For decades, sexual expression in older adulthood was a taboo topic in the public discourse and ignored in the empirical literature. As a result of several significant sociocultural changes and medical developments as well as an increasingly older population, however, perspectives are shifting and acceptance and interest in the sexual lives of older adults is growing. The purpose of this dissertation was to investigate sexual well-being in older adulthood and explore its diversity. Study 1 involved a systematic review of the literature on factors associated with the maintenance and cessation of sexual activity in adults 60 years of age and older. Data were extracted from a total of 57 studies and each was assessed for methodological quality. Surprisingly, only four factors (i.e., partner’s interest in sexual activity, past frequency of sexual activity, presence of erectile dysfunction, and partner-related illness) were consistently related, in more than one study, to whether or not older adults were sexually active. Significant variability in study results highlighted methodological caveats of the body of literature, but also the heterogeneity of older adults’ sexuality. Study 2 built upon the findings and recommendations of Study 1 and further examined diversity in sexual well-being. Sexual function and satisfaction, the absence of sexuality-related distress, breadth of sexual experience, and overall frequency of sexual activity were considered as indicators of sexual well-being. The Dual Control Model of Sexual Response (DCM) was used as the theoretical framework in this study of women 50 years of age and older. The DCM posits that sexual response depends on the relative activation of sexual excitatory and sexual inhibitory processes, two separate and independent systems. Study 2 results indicated that, independently, women’s propensities for sexual excitation and sexual inhibition were significantly associated with the majority of the indicators of sexual well-being and the directions of associations were consistent with the tenets of the DCM. The only association that proved not statistically significant was the relationship between sexual excitation and sexual distress. When examined together, sexual excitation and sexual inhibition factors significantly predicted sexual function, satisfaction, and frequency. Sexual distress was predicted more strongly by sexual inhibition factors and sexual breadth by sexual excitation factors. Partner physical and mental health and participant mental health were further identified as moderating variables of these associations. The results of Study 2 expand current knowledge regarding the DCM and its relevance to older women; sexual excitation and sexual inhibition appear to have heuristic value to better understand the variability in sexual activity and well-being in women aged 50 years and older. The results of this dissertation have important implications for the study of sexuality and ageing, perhaps most prominently in terms of highlighting the inter-individual variation in older adulthood and the conclusion that generalizations about “older adults” as a group may not be appropriate.

Background: Subjective cognitive decline (SCD; self-perceived decrements in cognitive functioning in spite of objective cognitive performance within the normal range) subtle cognitive decline (subtle CD; objective sub-clinical decrements in cognitive functioning), and APOE 4 genotype have each been identified as potential risk factors for Alzheimer’s and other pathological cognitive decline in later life. However, despite considerable research attention, our accrued knowledge of potential dementia risk factors has failed to coalesce into a reliable screening measure or assessment method at the earliest preclinical stages of decline. A key issue undermining this effort is the challenge of discriminating older adults experiencing age-normative cognitive changes and complaints from those with dementia risk-relevant concerns and experiences. This, in turn, may result from a fractured field that emphasizes some sources of information (e.g., cognitive test performance) at the expense of others entirely (e.g., self-reported experiences). In light of this, a mixed-methods approach integrating the various methods of enquiry and sources of data may be appropriate at this juncture. Sample and data collection: n=65 healthy community-dwelling older adults from Victoria, BC, Canada completed a brief neuropsychological assessment, participated in interviews related to their first-hand experiences of aging and cognitive change, and provided saliva samples for the purposes of genotype analysis. Chapter 1: This chapter presents a systematic review authored by the Principal Investigator and several Supervisory Committee Members prior to the commencement of this dissertation. This paper presents the current evidence regarding the relationship between SCD and APOE 4 genotype. It is included in this dissertation to contextualize our analysis and overall findings. Chapter 2: This chapter provides an overview of the methods and materials used for the subsequent dissertation studies. Chapter 3: The objective of this investigation was to identify specific psychosocial and demographic predictors of SCD and subtle CD and, by extension, to determine whether these two variables may reflect similar underlying factors. Our findings determined that the predictors for SCD and subtle CD were entirely separable. Moreover, SCD and subtle CD were not found to be related. Chapter 4: This study explored which commonly endorsed qualitative experiences correspond with SCD and subtle CD. Commonly endorsed qualitative experiences were categorized according to commonality and clinical convention. MANOVA and Mann-Whitney U analyses were performed to determine the association of SCD and subtle CD with categories of experience controlling for other demographic and psychosocial factors. Executive functioning declines and related compensatory strategies were strongly associated with both SCD and subtle CD – challenging the traditionally memory-centric focus of the majority of dementia risk research. Conclusions: As a first step, this work provides evidence that SCD may not relate to early sub-clinical objective cognitive declines. Further, executive functioning – and not episodic memory – may be a key area to explore when determining early risk-predicting cognitive declines. Overall, this work presents the potential utility of more qualitatively-oriented research to inform the development of comprehensive and multimodal risk assessment approaches. Caveats, limitations, clinical implications, and future directions are discussed. / Graduate / 2021-07-31

No description available.

Introducción: Los adultos mayores experimentan cambios a nivel físico, cognitivo, social y emocional que tienen un impacto en su calidad de vida. Por lo tanto, resulta necesario disponer de instrumentos con adecuadas propiedades de medición para identificar y medir esta variable, de modo que las inferencias o interpretaciones sean válidas para la toma de decisiones. Objetivo: El objetivo del estudio fue analizar las propiedades de medición del cuestionario de calidad de vida WHOQOL-OLD en adultos mayores peruanos institucionalizados. Método: Participaron 300 adultos mayores de 65 años (Medad=78.41) institucionalizados en un asilo de la ciudad de Lima, donde 173 (57.7%) fueron hombres y 127 (42.3%) fueron mujeres. Se analizó la estructura interna del WHOQOL-OLD a través del análisis factorial confirmatorio (AFC) y la validez convergente con el Índice de Calidad de Vida (ICV). Asimismo, se estimaron puntuaciones de fiabilidad y se obtuvo un baremo para la muestra de estudio. Resultados: Los resultados indican que la estructura de seis factores del WHOQOL-OLD presenta un ajuste satisfactorio con los datos (CFI = .97; TLI = .97; SRMR = .02; RMSEA= .06) y una adecuada consistencia interna (alfa de Cronbach entre .94 y .98). Asimismo, se evidencian relaciones significativas con las dimensiones autonomía (rs = .13, p < .05) y participación social del ICV (rs = .16, p < .01). Conclusiones: El cuestionario de calidad de vida WHOQOL-OLD cuenta con evidencias empíricas de validez y fiabilidad que lo sitúan como un instrumento adecuado para medir la variable de la calidad de vida. / Introduction: Older adults experience physical, cognitive, social, and emotional changes that have an impact on their quality of life. It is therefore necessary to have instruments with appropriate measurement properties to identify and measure this variable, so that inferences or interpretations are valid for decision-making Objective: The objective of the study was to analyze the measuring properties of the WHOQOL-OLD questionnaire for institutionalized older Peruvian adults. Method: The participants were 300 adults over 65 years (Mage=78.41) institutionalized in an asylum in the city of Lima, where 173 (57.7%) were men and 127 (42.3%) were women. The internal structure of the WHOQOL-OLD was analyzed through confirmatory factor analysis (CBA) and the convergent validity with the Quality of Life Index (LCI). In addition, reliability scores were estimated and a scale for the study sample was obtained. Results: Los resultados indican que la estructura de seis factores del WHOQOL-OLD presenta un ajuste satisfactorio con los datos (CFI = .97; TLI = .97; SRMR = .02; RMSEA= .06) y una adecuada consistencia interna (alfa de Cronbach entre .94 y .98). Asimismo, se evidencian relaciones significativas con las dimensiones autonomía (rs = .13, p < .05) y participación social del ICV (rs = .16, p < .01). Conclusions: The WHOQOL-OLD Quality of Life Questionnaire has empirical evidence of validity and reliability that makes it an appropriate instrument to measure the quality of life variable. / Tesis

Falls are caused by many factors in older patients. Medications have been shown to be a risk factor for falls, and studies have shown that patients taking more than five total medications may have a two-fold increased risk of impaired balance. A more recent model suggests only medications with sedating and anticholinergic properties contribute significantly to physical impairment. The authors of this paper helped to develop a multidisciplinary clinic to evaluate the risk of falls in at-risk patients. We present the case of a woman on multiple medications that increased her risk of falling. Of note, this patient was taking a total of 14 prescription medications, seven of which were considered sedating. Based on a comprehensive medication evaluation, six specific changes were recommended to improve this patient's medication regimen and reduce her risk of falling.

Background: The International Outcome Inventory for Hearing Aids (IOI-HA) was develo developed as a global hearing aid outcome measure targeting seven outcome domains. The published norms were based on a private-pay sample who were fitted with analog hearing aids. Purpose: The purpose of this study was to evaluate the psychometric properties of th the IOI-HA and to establish normative data in a veteran sample. Research Design: Survey. Study Sample: The participants were 131 male veterans (mean age of 74.3 years, SD = 7.4) who were issued hearing aids with digital signal processing (DSP). Intervention: Hearing aids with DSP that were fitted bilaterally between 2005 and 2007. Data Collection and Analysis: Veterans were mailed two copies of the IOI-HA. The participants were instructed to complete the first copy of the questionnaire immediately and the second copy in two weeks. The completed questionnaires were mailed to the laboratory. The psychometric properties of the questionnaire were evaluated. As suggested by Cox and colleagues, the participants were divided into two categories based on their unaided subjective hearing difficulty. The two categories were (1) those with less hearing difficulty (none-to-moderate category) and (2) those who report more hearing difficulty (moderately severe severe+ category). The norms from the current veteran sample then were compared to the original, published sample. For each hearing difficulty category, the critical difference values were calculated for each item and for the total score. Results: A factor analysis showed that the IOI-HA in the veteran sample had the ident identical subscale structure as reported in the original sample. For the total scale, the internal consistency was good (Chronbach's α = 0.83), and the test-retest reliability was high ( λ = 0.94). Group and individual norms were developed for both hearing difficulty categories in the veteran sample. For each IOI-HA item, the critical difference scores were <1.0. This finding suggests that for any item on the IOI-HA, there is a 95 percent chance that an observed change of one response unit between two test sessions reflects a true change in outcome for a given domain. Conclusions: The results of this study confirmed that the psychometric properties of th the IOI-HA questionnaire are strong and are essentially the same for the veteran sample and the original private-pay sample. The veteran norms, however, produced higher outcomes than those established originally, possibly because of differences in the population samples and/or hearing on aid technology. Clinical and research applications of the current findings are presented. Based on the results from the current study, the norms established here should replace the original norms for use in veterans with current hearing aid technology.

Prior to 1996, the prognosis of HIV disease was near-certain death; however, biomedical advancements in the past 20 years established HIV as a chronic manageable disease with a nearly normal life span. Recent advancements suggest the potential for a cure. One outcome of current medical treatments is that 50% of all HIV positive individuals are older (-?¥ 50years), and a substantial number of those individuals are long-term (-?¥ 20 years) survivors. Existing research Qualitative research has provided little insight about what older long-term HIV survivors believe about their disease circumstances and aging with the disease. A qualitative method in the phenomenological tradition was used to explore older long-term HIV survivors' notions about aging with HIV and an HIV cure. The self-regulation model of illness representations and the preventive and corrective, proactivity (PCP) model of aging with HIV disease for older adults guided the study. Using strategically placed flyers in HIV services environments, 12 older long-term HIV survivors volunteered to describe their beliefs about aging with HIV and an HIV cure. Participants' statements were entered into discrete cells in an electronic spreadsheet (Excel) and were coded, sorted, and categorized. The categories were sorted for commonality, and emergent themes and subthemes were identified. Older long-term HIV survivors believed they had few issues aging with HIV, expected to live a long time, and believed that finding a cure would have little effect on their lives. These research findings may be beneficial to healthcare providers and researchers who provide quality of life interventions and information to older adults living long-term with HIV who are concerned about aging, longevity, and a cure.

京都大学 / 0048 / 新制・課程博士 / 博士(情報学) / 甲第21207号 / 情博第660号 / 新制||情||114(附属図書館) / 京都大学大学院情報学研究科知能情報学専攻 / (主査)教授 河原 達也, 教授 黒橋 禎夫, 教授 石田 亨 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

No description available.

Current models of hospital-to-home transitions for older adults do not typically include a rehabilitation perspective, which led to the endeavor of this thesis. Chapter 2 (Paper 1) is a scoping review that summarized current literature related to slow-stream rehabilitation (SSR) for older adults. Chapter 3 (Paper 2) was a descriptive prospective cohort study that examined frequency, intensity, type and time (FITT) parameters for cardiovascular and resistance exercises completed by older adult participants in a community-based, SSR, hospital-to-home transition program; and to compare FITT parameters of completed exercises to established guidelines. Chapter 4 (Paper 3) was a qualitative study that examined perspectives of those working in or referring to the community-based, SSR, hospital-to-home transition program to identify factors that act as barriers or facilitators to successful implementation and function of an enhanced, community-based, SSR, hospital-to-home transition program. The scoping review found that SSR programs in single payer healthcare systems improved physical and functional outcomes, decreased hospital readmission and institutionalization for older adults with complex healthcare needs. SSR programs were multidisciplinary, ranged in program and session length, and only took place in institutional settings. The prospective cohort study found that older adults with complex healthcare needs participating in a community-based, SSR, hospital-to-home transition program were able to meet many of the cardiovascular and resistance frequency, intensity, and time (FIT) guideline parameters for community-dwelling older adults. Exercise interventions should be tailored to older adult needs and preferences, at the appropriate FIT to allow for functional gains. The qualitative study found the current program’s services e.g., rehabilitation, education, and nursing care were of benefit. Most of the stated barriers were at a macro or meso level and were out of the study participants’ control, while all the facilitators were at a micro level. Community-based, SSR, hospital-to-home transition programs can serve as a holistic model of care that address identified gaps in the literature. / Dissertation / Doctor of Philosophy (PhD) / Hospital-to-home transition care models do not often include a rehabilitation ‘lens’ which led to this thesis. Chapter 2 was a scoping review of slow-stream rehabilitation (SSR) for older adults; Chapter 3 looked at exercises older adults completed during an SSR hospital-to-home program; and, Chapter 4 studied facilitators and barriers to enhancing a current community-based, SSR, hospital-to-home program. These studies found: 1) SSR programs in healthcare systems like Canada were geared towards older adults with many health problems, only took place in hospital or long-term care settings, and were of benefit; 2) Older adults participating in a SSR hospital-to-home program should exercise at the appropriate intensity, time and frequency to see gains in function; 3) The current program’s services e.g., rehabilitation, education, and nursing care were beneficial, but barriers to enhancing the program were out of the participants’ control. Community-based, SSR, hospital-to-home transition models of care that include rehabilitation are very important for older adults.