A major demographic shift is projected to begin in 2011 due to the retirement of those born between 1946 and 1965, or the post-World War II baby boomer generation. Due to this trend, it is pertinent for Canadian communities to concentrate on creating ‘senior-friendly’ spaces, infrastructure and support services. One such initiative throughout British Columbia is the establishment of 18 designated Senior Community Parks (SCPs) across the province in 2008. This case-study research project, taking place in Oak Bay, British Columbia on the grounds of the Henderson Recreation Centre (HRC), examines park visitation levels, types of utilization and effectiveness of park accessibility, and infrastructure. A mixed methods approach was employed combining seven park observations, sixty-five quantitative questionnaires completed by patrons of the Henderson Recreation Centre, and 16 qualitative interviews with community-dwelling older adults between the ages of sixty-one and eighty and with six staff members of the HRC. Results indicate steady but low park visitation amounts as only 55 total people were seen during observations. Almost all persons were observed walking or jogging and only one person was seen using the equipment within the park. Quantitative data revealed under-utilization of the park and a wide discrepancy between the number persons aware of the SCP (90.8%) and those that visit more than once a month (38.5%). Qualitative interviews uncovered aspects of the park favored by participants (chip trail, park upkeep, exercise opportunities) and those that require improvement (exercise equipment, awareness). Two infrastructural shortcomings were identified; signage and equipment stations. Based on results, the ineffectiveness of the outdoor exercise equipment and awareness of the SCP need to be investigated further. / Graduate

Introduction: Creatine is a nitrogen-containing compound that is found in many supplements that claim to increase muscle mass and there is increasing evidence that creatine supplementation can increase muscle mass in older individuals. Purpose: To evaluate the safety of 12-months creatine supplementation and resistance exercise in older adults by monitoring measures of kidney and liver function, complete blood count, and reports of adverse events. Methods: Older adults (n=70, males 50 years of age or older (39), and post-menopausal females (31) who were not performing resistance exercise were recruited for the study and randomized by computer to creatine (32; 18 males, 14 females) or placebo (38; 21 males, 17 females) groups. Other exclusionary criteria were: presence/history or kidney impairments, consumption of creatine supplement/bone altering drugs, and the presence of fragility fractures. Participants were given creatine or placebo (0.1g/kg/day) consumed before and after resistance training on exercise days and with a meal on non-exercise days. The study used a double-blind, placebo-controlled design. Blood and urine were collected to assess complete blood cell count, liver function indicators (aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and Bilirubin), and creatinine clearance (kidney function) at baseline, 4 months, 8 months, and 12 months. A mixed ANOVA was used to determine differences in the kidney and liver measures within and between groups, and chi-square analysis was used to determine if the frequency counts for liver, kidney, and other adverse events were different between groups.

This investigation, comprising two studies, examined the number of barriers to physical activity (Study 1) and barrier strength (Study 2) reported by middle-aged and older adults using a social ecological framework (McLeroy et al., 1988). Researchers were interested in assessing age group (45-54; 55-64; 65-74 yrs) by physical activity group (active, less active) effects for barrier responses using analyses of variance. In Study 1, 180 participants completed a physical activity level survey (Godin & Shephard, 1985) and answered open-ended questions about barriers. Results indicated that 45-54 yr-olds reported more barriers overall, and more intrapersonal barriers than older groups. Less active 45-54 yr-olds reported more organizational-interpersonal barriers than the other groups. Descriptive analyses of coded themes demonstrated that common intrapersonal barrier sub-themes cited by younger adults related to family commitments, while sub-themes reported by middle-aged and older adults related to having a health problem or an injury. In the organizational-interpersonal category, the most common barrier sub-theme related to the workplace. In Study 2, 116 participants completed a survey assessing weekly physical activity and barrier strength for items pertaining to ecological categories and barrier sub-factors. Results showed that less active adults reported each of intrapersonal, interpersonal, and physical environment barriers more strongly than active adults, irrespective of age; the intrapersonal category was relatively the most constraining for our participants. In terms of barrier sub-factors, results showed that significantly higher barrier strength scores are most often associated with physical activity level (i.e., less active), and only occasionally associated with age group. The overall investigation can provide valuable information for improving physical activity interventions for middle-aged and older adults.

Background Some degree of cognitive decline is a normal, non-clinical part of aging. Physical exercise has been suggested as one strategy which may improve cognition in nondemented older adults. The findings of randomised, controlled trials conducted since the 1980s have been promising, but not unequivocal, and much remains to be understood about the relationship between exercise and cognition in older adults. There have also been suggestions that combining exercise and cognitive training may be beneficial. There has, however, been only one reported study comparing the benefits of exercise training, and combined exercise and cognitive training (Fabre, Chamari, Mucci, Masse-Biron, & Prefaut, 2002). While combined training was reported to be even more effective than exercise training alone for improving cognition in older adults, the study had some substantial limitations. Aims The overall aims of this thesis were to further explore the effect of exercise training on cognition in older adults, and to compare exercise training alone with combined exercise and cognitive training. Following a narrative review of the relevant literature, this thesis is presented in two parts. In Part One a randomized, controlled trial comparing the impact of exercise training, and combined exercise and cognitive training, on the cognitive functioning, physical functioning, functional performance, and psychological well-being of communitydwelling older adults is presented. For Part One, there were three specific aims: (1) To assess the efficacy of a 16 week exercise program (relative to control), on measures of cognitive functioning, physical functioning, functional performance, and psychological well-being; (2) To compare the efficacy of the 16 week exercise program with that of a 16 week combined exercise and cognitive training program; and (3) To identify the physical, psychological and training factors associated with changes in cognitive and physical functioning from baseline to post-test. In Part Two a qualitative evaluation of older adults’ experiences and perceptions of exercise training, and combined exercise and cognitive training, is presented. Methods Thirty-nine community dwelling, older adults (aged between 60 and 80 years) were randomly allocated to one of three groups: Exercise, Combination or Control. Participants in the Exercise group attended three aerobic and strength training sessions per week for 16 weeks. Participants in the Combination group attended two aerobic and strength training sessions, and one cognitive training session, per week for 16 weeks. Participants in the Control group were contacted every four weeks. Assessments were conducted at baseline, post-test (16 weeks) and six-month follow-up (40 weeks). Measures of physical function, cognitive function, functional performance, and psychological wellbeing were collected, along with anthropometric and physiological measures. For the qualitative evaluation, participants from the Exercise and Combination groups provided written feedback to questions about their experiences of the two training programs and their perceptions of the outcomes. These qualitative data were collected after post-test. Results Significant within-group improvements in physical and cognitive function, from baseline to post-test, were seen in Exercise and Combination participants. Combination participants also showed significant within-group reductions in symptoms of anxiety and depression. There were, however, only a few significant between-group differences among Exercise and Control participants, and among Exercise and Combination participants. There were no significant within-group improvements in functional performance, from baseline to post-test, among Exercise or Combination participants. Six-month follow-up data were difficult to interpret, due to the paucity of between-group differences at post-test and the small sample size. There were several significant associations between physical, psychological and training factors, and changes in cognitive and physical functioning. The most pertinent finding was that baseline functioning was consistently associated with change, such that participants with low baseline scores were most likely to improve from baseline to posttest. In the qualitative evaluation participants reported positive experiences of the training programs and reported improvements in physical, cognitive, functional and psychological wellbeing. Participants also highlighted components of the programs which require improvement and made recommendations for future programs. Conclusions The results of this thesis provide some cautious support for the notion that exercise, and combined exercise and cognitive training, may result in small improvements in cognition, physical functioning, and psychological well-being in older adults. Some of the findings must be interpreted with caution, however, given the small sample size. More research is required into the functional (or ‘real world’) impact of this type of training, the long-term effects of training, and the factors associated with changes in cognitive and physical function. Based on these findings, recommendations for the development and implementation of future research were made. As the population ages and the public health burden attributable to aging increases, research into the development and efficacy of programs to enhance well-being and independence in older adults is of great importance.

Despite empirical evidence for the health-related benefits of physical activity, a large proportion of older adults are insufficiently active. In New Zealand, the Green Prescription is the nationwide physical activity scripting programme. The Green Prescription has been found to be effective in increasing physical activity in previously low-active and sedentary adults. However, more information is required about the efficacy of Green Prescription use with older adults. The present research examined participants' views and experiences of physical activity counseling via the conventional Green Prescription and a modified pedometer-based Green Prescription. Both versions of the Green Prescription were effective in increasing and maintaining physical activity over a 12-month period. Demographic factors were found to significantly influence perceived barriers and motives for physical activity regardless of type of Green Prescription administered.

Does the Internet really improve the lives of older adults? The literature around information and communication technology would suggest that use of the Internet can help to promote social inclusion but is this the case for older adults? The aim of this study was to understand the relationship older adults have with the Internet. In-depth qualitative interviews were conducted with a purposive sample of 15 participants aged 70 to 90 in Fall 2014 to explore the perceived benefits and barriers older adults experience with regards to Internet use. The Internet was found to plays an important role in the lives of older adults who use it. Light Internet users were the group most dissatisfied with their Internet abilities. Light users and non-users both expressed feeling left out due to their perceived lack of abilities. Non-users had no intention of learning to use the Internet despite having access to potential support, whereas light Internet users indicated feelings of frustration around perceived lack of support. Users and non-users discussed feelings of concern and suspicions related to the Internet and their ability to access the resource. Medium and avid users stated that the Internet played an important role in their lives and that they would be lost without it. This research explores the lived experience of older adults and the Internet, offering a better understanding of how the Internet impacts their lives and ability to maintain social inclusion. This research can inform policy around promoting the use of the Internet among older adults and whether it is necessary to focus efforts on bridging the digital divide. / February 2016

This study investigated learning and memory performance similarities and differences between healthy, Spanish-speaking older adults of Hispanic/Latino descent and English-speaking Caucasian older adults. It explored the possibility that the novelty of verbal memory tasks, along with cultural and educational differences, may lead to performance differences in Spanish-speaking older adults' effective use of organizational strategies, such as semantic clustering. It hypothesized that an alternative strategy instruction, which provided explicit detail on how to use the effective semantic clustering strategy, would reduce differences observed between the Hispanic and Caucasian groups. Forty-eight healthy, Spanish-speaking older adults and 55 healthy, English-speaking older adults were administered list-learning tasks in their dominant language. Under standard task instruction, Spanish-speaking older adults with low levels of formal education learned fewer words on the task than Caucasian and Hispanic participants who had higher levels of education. Hispanic participants, regardless of educational levels, also utilized semantic clustering recall at lower rates than Caucasian participants under standard instruction. When provided with explicit strategy instruction, both groups showed reduced list learning, and Hispanic older adults demonstrated reduced response to strategy manipulation compared to Caucasian participants. Finally, in the Hispanic older adult sample, the quality of their formal education and level of acculturation were identified as important predictors of verbal learning outcomes. These findings highlight the need to continue to examine the complex role of demographic and cultural variables on verbal learning and memory processes, as they may impact the assessment of pathological processes such as dementia, as well as the development of effective cognitive interventions for diverse elders.

By the year 2030 it is estimated that one in five licensed drivers in the United States will be over the age of 65. Driving allows engagement in the community for shopping, banking, maintaining social connections, and accessing health care. However, age-related decline can impact many of the cognitive processes and physical abilities necessary for safe driving performance. Exercise has beneficial effects on specific cognitive processes and physical function, many of which are related to safe driving performance. Tai Chi exercise is known to benefit cognitive and physical function and may influence safe driving performance. The aims of this observational study were to: 1) examine relationships between Tai Chi exercise habits, cognitive processes and physical function related to safe driving performance, 2) compare cognitive processes and physical function related to safe driving performance to normative reference values, and 3) explore potential predictors of safe driving performance. Fifty-eight current Tai Chi practitioners (mean age = 72.9), with a median of greater than three years of Tai Chi practice were recruited from community Tai Chi classes and Tai Chi events. Participants completed a study packet describing self-reported Tai Chi and non-Tai Chi exercise habits, driving habits, self-report measures of dispositional mindfulness (Mindful Attention Awareness Scale, MAAS) and overall well-being (Vitality Plus Scale, VPS), personal history, and health history. Investigator-administered study measures included the DrivingHealth InventoryTM, digit span tests, the Driving Scenes Test, and the Right Foot Tapping test. Statistically significant correlations were found between several study measures. Compared to normative reference values participants performed better on several cognitive and physical measures, and on the MAAS and the VPS measures. Small to large effect sizes were calculated. The strongest predictor of safe driving performance was the digit span backward. Tai Chi exercise has the potential to positively impact cognitive processes and physical function related to safe driving performance through aerobic exercise mechanisms, development of mindfulness, and beneficial influence on overall vitality. The results of this study support the need for further investigation of Tai Chi exercise as a strategy to maintain safe driving performance in older adults.

This study investigates extant data concerning the current knowledge of geriatric case managers in Illinois who contracted with the Illinois Department on Aging in 2010 in order to provide case management services to adults age 65 and older. In examining the self-reported importance and frequency of geriatric case manager's knowledge domain areas in Illinois, the knowledge domain portion of the Case Manager's Role and Function Survey Instrument (CMRFSI) was utilized. The sample in this study consisted of 192 geriatric case managers. Participants were asked to complete the knowledge domain portion of the CMRFSI which contained a 5-point Likert scale of the importance of knowledge domains and a second 5-point Likert scale of the frequency of knowledge domains performed. Factor analysis was utilized to provide information regarding the underlying relationship between the variables. Factor analysis produced the following four factors: rehabilitation planning, care management, psychosocial aspects of case management, and service coordination/delivery survey. To provide a deeper understanding of the knowledge domain areas of geriatric case managers and the demographic variables of work setting, highest degree completed, major, and race/ethnicity a MANOVA was used. A significant difference was produced for race/ethnicity. Wilks' Lambda was used for multivariate statistical testing resulting in F (10, 4064.13) =1.20, p < .05. Each of the measure indicated that there was a significant (p < .05) difference on the four factors across the two races (White non-Hispanic and Minority). In addition, a univariate statistical test (see table 9) produced a significant (p < .05) alpha on factor I: rehabilitation concepts and factor II: care management indicating that when considered individually and collectively, rehabilitation concepts and care management are significantly different when considering race/ethnicity. Consequently, understanding the knowledge domains of geriatric case managers will assist in designing curriculum, certifications, and preparing students to providing services. In addition, implications, limitations, and suggestions for future research are discussed.

Thesis (M.S.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Objective: To determine ifself-rated health modifies the effect ofbaseline walking limitation on 5- and 10-year mortality in older women with early stage breast cancer Design: Secondary analysis of a multicenter 10-year prospective study of older women with early stage breast cancer Setting: Sixty-two clinical centers in four geographic areas Participants: 585 women aged 65 years or older with Stage I to IIIa breast cancer who were followed by annual telephone calls for up to 10 years. Measurements: Baseline self-rated health, ability to walk several blocks, age, race, marital status, financial status, social support, comorbid conditions, body mass index, tumor stage, estrogen receptor (ER) status, initial therapy, and emotional health. The main outcome was all-cause mortality at 5 and 10 years as determined by National Death Index and Social Security Death Index. Results: Subjects at baseline were 17% age 80+, 48% stage II-IIIa, 25% ER negative, 42% with ≤1 comorbid condition. At the time of breast cancer diagnosis, 39% of women reported low self-rated health, and 28% reported limitations in walking several blocks. Those with low self-rated health and walking limitation had higher mortality rates than those with high self-rated health and without walking limitation (28.1% vs. 12.7% at 5 years, p = 0.0002; 67.8% vs. 34.9% at 10 years, p < 0.0001). In the adjusted regression model, risk of dying from any cause by 10 years was higher for women aged 80+ (HR 3.87, 95% CI 2.45, 6.11); age 70-79 (HR 1.54, 95% CI 1.06, 2.24); with inadequate finances (HR 1.73, 95% CI 1.13, 2.65); and with the combination of low self-rated health and walking limitation at baseline (HR 1.48, 95% CI 1.02, 2.15). Conclusion: In this study of older women with breast cancer, the combination of low self-rated health and limitation in walking several blocks at diagnosis was a predictor of all-cause mortality at 10 years of follow-up; this finding was independent of age, comorbidity, tumor characteristics, and treatment. These self-report measures can be easily assessed in clinical practice and may represent an effective strategy to improve treatment decision-making in older adults with cancer.