Current therapeutic recreation research does not articulate how Certified Therapeutic Recreation Specialists (CTRS) complete the assessment process with older adults. A review of published research demonstrates various uses of theories, methodologies, unclear descriptions of populations of studies, and unknown competencies of researchers. The purpose of this study was to explore what current assessment practice looks like for CTRS’s that work with an older adult population. The study was guided by the principle of participatory action research and was completed with four participants using a semi-structured focus group. The participants’ experiences revealed complexities in practice that were interwoven with each other. Time, challenges in practice, building capacity with clients and other TR practitioners along with evidence based practice were key issues. Recommendations as a result of this study include further development of diagnostic protocols and practice-based evidence to inform clinical decision making.

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The purpose of this study was to investigate the relationship between personal factors and perceived built environmental factors and walking behaviour among middle-aged and older adults. The sample consisted of 647 people aged 45 years and above. Walking behaviour was assessed using pedometers. Decreased walking was significantly associated with increased age (r=-0.366, p<0.001). Education level (F=4.13, p=0.016) and self-rated health status (t=6.07, p<0.001) were positively associated with walking. When considering the effect of age, education level was no longer associated with walking. Better perception of general safety (F=3.105, p=0.005) and fewer safety concerns (F=7.531, p=0.001) were positively associated with walking. Age and self-rated health status jointly contributed to the walking behaviour (p<0.001), explaining 16.2% of the variance. These findings may suggest future neighbourhood interventions for age-friendly communities in Winnipeg, and help to accommodate changes through addressing perceived neighbourhood safety concerns and facilitating increased physical activity among middle-aged and older adults.

Relocation to a personal care home is a stressful experience and may occur at a traumatic moment in life. The effects of relocation to a PCH on nutritional status are unknown, yet under-nutrition is common among PCH residents. Objectives: To explore the effect of relocating to a PCH on the nutritional status, eating habits, and nutrition attitudes of adults aged 60 years and older. Methods: Fourteen Caucasian older adults (F = 57%) with a mean age of 83 years (SD = 9.79) consented to participate. Sixty-four percent of participants experienced inter-institutional relocation. Anthropometric, biochemical, clinical and dietary information was collected at Time Points A (2-3 months following relocation) and B (6-7 months following relocation) through face-to-face interviews, medical chart reviews and communications with nursing staff. Results: At Time B, cognitive function declined (z = -2.185, p < .05) and the number of medications prescribed increased (z = -2.00, p < .05). Levels of 25-hydroxyvitamin D were insufficient among 83% of participants at both time points. Mean serum albumin was 34.4 ± 7.2 g/L at Time B and the prevalence of nutritional risk increased from 57% to 77%. Dietary intake was inadequate according to Canada’s Food Guide recommendations. Nutrition attitudes did not change. Implications & Conclusions: Six months following relocation, nutritional risk was more prevalent, with early evidence of possible protein-energy malnutrition. Nutritional inadequacies may result if dietary intakes do not improve. A collaborative approach is needed to assess environmental, psychosocial and nutritional factors that contribute to poor dietary intake and will assist in the development of an intervention program.

Hand grip strength (HGS) is a new nutritional assessment parameter proposed by American Society for Parenteral and Enteral Nutrition (ASPEN) and the Academy of Nutrition and Dietetics (the Academy) for diagnosis of adult malnutrition related to acute illnesses, chronic diseases or starvation. Identification of ≥2 of the following conditions is considered to be malnourishment – weight loss, loss of muscle mass, loss of subcutaneous fat, fluid accumulation, diminished HGS and inadequate energy intake. HGS is also a marker of sarcopenia, a condition defined by low muscle mass and low muscle strength or performance, as identified by the European Working Group on Sarcopenia in Older People. It has also been shown that lower HGS is associated with deficits in activities of daily living (ADL) and mobility. HGS is emerging as an important screening tool especially in the malnourished and aging population. This research evaluates the applicability of HGS as a nutrition screening tool in long-term care older adults. Data from a total of 129 participants age ≥60 years involved in an ongoing walking program in long-term care facilities in Saskatoon available for analysis at the time this work was undertaken. Participants were randomly assigned for an intervention period of 16 weeks to one of three study groups: 1) Usual Care Group, 2) Interpersonal Interaction Group, and 3) Walking Program Group. Activity of daily living, cognition and depression scores and hand grip strength were recorded at baseline and every eight weeks. Information on vitamin D intake status prior to study commencement was also collected. This study provides values of low grip strength similar to those defined for the risk of sarcopenia in frail older adults. Stronger baseline HGS was correlated with greater ADL independence in females (B=0.079, P=0.044). Greater ability to eat at baseline was also associated with stronger grip in females when cognition status was taken into consideration. Baseline ADL (B=-0.024) and HGS (B=1.004) were significant predictors of subsequent ADL and HGS, respectively, in males (P<0.01). Baseline HGS was associated with subsequent ADL and HGS in females, but such association was modified by other covariates. In summary, if grip strength is to be used as a nutritional screening tool in long-term care facilities, dietitians shall be cautious of other factors such as the residents’ cognitive status and age and use in conjunction with other nutrition assessment methods.

The purpose of this study was to investigate the relationship between personal factors and perceived built environmental factors and walking behaviour among middle-aged and older adults. The sample consisted of 647 people aged 45 years and above. Walking behaviour was assessed using pedometers. Decreased walking was significantly associated with increased age (r=-0.366, p<0.001). Education level (F=4.13, p=0.016) and self-rated health status (t=6.07, p<0.001) were positively associated with walking. When considering the effect of age, education level was no longer associated with walking. Better perception of general safety (F=3.105, p=0.005) and fewer safety concerns (F=7.531, p=0.001) were positively associated with walking. Age and self-rated health status jointly contributed to the walking behaviour (p<0.001), explaining 16.2% of the variance. These findings may suggest future neighbourhood interventions for age-friendly communities in Winnipeg, and help to accommodate changes through addressing perceived neighbourhood safety concerns and facilitating increased physical activity among middle-aged and older adults.

Relocation to a personal care home is a stressful experience and may occur at a traumatic moment in life. The effects of relocation to a PCH on nutritional status are unknown, yet under-nutrition is common among PCH residents. Objectives: To explore the effect of relocating to a PCH on the nutritional status, eating habits, and nutrition attitudes of adults aged 60 years and older. Methods: Fourteen Caucasian older adults (F = 57%) with a mean age of 83 years (SD = 9.79) consented to participate. Sixty-four percent of participants experienced inter-institutional relocation. Anthropometric, biochemical, clinical and dietary information was collected at Time Points A (2-3 months following relocation) and B (6-7 months following relocation) through face-to-face interviews, medical chart reviews and communications with nursing staff. Results: At Time B, cognitive function declined (z = -2.185, p < .05) and the number of medications prescribed increased (z = -2.00, p < .05). Levels of 25-hydroxyvitamin D were insufficient among 83% of participants at both time points. Mean serum albumin was 34.4 ± 7.2 g/L at Time B and the prevalence of nutritional risk increased from 57% to 77%. Dietary intake was inadequate according to Canada’s Food Guide recommendations. Nutrition attitudes did not change. Implications & Conclusions: Six months following relocation, nutritional risk was more prevalent, with early evidence of possible protein-energy malnutrition. Nutritional inadequacies may result if dietary intakes do not improve. A collaborative approach is needed to assess environmental, psychosocial and nutritional factors that contribute to poor dietary intake and will assist in the development of an intervention program.

It has been hypothesized that depression can be both a risk factor and a consequence of oral diseases. Tooth loss leads to discomfort, pain, and functional limitations which could lead to disability and, subsequently, to handicap. However, the association between depression and edentulism has not been established yet. Data from the Canadian Community Health Survey (CCHS) Cycle 2.1 were used to examine the association between edentulism and depression in community-dwelling Canadians 45 years of age and older. Separate logistic regression models were developed for dentate and edentulous groups as well. Different regression selection methods were implemented and the area under the ROC curve was used to select models with the highest predictability. Analysis showed that edentulism was not associated with depression. For the edentulous group, oral/facial pain was the only oral health factor predicting depression, whereas avoiding smiling or laughing, dry mouth, oral/facial pain predicted depression in the dentate individuals.

It has been hypothesized that depression can be both a risk factor and a consequence of oral diseases. Tooth loss leads to discomfort, pain, and functional limitations which could lead to disability and, subsequently, to handicap. However, the association between depression and edentulism has not been established yet. Data from the Canadian Community Health Survey (CCHS) Cycle 2.1 were used to examine the association between edentulism and depression in community-dwelling Canadians 45 years of age and older. Separate logistic regression models were developed for dentate and edentulous groups as well. Different regression selection methods were implemented and the area under the ROC curve was used to select models with the highest predictability. Analysis showed that edentulism was not associated with depression. For the edentulous group, oral/facial pain was the only oral health factor predicting depression, whereas avoiding smiling or laughing, dry mouth, oral/facial pain predicted depression in the dentate individuals.

Maintaining balance is controlled by two different processes: feedforward and feedback control. Feed-forward control is used prior to performing voluntary movements whereas feedback control is used to correct for unexpected perturbations. Studies suggested that age-related changes in postural responses may contribute to increased risk of falls in older adults. To address whether Tai Chi training can induce improved patterns of feed-forward control, voluntary arm elevations during standing were performed. Compared to age-matched controls, smaller displacements of the center of pressure were found among older adults who practice Tai Chi. This may suggest adapted feed-forward control induced by training. To investigate feedback control, perturbations were applied while walking with various arm constraints. Context-dependent modulation in response amplitude was found with changing levels of postural threat in older adults, comparable to young adults. Delayed onset latencies and frequent inhibition of Soleus may suggest less effective balance strategies employed in older adults, and an increased risk of falling. / Rehabilitation Science