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Increasing access to and improving knowledge of rehabilitation strategies is essential to address the adverse health outcomes related to the increased prevalence of multimorbidity with our aging population. Physical literacy is emerging as a strategy to increase lifelong participation in physical activity, however, there is limited research exploring how physical literacy can support optimal aging for adults with functional decline associated with chronic conditions. This thesis investigated how to frame physical literacy for adults through a rehabilitation lens and explored outcomes related to function, mobility, and health awareness as a result of a novel physical literacy intervention. The first study was an integrative review examining what is known about physical literacy for adults. Thirteen new physical literacy constructs emerged, that differed from the current physical literacy definition and addressed the needs of aging adults. Purposeful activities, knowledge of age-related changes, and social interaction were identified as the top three. The objective of the second expert consensus study was to understand what components are required when acquiring physical literacy as an adult from the perspectives of healthcare professionals and researchers in optimal aging. The third qualitative study explored how adults with multimorbidity describe physical literacy for adults while considering barriers and facilitators associated with fluctuating health status. The findings from the preceding qualitative studies helped inform the program development of the fourth physical literacy intervention study and fostered a new rehabilitation-focused Physical Literacy framework for Adults and adults with Chronic Conditions (PLACC). A pre-post study involving 20 adults with 2 or more conditions (95% female, 59 + 6 years) participated in a 5-week multi-component, virtually delivered physical literacy group intervention. Post-intervention significant improvements were found for physical function (p=<0.001; cohen’s D=0.90), as measured by the patient specific functional scale, mobility with the 4-meter walk test at self-selected speed (p=0.03, cohen’s D=0.53) and all 3 physical literacy awareness questions (p=0.001, p=<0.001, p=0.001). The results of this program of research can inform future public health interventions, involving rehabilitation-focused physical literacy programs, designed by physiotherapists, and aimed at improving function and mobility for adults with chronic conditions. / Thesis / Doctor of Philosophy (PhD) / In Ontario, almost 80% of adults over the age of 45 are living with at least one chronic condition, such as diabetes, high blood pressure or arthritis. These conditions require on-going management and can cause challenges with one’s function and mobility. Physical literacy is a term that is used commonly in schools and sports to describe the basic movement skills that children need to be active for life. It is unknown how physical literacy can help support adults with chronic conditions to improve their overall health. This thesis explored how physical literacy could improve function and mobility for adults and older adults with chronic conditions. The first study examined all the existing literature on adults and physical literacy. The second and third studies asked physiotherapy researchers and adults with chronic conditions what physical literacy means to them. The results of these studies found that there are different skills needed to become physically literate as an adult than what is needed to become a physically literate child. A new physical literacy model for adults was developed that guided an intervention study for adults with chronic conditions. Results of this intervention study found that a 5-week education program delivered virtually by a registered physiotherapist could improve adults’ awareness of what physical literacy is, improve function and mobility outcomes and positively impact behaviours. The results of this thesis have provided a new way of thinking about physical literacy for adults and older adults. Physical literacy for adults involves self-monitoring movement, having knowledge of age-related changes, participating in meaningful, safe, and social movement activities, and understanding the benefits of physical activity for the management of chronic conditions.

Background Population aging has led to an increasing number of older adults living in the community with complex care needs such as functional limitations, cognitive impairment, and multimorbidity. These individuals may need help to remain in their homes, which has created a growing demand for home care. Strategies to manage complex older adults such as home care patients safely in the community typically emphasize robust and integrated primary care. The objective of this thesis is to explore how specific measures of quality in primary care are associated with emergency department use among home care patients in Ontario. Methods I conducted four studies on varying subsets of the same population-based retrospective cohort of long-stay home care patients assessed in Ontario from 2014-2016. The first study was a descriptive examination of the entire cohort that characterized their primary care and other health system use. The second was a case-crossover study among home nursing patients examining whether access to afterhours care modifies the association between home nursing visits and same-day emergency department visits. The third study looked at physician-level provision of primary care home visits and its association with emergency department visits among home care patients with extensive functional impairments. The final study examined and compared associations between continuity of primary and specialty physician care. Results Long-stay home care patients in Ontario are high users of both primary care and the emergency department. Better access to afterhours care reduced the likelihood of an emergency department visit on the same day as a home nursing visit. Patients with extensive functional impairments whose primary care physician who provided higher levels of home visits had lower rates of emergency department use. Finally, better continuity of both primary and specialty physician care were similarly associated with lower emergency department use. Conclusion Better quality primary care integrated with other sectors of the health system is crucial to enabling home care patients to age safety in the community. Access to care is particularly important and can be improved though enhancing the availability of afterhours care and increasing the provision of home visits for those who have difficulty reaching primary care offices. Improving continuity of specialty physician care should be a health system objective alongside improving continuity of primary care. / Thesis / Doctor of Philosophy (PhD) / Older adults receiving home care are a growing population of individuals with complex care needs and high rates of emergency department use. This thesis seeks to characterize the primary care use of home care patients in Ontario and examine to what degree better quality of primary care is associated with less use of the emergency department. My findings indicate that increased access to afterhours primary care, higher levels of primary care home visits, and better continuity of both primary and specialty physician care were associated fewer emergency department visits. In conjunction with other sectors, primary care plays a central role managing older adults with complex care needs in the community. Better quality of primary care, particularly advanced access, can help keep older adults safely at home and out of hospitals as they age.

Yes / Background: The study aim was to determine if state and trait intra-individual measures of everyday affect predict cognitive functioning in healthy older community dwelling European adults (n = 387), aged 55-87 years. Methods: Participants were recruited from centres in France, Italy and Northern Ireland. Trait level and variability in positive and negative affect (PA and NA) were assessed using self-administered PANAS scales, four times a day for four days. State mood was assessed by one PANAS scale prior to assessment of recognition memory, spatial working memory, reaction time and sustained attention using the CANTAB computerized test battery. Results: A series of hierarchical regression analyses were carried out, one for each measure of cognitive function as the dependent variable, and socio-demographic variables (age, sex and social class), state and trait mood measures as the predictors. State PA and NA were both predictive of spatial working memory prior to looking at the contribution of trait mood. Trait PA and its variability were predictive of sustained attention. In the final step of the regression analyses, trait PA variability predicted greater sustained attention, whereas state NA predicted fewer spatial working memory errors, accounting for a very small percentage of the variance (1-2%) in the respective tests. Conclusion: Moods, by and large, have a small transient effect on cognition in this older sample.

Yes / Older adults use their smartphones to learn new material but few studies examined their learning with the presence of a chatbot in a smartphone. We developed a three-week self-paced learning module on three topics (chatbot, QR scanner, Google Drive) using their smartphone. Our aims were to examine participants’ self-paced learning accuracy while exploring older adults acceptance of the chatbot. Twelve participants participated in this study (Mage: 64.75 years) for three weeks at their homes individually. Results showed that they had low accuracy for the chatbot but higher accuracy for the other two. Qualitative analyses indicated that participants disliked the chatbot and that good clarity in our instructional videos and slides may have contributed to the low acceptance for the chatbot. Our findings indicated that self-paced learning is feasible with slides and videos only, and to create more chatbot-related assessments to increase chatbot usage. / Newton Fund Institutional Links grant ID: 331745333. / The full-text of this article will be released for public view at the end of the publisher embargo on 04 Sep 2024.

This study investigated the stability of health care decisions and the influencing values of 21 competent older adults. Face to face interviews were conducted initially (T1) followed by taped, telephone interviews seven years later (T2). Each participant was presented with a list of value indicators from which they were asked to identify the five most influential values to their health care decision-making process. They were also instructed to make decisions regarding five health care treatment and five life-sustaining treatment scenarios across two health states and three different levels of prognosis. Using open ended questions, participants described why they would or would not consent to medical or life-sustaining treatments. No significant change in healthcare decisions was found for life-sustaining treatments over the seven year period. The only significant change for health care treatments was an increase in the proportion of individuals "not consenting" to hip replacement surgery from T1 to T2 regardless of health state or prognosis. Similarly, change occurred between T1 and T2 with more participants refusing cataract surgery with a prognosis of 50/50. High stability was noted with the values selected by participants. Four out of the top five values selected at the initial interview were also selected seven years later. Data from the interview transcripts revealed congruence between the values chosen on the values inventory and those described as factors determining whether or not consent was given to the medical or life-sustaining treatments at T1 and T2. / Ph. D.

Wants and needs for housing change over time as events occur (such as marriage, raising families, career promotions) that cause adults to re-examine their living environments. As people age, this reassessment continues, and alternative housing options may be considered. One housing option that is available to older adults is an independent living retirement facility. The purpose of this study was to examine the relationship between motivations for moving to independent living retirement facilities and subsequent satisfaction with that environment. The sample for this study consisted of residents of townhomes leased to older adults for age-segregated living in a planned retirement community, with health care amenities on site. The research was conducted in two phases: focus groups were convened with residents of this facility, and a self-administered instrument was developed and sent to all 94 residents of the townhomes. The instrument measured the influences on moving and residential satisfaction on a four-point Likert scale. The data were analyzed using descriptive statistics, correlation analysis, and multiple regression. A total of 79 usable responses were obtained from the initial mailing and one follow-up postcard, for a response rate of 84%. There were twice as many women as men in the sample group, and it was evenly divided between married-couple and widowed households. The average age for the residents was 78 years. They were well-educated older adults, and the majority had prior occupations in professional and managerial sectors. The influence on moving that received the highest number of positive responses (>2.5 on a Likert-type scale) was to maintain independence, followed by being free of home maintenance, and the knowledge that health care needs would be taken care of in the future. The residents were satisfied with their overall housing and neighborhood environment, especially with their neighborhood. They were less satisfied with maintenance of the facility and with the management. Two influences on moving emerged as having a positive relationship with residential satisfaction: preference for a homogeneous (age-segregated) community, and a desire to move closer to friends and family. The variables that significantly predicted residential satisfaction were (a) a preference for a homogeneous community, (b) a desire to move closer to friends and family, and (c) the pull of the macroenvironment (i.e., features available, or inherent, in the nearby vicinity of the retirement community that act as pulls, such as mountains, a nearby university, or a rural area), which had an inverse relationship to residential satisfaction. Four individual components of residential satisfaction (housing, neighborhood, maintenance, and management) were analyzed for predictors of satisfaction. One variable predicted housing satisfaction (homogeneous community), none predicted neighborhood satisfaction, five predicted satisfaction with maintenance (environmental concerns, homogeneous community, macroenvironment, future support, and family and friends), and three predicted satisfaction with management (homogeneous community, family and friends, and macroenvironment). The latter three predictors were the same predictors of residential satisfaction, emphasizing a strong relationship between management and residential satisfaction. / Ph. D.

The purpose of this study was to determine which archetypal settings independent living residents of facilities that provide assisted living need and expect in the private living spaces of assisted living residences. The researcher developed an Archetypal Place Concept for Assisted Living Private Dwellings, based on work by Spivak (1984), which included eight archetypal categories with four sub-categories each. This concept was then used as a tool to evaluate scale models of assisted living dwellings constructed by independent living residents of retirement communities that offer assisted living. Seventeen residents in four retirement communities in Southwest Virginia participated in the research. The findings revealed that sample members believed all eight archetypal categories should be included in assisted living private dwellings. However, the degree to which the archetypal categories should be developed in a dwelling varied depending on whether the sample members were familiar with large or small assisted living dwellings. The most popular combination of sub-categories for sample members familiar with large assisted living dwellings was: multiple rooms not shared by unrelated adults, with separate sleep and living areas; separate sleep areas out of the living room with a door; bathrooms with a toilet, sink, shower, vanity closet, and linen closet; food storage with cooking appliances; two built-in closets; windows facing one direction, some with an outdoor area; separate seating for living and dining out of the sleep area; and kitchenettes with a refrigerator, sink, and cooking appliances. The most popular combination of sub-categories for sample members familiar with large assisted living dwellings was: one room not shared; a sleep area not shared, with no separate living room; a bathroom with a toilet, sink and shower, tied with toile, sink, shower, vanity storage, and linen closet; food storage with no cooking appliances; two built-in closets; windows facing one direction; designated seating arrangement within sleep area; and no kitchen, possible food storage. It was concluded that assisted living facilities should include a variety of dwelling types to meet different people's needs. However, any assisted living dwelling should include all eight archetypal categories to allow residents to function more comfortably. / Master of Science

Late life relocation for the purpose of receiving care may be one of the more challenging transitions for older adults because of being uprooted from their long-time home and the perceived loss of independence. Of available supportive housing options for older adults, assisted living facilities are growing in popularity. A family life review intervention, with an older adult resident and a selected family member, was facilitated to support older adults transition to assisted living through mutual storytelling and acceptance. Sixteen dyads participated in one, ninety-minute family life review (FLR) session. A semi-structured follow up interview was conducted approximately one month later to explore the perspective of families on participating in FLR during a relocation transition. Emergent themes (e.g., raising emotions in families, seeing self in systems, and navigating the relocation transition) suggest that FLR facilitated positive connections and enhanced existing relationships, ameliorated older adults negative feelings, and promoted an acceptance of self and new family narratives. Participating in the FLR allowed dyads to reflect, during and after the session, on their resilience earlier in life and how this resilience prompted an easier recovery to some of the more challenging components of the relocation transition (e.g., relational challenges with decision making, disagreements with the ALF). Personal and relational factors including the older adults physical health status, mental health concerns (e.g., depression and loneliness), and family involvement and dynamics impacted families experience and openness during the FLR as well as their perspective of the overall intervention process. Avenues for future research and clinical implications include randomized control trials testing the effectiveness of FLR on relationship satisfaction, coping, decision-making, and individual outcomes (e.g., depression, loneliness, life satisfaction) and using family challenges as opportunities for reconciliation and promoting resilience. / Ph. D.

Research surrounding older adults, social support, and emotional well-being are richly researched topics. However, literature is devoid of qualitative studies and research focusing specifically on community centers and older adultsâ social networks, which are integral for understanding the growing needs of older adults in todayâ s society. Guided by the theoretical frameworks of phenomenology, activity theory, and ecological theory, four in-in-depth interviews were conducted and then coded for themes. The central themes highlighted family connection, connection with others, resiliency, helping others, type of activity, restoring self, community connection, exploration, convenience, and life stages. Suggestions for future research and possible impacts for clinical practice are discussed. / Master of Science