Doctor of Philosophy / Department of Kinesiology / Craig A. Harms / The overall aim of this dissertation was to determine the impact of lifestyle (i.e. habitual and acute physical activity and diet), age, and sex on systemic and airway inflammation and oxidative stress. In study 1 (Chapter 2) we examined the impact of habitual physical activity level on the post-prandial airway inflammatory response following an acute bout of moderate intensity exercise. Results indicated that the mean exhaled nitric oxide (eNO; marker of airway inflammation) response increased for all groups at two hours post high-fat meal (HFM) (~6%) and returned to baseline by four hours post-HFM. However, there was a varying eNO response from baseline to four hours in the group that exercised in the post-prandial period compared to the group that remained sedentary. These findings suggest airway inflammation occurs after a HFM when exercise is performed in the post-prandial period, regardless of habitual physical activity level. In study 2 (Chapter 3) we investigated the post-prandial oxidative stress response to meals of varying calories and fat. Specifically, we assessed the post-prandial airway and systemic 8-isoprostane (a marker of oxidative stress) responses to meals with moderate-fat (8.5 kcal/kg of bodyweight) and high-fat content (17 kcal/kg of bodyweight) from baseline to six hours post-meal in a randomized crossover design. This study revealed that systemic 8-isoprostane increased from baseline to six hours post-meal (38.3%), but there was no difference between the moderate-fat meal (MFM) and HFM conditions. There were no changes in airway 8-isoprostane from baseline to six hours post-MFM or HFM, or between the MFM and HFM conditions. Lastly, in study 3 (Chapter 4), we were interested in examining 8-isoprostane responses in older adults, since 8-isoprostane has been reported to increase with age. Previous research also suggests that older women (OW) and older men (OM) have differences with regard to prevalence and severity of late-onset asthma. In this study, we sought to determine whether the airway 8-isoprostane response to a strenuous bout of exercise was different in OW compared to OM. A secondary aim was to determine whether post-exercise 8-isoprostane generation was correlated with decrements in lung function. Our results showed that the generation of 8-isoprostane from pre- to post-exercise increased ~74±77% in OW and decreased ~12±50% in OM. The decrease in 8-isoprostane generation was not correlated with improvements in lung function from pre- to post-exercise. These findings collectively contribute to the literature by enhancing our understanding of the impact of lifestyle factors, age and sex on modifying and potentially mitigating the risk of developing chronic diseases.

Introdução: A anemia é a disfunção hematológica mais comumente encontrada nas pessoas idosas tendo, entre os que residem na comunidade, uma prevalência próxima de 10 por cento . Associa-se a várias condições crônicas e tem significativo impacto nos desfechos de saúde como fragilidade, mobilidade comprometida e comprometimento funcional. Objetivo: Avaliar os fatores associados à anemia e sua associação com desfechos adversos em saúde nas pessoas idosas do município de São Paulo. Métodos: Estudo observacional transversal de base populacional, com amostragem probabilística representativa, onde foram avaliados 1256 pessoas com idade igual e superior a 60 anos em 2010. A anemia foi diagnosticada a partir da concentração sanguínea de hemoglobina, de forma contínua e categorizada segundo parâmetros estabelecidos pela OMS (mulheres:<12g/dL; homens:<13g/dL). A regressão logística hierárquica foi utilizada para avaliar os fatores associados à presença de anemia e a associação de anemia com desfechos adversos em saúde. Resultados: A prevalência de anemia foi de 7,7 por cento na população e os fatores significativamente associados após ajuste foram idade mais avançada, diabetes e câncer referidos e presença de sintomas depressivos. Em relação aos desfechos adversos, a anemia permaneceu significativamente associada à fragilidade (OR=5,19; IC95 por cento =2,41-11,20) e mobilidade comprometida (OR=2,10; IC95 por cento =1,19-3,69). Com relação à concentração de hemoglobina, quanto maiores os valores, menores as chances de fragilidade (OR=0,91; IC95 por cento =1,03;1,08) e mobilidade comprometida (OR=0,81; IC95 por cento =0,67;0,97). As probabilidades de ocorrência de desfechos adversos quando se adota os parâmetros estabelecidos pela OMS são próximas de 20 por cento . Conclusão: A prevalência de anemia em pessoas idosas residentes no Município de São Paulo se aproxima de valores encontrados em outras populações. A doença foi associada à idade avançada, presença de diabetes, câncer e sintomas depressivos. Entre os desfechos adversos, a anemia foi associada à mobilidade comprometida e fragilidade. A alta probabilidade de ocorrência desses desfechos quando se considera os parâmetros vigentes reforça a necessidade de discutir a adequação dos pontos de corte para esse grupo etário, que auxiliaria na atuação mais precoce dos profissionais de saúde no tratamento da anemia e, consequentemente, evitaria, postergaria ou reverteria os desfechos adversos associados à doença. / Introduction: Anemia is the most commonly hematologic disorder in older adults, with a prevalence of approximately 10 per cent in community-living elderly. It is associated with several chronic diseases and other adverse health outcomes, such as impaired mobility, frailty and difficulties in activities of daily living (ADL). Objective: To evaluate factors associated to anemia and its relationship with adverse health outcomes in the older adults living in São Paulo, Brazil. Methods: An observational cross-sectional population-based study, with a representative sample, which evaluated 1256 elderly ( 60 years) in 2010. The hemoglobin blood concentration was considered continuous or categorized as anemia according to WHO cutoffs (women: <12g/dL; Men: <13g/dL). We used hierarchical logistic regression to assess factors associated with the presence of anemia, and to evaluate the association of anemia with adverse health outcomes. Results: The prevalence of anemia was 7.7 per cent , among older adults, and the factors that remain statistically significant after adjustment are higher age, presence of diabetes, cancer and depressive symptoms. When considering adverse health outcomes, anemia remained significantly associated with frailty (OR=5.19, 95 per cent CI=2.41,11.20) and mobility difficulty (OR=2.10, 95 per cent CI=1.19, 3.69). Hemoglobin continuous concentration showed negative effect on the probability of outcomes - the higher the blood hemoglobin, the less chance of frailty (OR=0.91, 95 per cent CI=1.03,1.08) and mobility difficulty (OR=0,81, 95 per cent CI=0.67, 0.97). The probabilities of outcomes when the current cutoffs for anemia are adopted are about 20 per cent . Conclusion: The prevalence of anemia in the older adults in São Paulo is close to the values found in other populations. The disease was associated with advanced age, presence of diabetes, cancer and depressive symptoms. Among health outcomes, anemia was associated to impaired mobility and frailty.The high probability of outcomes when the current WHO cutoff are take into account reinforces the discussion of rising the cutoff points for the older population, and even if it brings a greater burden for health services, it could help health professionals in early intervention for treatment of anemia, and thus prevent, delay or reverse the adverse outcomes.

Objective: Recent research has supported the construction of a model of depression and anxiety in older adults ( > 60years), in which the decline in working memory with age is implicated in increasing propensity to engage in repetitive negative thinking, thereby predisposing older adults to anxiety and depression. The study detailed here intended to extend these research findings by exploring the efficacy and acceptability of a working memory intervention in older adults. Methods: The study employed a randomised multiple-baseline single case research design, in which six older adults participated in baseline assessment of mood, repetitive negative thinking and working memory. Participants then tracked their repetitive negative thinking daily throughout a baseline phase, the length of which was defined by the randomisation procedure. Following phase change, participants continued to rate their repetitive thinking daily, as well as engaging in a daily working memory training intervention. On completion of the intervention phase, outcome measures of mood, repetitive negative thinking and working memory were repeated. Full visual and statistical analysis of all data was undertaken to support exploration of the findings. Results: Results of the study indicated that that the working memory training program was unlikely to have elicited a significant impact upon participants’ working memory. However, two participants demonstrated reliable improvement in both repetitive thinking and mood. Analysis of relevant variables to predict the selective impact of the intervention was not fruitful, but may indicate that improvements in working memory underscore the improvements in thinking and mood, lending support to the proposed model. There appeared to be a small, non-significant decrease in daily repetitive negative thinking across five of the six participants. Conclusion: Further research is needed to identify factors that may predict response to working memory training within older adult populations. The research supports the on-going investigation of innovative working memory interventions within an older adult population, although results are not sufficiently robust to indicate wider adoption of these models within health services or as routine treatments for this population.

Introduction: Chronic joint (CJ) pain is the foremost osteoarthritis (OA) symptom that affects older African Americans’ (AAs) functional ability. Every effort should be made to reduce the development of high-impact chronic pain. One way to effectively do this is for older AAs to consistently engage in self-management utilizing the recommended OA treatments. Recommended behaviors include land-based exercise, water-based exercise, strength (muscle and endurance) training and stretching, self-management education, analgesic medications, thermal (warm/cool) modalities, and use of assistive and/or orthotic devices. However, evidence suggests these core behaviors of chronic pain self-management are not optimally utilized in older AAs. Methods: A convergent, parallel mixed-methods study explored patterns, preferences, and predictors of stage of engagement (pre-contemplation, preparation, or action) in recommended OA and CJ self-management behaviors. One hundred ten AAs aged 50 and older from communities in north Louisiana completed quantitative surveys, and a subset of 18 participated in audio-recorded qualitative interviews. Using SPSS, multinomial and binomial regression were used to build predictive models to determine which contextual and cognitive factors predict stage of engagement in each recommended and complementary OA self-management behaviors. A qualitative descriptive approach underscored a conventional content analysis of qualitative data. Results: Older AAs were “dealin’ with it [pain]” in a variety of ways, and their experience of having OA and CJ pain was based on their ability and willingness to bear the pain, understand the nature of OA pain, and experience life with daily pain. These dimensions of dealin’ with pain acted as a catalyst for engagement in complementary and recommended behaviors. In addition, participants’ and providers’ cultural receptivity may limit or enable engagement in certain recommended evidence-based OA behaviors. Specifically, each recommended OA self-management behavior was associated with different predictors of engagement. Confidence to manage pain was a predictor for land-based exercise, while there were no factors associated with water-based exercise. The most reasonable explanation for this finding of lack of participation in water-based exercise is likely due to inability to swim and lack of access to a personal or community pool. Engagement in strength training was significantly associated with confidence, knowledge of strength training recommendation, motivation, pain interference, and spirituality. For self-management education, only knowledge of self-management education recommendation was a predictor. Most AA older adults were unaware that this was recommended or didn’t have access to a self-management program; subsequently the majority had never participated in such but were in the preparation stage. Predictors for medication use included confidence, knowledge, and pain interference. Almost all AAs were using either over-the-counter or prescribed medications. Use of thermal modalities was predicted by pain interference. Lastly, using assistive and/or orthotic devices was significantly associated with employment status, OA pain severity, pain interference, and perceived social support. Assistive and/or orthotic device use was evenly split between users and non-users. Pain interference emerged as the most salient factor predicting stage of engagement in any of the recommended behaviors. Depending on the specific behaviors, pain interference prevented or motivated engagement. Conclusion: OA and CJ pain is a significant symptom in older AAs. This study’s mixed method approach uncovered what older AAs do to manage pain. More specifically, these results illuminate the daily patterns and preferences for self-management. We identified specific barriers and motivators that influence engagement in OA self-management behaviors, and determined the most relevant predictors for each stage of engagement. In addition, we were able to develop a model of OA and CJ pain self-management based on the predictors.

This qualitative study used narrative analysis of interviews with 10 older lesbians (aged 55 and over) who have made a financial commitment to live in a continuous care retirement center (CCRC) specializing in lesbian, gay, bisexual and transgender (LGBT) care. The specific aims were to: 1. Describe what has impacted older lesbians' decisions to live in an LGBT-specific CCRC. 2. Describe factors that both positively and negatively impact older lesbians' perceptions of elder care. The study combined two qualitative strategies (across-case, thematic analysis and narrative analysis) and used a convenience sample. Themes identified in across-case analysis were interpreted in the context of patterns in the narrative analysis. Categories, topics and subtopics were organized temporally. This within and across case strategy facilitated the ability to view the whole as well as individual and identify salient themes and representative stories across cases. Stories of past negative experiences with family (resulting from the participants' sexual orientation) as well as past positive experiences within the gay community were widespread across cases. Presently, the participants are caring for older heterosexual family members and realizing that in their lesbian friendship circles they have experienced this type of care and support and not in their biological family relationships. Additionally, they are increasingly aware of their own aging and realizing that at some point they might not be able to support themselves and each other in ways that preserve their dignity and prevent discrimination, as they generally can now. The participants' past experiences (as well as expectations stemming from them) coupled with present experiences and realizations, have led to the decision to live in an LGBT CCRC. They have concluded that the only way to be assured of dignity and respect in elder care is to decide on the LGBT CCRC. Positive perceptions regarding the decision to live in this elder care option were straightforward and directly reflected the findings for Aim I. It is important to understand older lesbians' elder care decision making because continued lack of knowledge may potentially undermine optimal care delivery of elder lesbians across settings.

Stroke is the leading cause of disability worldwide. It often leads to mobility limitations resulting from deficits in muscle performance. While reduced muscle strength and rate of force production have been reported, little is known about the power generating capability of people after stroke and its relationship to mobility. Research in other populations has found that measures of muscle power may have a greater association with activity performance than do measures of muscle force alone. Consequently, in an attempt to optimise power, investigators have focused on identifying ideal parameters within which to train for power. One such parameter is the identification of the loading level at which maximal power is generated. Literature reporting optimal loads from both young athletic and healthy older populations has yielded mixed results, making the applicability to a hemiparetic population difficult. The purpose of this study was to investigate muscle power performance at differing loads and to determine at what load muscle power is best elicited in hemiparetic and age and gender matched control groups. A secondary aim was to ascertain whether there is a relationship between the muscle power values obtained and activities such as gait, stair climbing and standing from a chair. Twenty nine hemiparetic volunteers and twenty nine age and gender matched controls were evaluated. Involved and uninvolved legs of the stroke group and a comparison leg of the control group underwent testing. Leg press muscle power was measured using a modified supine leg press machine at 30%, 50% and 70% of a one-repetition maximum (1-RM) load. Participants were positioned on the leg press machine and asked to push, with a single leg, as hard and as fast as they could. Data was collected via a mounted force platform and a linear transducer connected to a platform on which the participants lay. From these, power was able to be calculated. The activities were timed while being performed as fast as possible. The results showed that peak muscle power values differed significantly between the involved, uninvolved and control legs. Peak leg power in all three leg groups was greatest when pushing against a load of 30% of 1-RM. Involved leg peak power tested at 30% of 1-RM (Mean:240; SD:145 W) was significantly lower (p<0.05) than the uninvolved leg (Mean:506; SD:243 W). Both the involved and uninvolved legs generated significantly lower peak power (p<0.05) than the control leg (Mean:757; SD:292 W). Correlations were found between the involved leg peak power and gait speed and involved leg peak power and stair climbing (r=0.6-0.7, p<0.05). No correlation was found between paretic leg peak power and chair stands. The control group leg peak power demonstrated significant associations with the performance of all three activities.In summary, there were significant differences between the involved and the uninvolved leg in power production after stroke. As well, there are significant differences between the uninvolved leg and the leg of those not affected by stroke. Power was related to a number of activities.

Lexical access is the process in which basic components of meaning in language, the lexical entries (words) are activated. This activation is based on the organization and representational structure of the lexical entries. Semantic features of words, which are the prominent semantic characteristics of a word concept, provide important information because they mediate semantic access to words. An experiment was conducted to examine the importance of semantic feature distinctiveness and feature frequency in accessing the lexical representations of young and older adults in an off-line task using features of animals. The McRae, Cree, Seidenberg, and McNorgan (2005) feature norm corpus is the basis for the selection of stimuli for the current research project. Semantic features were utilized to explore the structure of the lexicon. Stimuli varied in feature distinctiveness based on the study by McRae, et al. (2005) in 3 broad stimulus groups: Distinctive (D), Low Frequency Non-Distinctive (LFND), and Non-Distinctive High Frequency (NDHF). Participants were asked to list all of the concepts that came to mind for a given feature in an untimed task. Distinctiveness was examined between stimulus groups for the number of concepts and variety of first concepts given to the presented feature. It was found that fewer concepts were given and there was less variety in first concepts given for the distinctive features and the most concepts and greater variety of first concepts were given for the high-frequency non-distinctive features. Distinctiveness appears to vary along a continuum, supporting theories of lexical access based on activation and competition between concept words. Additionally, participant age groups were compared for the number of concepts given and the variety of first concepts given. The older adult group produced more concepts and more variety of first concepts than the younger group, in all three feature categories. These results indicate that greater (lifetime) language experience of the participants in the older group was reflected in their performance. A continued interest in semantic features is important to our understanding of the influence of features on the retrieval of semantic concepts and the changes in those retrieval processes over the lifespan.

The functional food industry has expanded yet research into consumer perceptions of functional foods is limited. Among consumers, older adults could benefit from functional foods due to age-related health concerns. This thesis aimed to generate information about the consumption of functional foods among community-dwelling older adults (>60 years old, n=200) using a researcher-administered questionnaire. Prevalence of functional food consumption was 93.0% and yogurt with probiotics (56.0%) was the top product consumed. The primary functional food matrix consumed was yogurt (51.5%) and dietary fibre was the primary functional food bioactive consumed (79.5%). Most participants (86.2%) consume functional foods to improve health and osteoporosis/bone health (67.5%), heart disease (61.0%) and arthritis (55.0%) were the primary health areas identified. Participants wanted more information about functional foods (63.5%) with preferred sources being newspapers/magazines/books (68.5%) and food labels (66.1%). These results inform stakeholders regarding the potential of functional foods to promote improved health among older adults. / Canadian Foundation for Dietetic Research

Research has shown that re-learning to understand speech in noise can be a difficult task for adults with hearing aids (HA). If HA users want to improve their speech understanding ability, specific training may be needed. Auditory training is one type of intervention that may enhance listening abilities for adult HA users. The purpose of this study was to examine the behavioral effects of an auditory training program called Listening and Communication Enhancement (LACE™) in the Digital Video Display (DVD) format in new and experienced HA users. No research to date has been conducted on the efficacy of this training program. An experimental, repeated measures group design was used. Twenty–six adults with hearing loss participated in this experiment and were assigned to one of three groups: New HA + training, Experienced HA + training or New HA – control. Participants in the training groups completed twenty, 30 minute training lessons from the LACE™ DVD program at home over a period of 4-weeks. Trained group participants were evaluated at baseline, after 2-weeks of training and again after 4- weeks of training. Participants in the control group were evaluated at baseline and after 4-weeks of HA use. Findings indicate that both new and experienced users improved their understanding of speech in noise after training and perception of communication function. Effect size calculations suggested that a larger training effect was observed for new HA users compared to experienced HA users. New HA users also reported greater benefit from training compared to experienced users. Auditory training with the LACE ™ DVD format should be encouraged, particularly among new HA users to improve understanding speech in noise.

The complexity and lack of coordination of the U.S. health care system is especially challenging for older adults, many of whom have multiple chronic conditions. The faith community is a potential partner to assist them, due to strong religiosity of older adults and specific characteristics of faith communities. This study explores the knowledge and practices of faith community nurses (FCNs) in meeting care coordination needs of older adults and identifies a model of gap-filling by FCN practice. An approach combining both quantitative and qualitative approaches was used. A survey was distributed to all known FCNs in Kentucky. From the 60 respondents, 15 FCNs were selected for personal interviews, and six care recipients were also interviewed. Survey data revealed a relatively older workforce, M=57 years, with 73% in nursing for more than 20 years. All served as FCNs in their own congregations, mostly as volunteers. FCNs relied on informal rather than formal assessments, with little consistency in type of health-related information obtained from congregants. The combined interview data revealed themes including, strong grounding in faith, sense of congregational family, reliance on general nursing assessment skills, intentional empowerment, bridging expanses, trust, and continuity. Findings suggest that FCNs in Kentucky identify and fill significant gaps in health care for older adults. Spirituality and religious rituals were important for FCNs and those they served. Congregants sought out FCNs to answer questions, interpret medical information, and assist with health care interactions. The stability of the FCNs in the lives of congregations was regarded as important; congregants counted on FCNs presence through transitions in health. A model to explain FCN intervention was developed based on integration of a social ecological perspective with the WHO International Classification of Functioning, Disability, and Health. This model reflects contextual factors that occur throughout nested environments that surround each individual, including immediate family, congregational family, health and social care systems, and societal policies. FCNs serve as a bridge between and among these nested environments, connecting them and facilitating change within each level.