Ageing is associated with declines in cardiorespiratory and muscular fitness; yet for older adults the ability to perform the basic tasks of daily living is partly dependent on upperand lower-body fitness. Exercise training is an effective approach to counteract these age associated declines, with combined exercise training and high-intensity interval training (HIT) capable of eliciting improvements in cardiorespiratory and muscular fitness simultaneously. Recently, a new hydraulic resistance exercise machine (Speedflex) has been developed with potential to be a viable training mode for older adults allowing users to perform high speed movements with upper- and lower-body muscles. Accordingly, the aim of this thesis was to evaluate the potential effectiveness of Speedflex as a training strategy in older adults. Initially, this work sought to determine the feasibility of performing exercise training using Speedflex in older adults by quantifying the acute training responses to 1) HIT and 2) strength training and comparing these against criterion exercise modes. Here, the observed physiological and perceptual responses demonstrated that Speedflex is a feasible mode of exercise training in older adults, capable of inducing a high-intensity training stimulus. Following this, a systematic review and meta-analysis was performed to quantify the effects of same-session combined exercise training in older adults with results demonstrating possibly small to possibly large beneficial effects on measures of fitness. As muscle power appears to be a critical determinant of physical functioning in older adults, chapter five evaluated the reliability of the Nottingham leg extensor power rig, finding it to be reliable both short- and long-term, thereby confirming its suitability as a primary outcome measure for the final study and providing data for sample size estimation. Finally, chapter six evaluated the effects of a 12-week combined upper- and lower-body HIT intervention using Speedflex on physical fitness in older adults. Clear beneficial improvements were observed for participants in the intervention group compared to those in the control group for maximal oxygen uptake (~8%), muscle power (~10%) and muscle strength (~6%). The findings presented in this thesis demonstrate that both same-session combined training and HIT performed using Speedflex are capable of simultaneously improving cardiorespiratory and muscular fitness in older adults.

The present study attempted to investigate the effects of extinction on the behavior of older adults with moderate to severe dementia. A touch screen computer displaying four large colored buttons was employed. Participants were exposed to three conditions: baseline, intervention, and a reversal. The target response (pressing green after yellow) resulted in a video stimulus in the intervention condition, and then the videos were withheld during the reversal condition. Data on button-pressing and vocal-verbal statements were visually analyzed to determine the effect of the videos on responding; however none of the participants acquired the task. Therefore, a discussion of extinction responding was not possible. Interesting findings in terms of reinforcement and implications for the treatment of problem behaviors in older adults with dementia are discussed.

Due to changing age demographics in the United States, by 2050, an estimated 62.1 Americans will be over the age of 65 and the number of Americans with cognitive impairment, such as Alzheimer’s disease, will increase drastically as well (Alzheimer’s Association, 2014; Ortman, Velkoff, & Hogan, 2014). Once a diagnosis or behavioral indicators of cognitive impairment are present, it would be beneficial to apply a treatment package that promotes the maintenance or re-establishment of stimulus control in the environment. From a behavioral perspective, stimulus control aids in learning and memory through both respondent and operant conditioning. In the current study, stimulus equivalence training was completed and compared to cognitive and functional assessments scores with older adult participants with and without cognitive impairment as a systematic replication of Gallagher and Keenan (2009). Formation of equivalence relations after exposure to linear series (LS) training with 2 3-member stimulus classes across arbitrary, familiar, and stimuli from Gallagher and Keenan (2009) was compared via trials to criterion, accuracy per relation, and session length to scores on the Mini-Mental Status Exam (MMSE), Saint Louis University State Exam (SLUMS), and Barthel ADL Index. Several methodological changes were applied to a second study to examine the impact of increased programmed stimuli, training changes, and the use of one-to-many (OTM) and many-to-one (MTO) training structures with 3 3-member stimulus classes on equivalence formation. Composite performance scores were created for accuracy during LS, OTM, and MTO training. Non-parametric analyses were conducted between assessment and composite scores. The SLUMS and Barthel ADL Index were not correlated with any composite scores. However, MMSE scores and LS composite scores were correlated. The SLUMS was more sensitive to the detection of cognitive impairment as judged by classification and diagnoses. OTM and MTO composite scores also had a strong, positive correlation. Overall, more participants demonstrated higher levels of accurate responding during LS training than during OTM and MTO training. In contrast to previous research, only 25% of the sample demonstrated equivalence formation. Limitations and future research directions are discussed.

abstract: Problems with recruiting and retaining older volunteers have resulted in less than one-quarter of older adults participating in volunteer activities (BLS, 2016). Much emphasis on volunteer motivations have been placed to enhance volunteer engagement among late-midlife and older adults (e.g., Davis et al., 2003). Although career motivations have not been shown to predict late-midlife and older adults’ volunteer participation (Planalp & Trost, 2009), there is some empirical evidence supporting the relevance of career domains in later life (Greller, 2006). By reframing volunteering as a compensatory strategy, the purpose of the current study was to evaluate factors, including career-related interests, that affect volunteer satisfaction and commitment among late-midlife and older volunteers. A series of hypotheses were posited to examine contributions to volunteer satisfaction and to future volunteer commitment, including volunteer motivation and congruence between career interests of volunteers and characteristics of the volunteer activities (volunteer-activity congruence). The online survey contained measures for study variables, including the Volunteer Functional Inventory (volunteer motivations) and Personal Globe Inventory (career interests). Participants (N = 167) were recruited from community and government volunteer programs with the average age of volunteers being 68.65 years old (SD = 9.36; range 50 to 90 years). The majority of volunteers were female (54.5%), White or Caucasian (90.4%), married (58.2%), reported some college experience (96.5%) and were retired (68.9%). Results from the current study indicated that time volunteering, volunteer motivations, and volunteer-activity congruence did not significantly predict volunteer satisfaction, accounting for 9.2% of the variance. In contrast, the final model did significantly predict volunteer commitment and accounted for 13.1% of the model variance, with altruistic values remaining a significant contributor to volunteer commitment. Findings from the current study highlight inconsistencies noted in previous research regarding volunteer motivations, satisfaction, and commitment. Possible generational influences on altruistic values and volunteerism were also noted. Although volunteer-activity congruence alone was not predictive of volunteer satisfaction or of commitment, results from the study warrant additional investigations in career interests and volunteering among late-midlife and older adults. Limitations of the current study and implications for volunteer recruitment and retention were also discussed. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2016

abstract: ABSTRACT This qualitative descriptive study described caregiver recognition of personal and social contextual resources guiding purposeful participation in self-care and well-being. This research builds on health empowerment theory, which conceptualizes health empowerment as an inherent, relational and ongoing process, expressive of health patterning of well-being (Shearer, 2009). By 2060, Americans 65 years and older will number nearly 98 million, more than double that in 2013. The number of older adults aged 85 and older will double from 6 million in 2003, to 14.6 million by 2040 (Health & Human Services, 2014). Sixty-five million adults serve as informal caregivers, many themselves suffering from chronic conditions (National Alliance for Caregiving & AARP, 2009). Current research has examined the burden of caregiving, but little is known about caregiver strengths and resources that foster personal self-care and well-being. Twenty-one older adult informal caregivers participated in focus groups or individual interviews. Length of time as caregivers ranged from one year to more than ten years; 24% of the participants were men. Seventy-six percent of the participants reported having one or more chronic condition. Themes generated from qualitative content analysis provided a basis for validating and extending the health empowerment theory among older adult informal caregivers. Across participants, empowerment reflected recognition of strengths and resources, as well as growth consistent with valued goals facilitating new health patterns and well-being. The health empowerment theory perspective provided a relevant basis for theory-based intervention focused on promoting strengths, abilities and potential among older adults, limiting vulnerability to diminished health and well-being. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2018

The current body of work aims to apply Processing Efficiency Theory (PET) and Attentional Control Theory (ACT) to novel dynamic settings by examining how anxiety influences perceptual-cognitive and perceptual-motor skills. Sporting domains and fall-risk in older adults are studied. Applying ACT to a tennis anticipation paradigm examines whether state anxiety influences processing efficiency and the use of contextual information during anticipation. Processing efficiency was reduced under anxiety, while overall response accuracy was unchanged. Furthermore, skilled performers were seemingly less able to utilise contextual information when anxious. Studies in Chapters 4 and 5 sought to test the predictions of PET and ACT compared with those of Reinvestment Theory (RT) in the field of fall-risk in older adults. In Chapter 4, trait anxiety, alongside increasing dual-task demands, produced processing and motoric inefficiencies through reduced visual planning and mean gait velocity. Furthermore, greater and more variable gait velocity reductions were found in those with higher trait anxiety. By contrast, greater reinvestment levels were associated with poorer visuospatial recall, higher stepping accuracy, plus larger and less variable gait velocity reductions. Chapter 5 further investigates the motoric inefficiencies observed in anxious older adults’ gait. The influences of trait anxiety, movement specific reinvestment, and falls efficacy on body segmental control during adaptive turning are studied. Trait anxiety and falls efficacy were mainly shown to influence differing facets of turning behaviour, though both were associated with greater coupling of body segments (en-bloc rotations), whereas, limited support was offered for RT. Overall, PET and ACT were supported when applied to these new dynamic domains. However, discrepancies are discussed due to testing theoretical hypotheses in more representative environments.

A systematic review was conducted of 51 English-language papers published since 2000 in the following databases: PsycNet, Ebsco, and Science Direct. Findings reveal a high comorbidity of depression in older adults. Moreover, they also exhibit stroke, diabetes, Alzheimer’s disease and Parkinsonism, with patterns of symptoms similar to those seen in depression resulting from disease impairment. Analysis shows that these diseases can also precede depression, even without an anatomical-functional link, due to the psychosocial burden borne by the patient. Depression is also seen as a risk factor for stroke and diabetes. Longitudinal studies are suggested to judiciously characterize etiological paths for depressionmore extensively. / La revisión sistemática de 51 artículos en inglés publicados a partir del año 2000 en las bases de datos PsycNet, Ebsco y Science Direct, revela una alta comorbilidad de depresión en adultos mayores. Asimismo, se observa que los adultos mayores presentaban también enfermedad cerebrovascular, diabetes, Alzheimer y parkinsonismo, con sintomatología similar a la depresión debido al deterioro que provocan. El análisis permitió observar que estas enfermedades pueden anteceder a la depresión sin necesidad de un vínculo anatómico - funcional directo, por cuanto a las implicaciones psicosociales que conllevan. La depresión es también un factor de riesgo para la incidencia de enfermedad cerebrovascular y diabetes. Se recomienda la realización de más estudios longitudinales, con el fin de caracterizar pormenorizadamente el curso etiológico de la depresión.

abstract: Spousal bereavement is one of the most stressful life events, resulting in increased morbidities and mortality risk. Negative health outcomes include depressive episodes, anxiety, sleep disruption, and overall poorer physical health. The older adult population is rapidly increasing and over 30% of the US population 65 years and older are widowed. Current studies regarding older adults and spousal bereavement treatment have been limited to psychological and educational interventions. Meditative movement practices (e.g. Tai Chi) have shown benefits such as mood elevation, anxiety reduction, and other physical function improvements. A feasibility study applying an 8-week Tai Chi Easy intervention was examined to address the sequelae of spousal bereavement among adults 65 and older. Grounded in geriatric nursing as a discipline that addresses the unique needs of older adults' psychological and physiological health needs and related theoretical constructs, this project also draws from exercise science, mental health, and social psychology. Theoretical premises include Orem's Self Care Deficit Theory (nursing), Stroebe and Schut's Dual Process Model (thanatology), and Peter Salmon's Unifying Theory (exercise). Aims of the study examined feasibility as well as pre-post-intervention changes in grief, and the degree of loss orientation relative to restoration orientation (Inventory of Daily Widowed Life). A trend in the direction of improvement was found in measured subscales, as well as a statistically significant change within the loss orientation subscale. Based upon these encouraging findings, effect sizes may be used to power a future larger study of similar nature. / Dissertation/Thesis / Ph.D. Nursing and Healthcare Innovation 2012

abstract: Research has demonstrated that temperature and relative humidity substantially influence overall perceptions of indoor air quality (Fang, Clausen, & Fanger, 1998). This finding places temperature quality as a high priority, especially for vulnerable adults over 60. Temperature extremes and fluctuation, as well as the perception of those conditions, affect physical performance, thermal comfort and health of older adults (Chatonnet & Cabanac, 1965, pp. 185-6; Fumiharu, Watanabe, Park, Shephard, & Aoyagi, 2005; Heijs & Stringer, 1988). The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) and the International Organization for Standardization (ISO) have developed thermal-comfort standards for working-age, healthy individuals. None of these standards address the physiological and psychological needs of older adults (ASHRAE Standard 55, 2010; ISO-7730, 2005). This dissertation investigates the impacts of thermal conditions on self-reported health and perceived comfort for older adults, hypothesizing that warmer and more-table indoor thermal conditions will increase the health and perceived comfort of these adults. To this end, a new set of thermal comfort metrics was designed and tested to address the thermal preferences of older adults. The SENIOR COMFORT Metrics 2013 outlined new thresholds for optimal indoor high and low temperatures and set limits on thermal variability over time based on the ASHRAE-55 2010 model. This study was conducted at Sunnyslope Manor, a multi-unit, public-housing complex in the North Phoenix. Nearly 60% (76 of 118) of the residents (aged 62-82) were interviewed using a 110-question, self-reporting survey in 73 apartment units. A total of 40 questions and 20 sub-questions addressing perceptions of comfort, pain, sleep patterns, injuries, and mood were extracted from this larger health condition survey to assess health and thermal comfort. Indoor environmental thermal measurements included temperature in three locations: kitchen, living area, and bedroom and data were recorded every 15 minutes over 5 full days and 448 points. Study results start to indicate that older adults for Sunnyslope Manor preferred temperatures between 76 and 82.5 degrees Fahrenheit and that lower temperatures as outlined by ASHRAE-55 2010 increases the rate of injuries and mood changes in older adults among other findings. / Dissertation/Thesis / Ph.D. Architecture 2013

Polypharmacy, the use of five or more medications, is a public health epidemic that leads to high health care utilization and costs in older adults globally. Health care organizations and professionals have used interdisciplinary collaboration (IC) interventions to reduce polypharmacy and health care costs with little benefit. There is limited research and integration of IC with an evidence-based practice (EBP) guideline among primary care providers (PCPs) in the primary care setting. The aims of this Doctor of Nursing Practice (DNP) project were to conduct a knowledge and needs assessment via Qualtrics survey to identify PCPs’ current knowledge, practices, and perceptions regarding IC and the American Geriatrics Society (AGS) Beers Criteria on reducing older adult polypharmacy in an urban primary care setting; and to assess PCPs’ interest in participating in IC with a pharmacist using the AGS Beers Criteria. The responses obtained from the Qualtrics survey revealed PCPs were comfortable in communicating to older adults about polypharmacy; however, PCPs with longer practice experiences displayed misconceptions due to lack of familiarity and interest in participating in IC using the AGS Beers Criteria. Overall, 70% of PCPs felt comfortable about participating in IC alone, 50% of PCPs were familiar with IC, and 60% of PCPs used the AGS Beers Criteria. Even though 60% of PCPs felt comfortable about participating in IC based on AGS Beers Criteria with a pharmacist, only 50% of PCPs were interested in participating IC with a pharmacist using AGS Beers Criteria. Barriers and recommendations are discussed further in this DNP Project paper.