For older adults, functional independent mobility is essential to well-being. Many care home residents have physical and cognitive impairments and use wheelchairs. Residents with difficulty self-propelling manual wheelchairs may benefit from power mobility; however, those with cognitive impairments may be precluded because of the potential for injury. My research goals were to apply novel power wheelchair technology to enable safe, independent mobility. Technology was developed to examine the value and implications of power mobility for residents with restricted mobility and mild or moderate cognitive impairments. The first study tested a prototype anti-collision wheelchair with a contact sensor skirt. Six single subject studies were completed. Distances travelled in manual and anti-collision wheelchairs were compared. Observational and interview data were collected. Focus groups (37 staff) and interviews (18 staff, six other residents, one spouse) were performed. Three of six residents were able or had potential to operate the prototype. One resident chose to use it beyond the study, and his mobility and well-being improved. Case analyses showed factors limiting prototype acceptance. Residents were unsatisfied with the appearance and slow speed, and found the interface frustrating to operate because of inadequate feedback. Social isolation and reduced autonomy restricted independence achievable with technology. Socialization and affective benefits of mobility were demonstrated in one case where prototype use was continually assisted. Residents and staff supported the anti-collision concept. On observation, the prototype compensated for absent or delayed responses of residents to obstacles below sensors and decreased injury risk. However, full sensor coverage of the environment was needed. The second study addressed acceptance and interface usability issues. A simulated collision-avoidance wheelchair with a multimodal feedback interface was evaluated. The interface provided audio, visual and haptic feedback to guide navigation away from obstacles. Through observations, interviews and questionnaires, five residents evaluated the device. High device acceptance and usability were found. The device was easy to use and assisted with performance of indoor mobility goals. Further research is necessary before power wheelchairs with new features are available for users; however, these results could play a fundamental role in shaping technology development and mobility interventions for this neglected population.

Introduction Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in this population. Methods Data from the National Social Life, Health, and Aging Project (NSHAP) wave 2 was utilized to examine the prevalence and characteristics of OTC medication use in a nationally representative sample (N=2,637) of community-dwelling US older adults (65 years and older). OTC medication use was characterized based on sociodemographic, intrapersonal, interpersonal, organizational, and community-level factors. Further, a mixed-methods study was conducted in two senior-living communities in Richmond, VA. The qualitative phase of this mixed-methods study used focus group methodology to explore the knowledge, attitude, beliefs, and experiences about OTC medications, and the OTC medication decision-making process in a sample (N=80) of older adults using the criterion sampling strategy of purposeful sampling. Results from the qualitative phase informed the development of a semi-structured questionnaire, which was used to collect data in the quantitative phase of the mixed-methods study. The quantitative phase used in-person interviews to quantify attitudes, beliefs, preferences, and practices associated with the OTC medication use and decision-making process in a different convenient sample (N=88) of older adults within the same settings. Results NSHAP Study: The majority of participants were women (54%), whites (82%), and with an education greater than high school (57%). Study findings indicate a high weighted prevalence (76%) of OTC medication use in a nationally representative sample of older adults. Among older adult men, education (p value=0.0038), race (p value=0.0003) and comorbidity (p value =<0.0001) significantly and independently predicted the OTC medication use. Older adult men who were whites had greater odds of using OTC medication than other races. Older adult men with higher than high school education were 1.54 times more likely (95% CI: 1.15-2.06) to use OTC medications than their counterparts. It was observed that with every unit increase in the number of co-morbid conditions, OTC medication use decreases by 26% (OR: 0.74, 95% CI: 0.65-0.84) among older adult men. Among older adult women, education (p value=0.0244), race (p value=0.0048), smoking (p value=0.0494), and social participation (p value=0.0341) showed a significant and independent association with OTC medication use. Older adult women who were whites and non-smokers had greater odds of using OTC medication than their counterparts. Older adult women with higher than high school education were 1.36 times more likely (95% CI: 1.04-1.79) to use OTC medications than their counterparts. It was observed that with every unit increase in the social participation, OTC medication use increases by 15% (OR: 1.15, 95% CI: 1.01-1.31) among older adult women. Qualitative Study: The majority of the sample were women (63%), whites (54%), and with an education greater than high school (60%). The study indicated that the OTC medications are generally considered very safe and effective for treating minor/routine symptoms by older adults. Brand version OTC medications were generally favored over generics by this sample of US older adults. There were found two types of decision-making scenarios following after the older adults make sense of their symptoms: 1) treatment decision-making and 2) purchase decision-making. The treatment decision-making comes with two approaches: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow physician’s recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person’s financial and healthcare resources, severity of the symptoms, experiences with the medication (past or current), and relationship with the physician. While purchasing OTC medication from the store, the majority of consumers first explore information on the drug-label, ask a pharmacist, compare various options (generic or brand), compare prices/deals, and make a final purchase decision favoring the maximum and fast relief, followed by the lower cost, and easy to swallow dosage forms. Quantitative study: The majority of the sample was women (55%), blacks (61%), and with an education less than or equal to high school (55%). Analgesics were the most (76%) prevalent OTC therapeutic category, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of the participants reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician-recommended use. A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most participants considered OTC medications very safe or safe (80%) and very effective or effective (80%) to use. The majority (79%) of participants felt very satisfied, and 16% felt satisfied with their OTC medication use. Brand name OTC medications were considered more safe and effective compared to generic versions. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source about OTC medications. Conclusions Older adults feel positive and satisfied with their OTC medication use, in general. Considering the self-reported high use, inappropriate use, and experiences of facing side effects, education focused toward older adults should be encouraged to aid in safe and responsible OTC decision-making.

Orientador: Alexandre Janotta Drigo / Resumo: A proporção da população mundial com 60 anos ou mais está aumentando rapidamente. No entanto, vidas mais longas não significam necessariamente vidas mais saudáveis. Assim, faz-se necessário um maior conhecimento sobre como promover saúde. De que forma a Educação Física (EF) pode contribuir e responder a essa situação? Está bem estabelecido na literatura como o exercício previne doenças crônicas. No entanto, falta conhecimento sobre como a EF pode contribuir para a promoção da saúde. Nesse contexto, o presente estudo foi delineado para abordar o tópico de como os profissionais de EF poderiam ajudar idosos a desenvolver sua saúde e vivenciar positivamente o envelhecimento. O objetivo foi investigar as práticas adotadas por profissionais de EF para oferecer práticas corporais para idosos em situações de desvantagem em programas de promoção da saúde e entender os processos de desenvolvimento de saúde que os idosos experimentaram e perceberam como relacionados à sua participação nas práticas corporais. O estudo se fundamentou na salutogênese, uma teoria para a promoção da saúde proposta pelo sociólogo Aaron Antonovsky. Juntamente com essa perspectiva teórica, a investigação se baseou nas noções de práticas corporais e pedagogia. O estudo foi conduzido por meio da abordagem qualitativa e do método da teoria fundamentada nos dados. A amostragem teórica norteou a inclusão de quatro programas de promoção da saúde, localizados nas regiões sudeste e sul do Brasil. Participaram seis prof... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: It is well known that the world population aged 60 or older is rapidly growing. However, longer lives do not mean necessarily healthier lives. Thus, further knowledge about how to promote health has been required. How physical education can contribute and respond to this situation? It is well established in the literature how exercise prevents chronic diseases. Nevertheless, knowledge about the ways physical education might contribute to health promotion is lacking. In this context, the present study was designed to address the topic of how Health-Physical Education (HPE) professionals might help older adults to develop their health and experience ageing positively. The aim was to investigate the practices adopted by HPE professionals to deliver bodily practices for disadvantaged older adults in healthpromoting programmes, and to understand what health development processes the older adults experienced and perceived as related to their participation in bodily practices. The study was informed by salutogenesis, a theory for health promotion proposed by the sociologist Aaron Antonovsky. Alongside this theoretical perspective, the investigation drew on the notions of bodily practices and pedagogy. The study was conducted with a qualitative approach and a grounded theory research design. Theoretical sampling guided the inclusion of four health-promoting programmes, located in the southeast and south regions of Brazil. Participants were six HPE professionals, three health centres´... (Complete abstract click electronic access below) / Doutor

The aim of this study is to investigate how older adults were affected by the COVID-19 restrictions that were put in place by the Swedish Health Authority during the first wave of the COVID-19 pandemic to protect them and the roles played by social workers during the pandemic. A qualitative study was conducted whereby two older adults aged seventy and two practising professional workers were interviewed, and their responses analyzed using thematic analysis. The results showed that one of the older adults felt isolated, while the other did not have the same experience. The social workers on the other hand felt that they were responsible for the lives of their clients as well as that of their staff.

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Long-term care facilities (LTCF) were impacted disproportionately by the coronavirus (COVID-19), suggesting their high risk for community-spread pandemics. This three-article dissertation with publications aims to a) aggregate the emerging research evidence of factors for nursing home residents' COVID-19 infections; b) explore hospitalizations due to COVID-19 among emergency admissions and length of hospital stays for long-term care facility (LTCF) residents with dementia; and c). investigate how comorbidity index score mediates the relationship between COVID-19 hospitalization and discharge outcomes among LTCF residents with dementia. This dissertation consists of a three-article format: a mixed-methods systematic review and two retrospective cohort studies. The first study is a systematic review to summarize major factors of nursing home residents' COVID-19 infections over the pandemic period (January 1, 2020, to October 31, 2022) in the United States providing a context for the two empirical studies on COVID-19 hospitalization outcomes for LTCF residents with dementia. The second study is a cross-sectional study and utilizes Texas Inpatient Public Use Data File (PUDF) to compare COVID-19 hospitalization outcomes for LTCF residents with dementia aged over 60 years (n = 1,413) and those without dementia (n = 1,674) during period January 2020 to October 2022. Logistic regression is used to predict emergency admissions and length of hospital stay, with pre-existing conditions mediating the relationship. The third is a cross-sectional study and uses the same dataset and criterion from the second study. Logistic regression, mediation analysis, and moderation analysis are used to investigate the effect of comorbidity index score and health insurance status on the association between dementia status and place of live discharge, while controlling for sociodemographic factors such as age cohort, race, and gender. Findings from the mix-method systematic review of 48 articles yielded evidence to suggest risk factors associated with COVID-19 infections among nursing home residents in the USA by geography, demography, type of nursing home, staffing, resident's status, and COVID-19 vaccination status through 48 articles. The second study found that with COVID-19 hospitalization, a diagnosis of dementia and preexisting conditions was significantly associated with emergency admission (OR = 1.70; 95%CI = 1.40-2.06) and shorter hospital stays (OR = 0.64; 95%CI = 0.55-0.74) when considering, adjusting for confounders such as demographics, health insurance, and lifestyle. In the third study, dementia diagnosis with COVID-19 hospitalization increased the likelihood of discharge to hospice care (OR = 1.44, 95% CI = 1.16-1.80), followed by LTCF (OR = 1.42, 95% CI = 1.23-1.65), but decreased the likelihood of discharge to recovery hospitals (OR = 0.70, 95% CI = 0.52-0.94). The findings highlight the increased risk of COVID-19 hospitalization disparities among individuals with dementia. Targeted health support programs for LTCF residents with dementia would enhance their COVID-19 hospitalization outcomes. Discharge plans for COVID-19 patients with dementia should be customized to their care needs, including hospice care, to minimize healthcare disparities compared to other residents. Further study is needed as to why recovery hospitals are less preferred for live discharge of COVID-19 patients with dementia diagnosis.

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Population ageing and the tendency for older adults to have poorer health status than younger adults have raised concerns about potential increases in the number of elderly suffering disease and disability. Significantly, many health problems experienced in later life are associated with the onset of a more sedentary lifestyle. Increasing older adults' participation in leisure time physical activity (henceforth LTPA) offers an opportunity to reduce the prevalence of preventable morbidity in later life and offset a potential burden of ageing on the public health sector. As a forerunner to the development of strategies to increase older adults' LTPA participation, researchers have investigated the intrapersonal, interpersonal and, to a lesser extent, environmental influences on this health behaviour. Recent findings from studies of the adult population have suggested that neighbourhood deprivation, a measure of the socioeconomic conditions of small areas, may significantly influence LTPA participation. Extending previous findings, this research investigated how neighbourhood deprivation influenced older adults' LTPA participation. A total of 63 older adults were recruited from high- and low-deprivation neighbourhoods in Christchurch, New Zealand. Neighbourhoods were selected because of their relative positions on the New Zealand Deprivation Index and were characterised by the researcher as "East-town", a neighbourhood of high deprivation, and "West-town", a neighbourhood of low deprivation. The research incorporated a cross-sectional, comparative and mixed-methods approach. The methods of enquiry employed in this research included a recall survey, Q method, and semi-structured interviewing. Each method addressed a different aspect of the primary research question and provided data that was used in the creation of an integrated model depicting the influence of neighbourhood deprivation on older adults' LTPA participation. The results derived from the three research methods showed that older adults from the low-deprivation neighbourhood of West-town participated in LTPA more frequently than older adults from the high-deprivation neighbourhood of East-town. East-town was identified as having many physical and social environmental constraints to LTPA and comparatively few facilitators. Alternatively, West-town was found to have many physical and social environmental facilitators to LTPA and relatively few constraints. Neighbourhood attributes which appeared to influence older adults' LTPA participation included appropriateness of leisure provision, neighbourhood attractiveness, walkability, traffic, and perceptions of crime and antisocial behaviour. One implication of this research is that environmental interventions should be considered in attempts to engage older adults in LTPA for health purposes, particularly in high-deprivation neighbourhoods.

Objetivo: Establecer la asociación entre el nivel de funcionalidad y la fuerza miembros inferiores en adultos mayores en comunidad. Materiales y métodos: Se realizó un estudio de transversal analítico en una comunidad de adulto mayor en Lima Perú. La población está conformada por adultos mayores de 60 años. Las variables de resultado fue la funcionalidad y las de exposición fueron la fuerza funcional en miembros inferiores y como confusoras el equilibrio y la masa magra apendicular para ello se aplicaron 6 pruebas. La primera evalúa la funcionalidad en general del adulto mayor mediante el SF-36, el cual abarca 8 dimensiones como funcionamiento físico, rol físico, dolor corporal, salud general, vitalidad, funcionamiento social, rol emocional y salud mental, el segundo evalúa la funcionalidad de miembros inferiores del adulto mayor. El tercero es el test de cinco veces pararse de sedente, que evalúa la fuerza muscular funcional de miembros inferiores. Para la medición de las variables confusoras utilizamos: El test de alcance máximo que mide la flexibilidad de miembros inferiores. Ponte de pie y anda que mide el equilibrio dinámico, coordinación y velocidad. Finalmente, se midió la masa muscular de miembros inferiores con la fórmula de Masa magra apendicular esquelética (MMAE). La recolección de datos se realizó con 2 personas y la muestra fue estratificada en edad y sexo. Se evaluó a cada participante en un ambiente específico para las evaluaciones en la misma comunidad de adulto mayor. Resultados: Se encontró asociación estadísticamente significativa entre la funcionalidad de miembros inferiores y la fuerza funcional de miembros inferiores (β =-0.642, p=0.003). Asimismo, otras variables que estuvieron asociadas a la funcionalidad de miembros inferiores son flexibilidad (p=0.006) y caídas (p=0.001). Conclusión: En el presente estudio fue realizado en Lima Perú; en el distrito de Molina Centro Integral del adulto mayor (CIAM) se encontró que existe asociación entre el nivel de funcionalidad de miembros inferiores con la fuerza funcional de miembros inferiores en adultos mayores. Asimismo, las variables caídas y flexibilidad también estuvieron relacionadas con el nivel de funcionalidad. / Objective: establish the association between the level of functionality and the lower member force in community older adults. Materials and methods: An analytical cross-sectional study was conducted in an older adult community in Lima Peru. The population is made up of adults over 60 years. The outcome variables were the functionality and the exposure variables were the functional force in the lower limbs and as balance the balance and the appendicular lean mass for this purpose, 6 tests were applied. The first assesses the functionality of the elderly in general through the SF-36, which covers 8 dimensions such as physical functioning, physical role, body pain, general health, vitality, social functioning, emotional role and mental health, the second evaluates functionality of lower limbs of the elderly. The third is the five-times sit to stand test, which evaluates the functional muscle strength of the lower limbs. For the measurement of confusing variables, we use: The maximum range test that measures the flexibility of lower limbs. Stand up and walk that measures dynamic balance, coordination and speed. Finally, the lower limb muscle mass was measured with the skeletal appendicular lean mass (MMAE) formula. Data collection was performed with 2 people and the sample was stratified in age and sex. Each participant was evaluated in a specific environment for assessments in the same senior community. Results: A statistically significant association was found between lower limb functionality and lower limb functional strength (β = -0.642, p = 0.003). Likewise, other variables that were associated with lower limb functionality are flexibility (p = 0.006) and falls (p = 0.001). Conclusions: In the present study, it was made in Lima Peru; In the district of Molina Centro Integral for the Elderly (CIAM) it was found that there is an association between the level of functionality of the lower limbs and the functional strength of the lower limbs in older adults. Likewise, the variables falls, and flexibility were also related to the level of functionality. / Tesis

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