INTRODUCTION: Age-related functional declines in the body and brain pose significant challenges to mobility and postural control. Older individuals are at increased risk for injury from a fall. Declines in gait and balance control make older adults more likely to suffer a fall or recurrent falls. According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury related death among adults age 65 years and older. (Important Facts about Falls | Home and Recreational Safety | CDC Injury Center, 2019) One out of three older adults falls annually and the likelihood of falling increases with age. (Stevens et al., 2008). In the US alone, the number of individuals living aged 65 and older is estimated at 46 million persons and is expected to reach 74 million by 2030. (Healthy Aging in Action: Advancing the National Prevention Strategy, 2019) Fall death rates in the United States increased by 30% from 2007 to 2016, and if this trend continues, it is expected that by 2030 there will be 7 deaths due to falls every hour. (Important Facts about Falls | Home and Recreational Safety | CDC Injury Center, 2019) Interventions designed to improve gait and balance control in the geriatric population can mitigate fall risk and positively impact these trends. OBJECTIVE: Gait and balance control, traditionally regarded as automatic motor processes, have since been determined to be complex motor functions reliant on executive function. (Hausdorff et al., 2005; Woollacott & Shumway-Cook, 2002) Normal walking and balance control are attentionally demanding and require shifting of attentional resources to frontal brain regions in order to maintain upright stance. This ability to dual-task is impaired in older adults. A single session of transcranial direct current stimulation (tDCS), a form of noninvasive brain stimulation, targeting the excitability of the left dorsolateral prefrontal cortex (l-dlPFC) has been found to reduce dual-task costs to gait and balance in both young and healthy older adults. (Manor et al., 2016; Zhou et al., 2014) However, little is known about how tDCS influences electroencephalogram (EEG) patterns and if changes in EEG are associated with functional outcomes. The specific aims of this study were to determine whether 1, 20-minute session tDCS targeting the l-dlPFC reduces the slow-wave/fast-wave frequency power ratio in EEG and absolute EEG power and whether these reductions are associated with changes in measures of postural control. METHODS: The data from this study was analyzed as part of a larger clinical trial testing multiple tDCS stimulation montages in combination with batteries of cognitive, gait, and balance assessments. Twenty-two older adults (median age=71 years) who were free of overt illness or disease were included in the analysis. Participants were outfitted with wireless movement sensors and a wireless 32-electrode EEG cap configured according to the 10-20 system. Participants completed a dual-task of serial subtraction by 3’s from a randomized three-digit number while standing for 60 seconds. EEG was simultaneously recorded during the 60 second trials. One, 20-minute tDCS stimulation targeting the l-dlPFC followed the balance assessment. EEG and dual-task assessments were repeated following the stimulation. EEG was not recorded simultaneously with tDCS. EEG data was processed and analyzed with Cartool EEG software. (Brunet et al., 2011) Spectral analysis of the EEG power values pre and post stimulation was conducted using a paired t-test. Power ratios of slow wave (4-8Hz) to fast wave (12-30Hz) were calculated for pre and post stimulation and analyzed for significant changes. Additionally, absolute power values in theta and beta frequency range were calculated. Postural sway velocity and postural sway area were also assessed and analyzed for changes following stimulation. RESULTS: Spectral analysis showed significant reductions in absolute power values across low theta frequency ranges following stimulation. This significant reduction in power was localized, but not exclusive, to frontal electrodes measuring activity of the l-dlPFC in the 4-8Hz frequency range. Most notably electrode F3, which has been found to correspond to the location and activity of the l-dlPFC using both the 10-20 electrode placement system and MRI guided neuronavigation. (Beam et al., 2009; De Witte et al., 2018) In addition to a significant reduction in power values, there was a reduction in slow-fast EEG ratios following stimulation. The percent reduction in EEG ratio was associated with a reduction in postural sway area (m2/s4) and sway velocity (m/s). CONCLUSION: tDCS is used to facilitate the excitability of cortical neurons. The l-dLPFC is a critical component of executive function. Due to the role of executive function in mediating attentional requirements of gait and balance, the l-dlPFC was chosen as a target to enhance dual-tasking capabilities, and thereby improve gait and postural control. The reduction in the slow wave-fast wave ratio and theta power indicates that participants had higher power in the fast wave relative to the slow wave after tDCS administration. The reduction in slow wave power may be indicative of less cognitive attentional effort required to complete a simultaneous dual-task involving postural control. This is supported by the associated reductions in postural sway following tDCS stimulation. These results further current research of tDCS as a viable intervention for improving balance and cognition in older adults and offers additional information about optimizing the efficacy of noninvasive brain stimulation to improve functional outcomes in this population.

Older adults often show declines in subjective and objective memory performance relative to younger adults. One potential path for helping older adults with memory may be compensatory memory training programs. Compensatory memory training programs teach strategies to manage memory impairment. Traditional compensatory memory training programs tend to be highly specific to a task and often do not generalize to other memory tasks. Ecologically Oriented Neurorehabilitation of Memory (EON-Mem) is a method for teaching memory strategies that may generalize for efficient use in everyday contexts. We performed a feasibility study to determine the value of pursuing a group-based version of EON-Mem with older adults in a future larger-scale randomized controlled trial. The current feasibility study took place in two phases with two separate samples. The first sample consisted of five separate groups of healthy young adults (n=39). The second sample consisted of three separate groups of older adults (n=26). We collected data on recruitment, treatment adherence, memory improvement, drop-out rate, cost, time spent, and participant-report data on barriers to successful implementation of EON-Mem treatment. We also collected data on memory performance and overall cognitive functioning. In order to assess improvement before and after treatment within our sample, reliable change indices were calculated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) delayed memory index score. Participants first performed a baseline assessment (traditional and ecological memory tasks, general cognition tasks, emotional functioning, demographics). After the baseline assessment, participants attended one treatment session (90 minutes) per week for a total of seven group-based EON-Mem treatment sessions. Thirty-nine young adults and 26 older adults enrolled in the study; 20 young adults and 10 older adults completed the treatment sessions. We prematurely ended older adult group treatment sessions due to the COVID-19 pandemic. All participants performed a post-intervention assessment using alternate versions when available. Attendance rates were low for the young adult sample (51% completed the treatment) and as expected for the older adult sample when accounting for COVID-related changes (77% eligible for completer status prior to cancelling sessions). Twenty percent of each sample reliably improved on the RBANS delayed memory index score before and after treatment. Costs were higher than expected ($345 and 18.6 research hours for each young adult participant; $319 and 16.9 research hours for each older adult participant). Subjectively, both samples reported enjoying the interactions with others and the presentation of the treatment, but disliked peg words. Overall, although a randomized controlled trial of group-format EON-Mem in older adults is feasible, such a study may or may not be cost-effective depending on the resources and goals of the researcher.

Limited or asymmetrical hip mobility can affect movement patterns common to everyday living. The aim of this study was to evaluate the relationship between hip mobility and performance on the Functional Movement Screen (FMS) in apparently healthy older adults. This relationship was evaluated in both males and females. In this observational study, 20 older adults (10 male, 10 female, mean age = 65.65 ± 10.18 years old) completed the Functional Movement Screen and measurements of passive hip range of motion. Separate regression analyses and Pearson Product-Moment Correlations were used to evaluate the relationship between hip mobility measures and FMS composite and FMS individual task scores. All analyses employed a pseudo-Bonferroni correction for multiple comparisons. Significant correlations were found between FMS Shoulder Mobility (left side scoring) and left leg hip flexion (p = 0.002, r = 0.636), Trunk Stability Push-Up and left leg external rotation (p = 0.008, r = 0.568), and Rotary Stability (scoring on the right side) and right leg flexion (p = 0.008, r = 0.571). The only measure of hip mobility that was significantly related to the FMS composite score was left leg hip external rotation (p = 0.006, r = 0.589). An independent t-test revealed a significant difference (p = 0.0002) between men and women on the FMS Trunk Stability Push-Up test. There was no sex difference in any other individual FMS test item or the composite FMS score. All of the participants were able to complete all of the measures of hip mobility and all of the individual FMS test items. Thus, a larger scale study could be conducted in an older group of participants to further evaluate the relationship between measures of hip mobility and the FMS, accounting for confounding variables such as physical activity level, BMI, and age. In this preliminary study, correlations between measures of hip mobility and FMS scores were strong but few in number. The findings of our study suggest that lower measures of hip mobility can lead to a decreased ability to perform task-specific FMS movements. This data gives evidence that hip mobility can influence functional movement patterns which may lead to alterations in functional movement related to activities of daily living.

There is no information in Peru on the prevalence of mental health problems associated with COVID-19 in older adults. In this sense, the aim of the study was to gather evidence on the factor structure, criterion-related validity, and reliability of the Spanish version of the Fear of COVID-19 Scale (FCV-19S) in this population. The participants were 400 older adults (mean age = 68.04, SD = 6.41), who were administered the Fear of COVID-19 Scale, Revised Mental Health Inventory-5, Patient Health Questionnaire-2 items, and Generalized Anxiety Disorder Scale 2 items. Structural equation models were estimated, specifically confirmatory factor analysis (CFA), bifactor CFA, and structural models with latent variables (SEM). Internal consistency was estimated with composite reliability indexes (CRI) and omega coefficients. A bifactor model with both a general factor underlying all items plus a specific factor underlying items 1, 2, 4, and 5 representing the emotional response to COVID better represents the factor structure of the scale. This structure had adequate fit and good reliability, and additionally fear of COVID had a large effect on mental health. In general, women had more fear than men, having more information on COVID was associated to more fear, while having family or friends affected by COVID did not related to fear of the virus. The Spanish version of the Fear of COVID-19 Scale presents evidence of validity and reliability to assess fear of COVID-19 in the Peruvian older adult population.

This project explored whether mindfulness and acceptance-based practices (MABPs) for older adults would reduce the negative effects of ageism and negative attitudes and beliefs related to aging. In addition, state affect and stress were explored. This study used an experimental design to compare two groups of older adults and two groups of undergraduate students – those who received a MABP and those who did not, after being presented with negative ageist stereotypes. Condition and condition by age sample comparisons revealed several findings. Following the MABP, undergraduates who received a MABP had significantly lower ageism scores than did undergraduates who did not. Older adult findings were opposite of proposed hypotheses, with older adults having higher scores on ageism after receiving the MABP, as compared to the scores of older adults who were in the comparison condition. Differences in state mindfulness were seen between conditions, with the MABP condition exhibiting more state mindfulness than in the comparison condition. However, there was no significant condition by age sample interaction effect. Change scores for state affect after the MABP were non-significant at either level of analysis, and older adults showed no difference in digit span stress scores based on their condition assignment. Exploratory analyses revealed some research consistent, as well as nuanced, findings. These findings suggest that undergraduates may respond to MABPs for recontextualizing aging, discrimination, and stigma. These findings also suggest that older adults may employ different coping strategies when confronted with ageism in an experimental context when asked to reflect, as oppose to participate in MABPs. Overall, a need for aging education, experimental research with older adults, and empirical understandings of MABPs for age-related issues, is needed. Limitations and future directions are discussed.

Purpose: To pilot test the efficacy of a documented 5-week karate training intervention for rehabilitation and neuroprotection in older adults. Methods: eleven older adults (4 male, 7 female, age 59-90y; 168.4±5.8cm; 67.2±10.7kg), five older adults (4 male, 1 female, age 67-76y;176.8±6.4 cm; 69.9±17.6kg) with chronic conditions, and two young adults (2 female, age 23; 165.1±4.9cm; 60.1±6.7 kg) participated. A commercial balance board was used to assess balance through dynamic posture. Arm and leg strength, Timed Up and Go (TUG), and spinal cord excitability (via the soleus H- reflex) were assessed. Results: Over the intervention participants completed approximately 2437 steps, 1762 turns, 3585 stance changes, 2047 punches, 2757 blocks, and 1253 strikes. Dynamic postural performance improved after the intervention (tTarget (18%, p=0.128), tCenter (9%, p<0.01), and tTotal (14%, p=0.073)), with 9 participants showing improvements in balance. No significant changes were found in TUG group data (p=0.539) but 5 neurologically intact participants (4-9%; p<0.05) and 1 Parkinson’s Disease participant (3%, p<0.05) improved. There was significant improvement to strength in the left hand (2%, p=0.037) and right leg (40%, p=0.050). Spinal cord excitability remained unchanged across the group a but 5 (3 neurologically intact (195%, 215%, 48% (avg= 153%); p<0.05); 2 Parkinson’s Disease participants (19%, 23%; p<0.05)) had significantly modulated H-reflex amplitudes following the intervention. Conclusion: Five weeks of training caused improvements in balance reactions and strength suggesting that neuromechanical integrity improved. Whole-body training in martial arts enhanced neuromuscular function and postural integration. The observations of this pilot investigation provide quantitative groundwork for explorations of dose and development of martial arts interventions as functional fitness intervention for older adults. / Graduate / 2022-01-01

Discontinued hearing-aid use is caused by a number of factors, most of which may lead to low hearing-aid self-efficacy (i.e. low confidence in one's ability to B a successful hearing-aid user). This paper describes the development of the Measure of Audiologic Rehabilitation Self-Efficacy for Hearing Aids (MARS-HA), which was constructed in accordance with published recommendations for self-efficacy questionnaire development. The psychometric properties of the MARS-HA were evaluated with new and experienced hearing-aid users. The results revealed strong internal consistency and good test-retest reliability in both groups, with the following subscales identified both for the new users and the experienced users: (1) basic handling, (2) advanced handling, (3) adjustment to hearing aids, and (4) aided listening skills. Validity was established through the examination of expected differences based on group comparisons, training effects, and the impact of particular hearing aid features. The MARS-HA is a reliable and valid measure of hearing-aid self-efficacy and can be used to assist clinicians in identifying areas of low confidence that require additional audiologic training.

Background and objective: The Coronavirus Anxiety Scale (CAS) is an instrument that measures the severity of anxiety due to COVID-19 or coronaphobia. In the context of the COVID-19 pandemic, older adults are the most vulnerable age group; therefore, the aim of the study was to evaluate the psychometric properties of the CAS in this group. Materials and method: 274 Peruvian older adults participated (Mage = 67.86; SD = 6.34, 64.6% women). In addition to the CAS, the 2-item Patient Health Questionnaire (PHQ-2), and 2-item Generalized Anxiety Disorder Scale (GAD-2) were applied. Confirmatory Factor Analysis (CFA) was used to assess the factor structure of the CAS and Item Response Theory was used to analyze item characteristics. A sequence of hierarchical variance models was used to evaluate the measurement invariance of the CAS according to age. To assess reliability, Cronbach's alpha coefficient (α) and the omega coefficient (ω) were used. The correlations between the CAS score and the scores of the PHQ-2 and GAD-2 scales were calculated with Pearson's correlation coefficient (r). Results: The results of the CFA indicated that the unidimensional model of the CAS fitted the data adequately and showed very good reliability (α and ω ≥ .83). Likewise, all items provided high information and adequate discrimination, which allowed for better detection of average and high levels of coronaphobia in the older adult population. However, the CAS did not show evidence of being strictly invariant between older adults aged 60–65 years and 66–86 years. The CAS showed significant correlations with anxiety (r = .72; [95%CI: .66, .87] p < .01) and depression (r = .53; [95%CI: .43, .76] p < .01). Conclusion: The CAS in Spanish shows evidence of validity based on internal structure, convergent and divergent validity, as well as an adequate reliability estimate to assess coronaphobia in older adults. The CAS can be used to detect average and high levels of coronaphobia in the older adult population.

Research has shown that age-related hearing loss may have profound implications on all aspects of an individual's life, including cognitive abilities. The relationship between hearing loss and cognition has led to research which indicates an association between objective hearing loss and reduced driving performance in older adults. However, little research exists on the relationship between self-perceived hearing loss and driving confidence, particularly in the South African context. The current study aimed to identify possible associations between driving confidence and hearing loss, age, sex and driving safety among older adults. Data analysis indicated a significant increase in driving confidence after one month of first-time hearing aid use. An insignificant or weak relationship was found between self-perceived hearing loss and level of driving confidence. Age, sex and a combination of both were significantly associated with level of driving confidence. No association was found between pure-tone average and level of driving confidence or between pure-tone average and driving safety. Further research in this area could assist in advising legislation relating to licensing and road safety campaigns targeted at older adults, as well as expanding audiologists' duty of care to include counselling on the potential positive effects of hearing aid use on driving confidence.

In Ontario, the population of older adults is increasing. While the provincial government is taking action to address increasing demand on health systems, older adults are still suffering the consequences of a health system that is not able to meet their complex care needs. Older adults face barriers to continuity of care including difficulties with memory, reliance on informal caregivers, frailty, and difficulties scheduling appointments. These barriers also exist within the long-term care setting. Long-term care facilities are making efforts to provide more effective care, including designing care approaches aimed to meet the complex care needs of older adults. Aspects of a goal-oriented approach suggest that it has the potential to reduce fragmentation and positively impacting continuity of care. However, the impact of goal-oriented care on continuity of care in a long-term care setting has yet to be explored. This thesis uses an exploratory case study methodology to describe how a goal-oriented care approach influenced continuity of care in a long-term care setting, as perceived by residents, staff, and administrators. The case study setting is the Perley & Rideau Veterans Health Centre in Ottawa, Ontario, where the SeeMe program, a frailty-informed approach with a goal-oriented component, was recently introduced. Factors associated with the SeeMe program and other organizational factors perceived to facilitate and inhibit informational, relational and management continuity were identified. Aspects of the SeeMe program that facilitated informational continuity were: goals-of-care meetings with residents, their care team and family; care conferences that helped residents understand their care options; and, procedures that ensured consistency in where resident’s goal information is stored. Aspects that facilitated relational continuity were: understanding residents’ values and preferences; staff increasing awareness of the program for families; and, integration of the family perspective into a resident’s care. Program aspects that facilitated management continuity were: discussions that led to informed decision-making; use of assessments as a reference tool in the case of an acute health event; discussions that empowered residents to talk to external care providers; and, creation of a structure that facilitated consistencies in care. These factors can be targeted when designing care approaches aimed to improve continuity in long-term care settings.