increase in variability of language production was observed with advancing age. Results indicated the need for further research on the relationships between age, attention, OTS, and task type in healthy aging to determine an underlying cause for increasing variability of language production with age.

This study investigated the accuracy of healthy aging adults‟ self-rating of communication style, as measured by quantifiable measures of discourse performance. Ninety cognitively healthy adults participated and comprised three age cohorts (20s, 40s, 60s). Participants completed discourse tasks that included recounting a vacation, telling a story, and describing a picture. Participants also self-rated their communication style, placing them in a talkative or reserved cohort. Communication style was measured by discourse performance variables of interest: length of output (TNW) and informativeness (%IU). When presented with an unconstrained task (recounting a vacation), talkative and reserved groups, regardless of age, produced a similar TNW and %IU. When considering age and self-rating, talkative 20, 40, and 60 year olds produced a similar TNW and %IU as reserved 20, 40, and 60 year olds. Overall, adults were found to be inaccurate, due to lack of significant differences between self-rating groups. Results indicated the need for further research on the relationship between age, discourse performance, and accuracy of self-rating of communication style of healthy aging adults.

This study investigated the lifespan influences of task type and working memory on the syntactic complexity of narrative discourse production. Participants included 180 healthy adults across three age cohorts: 20-29 years (Young Group), 60-69 years (Older Group) and 75-89 years (Elderly Group). Participants completed standardized working memory measures and four discourse tasks (single/sequential picture description, storytelling and personal recount). Syntactic complexity for each sample was measured via clausal density yielding a complexity index. For analysis, participants were placed into one of two groups based on working memory scores above (High Working Memory Group) or below (Low Working Memory Group) the mean. Significant differences in syntactic complexity between working memory groups were found for the single picture description and the storytelling; individuals in the high working memory group produced language with greater syntactic complexity. When the effects of cohort and working memory were investigated with a two-way ANOVA, working memory group was no longer significantly related to syntactic complexity. However, there was a significant relationship between cohort and syntactic complexity for the single picture description and storytelling tasks. Analyses indicate that the relationships between syntactic complexity, age, and working memory are dependent on task type.

Meditation, Tai Chi, and moderate aerobic exercise have been shown to positively affect executive attention. We compared the executive attention efficiency and aerobic capacity of long-term Tai Chi, meditation plus exercise, aerobic fitness, and sedentary participants. We hypothesized that because meditation and Tai Chi include moderate aerobic exertion and executive attention training, these groups would show significantly greater executive attention efficiency compared to aerobic exercisers or sedentary control groups. Our results support this. Tai Chi and meditation but not aerobic fitness practitioners significantly outperformed sedentary controls on key executive measures: percent switch costs and P3b ERP switch amplitude (Tai Chi, p = .001; p = .031, respectively; meditation, p = .006; p = .003, respectively). This suggests participation in chronic health practices requiring moderate aerobic exertion and attentional focus may offset declines in aerobic, neuromotor, and executive attention capacity often seen in normal aging.

This descriptive ethno-theatre case study explored the impact of intergenerational engagement through a reminiscence theatre arts initiative on the psychosocial quality of life for older adults with mild to moderate cognitive decline. Study participants were comprised of 11 adults 65 years and older residing in a dementia-specific residential care facility unit, and 13 University of Victoria Theatre students. Both qualitative and quantitative procedures were integrated into the case study. Qualitative processes consisted of older adult life history interview transcriptions, ethno-theatre field notes of theatre devising and performance processes, and post-program drama evaluations. Quantitative measures included pre- and post-administered instruments: CASP-19; Alzheimer’s Disease-related Quality of Life (ADRQL) – Revised; and older adult health perception surveys. Overall, it appears from the data that active engagement in reminiscence theatre (the process of creating and performing theatre from real life memories and stories) results in a positive impact on older adults’ well-being – increased self-esteem, elevated mood and social engagement, decreased isolation and boredom, and desire to continue with activities. This study’s findings suggest that the integration of reminiscence arts initiatives into residential care plans for older adults with mild to moderate cognitive impairment can substantially enhance psychosocial quality of life. These findings are consistent with reminiscence and life review theory in that intergenerational engagement in these processes promotes healthy aging. This study demonstrated that intergenerational connection between young and older adults through drama and storytelling activities occurred. The creative reciprocal initiatives of reminiscence arts in turn fostered a context for social and emotional engagement that appeared to reduce older adults’ isolation. / Graduate