Participants in the author’s training program for OT practitioners who work in skilled nursing facilities will gain an understanding of the need and requirements for ongoing wheelchair seating and positioning management of long-term care residents. BACKGROUND: Elderly individuals admitted to a skilled nursing facility receive initial occupational therapy (OT) evaluation for appropriate wheelchair (WC) seating. On extended stay, the resident’s seating needs often change, leading to postural impairment from improper positioning. Lack of awareness of poor positioning by residents, particularly when cognitive issues are present, can delay corrective action because they may not call attention to difficulties or discomfort. Occupational therapy practitioners (OTPs) can play a distinctive role in ensuring that proper wheelchair seating and positioning of older residents is maintained. The author’s aim is to create a prototype program designed to mitigate the risk that accompanies poor wheelchair positioning and that can be carried out at any skilled nursing facility (SNF). OBJECTIVES: The author’s project will address the recognized need for a training program for occupational therapy practitioners that will provide guidelines for assessing, evaluating and planning the appropriate intervention for an elderly manual wheelchair user in a skilled nursing facility. Objectives for the resident include reduction in the incidence of wound development, improvement of functioning, and increase in participation in the care environment with other wheelchair users. METHOD: Program implementation will begin with facility recruitment. The author will create a handout illustrating the planned program and will distribute it in person or via mail to administrators of skilled nursing and residential care facilities within a 100-mile radius that have a rehabilitation department and one or more OT practitioners. When interest is expressed by a recipient, the author will contact the facility and conduct a short interview to discuss problems and concerns, the availability of staff incentives for participation in inservice training, and payment for the author’s services. Depending upon the author’s assessment of participant knowledge, skills and needs, training will be adjusted from an introductory to intermediate level. As part of the proposed program, the author will recommend that OT practitioners instruct nursing and other caregiving staff to periodically screen every wheelchair-dependent resident when they are providing direct care during their daily routines. Miller, Miller, Trenholm, Grant and Goodman (2004) developed the Seating Identification Tool (SIT) to fill the need for an easy to administer screening questionnaire that would be sufficiently sensitive for clinical assessment and research. ANTICIPATED FINDINGS: Occupational therapy practitioners will play a distinctive role in ensuring that proper wheelchair seating and positioning of older residents is maintained. Preventing pressure ulcers will prove to be much less costly than medical treatment, both to the resident and the facility. Reduction in time lost from daily occupations to allow healing will improve the client’s sense of well-being. OT practitioners will be called upon to make periodic adjustments in wheelchair fitting and positioning, which might as simple as providing an appropriate wheelchair cushion. LIMITATIONS: Program development and program evaluation research are in the initial stages and have not yet been implemented in any skilled nursing facility. RECOMMENDATIONS: The author recommends implementation of the pilot program in a skilled nursing facility with data gathering for program evaluation research to gain evidence and further refine the program.

Communities for Older Adults: Rising to Integrate a Driver’s Education Resource Program (COA-RIDER) serves as a guide for leaders of local health and community welfare groups, including health-related personnel, that are interested in organizing and expanding a driving resource program in their local communities. This program is a response to the issue of limited community driving resource programs for older adults, many of whom will remain driving as they age. The COA-RIDER program aims to have more community organizations host and collect data for research to sustain future driving resource programs for older adults. Working in collaboration with various individuals, groups, and organizations can build cohesion among members of the community. This program is an opportunity for community members to gain a better understanding of professional roles and duties across different disciplines and fields. Collectively, all can help in the developmental process of providing a beneficial health and wellness resource program for aging drivers. Most importantly, this program not only educates on the importance of addressing mental, physical, and social health; it advocates for older adults to stay connected in their communities through driving, community mobility options, and local resources so that they can remain independent for as long as possible.

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The present study was designed to investigate the effects of a progressive strength training program on quiet postural sway and stability limits in healthy males (n=8) and females (n=12) aged 60-80 years. The ability of the subjects to utilize visual information (eyes open vs. eyes closed) to improve quiet postural sway and stability limits was also examined. Vision, was found to significantly improve quiet postural sway (lat and a-p) and stability limits (a-p). Vision improved stability limits (lat) for the male subjects but not for the female subjects. The strength training did not significantly improve any of the balance measures but a gender by training interaction was found for quiet postural sway (normalized to stability limits) in the a-p direction. The male subjects quiet postural sway decreased after the strength training and their stability limits increased, The greatest improvements in balance were noted for the subjects who had substantially higher baseline levels to begin with. Exercise was found to improve muscle strength and this increase may have contributed to the improvements in balance noted. / Thesis / Master of Science (MS)

The purpose of this study was to explain the safety and usability problems in the residential interior environment of Thai older adults. A sample of 163 retired government employees who live in Bangkok, Thailand were asked to complete a self-administered questionnaire which included questions about housing characteristics, interior environment features, personal information, health condition, and activity level. The mean age of the older adults was 68.1 and ranged from 60 to 93 years. The data were analyzed using frequencies, percentages, and means as descriptive statistics and one-way analyses of variance. The findings revealed that most of the Thai older adults had lived in their own two story detached houses more than ten years and with their family members. The majority of the respondents had vision problems, but almost all could easily perform activities of daily living by themselves and half of them could easily perform instrumental activities of daily living by themselves. Problematic interior environmental features in each area of the home were identified and prioritized. When respondents were divided by age group, significant differences appeared in the degree of difficulty with two safety and usability features in the home. Divided by daily activity levels, respondents revealed significant differences in the degree of difficulty associated with eight safety and usability features. When the homes were broken down to five categories: entrance and stairs, bedroom, bathroom, kitchen, and other interior features of the house, it was these other interior features that seemed to have the most problems in safety and usability. The kitchen had the most problems in safety and usability when compared to other rooms. Based on these findings, design recommendations for Thai housing were developed. / Master of Science

The purpose of this study was to identify whether the residential environments of Korean women age 65 and older living in apartments were safe for them. In order to accomplish the purpose, this study focused on the safety practices of older Korean women in their daily activities. The sample of 90 older women was selected from the residents living in three apartment complexes of Kang-Nam and Kang-Dong areas in Seoul, Korea. The data were collected through survey questionnaires, which had been pretested, and revised based on Tomlinson's instrument. The survey instrument measured perception of safety hazards, safety features, safety precautions, and intended modifications/assistance. The data were analyzed using frequencies, percentage, and means as descriptive statistics and chi-square analysis. The average age of the sample was 73.5 years old. Most of the respondents were in good health. The majority of the sample lived with the family of their adult child. Most of them received money from their children. Most of the dwelling units were owned by their child. The majority of the sample lived in dwelling units located below the ninth floor. / Master of Science

The Land-Grant University Cooperative Extension (herein: Extension) system has been an underutilized resource for physical activity programming. With the recent addition of physical activity as a focus of Extension work, efforts are needed improve dissemination and implementation of evidence-based physical activity interventions. Improving implementation requires overcoming limitations including institutional support and perceptions of Extension health educators who could develop, deliver, and evaluate these programs. A participatory approach that includes input at all delivery levels (program participants, delivery agents, and administrators) can aid implementation through considering program acceptability, appropriateness, and feasibility from the beginning. This dissertation includes three manuscripts that explore the Extension's role in promoting physical activity in older adults, both in the United States and abroad. Manuscript 1 detailed a systematic review of community-based older adult physical activity programs that was conducted in order to determine the characteristics of effective older adult physical activity programs and the extent to which programs implemented in Extension systems nationwide employ these characteristics. The results indicated notable differences between peer-reviewed literature and Extension programs as well as presented an opportunity for Extension programs to more effectively use evidence-based program characteristics, including behavioral theories and group dynamics. The results also suggested that Extension programs could more effectively report their findings through peer-reviewed sources so that effective programs can be disseminated to reach a broader population. Manuscript 2 was an exploratory study conducted as a first step in bringing older adult physical activity programming to Ghana through Extension. Results of the mixed-methods study suggested that older adults in Ghana have mostly positive perceptions of physical activity and would be receptive to an in-person physical activity program. In particular, without specific prompting on principles of group dynamics, across all focus groups, participants mentioned aspects of groupness ranging from the need for accountability to the enjoyment of exercising with others. The results also indicated a need for education on Ministry of Health physical activity recommendations and how to meet them. These findings can be used as the first step to adapting and delivering an evidence-based intervention in Ghana through an integrated research-practice partnership. This approach includes community-level decision making to ensure the resultant program is a good fit in the intended delivery system. Manuscript 3 detailed the translation of an evidence-based older adult physical activity program to an Extension system in a rural state (population 585,501). Results suggested that Extension health educators have overall positive perceptions of physical activity programming, but they experience barriers in delivering these programs. While the program has the potential to reach a representative sample of the population, the adoption rate among Extension health educators was low, and system-wide changes may be needed to improve physical activity program adoption rates among educators. Overall, results of the three manuscripts provided evidence and recommendations for Extension professionals to improve physical activity program implementation through using evidence-based interventions and characteristics, considering perceptions of end users prior to program implementation, and considering system-level changes that promote physical activity program adoption. / Ph. D.

Thesis advisor: Dorothy A. Jones / As the United States population ages, knowing and understanding the older adult couple’s experience living with chronic illness at home is significant to inform new strategies of care, and planning of resources for the improvement in the health and well-being for a potentially vulnerable population. The purpose of this qualitative study was to better understand the older adult couple’s experience while living with chronic illness at home by answering the following research questions: What is the life pattern manifested by an older adult couple living with chronic illness at home? Are there common themes across the life patterns of older adult couples living with chronic illness living at home? The theoretical framework guiding this study was Margaret Newman’s Health as Expanding Consciousness using a hermeneutic-dialectic phenomenology method. The study’s sample consisted of 14 married older adults (> 65 years of age) couples living together at home. The research method explored the experiences of the older adult couple through dialogue within the context of their social environment in all its complexity. This approach gave voice to the older adult couples’ experiences and their meaning from their perspective, which facilitated insights about each older adult couple as well as common themes across the older adult couples. Three themes emerged from the study, (1) an unfolding pattern of living meaningfully as an older adult couple with chronic illness while moving through life transitions, (2) couple interconnectedness strengthens the bonding within the older adult couple and promotes self-growth, and (3) a resonating process within the older adult couple promotes movement toward expanding consciousness. Conceptual models are proposed. The findings suggest older adult couples living with chronic illness at home strive to live meaningfully while experiencing multiple life transitions embedded in a resonating process that facilitates change. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Master of Science / Food Science Institute,Human Nutrition / Valentina M. Remig / Foodborne illness is a serious health problem in the United States, and especially in the mature adult population. This research examined food safety knowledge of mature Kansans(aged 55 years and older) in three important constructs (handwashing, food handling, and food preparation), their knowledge of foodborne illness symptoms, and their food safety concerns while eating away from home. One-hundred and forty participants completed a self-administered questionnaire containing ten food safety knowledge questions representing sixty answer options. Replies to those questions were compared by age, gender, geographic location,and educational attainment. Results indicated that geographic location was statistically significantly related to food safety knowledge; however, age, gender, and education had little to moderate association. Additional findings revealed food safety knowledge was not associated with participants’ level of food safety concern while eating away from home. In conclusion, the findings revealed that mature Kansans possessed general food safety knowledge; however, some responses indicated mature adults did not fully understand certain food safety protocols. Areas identified as needing further attention included appropriate hand drying and surface cleaning, safe food and refrigerator temperatures, proper thawing practices, as well as safe leftover and melon preparation.

Community colleges serve a diverse population of learners including many older students counting on the community college for enhanced skills or personal enrichment. Many of these colleges target this population with programs designed specifically to meet the needs and goals of the older adult but may not consider this population when designing a website. Older users of a community college website have similar needs to the traditional student; however, little was known about the impact of the typical navigational links on the successful completion of tasks and obtaining information for this type of user. It is essential for educational institution website designers to understand which navigational links will provide the best usability for older adults with differing levels of experience. Previous research has found that usage-oriented links and pages that offer both usage and subject-oriented links yield statistically higher performance than subject-oriented links. Other research has found that presenting navigational links in the form of an action enhances usability. For this study, three websites were created utilizing navigational links in the form of usage-oriented links, subject-oriented navigational links, and then a combination of both to conduct a usability study to expand on previous work. This study was designed to determine the impact of such navigation on obtaining the correct answer, time on task, and the user's perception of the navigation. The research question, Does website usability and the user's perception of usability vary for older users based on navigational links, task type, and audience type? was addressed through two hypotheses and data which were obtained during the study. The first hypothesis: Website navigation, task type, and audience type significantly affect usability, was based on performance, and was measured on the two components, correct answer ratio (CAR) and navigation time (NT). The results indicated that the older user's ability to complete tasks faster and more accurately depended on the user's experience level, the difficulty of the task, and the types of navigational links presented, with usage-based navigation being the more effective solution. The second hypothesis: Website navigation, task type, and audience type significantly affect perceptions of usability, was based on perception questions presented after task completion and was measured by a four question post-test questionnaire, which used a 7-point Likert scale. This study found the older user's perception of usability varied based on the navigational links presented, but the experience level of the participant or the task type did not have a significant effect on the perception of usability. Therefore, it is recommended that designers of educational sites present navigational links in a goal-oriented, action-based format to support the end users of all ages and to enhance usability of the institution's website. This research found that if developers emphasize accuracy and the need to navigate quickly as a goal of an educational website for the older user, the website should be designed using a usage-based navigation structure. This research provides the detail to support a better understanding of which navigation type results in higher usability for the older user and enhances the guidelines of website design for this population.