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.

Although previous research has focused on subcultures among deviant groups, very little research has been conducted on older adults' subcultures or subcultures within exercise settings. Given the lack of research on older and non-deviant groups, the current research study was designed to reveal how a senior water aerobics exercise class is indeed a subculture and provide a rich description of this understudied and unappreciated subculture. Data collection took place at a water aerobics exercise class at a health club in Central Florida. In the first phase of data collection, ethnographic observations were utilized to identify the social processes in the pool setting. In the second phase of data collection, semi-structured interviews were conducted with 13 seniors to provide a rich description of a water aerobics subculture. Using a constructivist grounded theory approach, the results revealed that the water aerobics class resembles a subculture with distinctive norms, social roles and rituals. Based on these findings, this study concludes that groups such as water aerobics classes may influence seniors' self-esteem, wellbeing and transition into late adulthood.

The social transition to older adulthood can be challenging for elderly individuals and their families when isolation poses a threat to well-being. Technology is currently providing younger generations with an opportunity to stay in contact with social partners through the use of online social networking tools; it is unclear whether older adults are also taking advantage of this communication method. This study explored how older adults are experiencing online social networking. Specifically, this research addressed how older adults' attitudes towards online social networking are related to their expertise in using computers and the internet for this purpose. A survey methodological approach was employed whereby older adults aged 65 and over were recruited from senior centers across the Central Florida area to fill out a series of questionnaires. The Computer Aversion, Attitudes, and Familiarity Index (CAAFI) was used to measure attitudes and expertise with computers. The Internet Technical Literacy and Social Awareness Scale was used to measure interest and expertise with the internet. The relationship between older adults' use of online social networking and their attitudes and expertise was also investigated. Finally, social connectedness, (measured using the Social Connectedness Scale) and subjective well-being (measured using the Satisfaction with Life Scale) were measured to explore whether older adults receive a psychosocial benefit from using online social networking. Findings showed expertise and attitudes scores were strongly correlated, and these scores were also predictive of online social networking use. The results of this study may help social service providers for elderly individuals begin to understand the many factors associated with using new forms of technology.

Purpose: To recognize and raise awareness about the psychosocial status and health outcomes in older adults living with HIV. Method: A literature search was conducted from the disciplines of nursing and medicine using the CINAHL, PubMed, and Medline databases. Inclusion criteria: articles exploring older adults who are HIV positive and factors related to depression, suicide and available healthcare resources. Exclusion criteria: articles including individuals under the age of 50 infected with HIV/AIDS and articles focused entirely on physiologic principles of HIV/AIDS. Results: In older adults living with HIV/AIDS, the literature review disclosed a comprehensive gap between identifying this age group as 'at risk', lack of communication between health care providers and older adults concerning sexual activity and/or status, and recurring psychosocial components related to lack of resources and standards of care among older adults living with HIV/AIDS. An unbalanced amount of research has focused on the care and prevention of HIV/AIDS among young adult populations, while a limited amount of research is geared toward detection, prevention and interventions for HIV/AIDS in older adults. Findings suggest that HIV/AIDS is a syndrome of bias based on age and/or gender by health care providers. Solutions to this epidemic must begin with an all inclusive plan that investigates the prevention, identification and intervention across the lifespan. Discussion: As the country ages and the population of older adults increase, nurses will encounter an increasing number of older adults living with HIV/AIDS. In order to competently provide quality care to older adults with a positive HIV/AIDS status, further research is needed to bridge the gap of literature connecting psychosocial aspects of care and accompanying health outcomes.

Traumatic brain injury (TBI) history has been linked to damaged cognition and poorer quality of life. While this link has been established, there is not much known about this relationship in older adult populations experiencing normal cognitive decline. In the current study, mental status was predicted to moderate the relationship between TBI history and life satisfaction among older adults. Additionally, details of the injury - years since injury and time spent unconscious - were expected to play a role in this relationship. Per analyses, there was no relationship found between TBI history, mental status, and life satisfaction. Moreover, there was no link found between time since injury, time spent unconscious, mental status and life satisfaction. While insignificant, these results yield important findings. The results lend support to more positive long-term outcomes for those with a history of TBI than initially expected, especially if the TBI was mild and resulted in no loss of consciousness or a loss of consciousness less than 5 hours.

The mutability of prejudicial attitudes can be elucidated by taking into account the declines in cognition that tend to emerge as we age. This study aimed to assess whether there is a relationship between prejudice towards different ethnic groups and cognitive flexibility throughout adulthood. Ninety-five older adults and 118 younger adults were asked to complete an electronic survey encompassing measures of cognitive flexibility, social desirability, personality, optimism, empathy, ethnic attachment and prejudice. It was hypothesized that older adults would report lower levels of cognitive flexibility and higher levels of ethnic attachment in comparison to younger adults, which would in turn make the inverse relationship between cognitive flexibility and prejudice stronger in older participants. The results did not support the hypotheses predicting that there would be cohort differences in cognitive flexibility and ethnic attachment. As expected, there was a negative correlation between prejudice and cognitive flexibility, but it was only significant in younger adults before controlling for the influence of social desirability. Additionally, regression models predicting prejudice based on cognitive flexibility and ethnic attachment were significant before and after controlling for social desirability, but only in younger adults. Exploratory analyses indicate that the strength of the correlations between all study variables were generally lower in older adults. The findings presented here raise an argument for evaluating how the interplay between prejudice and cognitive flexibility may change in the later stages of life.

Abstract Aims: 1) To determine fall risk assessment using subjective and objective measures; 2) To understand older adults' perception on fall risk assessment. Methodology: An explanatory sequential mixed methods design was used and consisted of two phases. Phase 1, the quantitative data was collected from nineteen older adults at an independent living facility in Orlando, Florida. Phase 2, the qualitative data was collected from three participants of Phase 1. After obtaining Institutional Review Board approval, the study was conducted at Lutheran Towers an independent living facility located in the downtown area of Orlando, Florida. Three measurement tools were used: demographic data sheet, an objective tool: BTrackS™ Balance Test (BBT), and Short Falls Efficacy Scale-International (FES-I). Results: In phase 1, 37% of participants had a high risk for falls assessed by the objective measure (BBT), and about 11% had high concern of fall risk assessed by the subjective measure (Short FES-I). Approximately 32% had congruent results between subjective and objective measures and 68 % presented incongruent results between subjective and objective measures. In phase 2, three themes were generated from the qualitative data :1) Perception and experience on fall risk assessment; 2) Perception of the subjective measure (Short FES-I) and 3) Perception of the objective measure (BBT). Conclusion: Those who have incongruent perceptions of their fall risk and physical abilities are most at risk. Performing fall risk assessment using both subjective and objective measures is critical for developing fall prevention plans, to identify those most at risk.

My thesis explores older adult lifelong learners’ experiences in transitioning their continued education participation to an online model. This research acknowledges and situates itself in the geragogy contexts of older adult learners, drawing on their experiences of the pandemic and lifelong learning, in addition to their opinions on education for older adults. As such, a case study methodology was employed so that this case could be studied within boundaries created by the pandemic. In my study, 25 older adult learners participated in individual interviews and provided their opinions and perceptions about their experiences with the pandemic and its effect on their learning ambitions. The COVID-19 pandemic has impacted these individuals differently based on their motivations and previous experiences with technology. Four distinct dialogue groups emerged based on the motivations that older adults have to participate in lifelong learning, which are social or instrumental, and also the opinions they have about technology, which are either positive or negative. The four dialogues are distinct in that they each hold alternate opinions about the two issues raised (motivators and opinions on technology) but there were no major identifiers within the groups that could characteristically distinguish one from another. The results indicate that not all discourses of lifelong learners are reducible to identities or recent experiences. My findings suggest that potential refinement in program delivery based on specific user needs could improve the experiences that older adults have in the virtual classroom, and that it is crucial to the administration of lifelong learning that older adults' unique needs are addressed in a collaborative manner. / Thesis / Master of Arts (MA) / This study investigated how older adults, who pursue lifelong learning in-person, have interpreted their transition to online learning because of COVID-19 pandemic meeting restrictions. Lifelong learners have had to transition from in-person learning to virtual formats, which has encouraged new older adults to become lifelong learners, and also for some lifelong learners to drop out of the practice entirely. The key goal of the study was to describe the Transitioners, New learners, and Dropout learners' experience with lifelong learning with respect to COVID-19’s impacts on their participation. Interviews were conducted with individuals who fell into these three categories and, through their responses, distinct dialogues emerged to describe their motivation to participate in lifelong learning, and their opinions on using technology as a means to access it. Confirming the motives to participate and how technology is appreciated by lifelong learners enables us to better develop and implement lifelong learning.

This study sought to extend the findings of previous research about the construct of spirituality–as measured by the Human Spirituality Scale (HSS) developed by Wheat. To expand the research across the entire adult life span, the researcher pooled preexisting data (Wheat) from middle-aged adults with data he obtained from 236 older adults living in independent living facilities. He analyzed the pooled data from 502 adults, with an age range of 25 to 98. Using the pooled data set, the researcher divided the data into five age groupings. He conducted confirmatory factor analysis, of the model of spirituality developed by Wheat, with the two separate data sets along with the pooled data set. The researcher determined that the model was an adequate measure of spirituality across the 5 developmental age groups. He also found the Wheat Model to be adequate when using data from either middle-aged or older-aged adults. Conclusions included: (a) spirituality is a multifaceted concept; (b) the HSS is appropriate for use in the study of human spirituality across the adult lifespan; (c) older adults are more spiritual than middle-aged adults; and (d) women are more spiritual than men. Practitioner recommendations included: (a) teach the dynamics of spirituality and aging in counselor preparation programs; and (b) assess clients’ level of spirituality during intake. Research recommendations included: (a) expand the HSS data set to allow for the development of scale scores to measure the factors proposed by Wheat; (b) develop norm tables to allow for the comparison of total HSS scores and scale scores by age groupings, and by sex; and (c) explore the relationship between HSS scores and other corollary issues such as culture and wisdom.