Introduction: The effects of chronic pain on health-related Quality of Life (HRQoL) among older Canadian adults with disability was not well known. Study Objectives: This study was conducted to examine the relationship between chronic pain and HRQoL among older Canadian adults with disability aged 55+. Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression techniques. Results: An estimated 68% of older Canadian adults with disability reported having chronic pain. Multivariate regression analysis confirmed a significant independent effect of chronic pain on self-reported HRQoL. Conclusion: Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.

Purpose: Hearing loss is a prevalent condition among older adults. Structural changes at the auditory periphery, changes in central audition and cognitive function are all known to influence speech understanding in older adults. Biological aging also alters speech and voice characteristics from the age of 50 years. These changes are likely to reduce the clarity of speech signals received by older adults with age-related hearing loss. Recent findings suggest that older adults with hearing loss subjectively find listening to the speech of other older adults more effortful than listening to the speech of younger adults. However, the observations of listener effort were subjective and follow up using an objective measure was recommended. Therefore, the purpose of this study was to determine the influence of speaker age (young versus older) on speech understanding and listener effort in older adults with hearing loss. In addition, the relationships between these parameters, and age and working memory was investigated. It is hypothesised that older adults with hearing loss will recognise less speech, and expend more effort, while listening to speech of an older adult relative to a younger adult. Method: A dual task paradigm was used to measure speech understanding and listening effort in 18 older adult listeners with hearing loss. The primary task involved recognition of target words in sentences containing either high or low contextual cues. The secondary task required listeners to memorise the target words for later recall following a set length of sentences. Listeners performed speech understanding (primary task) under six experimental conditions: For each speaker (i.e., older adult and younger adult) there were 3 listening backgrounds: quiet, and noise at 0 dB SNR and +5 dB SNR. Results: Speech understanding in older adults with hearing loss was significantly improved when the speaker was an older adult, especially in noise. The ability to recall words from memory was also significantly better when the speaker was an older adult. Age was strongly correlated with speech understanding with contributions from hearing loss. Age and working memory had moderate correlations with word recall. Conclusion: The findings provide further evidence that peripheral hearing loss is not the only contributor to speech understanding and word recall ability in older adults. The naturally occurring speech signal also has the potential to influence speech understanding and listening effort in older adults.

Introduction: Older adults have been shown to be particularly vulnerable to the effects of mild traumatic brain injury (mTBI). However, limited research exists that examines the information and support received by older adults after a TBI, despite suggestions that input may be insufficient. We therefore aimed to evaluate the information and rehabilitative support received by individuals after mTBI, and to determine whether there were any age-related differences. Method: Adults (n = 250) who presented at the Christchurch Hospital Emergency Department over a 12 month period, with a diagnosis of mTBI were invited to participate in the study. Of these, 106 consented and 80 were able to be contacted for follow up. Participants were aged 18-85 years (M = 48) and evenly distributed into four age groups (18-30, 31-50, 51-65 and 66-85 years). Participants were interviewed over the phone using a questionnaire developed in a pilot study. Questions focussed on information and treatment received after the participants’ injury, as well as questions about cognitive and mood problems following the injury. Data was analysed both quantitatively and qualitatively. Results: There were no significant differences between age groups for the number of post-TBI symptoms reported by participants. However, as predicted, the post-injury information and assistance received were inconsistent and differed across groups: 25% of all participants did not receive any information after their TBI, and older adults were the least satisfied with the information received. Post-injury assistance was most commonly offered by friends, family and significant others, but this may not have been sufficient to encourage complete recovery. Participants made suggestions for assistance and support that they would have liked following their injury. Conclusions: The current study has significant implications for the treatment of mTBI as ill-informed and neglected patients are unlikely to return to pre-injury functioning and mental state. Furthermore, a rapidly increasing older population makes immediate attention to mTBI in older adults imperative.

There is evidence that cholesterol presents an important risk factor for Alzheimer’s disease (AD), but the direction of this relationship is modified by age. High cholesterol during midlife and low cholesterol during late life are both associated with an increased risk for AD. This dissertation research engaged a life span approach to study the relationship between cholesterol, AD and cognitive functioning among older adults. The purpose of this research was to determine if trajectories of cholesterol from midlife through late life differ according to AD status and if these trajectories are associated with cognitive functioning during old age. This research employed a secondary analysis of cognitive, phenotypic and genetic data collected from subjects of the Framingham Heart Study (FHS) Original and Offspring Cohorts. Aim One involved creating three summary scores of the FHS neuropsychological battery. ROC analysis was used to determine which score best differentiated between cognitively normal, impaired and dementia subjects. Aim Two used generalized additive mixed models to examine trajectories of total, HDL and total/HDL cholesterol ratio according to AD status in the Original Cohort. Aim Three used mixed-effects models to examine the relationship between subject-specific trajectories of total cholesterol and cognition during old age. Aim One determined that a summary score that provided equal weight to each assessment in the FHS neuropsychological battery best differentiates between subjects classified as cognitively normal, cognitively impaired and dementia. The findings from Aim Two indicated that there are subtle differences in the longitudinal trajectories of total, HDL and total/HDL ratio according to AD status. The findings from Aim Three provide limited evidence for a relationship between subject-specific trajectories of total cholesterol and cognitive functioning later in life. Older adults in the highest quartile for cognitive functioning had lower total cholesterol at approximately 55 years of age, but there were no differences in the mean trajectories of total cholesterol according to cognitive functioning later in life. The findings from this research suggest that older adults with high cognitive functioning have lower total cholesterol during midlife, but life span cholesterol trajectories do not appear to be associated with AD status or cognitive function.

As aging occurs, safely maintaining an active lifestyle is critical for health and independence. Independent mobility is influenced by one???s ability to perform three essential tasks of daily living: transitioning from a seated to standing posture, maintaining upright stance and walking. In spite of the apparent similarities in the predictive utility of these different tasks, there are few studies that have explored the specific relationship between these tasks that define independent mobility within individuals to determine if they reflect unique challenges to control. The thesis focused on two studies to advance understanding of the determinants of independent mobility in older adults. Study 1 explored the association between measures of standing, transitions and walking in 28 older adults. An important element was the assessment using portable low-cost measurement technology (Wii force boards and wearable accelerometers) so that testing could be done in the community. The results of this study revealed the potential importance of sit-to-stand performance as an independent measure of function in older adults. One important outcome was the need for a more detailed measurement of the sit-to-stand task, which is characterized by different phases that have unique control challenges. As a result, Study 2 was designed to evaluate different measurements of the sit-to-stand phases in order to provide a measurement tool that could be used in community and clinical testing. Ground reaction forces were found capable of identifying the different sit-to-stand phases and therefore afford the ability to quantify this behavior using portable technology. Identifying the underlying control mechanisms and relationships between these mechanisms allows clinicians to prescribe targeted and potentially more effective interventions focused on behavior specific control challenges.

Although older Canadians constitute a large portion of patients in hospital, many receive less-than-optimal drug care. Most registered nurses (RNs) and other health care professionals who provide older adults (OAs) with drug therapy lack pre-professional education about that practice. Concurrently, there is little research available about how RNs learn about drug therapy for OAs. Using a qualitative method, this thesis explores hospital RNs’ insights about their knowledge about drug therapy for OAs, their associated learning needs and strategies, and contextual influences on their learning. The findings illuminated RNs’ extensive knowledge, their learning needs and varied learning strategies, and constraints and facilitators of their learning. Drug therapy for OAs is a complex activity. RNs play a pivotal role in that care and have ample knowledge. RNs’ learning is holistic, ongoing, mostly informal, and reflective of many adult-learning theories. By learning, RNs build and transform their repertoires of knowledge to stay current with the quickly changing landscapes of health care, gerontological know-how, and drugs and drug practices. As a result, sometimes RNs protect not only OAs but also other hospital stakeholders from the negative effects of uninformed practice. Nurse educators should teach students about drug therapy for OAs and broaden their own views about RNs’ knowledge and learning strategies for that care. Nurse leaders should maximize chances for RNs to learn and prepare them to influence other stakeholders in ways that support learning. Hospital administrators and other stakeholders should recognize RNs’ pivotal role in drug care and support their learning through organizational changes. Communities should design strategies that ease RNs’ learning. Policymakers should replace corporatism with innovations that champion learning. Researchers and RNs should collaborate on novel projects that bolster RNs’ learning.

Multivariable modeling was performed using data from the Nutrition Care in Canadian Hospitals Study, identifying factors independently associated with weight change, and specifically weight loss, prior to, during, and following acute hospitalization in older patients (≥65y, n=503). Male gender (OR=1.83, 95% CI 1.23-2.73) and oral nutrition supplement use (OR=2.1, 95% CI 1.31-3.36) were associated with self-reported weight loss (n=445, R2=0.06). Higher BMI (β=-0.2, p=0.001), occurrence of adverse events (β=-0.15, p=0.008), mean intake <75% of meals during admission (β=-0.19, p=0.001), and antibiotic use during admission (β=-0.11, p=0.049) were significantly associated with weight loss during admission (n=290, R2=0.14). Post hospital weight loss was associated with a poor self-reported appetite at follow-up (OR=3.82, 95% CI 2.1-6.97), eating with others never or rarely (OR=2.48, 95% CI 1.31-4.69), and having been admitted to a surgical ward (OR=1.86, 95% CI 1.03-3.35) (n=279, R2=0.16).

Although older Canadians constitute a large portion of patients in hospital, many receive less-than-optimal drug care. Most registered nurses (RNs) and other health care professionals who provide older adults (OAs) with drug therapy lack pre-professional education about that practice. Concurrently, there is little research available about how RNs learn about drug therapy for OAs. Using a qualitative method, this thesis explores hospital RNs’ insights about their knowledge about drug therapy for OAs, their associated learning needs and strategies, and contextual influences on their learning. The findings illuminated RNs’ extensive knowledge, their learning needs and varied learning strategies, and constraints and facilitators of their learning. Drug therapy for OAs is a complex activity. RNs play a pivotal role in that care and have ample knowledge. RNs’ learning is holistic, ongoing, mostly informal, and reflective of many adult-learning theories. By learning, RNs build and transform their repertoires of knowledge to stay current with the quickly changing landscapes of health care, gerontological know-how, and drugs and drug practices. As a result, sometimes RNs protect not only OAs but also other hospital stakeholders from the negative effects of uninformed practice. Nurse educators should teach students about drug therapy for OAs and broaden their own views about RNs’ knowledge and learning strategies for that care. Nurse leaders should maximize chances for RNs to learn and prepare them to influence other stakeholders in ways that support learning. Hospital administrators and other stakeholders should recognize RNs’ pivotal role in drug care and support their learning through organizational changes. Communities should design strategies that ease RNs’ learning. Policymakers should replace corporatism with innovations that champion learning. Researchers and RNs should collaborate on novel projects that bolster RNs’ learning.

Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Introduction: The effects of chronic pain on health-related Quality of Life (HRQoL) among older Canadian adults with disability was not well known. Study Objectives: This study was conducted to examine the relationship between chronic pain and HRQoL among older Canadian adults with disability aged 55+. Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression techniques. Results: An estimated 68% of older Canadian adults with disability reported having chronic pain. Multivariate regression analysis confirmed a significant independent effect of chronic pain on self-reported HRQoL. Conclusion: Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.