Falls in the elderly Canadian population pose a serious health problem; they are the leading cause of accidental death in persons aged 65 and older. The most common serious injuries associated with falling are hip fractures; more than 19,000 Canadians sustain a hip fracture yearly as a result of a fall. A review of the literature reveals that most of the studies on falling have been conducted in institutional settings. Community-based studies have identified the risk factors associated with falling to assist in case-finding and fall prevention. However, qualitative studies of falling for elderly community-dwelling individuals are non-existent. The purpose of this study is to describe the meaning of falling for elderly community-dwelling individuals. The phenomenological approach to qualitative methodology was used for this study. This approach seeks to describe human experience as it is lived. Individuals 65 years of age or older were contacted through a Long Term Care Unit. Eight women became informants, participating in repeated interviews guided by open-ended questions. From the content analysis of the data, three major categories of data that were common to the participants were identified and developed. The three categories represent levels of perception in relation to falling, which together represent the entire meaning of falling. At the first level, participants interpreted the various aspects of their falls. The second level describes the reactions to falling. The third level describes how participants coped with falling in the context of coping with aging. These findings revealed that falling was viewed as a symbol of aging and therefore, the emotional reaction to falling occurred in the context of growing old. Furthermore, it was found that coping with falling occurred in the broader context of coping with aging. The implications for nursing practise, education, and research were identified in light of the research findings. / Applied Science, Faculty of / Nursing, School of / Graduate

The establishment of intermediate care facilities in British Columbia, as well as the establishment of similar facilities throughout the rest of Canada, was and still is a well-intentioned approach to meet the long term care needs of the elderly. The practices and procedures adopted by long term care facilities, however, tend to inhibit the personal autonomy of residents (Thomasma, 1985). Specifically, a facility's practices and procedures tend to inhibit residents' latitude of choice regarding daily living activities. Residents' latitude of choice may also be lessened when nurses implement well-intentioned helping interventions based on their own motivations and goals, rather than those of elderly residents. Latitude of choice measures the extent to which an individual's perceived degree of choice includes activities of importance to him/her. At present, there is limited research addressing both resident and staff perceptions regarding the autonomy (freedom of choice) of residents, particularly in relation to their daily activities. Accordingly, this study's purpose was to determine the institutionalized elderly residents' and their caregivers' perceptions of residents' latitude of choice regarding activities of daily living. From determining these specific staff and resident perceptions, significant differences were isolated. This study was conducted in two intermediate care facilities located in a large city within the province of B.C. The data collection instruments in this study included selected questions from Hulicka et al.'s (1975) revised Importance, Locus and Range of Activities Checklist, as well as a demographic data sheet developed by the researcher. Forty-five intermediate care 1 residents and forty-five nurses (Registered Nurses, Licensed Practical Nurses and Nurses' Aides) completed the study questionnaire and the demographic data sheet. The researcher studied the residents' and staff's responses to the Importance, Locus and Range of Activities Checklist by using non-parametric techniques for statistical analysis. The researcher used these techniques to determine the existence and location of differences in perceptions among the residents and staff. Significant differences exist in residents' and staff's perceptions when each group's importance ratings are combined with choice ratings. Isolation of the above importance and choice components for individual analyses indicate that the residents and staff had significantly different response patterns regarding a) the importance residents attach to daily living activities and b) the degree of choice residents associate with daily living activities. The above findings indicated that residents' latitude of choice may not be realized to a greater extent if the staff do not attach a degree of importance to a particular activity(ies) similar to that attached by the residents. Residents' latitude of choice may not be recognized to a greater extent if staff do not perceive that residents associate "some" or "no choice" with an activity of particular importance to them. / Applied Science, Faculty of / Nursing, School of / Graduate

Depression is a common clinical and subclinical psychiatric disorder in the middle-age to older adult population. This study examined the relationship between depression and activities of daily living (ADLs) in middle-age to older adults. This study examined longitudinal data from the 1998, wave 4, and 2000, wave 5, of the Health and Retirement Study (HRS), a National Panel Study sponsored by the National Institute on Aging. A negative cross-sectional and longitudinal relationship between higher ADL scores and depression was hypothesized. A goal of the present study was to determine the temporal precedence of these two constructs using a cross-lag panel design to first examine the cross-sectional relationship between ADLs and depression at time-one and at time-two, and then the time-one to time-two longitudinal relationships to examine temporal precedence possible causal relationships. Finally, differences in these correlational relationships by retirement status and then by marital status were tested. There were several interesting findings, including those who were retired in both 1998 and 2000 reported fewer ADLs (i.e., worse functioning), but also reported better health than those who were working in both 1998 and 2000. Similarly, those people who were not married in both 1998 and 2000 reported fewer ADLs but better health than those who were married in both 1998 and 2000. Married individuals reported fewer depressive symptoms than those who were not married.

Attitudes toward the elderly were examined in three generations through analysis of media use, gender, contact with elderly, age, factual knowledge about aging, and parental influence on attitude formation. The results revealed that age, factual knowledge, perceived ageism in mass media and parental influence were significantly related to attitude toward the elderly.

It is widely believed among developmental psychologists that old age is a distinct developmental stage with unique goals, struggles and opportunities for growth. Achieving integrity involves making sense of disparate aspects of one's life and seing life as one complete whole, rather than bits and pieces of a puzzle. Integrity is achieved when each part of the puzzle is put into place, forming one complete picture.

Utilizing a sample of community-residing older adults, this pretest-posttest design evaluated the short term (approximately 1 week) impact on everyday functioning of Stress Inoculation (SI) training, a cognitive-behavioral intervention that is essentially a coping skills enhancement program. The targets of training were anxiety and concern about being able to successfully perform everyday living tasks. The training program was contrasted with a no contact (waiting list) control. In an effort to maximize the practical aspects of this study, the assessment battery included the use of two ecologically valid measures of everyday problem solving skills (one self-rated and one interviewer-rated). Also included were a measure of everyday intelligence widely used in gerontological research, two measures of self-efficacy, a geriatric depression scale, a state-trait anxiety scale, and a self-report measure of failures in perception, memory, and motor function. The results suggest that Stress Inoculation training is an effective intervention for improving everyday competence but that personal perceptions of self-efficacy and the emotional states of anxiety and depression mediate treatment effects. In general, only persons with lower levels of self-efficacy and higher levels of anxiety and/or depression saw improvement in their cognitive performance following SI training.

Review of life experiences for personal adaptation is a general tendency in older adults. A positive outcome of life review may be an increase in well-being. To test the hypothesis that reminiscence group activity, structured for life review, could increase well-being, a sample of 30 residents in a retirement community was studied, using a quasiexperimental, pretest-posttest design. Research subjects, average age 78 years, were randomly assigned to experimental and control groups. All were pre- and post-tested by four instruments: Life Satisfaction Index Form A, Affect Balance Scale, Zung Self-Rating Depression Scale, and the OARS Activities of Daily Living Scale. Control subjects received testing only. Experimental subjects participated in small reminiscence groups, structured for life review by the Haight Life Review Experiencing Form (LREF). The reminiscence group activity constituted one complex independent variable. Group activity included opportunity to write in private journals about LREF topics, shared voluntarily. Data from the four dependent variables were analyzed separately, using scale score differences. Neither t-tests, nor one-way analysis of variance of differences in relation to frequency of group attendance revealed any statistically significant findings, although posttest scores showed some nonsignificant improvement. / Master of Science

A review of the literature on adjustment to widowhood and survivorship reveals gaps in qualitative and quantitative studies which explore anticipatory processes for this expectable life event. Studies focusing on men anticipating this time of life are rare to non-existent. This is a qualitative study on the anticipatory processes (cognitive, emotional and behavioral) of individuals and couples. The theoretical underpinnings for the study are drawn from symbolic interactionist ideas of how individuals settle on a personal and functional reality and from the ideas of Peter Berger and his associates on how the marital conversation stabilizes the individual's sense of the world. Fourteen long-married couples ages 50 to 80 were interviewed. They are Caucasian, middle and upper-middle class people, married from 29 to 49 years. The first part of the study examines the following: whether people have a prediction relative to which of the couple will probably die first; whether members of the couple hold the same prediction; what factors inform such a prediction, and how much discussion there is of this topic. It was found that about one-half of the informants have a stable prediction and that three couples held the same view. Three typologies, the CLEARS, those IN PROCESS and the VAGUES, were used to describe the prediction behavior of the 28 participants. Among the seven factors highlighted were the sense of one's genetic inheritance, belief in the “common wisdom" that husbands pre-decease their wives, and observations of one's own energy level relative to one's partner. The second part of the study explores the worries and concerns of men and women as they look forward to a time without the life partner. The study uncovers the actions they take at present and actions they believe they would take in the future to best perform daily routines and to deal with emotional and relationship needs. It was found that the men and women envision their futures differently, that men anticipate the likelihood of remarriage and tend to see remarriage as a pleasant coping strategy. Women show a disinclination to remarry emphasizing the trade-offs of marriage. Their strategies are more varied, and are more likely to be based on observations of widowed women throughout their lives. Finally, the participants' religious and philosophical attitudes, broad enough to encompass death and loneliness, are noted. / Ph. D.

Locus of Control (LOC) is operationalized as a dispositional trait remaining stable throughout life, but may also be conceptualized as a domain specific state. Widowed persons' support groups, consisting of recently conjugally bereaved older adults (N=22) and one high functioning, long-term widowed peer group leader, were utilized to test LOC malleability. A significant increase in one State measure subscale, Desire for Control, was noted. Trait LOC remained stable. The change in State and Trait LOC change did not significantly relate to psychological symptom reduction. However, Trait LOC Internality related to fewer symptoms whereas State LOC Internality related to more symptoms.

Before the main study commenced, empirical work was conducted to establish and validate the Chinese version of the Satisfaction with the Nursing Home Instrument (SNHI-C), which was an instrument used to measure resident satisfaction in the main study. Testing was conducted on a cluster sample of 330 residents from 16 elderly residential care homes in Hong Kong. Findings demonstrated that the SNHI-C had good content validity with an index of .93. It also demonstrated high construct validity by having significant correlation with depression (r = -.42, p < .001), the physical component of health-related quality of life (r = .16, p < .05), the mental component of health-related quality of life (r = .41, p < .001), and global quality of care (r = .49, p < .001). The SNHI-C also demonstrated satisfactory internal consistency and good stability by having a Cronbach's alpha of .79 and intra-class correlation coefficient of .94, respectively. / Current study adds new knowledge to the psychosocial health benefits of Tai Chi for the residents living in elderly residential care homes. Findings were discussed in relation to previous research findings and in the context of elderly residential care setting. The present study has the strength of evaluating the health benefit of Tai Chi using a more stringent research design, in comparing with the previous studies. Limitations of this study included the use of convenience sampling, without random assigning participants into groups, and inadequacy in quantifying Tai Chi learning. The implications of the findings support incorporating Tai Chi training in routine elderly residential care. Based on the study experience, recommendations for a successful implementation of a Tai Chi program were provided. Future research is advised to further explore the most beneficial mode of a Tai Chi program particularly for the elderly residential care home residents. Evaluation of its effect over a longer period of time and using various approaches are also suggested for obtaining a more comprehensive picture of the health benefit of Tai Chi. Finally, it is also worthwhile to investigate the experience of practicing Tai Chi through a qualitative approach to complement present findings. / Like many areas in the world, Hong Kong is facing an aging population. To accommodate the increasing elderly population, particularly those who are frail and have limited family support, elderly residential care homes are growing in size and number. Despite of the escalating demand, it has been documented repeatedly that the nature of residential living can predispose the residents to a number of psychosocial challenges. Study findings highlight consistently that residents are prone to experience lowered self-esteem, poor social support, and poor health-related quality of life. Providing psychosocial support to the residents is an important dimension in elderly residential care. It is because older residents, despite of their deteriorating physical functions that cannot be cured, can still have the potential to live with optimum psychosocial well-being. Even though a number of interventions have been considered in the past to address the residents' psychosocial needs, evaluation on the effectiveness of these interventions is inconclusive. There is still a paucity of evidence suggesting a promising intervention that can promote psychosocial health for the residents. Given the general consensus that exercise is beneficial for the psychosocial health, and considering that the characteristics of Tai Chi are particularly suitable for the elderly population, Tai Chi is considered as a possible means to promote psychosocial health for the residents. This study aimed to examine the psychosocial effects of a Tai Chi program on the residents of the elderly residential care homes. / The main study adopted a non-equivalent pretest-posttest control group design to examine the psychosocial effect of Tai Chi on residents of elderly residential care homes. Residents were recruited from six elderly residential care homes in Hong Kong by convenience sampling. The experimental group (n = 66) joined a 26-week Tai Chi program three times per week with each session lasted for one hour. The control group (n = 73) continued their daily activities as usual. Outcome variables encompassing state self-esteem, the physical component of health-related quality of life, the mental component of health-related quality of life, social support network, and social support satisfaction were assessed at baseline, the 13th and 26th week of the intervention period. Doubly multivariate analysis of covariance was performed to examine the effect of the Tai Chi program. / With the confounding effect of resident satisfaction controlled, findings demonstrated that participants in the experimental group experienced greater improvement in the psychological composite outcome of state self-esteem, the physical component of health-related quality of life, and the mental component of health-related quality of life (p < .05). No significant changes were detected in any of the three individual psychological outcome variables. Non-significant result was also found regarding the social effect of Tai Chi program on the participants. / Lee Yin King. / "May 2006." / Advisers: Diana Lee; Jean Woo. / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1558. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 249-269). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.