Introduction: Sarcopenia is a disease with a high prevalence in the elderly population and a significant negative impact on quality of life. Physical activity along with adequate nutritional intervention are key to mitigating these effects. Methods: The research was conducted using a questionnaire survey in which 113 nursing homes participated. The quality of nutritional care in these facilities was determined using a survey. Results: A total of 113 nursing homes were included in the research. Of these, 57% of facilities had a registered dietitian available. Nursing homes assess the presence of malnutrition at least 4 times a year in 74% of cases, of which they most often use changes in weight (80 %) and monitoring of food intake (70 %). Only 50 % of the facilities use validated nutritional screening tool. 83 % of the facilities apply nutritional support, most often in the form of diet modification and sipping (98 %). They use food fortifications less often, in a total of 57 % of facilities. The presence of a registered dietitian is affected by the size of the facility, with the larger ones being available to the registered dietitian at a higher frequency. The presence of a registered dietitian in the facility significantly positively affects the frequency of detection of malnutrition (P = 0.039)....

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Research has shown that riding a motorcycle can potentially be much more dangerous than operating a conventional vehicle. There are factors inherent in driving or riding a small two wheeled vehicle, such as a motorcycle, moped or even bicycle that can potentially decrease their ability to be seen or noticed by other drivers. This disadvantage is reflected in the disproportionate over-representation of injuries and/or fatalities incurred by this particular driving group. This creates a significant problem which deserves dedicated evaluation as to causative factors and/or influential variables. The following research was conducted with intentions to investigate the topic of motorcycle conspicuity so as to further explain the variables which positively contribute to a motorcycle being seen and to supplement the body of knowledge that currently exists on this topic. This study specifically evaluated the influence of sex, age, motorcycle lighting conditions, and vehicular daytime running lights upon one's ability to effectively detect a motorcycle within a "high fidelity" simulated environment. This research additionally sought to examine the feasibility and validity of using a novel fixed base "high fidelity" simulator for the evaluation of motorcycle conspicuity. The results from this research clearly indicate a link between vehicular DRLs and the effective detection of motorcycles and also support previous research as to the effectiveness of motorcycle DRLs. Additionally, these results suggest that as one ages, certain degradations in vision, cognition, and physiology occur which decrease one's performance in detecting and responding to a motorcycle. These findings additionally provide support for the use of a "high definition" fixed base simulator as a valid technology for the evaluation of motorcycle conspicuity.

As the population of older adults in the US increases so do their rates of chronic disease (CDC, 2020). There is limited availability of occupational therapy led health promotion programs for older adults despite being shown to prevent and/or manage chronic disease while helping them thrive (Berger et al., 2018; Cassidy et al., 2017; Clark et al., 2012; Smallfield & Lucas Molitor, 2018b). Factors contributing to limited programming include lack of training for occupational therapy practitioners in preventive health (Metzler et al., 2012), occupational therapy having little recognition as a provider in preventive care amongst health professionals (Halle et al., 2018), and lack of referrals and reimbursement for occupational therapy services in preventive care (Hildenbrand & Lamb, 2013; Metzler et al., 2012). ageWISE is an innovative evidence-based preventive occupational therapy program developed to improve the mental and physical health of older adults. The six-month program develops participant efficacy in optimizing self-selected health behaviors through topics including fall prevention, sleep and rest, ADL performance, socialization, and navigating healthcare technology by utilizing a blend of didactic lecture, experiential learning, peer discussion, goal-setting, and journaling. Comprised of eight in-person group-based sessions and two telephone-based individual sessions, all ageWISE sessions are led by an occupational therapy practitioner and supported by an occupational therapy doctoral student. ageWISE is positioned to not only improve the health of older adults but to expand the reach of occupational therapy in a setting where its value is a necessity…preventive care.

In the context of health care delivery for senior citizens, this research utilizes three studies that examine the development and implementation of health policy and the factors that can directly or indirectly impact the effective delivery of health services to senior citizens. It utilizes three essays employing mixed methods (qualitative and quantitative) methods including semi structured interviews, multiple regression and partial least squares structural equation modelling to examine the extent to which the implementation of health services delivered attributes of primary and integrated care to seniors. The two essays identified methods, approaches and strategies of integrated care relevant to the development of policy that can be successfully implemented when the contextual issues that older people consider to be important in maintaining their functional capabilities and their motivation to improve health as perceived by them are addressed. Consequent upon the results from these studies, the third essay examines the methodological issues on integrated geriatric care implementation when guidelines for effective policy development identified were not followed. By highlighting the relationship between effective policy and patient satisfaction, these three essays' recommended approach enhances the theory of health design that confirms that theoretical models of primary care must incorporate the system, process and service delivery levels of care to optimize seniors health.

In 2014, UNAIDS published the Gap Report that identified adults aged 50 years and older as a vulnerable group being left behind in HIV treatment and prevention efforts (UNAIDS, 2014). This manuscript thesis is composed of two data chapters that aim to address the gap in the HIV, aging, and disability literature by exploring what is known about the quality of life and disability experiences of older adults aged 50 years and older living with HIV in sub-Saharan Africa (SSA). The purpose of the scoping review was to map out published literature on quality of life among older adults living with HIV in SSA. Following Arksey & O’Malley’s framework for conducting scoping reviews, 6 databases were searched resulting in 1021 titles and abstracts that were screened for inclusion resulting in a total of 8 articles included for review and synthesis. The review confirmed a dearth in research literature on older adults living with HIV in SSA as included studies were only conducted in 2 out of 47 countries in the region. The qualitative study addressed this gap in knowledge by exploring the disability- related experiences of 10 older men and women living with HIV in Zambia. The qualitative study identified 5 major themes: 1. Multiple Symptoms and Impairments: Variation in Onset and Duration; 2. Daily Activities and Participation: Shaped by Gender Roles; 3. HIV Status Disclosure: Hindered by Stigma, Driven By A Purpose; 4) Poverty and Food Insecurity: Precarious Employment; and 5) Managing An Altered Uncertainty: Changes Resulting From A Prolonged Life. These findings demonstrated that while participants were benefiting from antiretroviral therapy, many still experienced disability. The component studies in this thesis complement one another and advance dialogue about the quality of life and experiences of disability in older adults living with HIV in SSA and points to a need for further research so that fewer people are left behind. / Thesis / Master of Science (MSc)

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<p>Older adults admitted to hospital often must make discharge decisions about whether they will be able to safely manage at home. Decision-making for clients and teams is supported by occupational therapy assessment. This thesis presents three manuscripts from a single study that was designed to address a need for evidence of validity of two measures for predicting harm.</p> <p>The design was a prospective observational study in which older adults from an inpatient unit (n=47) were followed for six months for reports of incidents of harm. Baseline data included independent variables (e.g. age, sex, education, living alone, comorbidities, caregiving hours, ADL score) and scores on two measures: the Assessment of Motor and Process Skills (AMPS) and the Cognitive Performance Test (CPT).</p> <p>The first manuscript contributed needed validation evidence for the CPT. The CPT correlated moderately with cognitive measures, and scores were not affected by age, and years of education. The CPT differentiated impaired persons differently from other measures. Results highlighted that further evidence to test the CPT against a criterion related to outcomes in the community was needed.</p> <p>The second manuscript tested the trustworthiness of the outcome “incidents of harm”. Test-retest reliability was high and validation against daily logs and medical charts supported this method of measurement of incident of harm.</p> <p>The third manuscript determined whether the AMPS and CPT were valid for predicting incidents of harm after discharge. The results showed that, compared with all independent variables, AMPS-Process scores were the most significant predictor of harm outcome. The CPT had a high specificity for identifying persons who did not have harm. Living alone, age and sex contributed to the prediction of harm. The implications of these results are that scores on the measures can inform patients, families and the team about older adults’ risk of incidents of harm after discharge.</p> / Doctor of Philosophy (PhD)

Exploration of the internal structures of teeth is complex and has the potential to add greatly to existing information about the lifecourse of archaeological individuals, but has yet to realize its full interpretative value as an avenue of bioarchaeological inquiry. This thesis consists of three papers that focus on the potential for internal dental structures to provide important information on chronological age, and physiological alterations linked to vitamin D deficiency. The first paper used SEM, microscopic imaging, and histological investigation of tooth dentin to determine the presence of mineralisation defects, observed as interglobular dentin (IGD) (spaces following incremental lines) in living (with known medical history) and archaeological individuals with clear healed rickets. This paper demonstrated that incremental bands of IGD are indicative of vitamin D deficiency. The second paper expands identification of those with deficiency by quantifying morphological changes in pulp chambers of living and archaeological individuals. Pulp chambers were radiographed, evaluated histologically, and measured. Those with evidence of past vitamin D deficiency displayed constricted or chair shaped pulp horns. This radiographic technique provides a non-destructive tool to identify individuals that experienced childhood vitamin D deficiency. The role vitamin D plays in the development of IGD over the lifecourse requires that accurate age estimates be conducted on older as well as younger adults. The third paper used a new version of pulp/tooth area ratios to provide an accurate estimation of age-at-death in older adults (50+). ImageJ software was used to calculate areas on sectioned teeth and results provided a mean absolute error (MAE) of ±3.9 years in older adults. The results described in this thesis contribute to broader topics of discussion in anthropology, such as investigating health and metabolic disease in human populations, and adds to the ongoing discussion and evaluation of age-at-death techniques used to extend our ability to study the lifecourse of archaeological individuals. / Dissertation / Doctor of Philosophy (PhD) / Teeth record life events and the three papers in this thesis use dental structures to provide methodological foundations to evaluate the occurrence and severity of vitamin D deficiency in early life. The potential long-term consequences of such events are investigated through accurate recognition of older adults. Vitamin D regulates skeletal health by mediating calcium absorption and phosphorous homeostasis and deficiency is recognised as an important health concern. Accurate identification of older adults is also a widely recognised problem in skeletal studies. Age-at-death estimation in older individuals was calculated and the exploration of abnormal pulp chamber shape and mineralisation defects in tooth dentin was done to determine vitamin D status in both younger and older individuals. This research established that internal dental structures enables past episodes of vitamin D deficiency to be recognized in cases where skeletal indicators are not clear and permits increased precision in age-at-death estimations in the older individual.