Opioids are the most powerful pain relievers currently known (Huang & Mallet, 2013) and opioid abuse is considered a significant public health crisis (Pezalla, Rozen, Erensen, Haddox, & Mayne, 2017). Older adults face elevated risks for opioid abuse given the unique pain reported by many late adults (Wilder-Smith, 2012) and the potential for overuse of opioids is especially high given the growing population of older adults in the U.S. (Centers for Disease Control and Prevention, 2003). This project aims to explore the trends of opioid use and abuse by older adults and how to manage this growing epidemic by examining a multitude of options including the marketing of opioids, different addiction treatments, and other solutions.

Purpose: The concept of aging at home is one that has seen massive gains in popularity amongst older adults in the last few years, especially with the advent of technologies that help them maintain autonomy and functional independence. However, in order to support such an endeavor and ensure the safety and well-being of older adults who choose to partake, an analysis of the concept of home and its many facets should be explored, including its relationship with technology. The aim of this research was to develop a model of the relationship between wellness technology and experiences of home for older persons and examine the role of loneliness (as an important component of wellness) in this relationship. The project addressed the following research questions: (i) Does technology influence experiences of loneliness in older adults? (ii) How does loneliness affect an older adult's experience of home? Methods: A mixed methods study was used that included Go-Along interviews with 15 older adults receiving services from a unique, older adult centered facility in Ottawa, the Perley Rideau. Services at the Perley Rideau include but are not limited to providing short term care, long term care, as well as independent senior living apartments. Participants completed a number of scales that assessed their attitudes towards technology as well as their levels of loneliness. After conducting an initial round of interviews, participants were introduced to a wellness technology called WellAssistTM. They were asked to use the technology for a period of three months after which an exit interview was conducted. The exit interview included an additional Go-Along interview, a loneliness assessment, and administration of the Psychosocial Impact of Assistive Devices Scale (PIADS) to examine the user's perceptions about the effects from using the WellAssistTM. Twelve participants completed the exit interview. Results: The pre and post intervention analysis of the UCLA Loneliness scale showed a statistically significant decrease in loneliness scores with increased usage of the wellness technology, WellAssistTM. The thematic analysis of our interviews showed that loneliness affected the experience of home in the following way(s); diminished connection to home and feelings of home which negatively impacted the older adult's overall experience of home. Discussion: The findings suggest that wellness technology can have an impact on the older adults' experience of home by reducing loneliness and improving their overall state of wellness. Further research is needed to explore how such results would carry over onto larger sample populations as well as to explore the direct of relationship between technology that promotes wellness and the older adult's experience of home.

Older adults living with frailty have increased healthcare needs, but require accurate identification for optimal care; nurses’ screening practice is unclear. This cross-sectional survey explored nurses’ frailty screening practices and barriers/facilitators in acute care. Descriptive statistics were generated from 5-point frequency and 101-point scales of frailty screening methods; practice areas were compared using linear regression. Means for barriers and facilitators were generated from a 43-item 6-point Likert-type Theoretical Domains Framework questionnaire. Respondents (n = 228) reported “usually” screening by clinical impression (median = 4, interquartile range = 4-5) and preferring it to formal frailty tools (M = 67.1, SD = 25.7). Practice area influenced general frailty screening (B = 0.81, r = .31, p < .001). The top barrier was belief conducting frailty screening was routine (M = 2.68, SD = 1.42, p > .05). Frailty screening tools supporting clinical judgement and embedded into routine have greater likelihood for uptake.

With our global aging population, low muscular strength and function significantly impact an older adult’s capacity to remain independent. Older adults experience gradual declines in physical function and mobility leading to difficulty completing activities of daily living. These difficulties are conceptualized as an expression of mobility disability or through diagnoses of clinical geriatric syndromes such as frailty. Aging physiology in the musculoskeletal system clinically translates into declines in physical function due to losses in muscular strength. Preventative interventions may be appropriate as failing to intervene until critical thresholds are reached will increase healthcare expenditure. Resistance training is a highly beneficial, cost-effective, conservative strategy for community-dwelling older adults to optimize physical resiliency through increasing muscular strength and function lost due to aging, sedentary behaviour and/or physical inactivity. Resistance training needs to be dosed appropriately for function to improve, but clinicians rarely prescribe high-load resistance training with older adults, especially those at risk for mobility decline and frailty. The overarching goal of this thesis was to evaluate the role of resistance training in managing mobility disability and prefrailty. This thesis is comprised of three studies to address this goal: (1) The role of resistance training to improve or prevent mobility disability in community-dwelling older adults: a systematic review and meta-analysis. (2) The use of High- Intensity Enhanced Resistance Training (HEaRT) to optimize independence and quality of life in older adults with or at-risk of mobility disability: a pilot randomized controlled trial. (3) An Ounce of Prevention: a substudy of pre-frail older adults from the HEaRT pilot randomized controlled trial. / Thesis / Candidate in Philosophy / As people get older, the amount of muscle they have, and their strength start to decrease. When too much strength is lost, individuals can begin to have difficulties completing tasks around their home or can be at risk for developing health issues such as disability and frailty. Strength training has been one way proposed to increase strength and physical function for those at risk for mobility disability and those at risk for frailty (prefrailty). This strength training is often of low intensity despite guidelines advocating for higher-intensity exercise. This thesis evaluates the benefit of strength training, specifically using high-load, for those with mobility disability and the safety and feasibility of high-intensity resistance training for those with prefrailty and those at risk for or with established mobility disability.

No description available.

No description available.

Social support is a key factor influencing older adults’ health and well-being. Disclosing one’s lesbian, gay, or bisexual identity at any age has great potential for altering, if not destroying, existing relationships with family, friends, and others. With long-established social roles and personal relationships, the potential risks may be accentuated for those who come out in mid- or later-life. Yet, researchers have paid scant attention to this phenomenon. This exploratory qualitative study examines the impact of coming out “late” on older adults’ social networks. In-depth interviews were conducted with a sample of fourteen older adults who disclosed their non-heterosexual identity at or after age 39. Interviews inquired about participants’ past and present social networks and the coming out process, particularly the influence of coming out “off time.” Findings show coming out is a dynamic, continuous, and non-linear process that simultaneously characterizes and is characterized by social network gains and losses.

Designing for older adults often takes the form of design for declining sensory, motor orcognitive ability. Instead of starting from disabilities this thesis aims to explore theproblems older adults experience in relation to information technology from theperspective of the older adult. Through the use of situational analysis data from fiveinterviews and five observations were analysed in order to find what problems, if any,the older adults gave voice to. This resulted in a study focused on three such problems:the instructions older adults receive when learning how to use information technology,the role of the surrounding of the older adults, and the feelings those interactions create.The result is a mix of different ways to view ageing along with a proposition that showsone possible way to reconfigure this interplay between older adults, the surrounding andinformation technology in order to lessen the impact of those problems.

Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.

Background: In order to aid effective assessment and detection of psychological health, a clear understanding of the risk factors for disturbance is required. This study was undertaken to test the hypothesis that demographic factors, health factors, social factors, attitudes to ageing, number of life events in the last year and relocation status would each significantly account for, and contribute to, the variance in psychological health. Method: The study employed a cross-sectional design in which 1,080 individuals over the age of 55 were randomly drawn from the community health index (CHI) of a rural health board in Scotland and invited to participate in the study. One hundred and ninety-six respondents completed questionnaires assessing psychological health and a range of potential predictors. Results: Overall, negative attitudes to ageing were the most prominent predictors of poor psychological health. Psychosocial loss was the only variable found to be a predictor of all seven outcome variables, including anxiety and depression, physical, psychological, social, and environmental quality of life, and general psychological and social functioning. Other predictors included a higher number of life events, poor social support from friends, poor self-rated health and not having a spouse/partner. Conclusions: Attitudes to ageing appear to play a significant role in the psychological health of older adults. Promoting positive perceptions of ageing in society may potentially pay dividends in the prevention of emotional distress in later life. Psychological interventions, such as cognitive behaviour therapy (CBT), may be key to addressing negative attitudes to ageing at an individual level.