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Unplanned hospital admissions (UHA) in older adult populations are a recurring problem in older adults with cancer. Older adults comprise approximately 60% of cancer diagnoses and receive the majority of cancer treatment. However, little is known about why older adults under treatment for cancer experience a high number of unplanned hospital admissions. A review of the literature provided few study findings and a gap in the current knowledge was identified regarding the factors associated with unplanned hospital admissions in older adults under treatment for cancer. A conceptual framework based on the literature and this researcher's clinical experienced guided this study. The purpose of this study was to explore the factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions of older adults with cancer. A convenience sample of 129 dyads of older adults with cancer and their family caregivers were approached and enrolled in the adult oncology outpatient infusion centers and inpatient units within a community cancer center in central Florida. Patient demographic and clinical data were obtained through a retrospective medical record review. Family caregiver demographic and side effect knowledge data was collected prospectively during interviews with family caregivers using a newly developed tool, Nurse Assessment of Family Caregiver Knowledge and Action Tool (NAFCKAT). The NAFCKAT contains 11 items to determine baseline knowledge about side effects and plan for managing side effects. A fever subsection consists of 4 knowledge and 2 action questions and a dehydration subsection consists of 2 knowledge and 2 action questions. Preliminary research was conducted to determine reliability and validity of the NAFCKAT. Excellent inter-reliability was found for the tool and preliminary support for validity was determined for the fever subscale. Descriptive statistics and logistic regression analyses were used to evaluate data collected from patient medical records and NAFCKAT scores. Study findings revealed that unplanned hospital admissions were more likely to occur when older adults had the presence of impaired function prior to treatment initiation and/or experienced side effects of infection /fever and vomiting/diarrhea during treatment. The presence of impaired function and family caregiver support (knowledge and availability) did not moderate the relationship between side effects and unplanned hospital admissions. Findings suggest that the presence of impaired function and side effects of infection and fever, and vomiting and diarrhea, predict unplanned hospital admissions in older adults during the active cancer treatment phase. Nurses should advocate for and conduct targeted assessments to identify the presence of functional impairments prior to cancer treatment initiation. In addition, nurses should actively monitor for the presence of cancer treatment-related side effects during the treatment phase of the cancer trajectory. Information gained from these assessments will assist nurses to provide practical and tailored strategies to support older adults and their family caregivers during cancer treatment and reduce the risk for unplanned hospital admissions.

Many older adults are electing to age in place within their communities. Even though they may be frequent consumers of community programs and services, their role as contributors to community well-being should not be overlooked. Sense of community is a core dimension of well-being because the connections associated with sense of community are important for everyday life. The model in this study was developed to explore the effects of community connections (community capacity, ease of making connections, active participation in the community, and informal supports) and demographic variables on sense of community. A probability sample of 1,499 adults 65 years and older that resided in rural areas responded to questions concerning their sense of community and community connections. Using multiple regression analysis, results indicate that community capacity, ease of connecting with others in the community, and having an informal support network are significant in predicting sense of community. Nonsignificant associations were found with regard to participation in community activities, age, sex, health status, and length of time living in the county. These findings suggest that key dimensions of aging (age, sex, health status) are less relevant when addressing sense of community when compared to associations and connections. Factors that predict sense of community may be amenable to community-level interventions, thus allowing for the development of sense of community among community members, which could ultimately lead to their participation as community resources. / Master of Science

The purpose of this inquiry was to develop substantive theory that describes the social process that influences the eating behavior of hospitalized older adults. Undernutrition or the inadequate intake of dietary nutrients necessary to maintain health, contributes to negative health outcomes such as increased morbidity and mortality in hospitalized older adults. Inadequate dietary intake is a risk factor for undernutrition. Despite the availability of vast resources within the hospital environment, hospitalized older adults have inadequate dietary intake. Undernutrition has been studied from a dietary intake perspective; however, why dietary intake remains inadequate is unknown. Inquiry of eating behavior and the social process that influences eating behavior will provide insight into why dietary intake remains inadequate. The Quality Health Outcomes Model was the conceptual framework that guided this inquiry. A qualitative, grounded theory methodology was used to investigate this phenomenon. Participants included acutely ill, hospitalized older adults and their healthcare providers. Field work included observation, interview, and document review to better understand the actions, interactions and perceptions of participants as to the process that influenced hospitalized older adult eating behavior. Datum was compared, coded, and analyzed using the constant comparative method. The Theory of Compromised Eating Behavior was developed and describes the process of compromise older adults experience related to eating behavior while hospitalized. The Theory has four stages: self-indication, joint-action, negotiation, and action. Hospitalized older adults choose to compromise their health should they eat inadequately or alternatively compromise their acculturated foodways should they eat adequately. Additionally, healthcare providers compromise their beliefs when older adult patients do not eat adequately. Older adults are at risk for negative health outcomes due to inadequate dietary intake while hospitalized. The meaning of hospital food and mealtimes differs from traditional food and mealtimes for the older adult, resulting in compromise. Intervention which enhances the meaning of food and mealtimes for the older adult during hospitalization may improve dietary intake and nutritional outcomes.

Loneliness affects Black older adults (BOAs) in different and debilitating ways. BOAs aged 65 years and above make up 7.3% of the Black population and 15.9% of the total population of those aged 65 years and above in Canada. Also, the population of BOAs in Canada has doubled within the last two decades, highlighting the need to understand the unique experience of aging of this population, including their experiences of loneliness and social participation. Contrarily, there exist notable gaps within the loneliness literature on the experience of loneliness and social participation among BOAs living in Canada. This doctoral dissertation addresses these knowledge gaps by providing insight into the factors influencing social and emotional loneliness and lack of social participation among BOAs and proffers ways to address the issues, expressly informing future research, services, and programs targeting this group. This dissertation is comprised of four papers. Paper 1 is a scoping review of 27 articles that reveal the dearth of empirical evidence on the experience of loneliness or subjective social isolation and the contributing factors among BOAs in Canada. The data used for the remaining three papers were collected through 25 narrative interviewing conducted with 13 BOAs living in Hamilton and Windsor, Ontario. Findings from this paper shows that in addition to unavailability of social provisions (relational gains), loneliness among BOAs is exacerbated by socio-economic factors, health-related factors and behaviours, and technology, media device possession and usage. The results also indicate that there is need for inclusion of BOAs in loneliness research in Canada. Following Paper 1, Paper 2 investigates the unique experience of loneliness among BOAs living in Canada and the suitability of the social provision framework in identifying and understanding the experience of loneliness among this group. Findings from this paper demonstrates the significance of social connection, reliable relationships and relational gains in reducing and increasing experience of loneliness among BOAs. Paper 3 analyzes the constellation of factors that contribute to loneliness among BOAs and how they cope with their experience of loneliness. The results from this paper highlight the complex overlapping factors that contribute to the experience of loneliness among BOAs including time, sense of place and belonging, weak socio-personal interaction, and level of exclusions. Paper 4 and final paper uncovers the micro and macro level factors that hinder BOAs from participating in social programs and services and suggests ways to improve their social participation. Specifically, findings from this paper uncovers the need for programs and services that are culturally diverse and sensitive to the unmet needs of racialized and minoritized groups. Collectively, the four papers contribute to knowledge on the experience of loneliness among BOAs and contributory factors and highlight the need for more inclusive research and practice on addressing loneliness among this group. / Thesis / Doctor of Philosophy (PhD) / This research aims to understand how loneliness affects Black older adults (BOAs) living in Canada and how to reduce their loneliness. This is a group that is not usually included in the loneliness literature. The dissertation is organized into six chapters comprising of the introduction, four papers and the conclusion. Paper One analyzes 27 articles describing the factors that contribute to loneliness among Black older adults globally. The 27 papers reveal while loneliness is devastating for BOAs, studies that have examined the experience of loneliness among BOAs in Canada is very scanty. Paper Two, Three and Four all report results from narrative interviews conducted with 13 Black older adults living in Windsor and Hamilton, Ontario. Paper Two explores the unique experience of loneliness among BOAs. Paper Three analyzes the influence of time, place and interaction as factors that contribute to the experience of loneliness among Black older adults and their coping strategies. The final paper explores the significant factors that hinder BOAs from participating in social programs and services and ways to improve their participation. Generally, the results of these papers provide important insights into the ways to address loneliness and the lack of social participation among BOAs. The results show that programs and services targeting loneliness in Ontario need to be made more culturally sensitive and representational of minoritized groups. Lastly, it highlights the need for the inclusion of BOAs in loneliness research among older adults in Canada.

Short-term physical inactivity in older adults has been shown to cause muscular atrophy and impaired glycemic control, however, the ability to recover remains unknown. We aimed to determine the impact of step-reduction (SR) on older adults and if they could recover simply by returning to habitual activity. Ten older adults (6 men, 4 women, 69 ± 3 yr) completed 7d of normal baseline activity (BL), subsequently underwent SR by 86 ± 9% (8568 ± 3741 to 973 ± 76 steps/d; p<0.001) for 14d and then returned to 8383 ± 4513 steps/d for 14d (RC). During an oral glucose tolerance test (OGTT), SR resulted in elevated plasma glucose concentration ([G]) area under the curve (AUC; 325 ± 126 to 375 ± 137, p = 0.13), maximum [G] (10.2 ± 2.4 to 11.9 ± 1.7 mM, p = 0.027) and 2-hr [G] (7.9 ± 1.3 to 9.1 ± 1.1 mM, p = 0.085), while all [G] indices returned to BL after RC. However, Matsuda insulin sensitivity index was reduced (3.5 ± 0.3 to 2.7 ± 0.7, p < 0.001) and homeostatic model assessment of insulin resistance was elevated (2.8 ± 0.3 to 3.6 ± 0.7, p = 0.02) with SR, remaining different than BL after RC (p < 0.005). During free-living conditions, 3-hr post-prandial [G] (PPG) AUC and peak PPG increased following SR (p > 0.05), returning to BL with RC. Body composition and physical function remained unchanged with SR. These results show that periods of physical inactivity, characterized by reduced daily stepping, do not present detectable changes in body composition or physical function yet result in reduced glycemic control in older adults. While elevations in blood [G] are abolished with 14d of normal physical activity, our findings suggest that the SR-associated reductions in insulin sensitivity are not normalized as quickly. / Thesis / Master of Science in Kinesiology / Periods of physical inactivity such as hospitalizations decrease daily steps for older adults and this inactivity can cause losses of muscle, strength, and symptoms of diabetes. It was unknown if by simply returning to normal physical activity older persons could ‘reverse’ the consequences of step-reduction so we conducted a study involving two weeks of step-reduction and two weeks of recovery. While there was no change in strength or muscle mass, we found that when older adults reduced their daily steps to fewer than 1000/day, after two weeks they became ‘resistant’ to insulin, a hormone that helps control blood sugar and is connected to the development of type II diabetes. Although these older adults resumed normal step-count levels in the recovery phase, they did not recover their insulin sensitivity such that two weeks of normal daily activity was not sufficient to overcome the consequences of two weeks of inactivity.

Background and Purpose: Evidence now links poor oral hygiene to systemic and infectious diseases such as pneumonia. Hospitalized patients, who now retain their teeth into older adulthood, often rely on nurses to provide oral hygiene care. Nurses have the potential to impact oral health outcomes and quality of life by controlling plaque. However, oral hygiene care practices of nurses in post-acute hospital settings are relatively unknown. The purpose of this study was to explore how nurses provide bedtime oral hygiene care, how they decide on interventions provided, and how certain factors influence their ability to provide oral care. Methods: A qualitative, exploratory multiple-case study was conducted with 25 nurses working on five inpatient units at different hospitals. Nurses were accompanied on their evening rounds to observe oral care practices, the physical environment, and workflow. Thematic analysis was used to analyse the case study data base including transcripts of guided conversations, field notes, and documents. Within-case analysis was followed by cross-case analysis. Findings: Findings indicate that: (a) nurses often convey oral hygiene care to their patients as being optional; (b) nurses are inclined to preserve patient autonomy in oral hygiene care; (c) oral hygiene care is often spontaneous and variable, and may not be informed by evidence; and (d) oral hygiene care is not embedded into bedtime care routines. Implications: Oral health history and assessment data are essential to the creation of individualized, feasible oral hygiene care plans that consider patient dignity. Knowledge of the health benefits of oral care, and skills related to assessment and approaches to oral care are required by nurses. Availability of effective products and supplies facilitates provision of oral care. The evidence for oral hygiene care practices, outcomes of nurse-administered oral care, and the role of nurses in influencing the oral health literacy of patients requires further study. / Dissertation / Doctor of Philosophy (PhD) / When in hospital, older people often rely on nurses for help with oral care. Little is known about how nurses provide this type of care, but poor oral care can lead to pneumonia, gum disease, and other diseases of the body. In this study, nurses were accompanied as they provided bedtime oral care to patients. Findings showed that: (a) nurses let patients decide about doing oral care and do not encourage it, (b) nurses let patients do oral care themselves, even if they cannot do a good job, (c) the oral care given depends on the nurse, and (d) bedtime oral care, the most important time of day, is not part of the bedtime routine. Nurses should (a) ask patients about their oral health and inspect their mouths, (b) have the right supplies available so they can more easily provide effective oral care, and (c) teach their patients about the importance of oral hygiene.

The purpose of this thesis was to determine the perceived risk of falling and its relationship to balance and falls in older community-dwelling adults with type 2 diabetes mellitus (DM2). Study One was a systematic review of published literature on risk factors for falling in older adults with DM2. Study Two was a prospective cohort study for parameter estimation, the goal was to determine the test-retest reliability, internal consistency, construct validity and factor structure of a falls Risk Perception Questionnaire in older community-dwelling adults with DM2. Study Three was also a prospective cohort study; the goals of this study were to determine the association between perceived of falling and balance in older adults with DM2 and to determine whether older adults alter their perceived risk of falling after receiving feedback about their balance. The information gained from these studies will be used to guide subsequent research as well as falls risk assessment and prevention in older adults with DM2. / Thesis / Master of Science (MSc)

PhD Thesis / Older adults are a rapidly growing segment of the population with unique healthcare needs. As people age, they are more likely to become susceptible to diseases and develop complex health conditions that require tailored strategies to address. These vulnerabilities could also impact different stages of the research process to generate evidence that promote healthy aging and better quality of life for this population. Attrition and missing data are some of the common methodological challenges in research with older adults. These issues could affect the quality of evidence generated if not properly addressed. There is also limited evidence to guide the development of interventions in specific populations of older adults with frailty, who have reduced function and are at higher risk for poor health outcomes. Across six chapters, this thesis addresses these methodological and interventional gaps in research with older adults. Using different research methodologies including a systematic literature survey, secondary data analysis of a cohort study, and two randomized feasibility trials, this thesis provides some important considerations for practice. In particular, we (i) evaluated the magnitude, pattern, and factors associated with attrition in the Global Longitudinal Study of Osteoporosis in Women (GLOW) Hamilton cohort of older adults; (ii) performed a systematic survey of the reporting and handling of missing data in longitudinal observational studies of older adults; (iii) conducted a randomized controlled feasibility trial of the Geras virtual frailty rehabilitation program to build resilience in vulnerable older adults during the COVID-19 pandemic; and (iv) evaluated the feasibility of the FitJoints randomized controlled trial of a multimodal intervention in frail older patients with osteoarthritis awaiting hip and knee replacement. / Thesis / Doctor of Philosophy (PhD) / The number of people who are old is increasing by the day and so is the need to understand how to ensure they are aging well. Old age makes people more prone to diseases. The risks of becoming ill could make the efforts to generate knowledge that can help them thrive challenging. They could drop out of a study making it difficult to collect enough information for data analysis. For some older adults who are frail and have higher risk for diseases, there is little known about how to design programs that will enable them stay active and healthier during the COVID-19 pandemic or before they have hip or knee replacement surgery. This thesis contributes to the knowledge on how to improve the quality of research involving older adults and bridge the gap in the knowledge about how to support those who are frail among them.