Cannabis is increasingly accessible in the United States for recreational and/or medical use. Additionally, the Baby Boomer birth cohort exhibits a greater prevalence of cannabis use than prior generations of older adults. Past research has most frequently addressed the potential cognitive effects of cannabis use in populations of adolescents and young adults. Some of these studies suggest that cannabis use is chronically associated with worse performance on tasks of verbal working memory and executive functioning, however, due to methodological variation and a wide variety of potential confounds including duration of abstinence and frequency of use, results are still inconclusive. Through use of a longitudinal, publicly available secondary dataset, the Health and Retirement Study, immediate, delayed, and working memory were evaluated in older adults who have used cannabis within the past year, within their lifetime but not the past year, and those who have never used. Uncontrolled, one-way ANOVAs and controlled ANCOVAs were used to examine these effects. When controlling for age, gender, education, and race, current frequent users demonstrated significantly worse immediate memory performance than past and non-users. Results suggest that greater than weekly cannabis use may result in attentional and short-term memory deficits. Further, these effects may be mitigated by sustained abstinence over time. Certain limitations including sample size and measures of cannabis use warrant future studies to replicate and build upon these findings.

ABSTRACT Introduction: An increase in the population of older adults is a growing public health concern. Health promotion and prevention programs provide a myriad of physical, social and psychological benefits for older adults, and recent health care trends has seen the emergence of Emergency Medical Services (EMS) in providing these programs. However, to date little is known about these programs, commonly titled, “community paramedicine”. Methodology: This study utilized a mixed methods, interpretivist qualitative approach to understand older adults experiences with a novel community paramedicine program, the Cardiovascular Health Awareness Program by EMS (CHAP-EMS), operating in a subsidized housing building in Hamilton. Participant observation and semi-structured interviews were conducted with participants of the program in addition to surveys of non-participating building residents. Data was analyzed using thematic analysis. Results: Six themes arose from the participant data including: filling the health care gap; motivators to attend; relationships between the paramedics and participants; social connectedness; the added value of EMS skills; and changes due to the program. Conclusion: Community paramedicine programs may provide older adults with access to social support, opportunities for social engagement and a reliable environment to discuss their health. However, barriers such as conflict between residents, conflicting beliefs of the program, and language barriers may impede participation in this initiative if left unaddressed. / Thesis / Master of Arts (MA)

Con los recientes acuerdos del gobierno peruano con los laboratorios Sinopharm, Pfizer y Astrazeneca para la adquisición de vacunas contra la COVID-19, surge la pregunta de si un número suficiente de personas estarían dispuestas a ser inmunizadas para controlar la pandemia y la manera de garantizar que la población esté adecuadamente informada sobre la vacuna1.

No description available.

Diabetes (DM) and hypertension (HTN) are prevalent chronic diseases among older adults. For example, in the U.S., 1 in 4 older adults have DM, 3 in 4 have HTN and 1 in 6 have DM and HTN. Moreover, each year, health care costs attributable to DM and HTN are estimated at $327 billion and $131 billion USD respectively. Both diseases also impose tremendous burden on the health and well-being of older adults. For example, gait speed (GS) is reduced in older adults with DM or HTN compared to older adults without DM or HTN. Gait speed is a powerful indicator of health status among older adults. Reduced GS predicts various adverse health outcomes including falls, frailty, cognitive impairment, reduced quality of life, hospitalization and even death. Moreover, adequate GS is required to safely execute daily activities. For example, GS of 1.14 m/s or faster is required to safely cross the street. Reduced GS in older adults with DM or HTN can partly be explained by multimorbidity (e.g., older adults with DM are at increased risk of developing HTN) as well as complications that are frequently associated with DM and HTN. For example, older adults with DM or HTN are at increased risk of developing peripheral artery disease, which causes reduced lower extremity muscle strength and pain, as well as retinopathy, which causes vision impairment. Additionally, older adults with DM are at increased risk of developing peripheral neuropathy, which causes pain and impaired balance. Although the physiological mechanisms of these complications are largely understood, research is needed to determine the extent to which these complications contribute to GS decline among older adults with DM, HTN or DM and HTN. The overarching objective of this thesis was to examine how multimorbidity patterns (i.e., types/combinations of chronic diseases), and sensory and motor impairments impact GS in older adults with DM, HTN or DM and HTN. This thesis also examined how GS changes over time (i.e., trajectories) in this population. This thesis is comprised of 3 manuscripts and was conducted using data from the National Health and Aging Trends Study (NHATS); a large, nationally representative sample of American older adults. Annual data collection began in 2011 and is ongoing. In 2015, the NHATS was replenished with approximately 50% new participants, to account for death and loss-to-follow-up. Therefore, data was analyzed in two cohorts: cohort A (individuals recruited in 2011) and cohort B (individuals recruited in 2015 and individuals recruited in 2011 who remained in the sample at the time of replenishment). In manuscript 1, latent class analysis was performed to identify multimorbidity patterns in older adults with DM, HTN or DM and HTN. Additionally, analysis of covariance (ANCOVA) was conducted to examine differences in GS among these multimorbidity patterns. This study identified a total of nine multimorbidity patterns in cohort A: two patterns in older adults with DM (low multimorbidity and cardiovascular-joint multimorbidity), three patterns in older adults with HTN (low multimorbidity, psychological multimorbidity and cardiovascular multimorbidity) and four patterns in older adults with DM and HTN (metabolic-cardiovascular-psychological-joint multimorbidity, metabolic-bone-joint multimorbidity, metabolic-cardiovascular-joint multimorbidity and metabolic multimorbidity). Additionally, this study identified a total of ten multimorbidity patterns in cohort B: two patterns in older adults with DM (low multimorbidity and joint multimorbidity), four patterns in older adults with HTN (cardiovascular-joint-respiratory multimorbidity, cardiovascular multimorbidity, psychological-joint multimorbidity and joint multimorbidity) and four patterns in older adults with DM and HTN (metabolic-cardiovascular-joint-respiratory multimorbidity, metabolic-psychological-joint multimorbidity, metabolic-bone-joint multimorbidity and metabolic-joint multimorbidity). Overall, multimorbidity patterns with larger numbers of chronic diseases patterns or patterns that included depression or anxiety were associated with the slowest GS. In manuscript 2, multinomial logistic regression was used to conduct state-based analyses which examined the relationship between impairments (i.e., hearing, and vision impairment, pain, balance, and lower extremity strength impairment) and GS transitions (i.e., fast to, intermediate walker, intermediate to slow walker etc.) in older adults with DM, HTN or DM and HTN. Balance and lower extremity strength impairment were associated with an increased risk of GS decline (i.e., transitioning from an intermediate to slow walker). Moreover, older adults with vision, hearing, balance, or lower extremity strength impairment and those who used pain medication at least 5 days/week were more likely to be slow walkers at baseline and remain slow walkers at follow-up. In manuscript 3, group-based trajectory modeling was used to identify longitudinal trajectories of GS in older adults with DM, HTN or DM and HTN. Multinomial logistic regression was then conducted to examine the correlates of these trajectories. This study identified four GS trajectories in both cohorts: i) fast-stable GS, ii) intermediate GS with slow decline, iii) intermediate GS with moderate decline and iv) slow GS with fast decline. Additionally, one trajectory was unique to cohort A: intermediate-stable GS and two trajectories were unique to cohort B: fast GS with slow decline, and intermediate GS with fast decline. In both cohorts, individuals who were older, Black (non-Hispanic), had a higher number of chronic diseases or higher body mass index (BMI) were more likely to belong to a trajectory group with faster GS decline. Conversely, individuals with higher education, or higher baseline GS were less likely to belong to a trajectory group with faster GS decline. From a population health perspective, findings from this thesis can inform large-scale monitoring and management strategies to mitigate GS decline in older adults with DM, HTN or DM and HTN. For example, individuals who are older, identify as Black non-Hispanic or those with a higher number of chronic diseases or higher BMI may benefit from more frequent monitoring of their GS. Moreover, findings from this thesis can be used to determine how older adults with different multimorbidity patterns, or different types of sensory and motor impairments respond to interventions. Lastly, older adults with DM and/or HTN should be educated about the importance of maintaining their GS as they age to prevent adverse outcomes including falls, hospitalization, and premature death. / Thesis / Doctor of Philosophy (PhD) / Diabetes and hypertension are common chronic diseases among older adults globally. Moreover, these two chronic diseases are frequently found in the same individual due to shared risk factors including physical inactivity, and family history. Additionally, older adults with diabetes and/or hypertension are at risk of developing complications including vision loss, heart disease and stroke. These complications often cause impairments (i.e., changes in body structure or function) which also occur with aging including vision and hearing impairment, pain, and balance impairment which may reduce physical function (e.g., walking speed). There is a need for research to examine which other chronic diseases are linked to diabetes and hypertension and the impact of these diseases and disease-related impairments on walking speed among older adults with diabetes and/or hypertension. Moreover, it is important to examine how walking speed changes over time (i.e., trajectories) in older adults with diabetes and/or hypertension. Results from this thesis show that older adults with diabetes and/or hypertension who used pain medication at least 5 days/week, had vision, balance, or lower extremity strength impairment as well as older adults who are female, Black non-Hispanic, had a higher number of chronic diseases and a higher body mass index were at greatest risk of reduced walking speed. On the other hand, higher education and higher baseline walking speed were linked to lower risk of walking speed decline. Older adults who were identified as “high-risk” may benefit from closer monitoring and management of their walking speed to prevent further decline.

Family caregivers of older persons with dementia (PWD) and multiple chronic conditions (MCC) provide high levels of in-home care. Caregiving is complicated by transitions such as changes to one's environment, roles, relationships, and overall health. Although PWD often have MCC, few studies have focused on the influence of MCC on dementia caregiving and transitions. The purpose of this study was to explore the transition experiences of caregivers of PWD and MCC. This study is a sub-study of a larger pragmatic mixed methods randomized controlled trial called MyTools4Care (MT4C). Using interpretive description methodology, semi-structured interviews were conducted across Ontario with a subset of caregivers (n=19) and clinicians working with dementia caregivers (n=7). Purposive theoretical sampling and concurrent data collection and analysis were used. Participants described their transition experiences, factors that influenced these experiences, potential outcomes of transitions, and the influence of MCC on dementia caregiving. Participants identified five key transitions which included: (a) There's no turning off (progressive increase in responsibilities); (b) I'm filling in many roles (changes in roles and relationships); (c) I'm sick, too (changes in overall health and well-being); (d) Dementia defines my social life (changes in social boundaries), and; (e) I know that day will come (changes in preparing for the future). Study findings emphasized how the co-existence of dementia and MCC resulted in added complexity and burden to care management and decision-making for caregivers. Findings suggest that health care professionals (HCP) are an important extension of caregivers' support networks. Thus, HCP need to be comfortable, trained, and knowledgeable in diagnosing and managing dementia and MCCs in order to support caregivers in their transitions. Future research should explore the experience of dementia within the broad context of MCC in order to understand the impact on the dementia caregiving experience. / Thesis / Master of Science (MSc)

The objectives of the present dissertation were: (1) determine the relationships between time use in physical vs social leisure activities (PLA - SLA), and cognitive vs emotional leisure activities (CLA - ELA) by older adults age cohort (60-69, 70-79 and 80-plus yrs.); (2) ascertain the role of sex in moderating the relationship between time use in PLA-SLA and CLA-ELA by older adults age cohort; and (3) assess how employment status mediates the relationship between time use in PLA-SLA and CLA-ELA by older adults age cohort with moderation by sex. Secondary data was obtained from the 2019 American Time Use Survey database. Applying a cross-sectional design, data were analyzed using a linear regression model in SPSS version 27 and PROCESS Macro with Hayes Model 1 and 59. We identified the extent of the conditional indirect moderation effect of sex and the indirect employment status mediation effect moderated by sex in the relationship between PLA-SLA and CLA-ELA by older adult age cohorts. An index of moderated mediation was used to test the significance of each effect. The 80-plus yrs. cohort SLA time use was greater than in PLA across cohorts. Sex moderation showed a stronger effect in men by substantially decreasing their engagement time in PLA than in women across cohorts. A non-significant moderated mediation effect in SLA and PLA across age cohorts was observed. Women had the lowest minutes of engagement in both ELA and CLA compared to men. Sex moderation showed a more substantial negative effect on ELA and CLA in men than women. Finally, a significant moderated mediation effect in ELA and CLA across age cohorts was observed, where the mediation effect was stronger for males than females. Our findings indicate age cohort and sex effects on time engagement in both SLA-PLA and ELA-CLA, likely tied to sex roles that amplify at an older age. Sex effects in both ELA and CLA by age cohort appear not immutable in the life span and to equate among the oldest old, suggesting compression of leisure use in later years of life. Work participation is important for ELA and CLA among older adults, but not their SLA and PLA, which is likely explained by the loss of workplace social networks with retirement. Our findings suggest a need for aging well-being policies and initiatives to focus on older adults leisure participation variations within cohorts by sex and work life for optimally targeted interventions.

Age-related structural and molecular changes in older adults have been shown to significantly affect their cognitive and motor functions (Trollor and Valenzuela, 2001). Given the growing population of older adults, it is imperative to bridge the gaps in scientific understanding of cognition and motor capabilities in healthy older adults’ population. This study investigates five major neurochemicals and their potential correlations with gait, balance, executive function, and attention in healthy older adults. Additionally, we explore the interplay between cognition and motor performance in our participants. Furthermore, we hypothesize that the neurochemical values of interest may serve as predictive indicators for motor performance and cognition in healthy older adults.

No description available.

No description available.