Many older adults experience complications related to hospitalization. The most prevalent of complications is delirium which often goes undetected and untreated and results in increased morbidity and mortality. Nurses are in an ideal position to detect and manage delirium because of their close patient contact, however delirium remains underrecognized even when using a valid screening tool. This study adopts a qualitative descriptive approach to identify the barriers to nurse detection of delirium. Ten frontline surgical nurses participated in semi-structured interviews from which five major themes emerged through an inductive thematic analysis. Nurses have a knowledge deficit of the features of delirium and find it difficult to access information regarding their patients’ baseline cognitive function. Nurses reported inadequate time with patients that led to a self-perpetuating delirium cycle and furthermore, nurses stated that hyperactive delirium symptoms prevented adequate assessment and care. Nurse-physician communication plays an important role in delirium detection and treatment with both psychological and feminist perspectives offered. Recommendations include improvements in nursing knowledge, management of time and enhancements to current written and verbal communication about delirium. / Graduate

The aim of this study was to evaluate the effect of participation in the Otago Exercise Programme (OEP) on strength and balance. The change in a number of balance and strength measures were compared between a group of community dwelling women over the age of 80 years participating in the OEP and a control group matched by gender and age.Study design: A cohort study of two independent groups.Participants: Nineteen women over the age of 80 years who were community dwelling and participating in the OEP and 18 age matched community dwelling women who continued with their normal activities of daily living.Main outcome measures: Participants' strength and balance was measured using the timed up and go test, the step test, the 30 second chair stand test and gait velocity. Participants' fear of falling was measured with the Modified Falls Efficacy Scale and falls were monitored using a falls diary.Results: There were no statistically significant improvements in strength and balance in the OEP group and no statistically significant differences between the OEP and control group, after participating in the OEP for 6 months. The only statistically significant change in the OEP group was a slowing of gait velocity, all other outcome measures remained unchanged for both the OEP group and the control group.Conclusions: There were no statistically significant improvements in strength and balance after participating in the OEP. These results are consistent with those of the original Otago trial and the subsequent meta-analysis of all the Otago trials. The results from this study need to be interpreted with caution, as due to the small sample size the study was underpowered. The critical components of the OEP remain unknown.

The high prevalence of overweight and obesity among older Australian adults and their strong association with an increased risk of ill health, functional limitation and disability, are well documented. This thesis examines the assessment and management of overweight and obesity in older adults. Meta-analyses of randomised controlled trials were undertaken to assess the effects of psychological interventions and of exercise on body weight and health. A series of analyses were then undertaken using data from the 1053 participants enrolled in The Tasmanian Older Adult Cohort Study, an ongoing prospective cohort study whose aim is to identify the environmental, genetic and biochemical factors associated with the development and progression of a number of chronic diseases. The purpose of the analyses was to investigate changes in body composition (measured using dual-energy X-ray absorptiometry) that occur with age, the most accurate field methods for assessing body composition in different age groups, the influence of lifestyle risk factors on body composition, and the complex interrelationships between age, lifestyle, body composition and cardiovascular disease risk factors. Results demonstrate that body fat increases and lean body mass decreases with increasing age in older adults. The most accurate field methods for assessing body composition in older adults are body mass index (BMI) and waist circumference. Lean body mass is predominantly influenced by age in older adults and decreases as age increases. Body fat, however, is predominantly influenced by lifestyle risk factors. Physical activity levels, smoking and alcohol consumption in females are associated with lower body fat, whereas the presence of chronic pain and alcohol consumption in males are associated with higher body fat. In younger and middle aged adults, meta-analyses of randomised controlled trials demonstrate that exercise is an effective weight loss intervention, particularly when combined with low fat or low calorie diets. Exercise also improves factors commonly associated with cardiovascular disease, even in the absence of weight loss. Meta-analyses of randomised controlled trials also demonstrate that adults who are overweight or obese can reduce weight with psychological interventions, particularly behavioural and cognitive behavioural interventions. In older adults, observational data demonstrate that higher levels of pedometer-determined physical activity are associated with lower body fat, supporting the efficacy of physical activity or an active lifestyle as a weight loss intervention in this group also. The greatest impact of physical activity on body fat is observed when participants increase activity levels to greater than 7 500 steps per day. However, higher levels of physical activity are not associated individually with improved blood pressure, lipids or fasting serum glucose. Instead, higher physical activity levels are associated with a lower total number of cardiovascular risk factors, suggesting that in older adults, physical activity reduces the likelihood of multiple cooccurring cardiovascular disease risk factors. The studies within this thesis provide an evidence base for the continued development of an understanding of the assessment and management of overweight and obesity in older adults. A number of research priorities have also been highlighted. These include the need for long-term randomised controlled clinical trials in older adults in order to: assess the efficacy and safety of multi-component weight loss therapies (diet, physical activity and psychological therapy); determine the combination of physical activity and dietary therapy that will maximize loss of body fat while maintaining lean body mass in older adults for whom weight loss therapy is appropriate; and assess the effect of weight loss, diet and physical activity on clinical outcomes, particularly chronic disease end-points and risk factors in older adults. Longitudinal studies are required to: explore the interrelations between ageing, physical activity levels, body composition and cardiovascular disease risk in older adults; determine the causal relationships that exist between lifestyle risk factors, body composition and chronic disease in older adults; and better assess the effect of alcohol consumption on body composition using sensitive measures in older adults.

Self-Neglect among older adults is a major concern in the United States. It is estimated that one in ten older adults report experiencing some form of abuse or potential for neglect (Acierno et al., 2010). The National Center on Elder Abuse has estimated that for every one case of elder abuse, neglect, exploitation, or self-neglect reported to authorities, about five more cases go unreported (National Elder Abuse Incidence Study, 1998). Among literature regarding elder mistreatment, researchers have indicated self-neglect as the most common form of elder abuse and neglect reported to adult protection and social service agencies (Dong, Simon, & Evans, 2012). Maintaining the environment is one of the most frequently cited concerns of elder self-neglect reported to adult protection services (Dyer et al., 2006). This study evaluated the efficacy of an intervention, found within the environmental neglect literature, as an intervention for environmental symptoms of self-neglect among older adults.

abstract: Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population. Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients. Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge. Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06). Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days. / Dissertation/Thesis / Doctoral Dissertation Exercise and Wellness 2015

Background: A critical component of sexual health is healthy sexual functioning; being able to experience sexual enjoyment and satisfaction when desired. Sexual difficulties are not unusual and can have either physical or psychological causes. An estimated 100 million males worldwide suffer from erectile dysfunction (ED), with the expectation that this sexual problem will increase to 322 million cases by the year 2025 (Bacon, Mittleman, Kawachi, Giovannicci, Glasser, & Rimm, 2003). The prevalence of ED greatly escalates in older males and those with Cardiovascular Disease, Hyperlipidemia, and Diabetes due to related endothelial dysfunction (Bivalacqua, Usta, Champion, Kadowitz, & Hellstrom, 2003). Sexual dysfunction is a concern for all males, including those over the age of 65. Because sexual function or sexuality is a critical factor contributing to the quality of life among older adults (Gelfand, 2000; Robinson & Molzahn, 2007), attention to sexual dysfunction is needed to ensure a high quality of life among older adult males (Vincent & Velkoff, 2010). Furthermore, psychological and emotional stress have been associated with sexual dysfunction among males; both as a cause and a result of this condition. Purpose: The purpose of this study was to determine the level of distress associated with perceived stress and sexual function among community-dwelling older adult males in stable relationships. Study Aims: The study aims are to 1) describe perceived stress and sexual function in a community-dwelling older adult male population, 2) describe the relationship between perceived stress and sexual function, and 3) describe the relationship between perceived stress and sexual function while controlling for individual characteristics of the sample. Methods: A descriptive, cross-sectional research design was used. The sampling technique was a convenience sample of males aged 65 and older enrolled in a university affiliated lifelong learning institute in the southwestern United States. Inclusion criterion consisted of independent, active males aged 65 and older, in addition to being able to speak and read English. Exclusionary criterion comprised of those who have cognitive impairment determined by an Abbreviated Mental Test Score (AMTS) of six or less. Results: The majority of the 92 participants were between the ages of 65-70 and Caucasian. Overall, the sample was highly educated with most holding an Associate college degree or more advanced degree, was married, in age-related retirement, currently not working, and considered them self financially within the middle to higher middle-income level. Over half declared they have had sexual activity in the last month with an average level of sexual functioning and above average level of sexual satisfaction. In general, the participants indicated they are not stressed. There is a significant and negative correlation between perceived stress and sexual function (satisfaction). There is a significant relationship between perceived stress and Obesity with sexual function (erection, ejaculation, and satisfaction). Significant univariate effects were found on age with sexual function (erection, ejaculation, and satisfaction). Furthermore, significant univariate effects were found on Obesity with sexual function (ejaculation and satisfaction). Subsequently, a significant univariate effect was found on Cancer with sexual function (satisfaction). Significance: These study findings may serve as a foundation for enhancing sexual function; thus, establishing improved sexual health and quality of life among older adult males.

Introduction Diabetes is highly prevalent among older adults and can result in adverse health and economic outcomes. Patient satisfaction is an important quality of care indicator that often reflects the extent to which individuals have access to care and the ability to engage in preventive screenings and services needed to postpone or delay adverse outcomes associated with diabetes. Few studies have examined the role of patient satisfaction with care, specifically, among Medicare beneficiaries with diabetes. The purpose of the study is to describe provider satisfaction and associated characteristics among Medicare beneficiaries Methods A cross-sectional study was conducted using nationally representative data from the 2019 Medicare Current Beneficiary Survey (MCBS). Analysis was limited to persons 65 years and older who self-reported having diabetes. Satisfaction of care was the primary independent variable of interest, and it was assessed using the MCBS question ‘Have you been very satisfied, satisfied, dissatisfied, or very dissatisfied with the overall quality of health care received over the past year?’ Responses were recoded into dichotomous variables reflecting those with high satisfaction (very satisfied and satisfied) versus those who are not satisfied (dissatisfied and very dissatisfied). Results Approximately 3,852 individuals with diabetes were included in the study. Among study participants, 96.5% (3684) were satisfied with care and 3.5% (132) were dissatisfied with care. Among those satisfied with care, 52% were females, 68% were non-Hispanic Whites, 53% had more than high school education, 69% had more than a household income of more than $2500 married, 82% lived in a metropolitan area, 56% were married and 46% had obesity. Of those satisfied with care, 76% self-reported a general health status ranging from very good to excellent, 79% self-reported not being on insulin treatment and 79% self-reported having concurrent high blood pressure. In addition, about 82% of those satisfied with care, reported a recent HbA1c level of ≤7.5% or an average blood test of ≤140mg/dl, 64% reported self-testing for blood glucose and 65% of respondents reported having an annual foot examination by a doctor or other health professional. However, only 37% of participants satisfied with care reported participating in a diabetes self-management course, and less than 1% of those satisfied with care reported having an annual eye examination. Conclusion Findings from this study suggest that majority of Medicare beneficiaries are satisfied with care. Study participants who are satisfied with care reported low participation in diabetes self-management course and having an annual eye examination. Future studies are needed to examine the association between satisfaction of care and participation in a self-management course and annual eye examinations as these have implications for long-term diabetes outcomes. In addition, it may be important to undertake qualitative research to explore the determinants of dissatisfaction of care among Medicare beneficiaries with diabetes in order to address their specific needs.

Background: In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifi cally in impaired older adults. Purpose: To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults. Methods: Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised intervalbased training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV). Results: Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a signifi cant effect on MIP YRT (F 6,204 = 6.755, P <.001, η 2 = 0.166), MEP (F 6,204 = 4.257, P <.001, η 2 = 0.111), and MVV (F 6,204 = 5.322, P <.001, η 2 = 0.135). Analyses showed that the YRT group had a greater increase of RM strength (MIP and MEP) and endurance (MVV) than control and/or ITT groups. Conclusion: Yoga respiratory training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible.

Hearing aid self-efficacy (i.e., beliefs individuals have in their ability to perform the skills needed to be successful hearing aid users) may be related to long-term hearing aid use. The purpose of the present investigation was to determine the audiologic correlates of hearing aid self-efficacy as assessed by the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA). New and experienced hearing aid users (n = 211) were given the MARS-HA. The results indicated that individuals with moderately severe hearing loss had lower self-efficacy for aided listening conditions than individuals with mild hearing loss. Individuals with poor word recognition abilities in quiet also had lower overall hearing aid self-efficacy than individuals with good to fair word recognition abilities. These results suggested that hearing aid users who have a moderate hearing loss (or worse) and hearing aid users with poor word recognition abilities may require additional counseling and audiologic rehabilitation to increase their hearing aid self-efficacy.

Hip fracture in older adults may be the sentinel event leading to functional decline, long-term disability, and death. For the substantial number of older persons who fracture a hip each year, the chances of full functional recovery remains relatively low. The purpose of this study was to examine the differences between older persons with hip fracture who recover fully and those individuals who do not fully recover. A chronic disease trajectory framework guided the theoretical design of the research. Data were collected from the medical records of 102 persons aged 60 years and older who sustained a proximal hip fracture from 1993 to 1998 at a medical center in North Carolina. Data included personal characteristics, prefracture health status, hospital factors, rehabilitation features, and functional outcomes. The analysis consisted of a two-step hierarchical logistic regression model with the control variables of age, prefracture ambulation status, and prefracture cognitive status entered first and the variables of type of therapy program, frequency of therapy, number of therapy provider organizations, and location of therapy at 4 weeks entered second. Significance of the final model was observed, Chi-Square(7, n = 99)=43.55, p < .05. Significant individual predictors (p < .05) in the model were prefracture ambulation status (43.56 odds ratio) and cognitive status (6.44 odds ratio). Post-hoc analysis of the cases revealed a substantial lack of stability in ambulation status from three months post-fracture to the six-month and one-year follow-up. Findings support other research studies that indicate prefracture personal characteristics of older persons who fracture a hip are the most influential factors in predicting successful recovery. Linkage of the findings to the chronic disease trajectory model suggests that intervention efforts should focus on prevention, health promotion, and policies that extend the ability of health care providers to assist older persons with hip fracture in managing their conditions. / Ph. D.