Encouraging older adults to become more active and maintain that activity is critical to the promotion of their health and well-being, social networks and independence. Leadership behaviour and quality of instruction is important in influencing engagement of older adults in exercise classes. Instructors' attitudes could influence older adults' uptake and adherence to classes, but little is known about the relationship between attitudes and characteristics of instructors and their delivery in relation to uptake and adherence of older adults to exercise classes. Methods: Underpinned by the Theory of Planned Behaviour and using a mixed methods approach this thesis uses three studies to:1) Survey 731 United Kingdom exercise instructors with Level 3 older adults exercise qualification to investigate instructors' characteristics and attitudes towards older-adults' participation in exercise. 2) Interview 19 instructors to further explore instructors' attitudes, experiences and beliefs in relation to their exercise classes for older adults and how their attitudes, experiences and beliefs are influenced by their training and characteristics.3) Follow up a cohort of 16 instructors and 193 of their class participants over 6 months to explore what characteristics of exercise instructors, the group and class participants influence adherence and also whether instructors influence uptake and adherence to home exercise. Results and Conclusion: The first study establishes that there is a relationship between instructors' training, experience, characteristics and their attitudes. The second study supports these findings and demonstrates how instructors' think that these factors and others not only influence how they deliver and promote their classes but also influence older adults' uptake and adherence to exercise classes. The final study enables us to look at the relationship between instructor variables and the participant within the exercise class setting. Class participants' mental well-being, education and housing were key factors related to their attendance. Having attended the class for more than six months at baseline was an important factor related to adherence. Individual factors such as participants' attitudes, beliefs about group cohesion and instructor variables such as personality traits and experience emerged in the final models both in relation to participant attendance and adherence. There are a series of complex interactions between the instructor, participant, the group and others which influences beliefs and attitudes. It is clear that the instructor can influence participants and they have an important role to play in creating an atmosphere and environment of which participants want to be a part of.

Previous research, as well as theory, has supported the existence of a relationship between death anxiety and loneliness in older adults but a causal examination has not been possible until now. A hypothesized model was developed which states that loneliness will lead to death anxiety mediated by cultural worldview. Longitudinal data was analyzed using Structural Equation Modeling in order to more fully explore this potentially causal relationship. The primary model was supported suggesting that loneliness can lead to death anxiety as mediated by cultural worldview. Implications and future directions are discussed.

Diabetes mellitus affects 7.8% of the American population. National health statistic data and other research shows that racial/ethnic disparities exist in terms of prevalence and treatment outcomes. The present study investigated the role of patient health beliefs (i.e., locus of control, self-efficacy) and the doctor-patient relationship (e.g., satisfaction and collaboration with health care provider), as relative predictors of diabetic control (i.e., HbA1c levels) and overall satisfaction with diabetes care, in older adult participants with diabetes. Demographic, psychosocial, and diabetes-related data from the Health and Retirement Study (HRS) 2003 Diabetes Study were analyzed to compare treatment outcomes among non-Hispanic White, non-Hispanic Black, and Hispanic individuals with various types of diabetes. Non-Hispanic White individuals exhibited better diabetic control than their minority counterparts (F(2, 592) = 7.60, p < .001); however, no significant group differences were noted in terms of psychosocial factors. Diabetic control was best predicted by time since diagnosis (&#946; = -.21, p < .001), satisfaction with diabetes self-care (&#946; = .19, p < .001) and age (&#946; = .12, p < .01). In addition, satisfaction with provider care was best predicted by perceived collaboration with provider (&#946; = .44, p < .001), satisfaction with diabetes self-care (&#946; = .22, p < .001) and diabetes self-efficacy (&#946; = .08, p < .05). Recommendations for future research were discussed.

京都大学 / 0048 / 新制・課程博士 / 博士(人間健康科学) / 甲第21704号 / 人健博第70号 / 新制||人健||5(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 青山 朋樹, 教授 黒木 裕士, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

The study’s rationale: Physical difficulties as well as socio-psychological factors have an impact on the nutritional status and well-being of the elderly, leading to reduced capacity. In addition, feeding difficulties in the elderly after stroke or with illnesses – holding cutlery, bringing food to the mouth, chewing and swallowing –are a factor reducing independence and contributing to malnutrition. Aim: The aim of this study was to develop and evaluate the acceptability of proteinrich in-between recipes intended as fingerfoods for home usage among older adults with eating disabilities. Recipes intended for publication in a recipe book. Methods: Several prototypes per recipe were developed using the creative design method. Measurements on physical characteristics – firmness, stickiness, viscosity, colorimetry – as well as consumer tests at home – general appreciation, appearance, smell, taste, texture – were conducted. Results: The measurements of the physical characteristics helped to reduce the number of samples presented in the hedonic test. The laboratory measurements combined with the results of the hedonic tests (n= 57-77 participants) were used to determine the most suitable and appreciated recipe. The participants' comments enabled the improvement of the recipes. Conclusion. Four acceptable fingerfood recipes for in-between meal for older adults with eating disabilities were developed: blinis, pancakes, banana drinks, chocolate chip cakes. While the addition of spirulina is not appreciated, the addition of vanilla whey protein or sauce may be good both for acceptability and nutritional reasons.The higher the content of protein, the lower the firmness of the solid fingerfoods.Completing this study by ensuring acceptability and attractiveness among older adults with eating difficulties could confirm the recipes. / <p>ISBN: 978-91-87973-60-4</p> / Fingerfoods – en väg till ökad matglädje, ökad självständighet och ökat välmående bland äldre

This study of 535 older married couples examined the relationship between depression and health and sexual satisfaction directly and when mediated by communication. The sample included 535 older couples who completed a survey questionnaire known as Project Couple Retire. Among the items in the questionnaire were measures of depression, health, perception of sexual intimacy, communication and other demographic information. Results from Structural Equation Modeling indicated that for women, health was a significant predictor of sexual satisfaction. For both genders, the results suggest that depression, when mediated by communication, is a predictor of sexual satisfaction among older couples.

Footwear can affect postural stability in individuals, particularly in elderly people. Aging-related decline in postural stability, particularly in the mediolateral (ML) direction, is a risk factor for falls and fall-related injuries among older adults. This study aimed to investigate the effects of high cushioned and minimal shoes on dynamic postural stability in ML during obstacle crossing in defined older and younger adults. Six healthy older adults (50–60 years old, body weight: 74.8 kg, body height: 168.0 cm) and six healthy younger adults (18–32 years old, body weight: 73.8 kg, body height: 174.8 cm) participated in the study. A Vicon motion analysis system with 10 optical cameras was used to capture the obstacle (20 cm height) crossing motion of the participants at 200 Hz, and ground reaction forces of obstacle crossing were collected at 1000 Hz. Motion data of obstacle crossing were collected at three shoe conditions, namely, minimal shoe, high cushioned shoe and barefoot (control). Data from five trials of obstacle crossing for each shoe condition were processed using Vicon Nexus software 2.11.0 and Matlab R2013b. Displacement and velocity of centre of mass (COM) in the ML direction, COM–centre of pressure (COP) ML separation, step length, step velocity, toe clearance, pre-horizontal distance, hip flexion angle and hip abduction angle during obstacle crossing were examined. One-way ANOVA with pairwise analysis showed that toe clearance was significantly larger in the high cushioned shoe conditions than in the minimal shoe and barefoot conditions in older adults (high cushioned shoes vs. barefoot: p = 0.019; cushioned shoes vs. minimal shoes: p = 0.031) and younger adults (high cushioned shoes vs. barefoot: p = 0.016; high cushioned shoes vs. minimal shoes: p = 0.000). No significant difference in the measures was found between the minimal shoe and barefoot conditions in each group. Compared with older adults, younger adults showed significantly larger step length in barefoot condition (p = 0.000) and minimal shoe (p = 0.016). Independent t-test for examination of the significant difference of the means of each measure when the shoe condition was changed showed that only step length and step velocity were significantly different between older and younger adults. When the shoe condition was changed from minimal shoe or barefoot to high cushioned shoe, older adults showed significantly bigger change in step velocity (10.04 ± 4.39 cm/s for older; 1.87 ± 0.81 cm/s for younger; p = 0.034) and step length (14.26 ± 6.99 cm for older; 2.086 ± 1.13 cm for younger; p = 0.041) than younger adults. This result indicates that older adults had 23% greater total range of step length and 12% greater total range of step velocity compared with younger adults when shoe condition changed. Moreover, older adults showed 16% smaller total range in their maximal COM-COP ML separations than younger adults when shoe condition changed. It is concluded that high cushioned shoes can influence dynamic postural stability in the ML direction during obstacle crossing in younger and older adults. The minimal shoe and barefoot conditions did not show significant influence on postural stability in the ML direction during obstacle crossing in older and younger adults. The minimal shoe on dynamic postural stability in the ML direction is not significant. Age differences in dynamic postural stability in the ML direction during obstacle crossing were found at the same shoe conditions. Moreover, when shoe condition was changed, shoe cushioning conditions affected postural stability to a larger extent in older adults compared with younger adults. The high cushioned shoe led to a more challenged postural stability in adults aged 50 to 60 than younger adults aged 18 to 32.

No description available.

Sammanfattning Bakgrund: Äldre är en allt mer växande grupp i samhället då medellivslängden i Sverige har ökat. En stor del av världens äldre population är fysiskt inaktiv och drabbas av kroniska sjukdomar med ökad ålder. Detta har resulterat i en ökad belastning på sjukvården som kunde minska om fler äldre skulle delta i fysisk aktivitet. Syfte: Syftet var att undersöka vilka faktorer som upplevs påverka deltagande i fysisk aktivitet hos äldre som regelbundet tränar på Träffpunkter samt hur de upplever träningen som erbjuds där. Metod: En kvalitativ intervjustudie genomfördes. Informanterna bestämdes med ett strategiskt urval. Kvalitativ innehållsanalys har använts vid databearbetning.  Resultatsammanfattning: Individuella faktorer som obehagskänslor kopplade till fysisk aktivitet och nedsatt kroppsfunktion nämndes som utmaningar för deltagande. Informanterna beskrev att det krävs flexibilitet och anpassningsförmåga utav individen samt att det krävs att samhället anpassar utbud och resurser till den äldre populationen. Informanterna i studien motiverades av positiva effekter av träning samt uppskattade den anpassningsbara träning och det sociala utbytet som Träffpunkten erbjuder. Slutsats: Äldres deltagande i fysisk aktivitet påverkas av faktorer på individnivå som obehagskänslor, funktionsbegränsningar och flexibilitetsförmåga. Dessa faktorer samspelar med faktorer på samhällsnivå som anpassad träning, lokalutformning och transportmöjligheter. Träningen på Träffpunkter anses vara anpassningsbar och bidra till en social samvaro som underlättar deltagandet i fysisk aktivitet. Ett större utbud av träningsformer skulle kunna öka motivation för deltagande i fysisk aktivitet. Mer forskning inom området behövs. / Abstract Background: Older adults are a growing population in society as the life expectancy increases in Sweden. Many are physically inactive and are exposed to chronic diseases. This has resulted in a considerable load on healthcare which could be decreased if this group would increase their physical activity. Aim: The aim of this study was to explore factors that affects participation in physical activity for older adults that are exercising regularly at Träffpunkter and their experience of the exercise provided. Method: A qualitative interview study was used. Participants were selected using a strategic sample procedure. A qualitative content analysis approach was used for data analysis. Results: Individual factors such as negative feelings linked to physical activity and reduced bodily function, were mentioned as challenges to participation. Participants expressed that they need to be flexible to overcome barriers and that the society need to provide accessible and adjustable exercise. The motivators were similar for all participants such as the positive effects of exercise and they appreciated the adjustable training and the social climate at Träffpunkten. Conclusion: Factors that affects participation in physical activity are factors relating to the individual such as negative feelings, physical limitations and flexibility. They interact with environmental factors such as facility- and exercise design and transportation. Träffpunkter are viewed to provide adjustable training and a positive social climate. A increased variety of exercise could motivate participation in physical activity. More research in the field is needed.

Occasionally healthy older adults trip over stationary objects even when seen well in advance. These are known as “inadvertent” trips. The purpose of this study was to determine the prevalence of inadvertent trips in older males and older females under conditions of normal vision with good lighting. We also determined their relationship with unobstructed gait measures and other risk factors associated with falls during everyday activities. Forty-one subjects stepped over an obstacle (height set to 25% of leg length) 100 times. The obstacle was contacted by 15 participants (37%) in a total of 29 trials (0.7% of all trials). Of the 29 obstacle contacts, 52% occurred with lead limb. There was no difference in the frequency of contacts between males and females. Slower stride speed, shorter stride length, and increased gait cycle time variability during unobstructed walking were associated with contacts during the obstacle crossing trials (p <u><</u> 0.041). Inadvertent trips were also associated with the number of prescription medications taken by participants (p = 0.019) and participants’ maximum reported rating-of-fatigue (p = 0.022<u>)</u>. Fatigue was an important factor and 36 subjects (88%) reported an increase in their fatigue across trials highlighting the importance of considering fatigue in all obstacle crossing studies using older adults. We conclude that inadvertent trips are not uncommon in older adults and point to useful future areas of research and risk factors that could be targeted by fall intervention programs