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

Despite extensive research in the field of aging neuroscience, it still remains unclear whether age related cortical changes can be detected in different functional networks of younger adults and whether these networks respond identically to healthy aging. We collected high-resolution brain anatomical data from 56 young healthy adults (mean age = 30.8 +/- 8.1 years, 29 males). We performed whole brain parcellation into seven functional networks, including visual, somatomotor, dorsal attention, ventral attention, limbic, frontoparietal and default mode networks. We estimated intracranial volume (ICV) and averaged cortical thickness (CT), cortical surface area (CSA) and cortical volume (CV) over each hemisphere as well as for each network. Averaged cortical measures over each hemisphere, especially CT and CV, were significantly lower in older individuals compared to younger ones (one-way ANOVA, p < 0.05, corrected for multiple comparisons). There were negative correlations between age and averaged CT and CV over each hemisphere (p < 0.05, corrected for multiple comparisons) as well as between age and ICV (p = 0.05). Network level analysis showed that age was negatively correlated with CT for all functional networks (p < 0.05, corrected for multiple comparisons), apart from the limbic network. While age was unrelated to CSA, it was negatively correlated with CV across several functional networks (p < 0.05, corrected for multiple comparisons). We also showed positive associations between CV and CT and between CV and CSA for all networks (p < 0.05, corrected for multiple comparisons). We interpret the lack of association between age and CT of the limbic network as evidence that the limbic system may be particularly resistant to age-related declines during this period of life, whereas the significant age-related declines in averaged CT over each hemisphere as well as in all other six networks suggests that CT may serve as a reliable biomarker to capture the effect of normal aging. Due to the simultaneous dependence of CV on CT and CSA, CV was unable to identify such effects of normal aging consistently for the other six networks, but there were negative associations observed between age and averaged CV over each hemisphere as well as between age and ICV. Our findings suggest that the identification of early cortical changes within various functional networks during normal aging might be useful for predicting the effect of aging on the efficiency of functional performance even during early adulthood.

Le partenariat est reconnu et promu par de nombreux scientifiques comme un mode de régulation sociale qui est appelé à remplacer les modes traditionnels de régulation axés sur la centralisation du pouvoir. Les conditions de réussite du partenariat sont largement documentées. Pourtant, le débat reste ouvert concernant l’efficacité ou non de ce type d’arrangement social et les dérives auxquelles il peut donner lieu. Cette thèse de doctorat représente le produit de l’analyse d’une expérience partenariale sous l’angle des compromis sociaux. Le partenariat analysé a été le dispositif utilisé par la première communauté au Québec ayant adopté l’approche Vieillissement en santé (VES), qui fut conçue en 2008 et promue par l’Institut national de santé publique du Québec (INSPQ). La mise en œuvre de cette expérience a été réalisée par un établissement de santé d’une région semi-urbaine du Québec à travers un large partenariat territorial. La recherche s’est penchée sur la période comprise entre le lancement de la démarche en 2010 et la réforme du réseau de la santé et des services sociaux survenue en 2015. Les résultats de notre recherche montrent que, pour être possible et efficace, un partenariat doit être bâti sur une capacité collective à élaborer des compromis sociaux. Lorsqu’ils s’appuient sur la bonne volonté et la bonne foi de toutes les parties impliquées dans un projet commun et que tous les acteurs concernés sont engagés et participent de manière équitable à la démarche, les compromis sociaux issus du processus de négociation favorisent la réussite du partenariat. Cette thèse apporte une contribution aux travaux de réflexion autour du thème du vieillissement en santé et offre des pistes permettant de bonifier l’apport du partenariat proposé par cette approche comme mécanisme d’adaptation de la société au vieillissement général de la population. Les principaux compromis sociaux que notre recherche nous a permis d’identifier les suivants : (1) l’accord sur le partage de leadership entre les principaux acteurs, (2) l’entente sur la délimitation (ou la redélimitation) de l’expertise, du statut et du rôle de chaque acteur, (3) la réalisation du pragmatisme clairvoyant, (4) le principe convenu de décomplexification de l’accès à l’information, (5) l’instauration de l’habilitation mutuelle fonctionnelle, (6) le déploiement du décloisonnement sectoriel, et (7) l’accord sur la reconfiguration du territoire. Par ailleurs, la négociation de ces compromis sociaux fut rendue possible par différents facteurs d’ordre individuel, communicationnel, relationnel, organisationnel et procédural. Toutefois, les efforts des acteurs de terrain pour bâtir leurs relations sur des compromis sociaux ne peuvent compenser les lacunes dans la relation liant les instances de tutelle et leurs représentants locaux. Effectivement, tant pour leur déploiement et leur maintien que pour leur légitimation, les compromis sociaux obtenus localement ont besoin d’être soutenus par des compromis globaux institués entre les paliers gouvernementaux supérieurs et les instances locales. L’atteinte de ces compromis globaux se fait par le biais de structures intermédiaires de soutien et d’accompagnement permettant d’assurer un arrimage entre les approches de type top-down et celles de type bottom-up. / Abstract : Partnership is known and promoted by many researchers as a social regulation mode that can be called upon to become an alternative to traditional regulation modes based on the centralization of power. Conditions leading to a successful partnership are well known and documented. However, the debate remains open over the efficiency of this type of social arrangement and the failures to which it can give rise. The purpose of this doctoral thesis is to study a partnership experience carried out by the first community in Quebec to adopt the Vieillissement en santé (Healthy Aging) approach, which was developed in 2008 and promoted by the Institut national de santé publique du Québec (INSPQ). The implementation of this experiment was carried out by a health care center located in a semi-rural region in Quebec through a large territorial partnership. Our research focused on the period between the implementation of the Vieillissement en santé approach in 2010 and the reform of the health and social services network that took place in 2015. The results of our research show that in order to be conceivable and effective, a genuine partnership must be established on the collective capacity to reach social compromises. When they are based on the good will and good faith of actors that are motivated and really committed to a common project and able to participate equitably in the process, social compromises agreed upon by all parties by way of negotiation contribute to the fulfilment of the conditions that lead to a genuine and successful partnership. This doctoral thesis provides additional thought to the reflection on healthy aging and suggests some avenues to be explored to improve the contribution of the partnership that the Vieillissement en santé approach propose as an adaptation mechanism of the society to the issue of an ageing population. In the context of that experience, the following main social compromises were identified : (1) the agreement between the various actors regarding leadership; (2) the agreement about the delimitation or redelimitation of expertise, status and role of the different actors; (3) the achievement of farseeing pragmatism; (4) the application of the principle of decomplexification of access to information; (5) the implementation of functional mutual empowerment; (6) the implementation of sectorial decompartmentalization; and (7) the agreement pertaining to the reconfiguration of the territory. The negotiation of such social compromises was made possible by individual, relational, communicational organizational and procedural factors. However, efforts made by the actors from the community to establish their relationships on social compromises are not sufficient to compensate for the deficiencies in the relationship between the governing body and its local representatives. The preservation, legitimization and implementation of social compromises at the local level need to be supported by social compromises reached between the highest levels of government and local entities. These social compromises can be achieved through the establishment of intermediary structures of accompaniment and support that will insure the articulation between top-down and bottom-up approaches.

Research indicates that increased knowledge about the menopause transition positively impacts a woman’s attitude about this stage in her life, and a more positive attitude leads to less distress during the transition. However, there has been no research regarding how women gain this knowledge about menopause, what factors in her environment may hinder or assist her, or how women’s knowledge of menopause is leveraged by health care providers to help facilitate her menopause transition. The purpose of this research was to explore the self-directed learning actions of women regarding their search for information about menopause, and to understand what factors, if any, may have helped or hindered her search. A convenience sample of women 35-55 years of age was invited to participate in an online survey; a total of 227 usable responses were collected. Answers were analyzed by utilizing a simple frequency distribution to illustrate more and less common responses. Chi-square tests of independence were used to examine bivariate relationships, and content analysis was used to examine free response answers. The results of this study indicated that most women did not seek information about menopause on their own. Women who sought information were primarily motivated by symptoms: what to expect, symptom relief, or validation that their experiences were normal. This study also indicated that the most utilized resource for finding information was the Internet. It also found that women need more information from the health care community than they were receiving. Findings from this study suggest a need to continue to connect adult education with health promotion. Additionally, women had a need for greater interpersonal support and beneficial interactions with the health care community. Finally, this study demonstrated that women may benefit from the normalization of menopause as a social construct. Perhaps this could best be achieved through education within larger conversations about human reproduction and about natural aging.

Resilience has been suggestive of successful aging. However, the resilience literature lacks a well-developed theoretical model of resilience in later life for diverse groups. The purpose of this study was to examine and compare the resilience and its predictive factors in participants 60 years and older from the U.S. and Nepal. Secondary data from the Healthy Aging Research Initiative and newly collected data from Nepal were analyzed. Independent t-test using Welch’s test was used to assess the differences in resilience, functional activity, frailty, social support, personality, spirituality, physical health, and mental health of participants between the two countries. One-way analysis of variance and multiple comparisons of the groups using the Games-Howell post hoc test was conducted to assess the differences in resilience of participants across groups of ethnicities, frailty status, and religious attendance. Pearson correlations were used to assess the relationship of resilience with independent variables. Backward elimination regression was used to identify the predictive factors of resilience. The model fit for the constructed conceptual model in the study was tested by Structural equation modeling. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2021. / FAU Electronic Theses and Dissertations Collection

Worldwide we are becoming witnesses to trend leading to rising number of people living to an older age. Focus of the research changes compared to previous studies in last few decades which studied the pathological aging and shifts to identification of factors leading to healthy (also "successful" aging). The focus is thus on finding the definition of successful and unsuccessful aging, so we would be able to timely identify the risks connected with aging and their influence on health or the level of quality of life. In connection with this, new concepts are becoming known, meaning "SuperAging" and "SuperAger" (SA). SuperAging is a phenomenon presenting successful (also as healthy) aging. SuperAger is the given individual, who is successfully (also as healthy) ages. In the theoretical part of the submitted thesis is presented the summary of findings in the field of neuropsychological changes connected with aging. The concept of successful (or healthy) aging is presented and the methodology of cognitive deficit detection in old age is described. The research part presents the summary of four studies following two main objectives. In the first part, we focused on improvement of conditions of neuropsychological clinical diagnostics by expanding the available diagnostic tools usable in the environment of...

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Background: Given the growing aging population, it is crucial to better understand the neurobiological underpinnings of healthy aging and how changes in structure relate to changes in function. The current study derived diffusion tensor imaging (DTI) metrics of white matter microstructure in younger and older adults to simulate the healthy aging process. Methods: The DTI metrics of fractional anisotropy (FA) and mean diffusivity (MD) as well as the cognitive domains of memory and executive function were examined in 34 healthy participants divided into older adults (17; Mean = 70.9, SD = 5.4) and younger adults (17; Mean = 28.1, SD = 2.8). Cognitive performance on the California Verbal Learning Test 2nd Edition (CVLT-II) and the trails making test (Trails-A & Trails-B) were used to evaluate memory and executive function, respectively. The differences in white matter microstructure between older and younger adults were analyzed using tract based spatial statistics (TBSS; p < 0.05, corrected for multiple comparisons) in FSL. Associations between the DTI metrics and cognition were then evaluated for each group. Results: Older adults had lower FA and higher MD in diffuse brain regions, including major tracts such as the corticospinal tract, corpus callosum and superior and inferior longitudinal fasciculi. There was a significant negative correlation between executive function and MD in the right superior and anterior corona radiata and the body of the corpus callosum of older adults. No significant relationship was detected between memory performance and DTI metrics in older adults. Furthermore, no significant relationships were detected between memory or executive function performance and FA or MD in younger adults. Conclusions: The differences in DTI metrics between groups as well as the association between MD and executive function support further examinations into the healthy aging process. Future studies should use longitudinal designs with large sample sizes to better understand changes and trajectories during healthy aging. / Graduate / 2023-08-19

Little is known about the relative influence of age-differentiated leadership on healthy aging at work. Likewise, the age-conditional influence of age-differentiated leadership is understudied, and especially so in the context of the COVID-19 pandemic. Using a three-wave longitudinal study, we examined the role that age-differentiated leadership plays in the prediction of work ability, as measured three times over six months (n = 1130) during the early stages of the COVID-19 pandemic in Germany (i.e., December 2019, March 2020, and June 2020). The results suggest that although there were no systematic changes in work ability on average, there was notable within-person variability in work ability over time. Additionally, we find that a balanced approach to age-differentiated leadership that considers the needs of both older and younger employees matters most and complements the positive influence of leader–member exchange for predicting within-person variability in work ability. We also find that older employees’ work ability benefits from an approach to age-differentiated leadership that considers older employee’s needs, whereas younger employees’ work ability especially benefits from leader–member exchange and a balanced approach to age-differentiated leadership. Overall, these results provide initial support for the idea that an age-differentiated approach to leadership is important when considering healthy aging at work.

The older population in Thailand is growing, and the number of older people who suffer from health problems is increasing as well. The health situation of the older population challenges healthcare providers to care for older people. Healthy aging is key to promoting the health of older people and sustaining their well-being. However, little is known about healthy aging in Thailand, especially in northeastern Thailand, or the Isan region, where the number of older people is increasing. Thus, this thesis aims to understand the factors associated with perceived health and healthy aging and how older people and their relatives in the Isan region conceptualize healthy aging. This thesis also focuses on how community nurses experience the meaning and promotion of healthy aging in this region. This thesis includes four studies. The first is a quantitative cross-sectional study with 453 participants aged 60 years or older. The second and third studies are qualitative with a phenomenographic approach that is based on lifeworld theory. Participants in the second and third studies include 17 older people and 14 relatives who are responsible for caring for older people, respectively. The fourth study is a qualitative study that involves focus group interviews with 36 community nurses who work with older people in the Isan region. The findings of the first study show a variance (24.3%) in perceived health and healthy aging based on residential area, marital status and disability status. The meaning of healthy aging, which was derived from the second, third and fourth studies, was divided into three domains: being interconnected; being able to do something good and feeling strong; and thinking beyond the capacity and functions of body and mind. The promotion of healthy aging was described as “providing health assessments”, “sharing knowledge”, and “having limited resources”. The findings of the first study revealed the key factors that will help healthcare providers promote healthy aging. The findings of the second, third and fourth studies revealed that older people, their children and grandchildren, and community nurses attach different meanings to healthy aging. The finding regarding promotion of healthy aging emphasizes that the person-centredness should be integrated in practice when promoting healthy aging. The results of this thesis will be useful to policymakers, who can apply this enhanced understanding of healthy aging to develop healthcare practices that promote healthy aging.