Rising up from a chair (sit-to-stand; STS) and stair climbing are both activities of daily living (ADLs) done throughout our lives. The ability to complete ADLs is crucial for independent living. The goal of this thesis was to research how two ADLs interact with each other and affect postural control. It was hypothesized that an increased number of flights of stairs climbed would lead to a decline in postural control during/after a STS in older more than younger adults. Fourteen older adults and fourteen young adults were tested by completing three STSs before and after climbing 1, 3 and 5 flights of stairs, chosen at random. Movements of the center of pressure (COP) for each STS were obtained from a force platform. Only an age effect was found for COP velocity (left-right and anterior-posterior directions) during the momentum transfer phase, during stabilization and after stabilization. Therefore, contrary to our hypothesis, stair climbing did not lead to significant changes in COP movements during and following a STS.

It is well known that physical activity can bring many benefits to people as they become older. In addition, a great deal is known about the personal and environmental motivators and barriers for older adults engaging in physical activity, yet policy imperatives have failed to deliver the change in activity levels required to even relatively modest levels of activity. This study has sought to ascertain the effect of involving older adults in the design, delivery, implementation and promotion of interventions to promote physical activity amongst their age group. Through a two phase design the study has sought to find out what the essential ingredients of a successful intervention to promote physical activity would be, before applying some of these findings to the promotion of interventions and considering their effect. The first phase of the study consisted of a qualitative study to identify older adults’ views and experiences. Some 61 older adults, aged between 49 and 87 years, were involved in 11 focus groups and 12 individual semi-structured interviews. Participants were asked why they engaged in physical activities, or what might encourage them to do so. The study was designed to identify the essential elements of a successful physical activity intervention. The second phase of the study, an action research project evolving from the qualitative study, involved older adults who were running community groups and physical activity sessions in their local areas and were keen to increase membership numbers. The Action Research Group, consisting of six older adults, two community development workers and the researcher, identified a number of problems to address as part of the study. New promotional literature for the community groups was developed, using the findings from the first study. Easy access, enjoyment, fun and affordability were highlighted on posters and leaflets that were distributed in the local communities. The studies established that there are various factors that make engaging in physical activities accessible and appealing to older adults. Participants reported that activities must be flexible; affordable; accessible; sociable; enjoyable and that engagement is seasonal. Factors relating to personality and lifestyle were also important. Not feeling the need to be active, and being unmotivated to do so, cannot be easily influenced by external promotion of physical activity. However, ensuring that activities are as easy as possible to engage in could help to encourage older adults to try activities that they might otherwise rule out. The health benefits of physical activity were far less important to the participants than the social benefits. Involving older adults in the promotion of activities, focussing on the characteristics of activities that appeal to them, had some success. Difficulties in appealing to older adults across a broad age range emerged, as many participants in both studies were put off attending any activity labelled as for ‘over 50s’. They did not identify themselves as ‘over 50’. Both studies highlighted the additional difficulty of attracting men to existing activity groups and sessions. A multilevel, social ecological model is presented, which highlights the influences on engagement in physical activity at individual and environmental levels. The future promotion of physical activity should focus on the social benefits and enjoyment that can be gained through participation, rather than on potential health benefits. How activities are labelled and promoted requires careful consideration and local older adults should be involved in local interventions. Community groups delivering interventions must receive tangible support.

Encouraging older adults to become more active and maintain that activity is critical to the promotion of their health and well-being, social networks and independence. Leadership behaviour and quality of instruction is important in influencing engagement of older adults in exercise classes. Instructors' attitudes could influence older adults' uptake and adherence to classes, but little is known about the relationship between attitudes and characteristics of instructors and their delivery in relation to uptake and adherence of older adults to exercise classes. Methods: Underpinned by the Theory of Planned Behaviour and using a mixed methods approach this thesis uses three studies to:1) Survey 731 United Kingdom exercise instructors with Level 3 older adults exercise qualification to investigate instructors' characteristics and attitudes towards older-adults' participation in exercise. 2) Interview 19 instructors to further explore instructors' attitudes, experiences and beliefs in relation to their exercise classes for older adults and how their attitudes, experiences and beliefs are influenced by their training and characteristics.3) Follow up a cohort of 16 instructors and 193 of their class participants over 6 months to explore what characteristics of exercise instructors, the group and class participants influence adherence and also whether instructors influence uptake and adherence to home exercise. Results and Conclusion: The first study establishes that there is a relationship between instructors' training, experience, characteristics and their attitudes. The second study supports these findings and demonstrates how instructors' think that these factors and others not only influence how they deliver and promote their classes but also influence older adults' uptake and adherence to exercise classes. The final study enables us to look at the relationship between instructor variables and the participant within the exercise class setting. Class participants' mental well-being, education and housing were key factors related to their attendance. Having attended the class for more than six months at baseline was an important factor related to adherence. Individual factors such as participants' attitudes, beliefs about group cohesion and instructor variables such as personality traits and experience emerged in the final models both in relation to participant attendance and adherence. There are a series of complex interactions between the instructor, participant, the group and others which influences beliefs and attitudes. It is clear that the instructor can influence participants and they have an important role to play in creating an atmosphere and environment of which participants want to be a part of.

Previous research, as well as theory, has supported the existence of a relationship between death anxiety and loneliness in older adults but a causal examination has not been possible until now. A hypothesized model was developed which states that loneliness will lead to death anxiety mediated by cultural worldview. Longitudinal data was analyzed using Structural Equation Modeling in order to more fully explore this potentially causal relationship. The primary model was supported suggesting that loneliness can lead to death anxiety as mediated by cultural worldview. Implications and future directions are discussed.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21704号 / 人健博第70号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 青山 朋樹, 教授 黒木 裕士, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The study’s rationale: Physical difficulties as well as socio-psychological factors have an impact on the nutritional status and well-being of the elderly, leading to reduced capacity. In addition, feeding difficulties in the elderly after stroke or with illnesses – holding cutlery, bringing food to the mouth, chewing and swallowing –are a factor reducing independence and contributing to malnutrition. Aim: The aim of this study was to develop and evaluate the acceptability of proteinrich in-between recipes intended as fingerfoods for home usage among older adults with eating disabilities. Recipes intended for publication in a recipe book. Methods: Several prototypes per recipe were developed using the creative design method. Measurements on physical characteristics – firmness, stickiness, viscosity, colorimetry – as well as consumer tests at home – general appreciation, appearance, smell, taste, texture – were conducted. Results: The measurements of the physical characteristics helped to reduce the number of samples presented in the hedonic test. The laboratory measurements combined with the results of the hedonic tests (n= 57-77 participants) were used to determine the most suitable and appreciated recipe. The participants' comments enabled the improvement of the recipes. Conclusion. Four acceptable fingerfood recipes for in-between meal for older adults with eating disabilities were developed: blinis, pancakes, banana drinks, chocolate chip cakes. While the addition of spirulina is not appreciated, the addition of vanilla whey protein or sauce may be good both for acceptability and nutritional reasons.The higher the content of protein, the lower the firmness of the solid fingerfoods.Completing this study by ensuring acceptability and attractiveness among older adults with eating difficulties could confirm the recipes. / <p>ISBN: 978-91-87973-60-4</p> / Fingerfoods – en väg till ökad matglädje, ökad självständighet och ökat välmående bland äldre

This study of 535 older married couples examined the relationship between depression and health and sexual satisfaction directly and when mediated by communication. The sample included 535 older couples who completed a survey questionnaire known as Project Couple Retire. Among the items in the questionnaire were measures of depression, health, perception of sexual intimacy, communication and other demographic information. Results from Structural Equation Modeling indicated that for women, health was a significant predictor of sexual satisfaction. For both genders, the results suggest that depression, when mediated by communication, is a predictor of sexual satisfaction among older couples.

Footwear can affect postural stability in individuals, particularly in elderly people. Aging-related decline in postural stability, particularly in the mediolateral (ML) direction, is a risk factor for falls and fall-related injuries among older adults. This study aimed to investigate the effects of high cushioned and minimal shoes on dynamic postural stability in ML during obstacle crossing in defined older and younger adults. Six healthy older adults (50–60 years old, body weight: 74.8 kg, body height: 168.0 cm) and six healthy younger adults (18–32 years old, body weight: 73.8 kg, body height: 174.8 cm) participated in the study. A Vicon motion analysis system with 10 optical cameras was used to capture the obstacle (20 cm height) crossing motion of the participants at 200 Hz, and ground reaction forces of obstacle crossing were collected at 1000 Hz. Motion data of obstacle crossing were collected at three shoe conditions, namely, minimal shoe, high cushioned shoe and barefoot (control). Data from five trials of obstacle crossing for each shoe condition were processed using Vicon Nexus software 2.11.0 and Matlab R2013b. Displacement and velocity of centre of mass (COM) in the ML direction, COM–centre of pressure (COP) ML separation, step length, step velocity, toe clearance, pre-horizontal distance, hip flexion angle and hip abduction angle during obstacle crossing were examined. One-way ANOVA with pairwise analysis showed that toe clearance was significantly larger in the high cushioned shoe conditions than in the minimal shoe and barefoot conditions in older adults (high cushioned shoes vs. barefoot: p = 0.019; cushioned shoes vs. minimal shoes: p = 0.031) and younger adults (high cushioned shoes vs. barefoot: p = 0.016; high cushioned shoes vs. minimal shoes: p = 0.000). No significant difference in the measures was found between the minimal shoe and barefoot conditions in each group. Compared with older adults, younger adults showed significantly larger step length in barefoot condition (p = 0.000) and minimal shoe (p = 0.016). Independent t-test for examination of the significant difference of the means of each measure when the shoe condition was changed showed that only step length and step velocity were significantly different between older and younger adults. When the shoe condition was changed from minimal shoe or barefoot to high cushioned shoe, older adults showed significantly bigger change in step velocity (10.04 ± 4.39 cm/s for older; 1.87 ± 0.81 cm/s for younger; p = 0.034) and step length (14.26 ± 6.99 cm for older; 2.086 ± 1.13 cm for younger; p = 0.041) than younger adults. This result indicates that older adults had 23% greater total range of step length and 12% greater total range of step velocity compared with younger adults when shoe condition changed. Moreover, older adults showed 16% smaller total range in their maximal COM-COP ML separations than younger adults when shoe condition changed. It is concluded that high cushioned shoes can influence dynamic postural stability in the ML direction during obstacle crossing in younger and older adults. The minimal shoe and barefoot conditions did not show significant influence on postural stability in the ML direction during obstacle crossing in older and younger adults. The minimal shoe on dynamic postural stability in the ML direction is not significant. Age differences in dynamic postural stability in the ML direction during obstacle crossing were found at the same shoe conditions. Moreover, when shoe condition was changed, shoe cushioning conditions affected postural stability to a larger extent in older adults compared with younger adults. The high cushioned shoe led to a more challenged postural stability in adults aged 50 to 60 than younger adults aged 18 to 32.

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Sammanfattning Bakgrund: Äldre är en allt mer växande grupp i samhället då medellivslängden i Sverige har ökat. En stor del av världens äldre population är fysiskt inaktiv och drabbas av kroniska sjukdomar med ökad ålder. Detta har resulterat i en ökad belastning på sjukvården som kunde minska om fler äldre skulle delta i fysisk aktivitet. Syfte: Syftet var att undersöka vilka faktorer som upplevs påverka deltagande i fysisk aktivitet hos äldre som regelbundet tränar på Träffpunkter samt hur de upplever träningen som erbjuds där. Metod: En kvalitativ intervjustudie genomfördes. Informanterna bestämdes med ett strategiskt urval. Kvalitativ innehållsanalys har använts vid databearbetning.  Resultatsammanfattning: Individuella faktorer som obehagskänslor kopplade till fysisk aktivitet och nedsatt kroppsfunktion nämndes som utmaningar för deltagande. Informanterna beskrev att det krävs flexibilitet och anpassningsförmåga utav individen samt att det krävs att samhället anpassar utbud och resurser till den äldre populationen. Informanterna i studien motiverades av positiva effekter av träning samt uppskattade den anpassningsbara träning och det sociala utbytet som Träffpunkten erbjuder. Slutsats: Äldres deltagande i fysisk aktivitet påverkas av faktorer på individnivå som obehagskänslor, funktionsbegränsningar och flexibilitetsförmåga. Dessa faktorer samspelar med faktorer på samhällsnivå som anpassad träning, lokalutformning och transportmöjligheter. Träningen på Träffpunkter anses vara anpassningsbar och bidra till en social samvaro som underlättar deltagandet i fysisk aktivitet. Ett större utbud av träningsformer skulle kunna öka motivation för deltagande i fysisk aktivitet. Mer forskning inom området behövs. / Abstract Background: Older adults are a growing population in society as the life expectancy increases in Sweden. Many are physically inactive and are exposed to chronic diseases. This has resulted in a considerable load on healthcare which could be decreased if this group would increase their physical activity. Aim: The aim of this study was to explore factors that affects participation in physical activity for older adults that are exercising regularly at Träffpunkter and their experience of the exercise provided. Method: A qualitative interview study was used. Participants were selected using a strategic sample procedure. A qualitative content analysis approach was used for data analysis. Results: Individual factors such as negative feelings linked to physical activity and reduced bodily function, were mentioned as challenges to participation. Participants expressed that they need to be flexible to overcome barriers and that the society need to provide accessible and adjustable exercise. The motivators were similar for all participants such as the positive effects of exercise and they appreciated the adjustable training and the social climate at Träffpunkten. Conclusion: Factors that affects participation in physical activity are factors relating to the individual such as negative feelings, physical limitations and flexibility. They interact with environmental factors such as facility- and exercise design and transportation. Träffpunkter are viewed to provide adjustable training and a positive social climate. A increased variety of exercise could motivate participation in physical activity. More research in the field is needed.