<p><strong>Background </strong>The possibility of ageing independently during the past 2 decades assumed a meaning which comprises different aspects. It has been recognized, in studies involving older adults but also by important Health Organizations (such as WHO), that disability could originate from different causes: physical limitations, external causes (such as personal assistance or building barriers), individual causes (lifestyle, behavior, positive attitude) and societal factors. Measuring the level of disability in a comprehensive way could help predict the amount of help and the best resources needed for older adults to cope with disability and remain independent as much as possible. The SAGE scale has been developed to be a complete and easy to use tool to measure independence in older adults.<strong></strong></p> <p><strong>Objectives </strong>The aim of this thesis is to describe the methodology and the design of a study and to assess the validity and reliability of the SAGE scale.<strong></strong></p> <p><strong>Design </strong>SAGE validation will be measured in a cross sectional study, involving 240 older adults conveniently sampled from 3 different facilities in the Hamilton area. Community dwelling older adults, patients recovering from a stroke and subjects living in a nursing home, will be assessed at one point in time with the new tool (the SAGE scale) together with four widely used scales to assess cognitive abilities (Montreal Cognitive Assessment), functional abilities (The Franchay Activity Index), the modified-Rankin scale and the CSHA Clinical Frailty Scale. This thesis will describe the processes through which assess the content, construct and criterion validity. The hierarchical sequence of items will also be investigated as well as specificity and sensitivity of the new tool. <strong></strong></p> <p><strong>Conclusion </strong>The development of the SAGE was motivated by the recent need for an instrument able to capture all the activities that are important for the elderly to be able to age with dignity and independence. The results of this study, if positive, will be useful for further investigation of the SAGE, as a screening tool to recognize and detect early loss of independence in this group of individuals.<strong></strong></p> / Master of Science (MSc)

As the use of social networking sites (SNSs) has become more wide-spread, some age groups have taken to the media much more readily than other groups. Older adults are lagging behind in their adoption of SNSs, while this group of the population tends to be more socially isolated and lonely. In this thesis, the uses of SNSs have been broken down into different components such as the intimacy level of the message content, types of contacts, etc. A framework for social capital is utilized, in order to bridge the knowledge gap between how older adults use social networking sites to gauge its impact on loneliness. The findings suggest that the use of SNSs increases social capital but does not directly reduce loneliness. The impact of the increase of social capital by using SNSs on loneliness is negligible. However, increased social capital due to SNSs use tends to moderate the effects that health status, financial wellbeing and satisfaction with offline relationships have on loneliness. / Thesis / Doctor of Philosophy (PhD)

Introduction: Alternate Level of Care (ALC) patients are those who are kept hospitalized although they are medically well enough to be discharged. Those patients wait in acute care because they cannot access an appropriate alternative level of care outside the hospital. ALC leads to the improper consumption of valuable resources that are needed for patients waiting in other departments such as emergency rooms. This reflects poor quality outcomes of the healthcare system and represents a significant economic burden. Moreover, particularly when it concerns older adults, longer stay in hospital results in worsening their health outcomes, declining their functional status and increasing their needs for long-term care. Therefore, ALC is costly from both patient and health care system perspective. Objectives: The main objective of this study was to assess the impact of the Home First strategy on the incidence of ALC. Moreover, the study addressed both the specialized clinical needs (such as dialysis, chemotherapy and mechanical ventilation) and socioeconomic status of ALC patients in order to unveil their association with the ALC length of stay. Methods: This study involved a secondary analysis of data from the Institute for Clinical Evaluation (ICES). The analyzed dataset included a cohort of 6,059,033 hospitalization records of Ontario citizens, aged 65 years and older, who were admitted to an acute care facility between April 2004 and March 2017. The study involved descriptive analytics grouping the dataset into ALC and non-ALC subsets and examined the percentage of ALC hospitalizations, ALC days and reported odds ratios across several patients' characteristics. Results: From 2004 until 2016, ALC patients waited to access an appropriate destination for 10.7 million days. Those numbers represented 19.7% of all hospitalization days across Ontario. ALC was more likely among seniors aged 75-84 (OR 1.36, 95% CI 1.35-1.36), aged 85-94 (OR 2.16, 95% CI 2.15-2.17), aged 95+ (OR 2.46, 95% CI 2.40-2.50), females (OR 1.37, 95% CI 1.35-1.36), those who were hospitalized 90 days prior to their current admission (OR 1.22, 95% CI 1.21-1.22), and those who were admitted to hospital through Emergency Department (OR 2.64, 95% CI 2.62-2.67). Moreover, ALC was 10 times more likely in the subgroup of patients who were discharged to long-term care (LTC) (OR 9.71, 95% CI 9.66-9.77). For the socioeconomic characteristics, this study showed that patients were more likely to have ALC days when they lived in urban areas, had a lower income, and were highly unstable and dependent. Furthermore, patients with special clinical needs spent from 10% to 25% of their total hospitalization length of stay waiting to be discharged to an appropriated alternative level of care. Finally, the study revealed that although the implementation of a Home First strategy resulted in a 26% reduction of ALC hospitalizations and a 13% decrease in ALC days, the percent of patients discharged to LTC did not change. For the subgroup having the highest percentage of ALC hospitalizations (53.4%) and ALC days (40.3%), this reflects a partial failure of the Home First strategy in achieving its main objective of facilitating the discharge of patients to their homes. Conclusions: Policy makers and health care practitioners may benefit from the findings of this study by considering the needs of the ALC patients while planning, allocating resources, and developing polices for discharge, LTC and community care. However, more work is required to quantify the impact of the ALC determinants suggested in this study and assess the efficiency of the current policies and procedures. Introduction: Alternate Level of Care (ALC) patients are those who are kept hospitalized although they are medically well enough to be discharged. Those patients wait in acute care because they cannot access an appropriate alternative level of care outside the hospital. ALC leads to the improper consumption of valuable resources that are needed for patients waiting in other departments such as emergency rooms. This reflects poor quality outcomes of the healthcare system and represents a significant economic burden. Moreover, particularly when it concerns older adults, longer stay in hospital results in worsening their health outcomes, declining their functional status and increasing their needs for long-term care. Therefore, ALC is costly from both patient and health care system perspective. Objectives: The main objective of this study was to assess the impact of the Home First strategy on the incidence of ALC. Moreover, the study addressed both the specialized clinical needs (such as dialysis, chemotherapy and mechanical ventilation) and socioeconomic status of ALC patients in order to unveil their association with the ALC length of stay. Methods: This study involved a secondary analysis of data from the Institute for Clinical Evaluation (ICES). The analyzed dataset included a cohort of 6,059,033 hospitalization records of Ontario citizens, aged 65 years and older, who were admitted to an acute care facility between April 2004 and March 2017. The study involved descriptive analytics grouping the dataset into ALC and non-ALC subsets and examined the percentage of ALC hospitalizations, ALC days and reported odds ratios across several patients' characteristics. Results: From 2004 until 2016, ALC patients waited to access an appropriate destination for 10.7 million days. Those numbers represented 19.7% of all hospitalization days across Ontario. ALC was more likely among seniors aged 75-84 (OR 1.36, 95% CI 1.35-1.36), aged 85-94 (OR 2.16, 95% CI 2.15-2.17), aged 95+ (OR 2.46, 95% CI 2.40-2.50), females (OR 1.37, 95% CI 1.35-1.36), those who were hospitalized 90 days prior to their current admission (OR 1.22, 95% CI 1.21-1.22), and those who were admitted to hospital through Emergency Department (OR 2.64, 95% CI 2.62-2.67). Moreover, ALC was 10 times more likely in the subgroup of patients who were discharged to long-term care (LTC) (OR 9.71, 95% CI 9.66-9.77). For the socioeconomic characteristics, this study showed that patients were more likely to have ALC days when they lived in urban areas, had a lower income, and were highly unstable and dependent. Furthermore, patients with special clinical needs spent from 10% to 25% of their total hospitalization length of stay waiting to be discharged to an appropriated alternative level of care. Finally, the study revealed that although the implementation of a Home First strategy resulted in a 26% reduction of ALC hospitalizations and a 13% decrease in ALC days, the percent of patients discharged to LTC did not change. For the subgroup having the highest percentage of ALC hospitalizations (53.4%) and ALC days (40.3%), this reflects a partial failure of the Home First strategy in achieving its main objective of facilitating the discharge of patients to their homes. Conclusions: Policy makers and health care practitioners may benefit from the findings of this study by considering the needs of the ALC patients while planning, allocating resources, and developing polices for discharge, LTC and community care. However, more work is required to quantify the impact of the ALC determinants suggested in this study and assess the efficiency of the current policies and procedures. / Thesis / Master of Science (MSc)

Hip fractures in older adults have severe effects on patients’ morbidity as well as mortality, so it is crucial to avoid this injury through the early identification of patients at high risk. Currently, the diagnosis of osteoporosis and consequently hip fracture risk is done through the measurement of bone mineral density by a dual-energy X-ray absorptiometry (DXA) scan. However, studies show that this method is not accurate enough, and a high percentage of patients who sustain a hip fracture had non-osteoporotic DXA scans less than a year before the incidence. In this research, to enhance the hip fracture risk prediction, the effect of a femur’s geometry and bone mineral density distribution was considered in the hip fracture risk estimation. This was done through 2D and 3D statistical shape and appearance modeling of the proximal femur using standard clinical DXA scans. To assess the proposed techniques, destructive mechanical tests were performed on 16 isolated cadaveric femurs. Also, through collaboration with the Canadian Osteoporosis Study (CaMos), the proposed statistical techniques to predict the hip fracture risk were evaluated in a clinical population as well. The results of this study showed that new techniques can enhance hip fracture risk estimation; in the clinical study, 2D and 3D statistical modeling were able to improve identifying patients at high risk by 40% and 44% over the clinical standard method. Also, the percentage of correct predictions using 2D statistical models did not differ significantly from the 3D predictions. Therefore, by applying these techniques in clinical practice it could be possible to identify patients at high risk of sustaining a hip fracture more accurately and eventually reduce the incidence of hip fractures and the pain and social and economic burden that comes with it. / Thesis / Doctor of Philosophy (PhD) / Diagnosis of osteoporosis and consequently hip fracture risk is based on the measurement of bone mineral density in clinical imaging called DXA scanning. However, studies have shown that this method is not sufficient in identifying all patients at high risk of sustaining a hip fracture. The purpose of this work was to incorporate the geometry and bone mineral density distribution of the proximal femur in hip fracture risk prediction through image processing of DXA scans. Two algorithms of 2D and 3D statistical shape and appearance modeling were implemented and evaluated in a cadaveric study (comparing the predicted fracture load to measured ones) as well as a clinical study (comparing the fracture predictions to the fracture history of patients). The results indicated that new techniques can enhance hip fracture risk estimation compared to the clinical standard method, and hence the devastating injury can be prevented through applying protective measures.

Seventy five percent of older adults are affected by multiple chronic diseases. Consuming a high quality diet consisting of fruits, vegetables, whole grains, and lean protein assists with chronic disease prevention and management. Healthful food availability is a major determinant of individual eating behaviors. The purpose of the current study was to describe the types, variety, and density of food outlets and to estimate access to a high quality diet for older adults in an urban setting. The Community Nutrition Environment Evaluation Data System (C-NEEDS) survey and restaurant menus were used to determine availability of healthful food in thirteen neighborhoods in Springfield, Massachusetts. A "Dietary Guidelines for Americans Adherence Index Food Environment" (DGAIFE) algorithm was created to estimate access to a high quality diet based on the stores and restaurants within the study area. Environmental characteristics that are recognized as facilitators or barriers to a high quality diet were added to the DGAIFE algorithm to calculate a "Dietary Guidelines for Americans Adherence Index Food Environment plus Environmental Characteristics" (DGAIFEC) score. The DGAIFE and DGAIFEC score ranges for all study areas were 1.53-2.25 and 1.38-2.50, respectively (possible range 1.00 higher to 5.00 lower access). Access to a high quality diet is within reach but not equal across the thirteen study areas. The findings can be used by Registered Dietitians to guide clients to make healthful food choices in urban neighborhoods and provides information to improve public health policy to increase access to healthful foods.

Yes / Background: We wanted to understand older adults’ experiences of learning how to use a tablet computer in the context of an intervention trial, including what they found helpful or unhelpful about the tablet training, to guide future intervention studies. Methods: Mixed methods study using questionnaire and focus group approaches. Forty-three participants aged between 65 and 76 years old from the “Tablet for Healthy Ageing” study (comprising 22 in the intervention group and 21 controls) completed a post-intervention tablet experience questionnaire. Those who completed the tablet training intervention were invited to share their experiences of engaging with new technology in post-intervention focus groups. We conducted three separate focus groups with 14 healthy older adults (10 females). Results: Questionnaire data suggested that the overall experience of the 22 participants who participated in the tablet training intervention was positive. The majority of participants said that it was likely or very likely they would use a tablet in the future. The focus group themes that emerged were related to the perception of tablet training, the experience of using tablets, and suggestions for future studies. Participants mentioned that their confidence was increased, that they enjoyed being part of a social group and downloading applications, but they also felt challenged at times. Advantages of using tablets included the ability to keep in touch with family and friends, a motivation to contribute to the community, and the potential for tablets to improve mental abilities and overall health and wellbeing. Participants made suggestions that would enable tablet usage, including improvement of features, and suggestions that would improve future tablet training studies, including smaller classes. Conclusion: Our findings have implications for the development of interventions utilizing new technologies that might promote the health and wellbeing of older adults. / This work was supported by The Dunhill Medical Trust (R359/0514).

Yes / Background: New technologies provide opportunities for the delivery of broad, flexible interventions with older adults. Focus groups were conducted to: (1) understand older adults’ familiarity with, and barriers to, interacting with new technologies and tablets; and (2) utilize user-engagement in refining an intervention protocol. Methods: Eighteen older adults (65–76 years old; 83.3%female) who were novice tablet users participated in discussions about their perceptions of and barriers to interacting with tablets. We conducted three separate focus groups and used a generic qualitative design applying thematic analysis to analyse the data. The focus groups explored attitudes toward tablets and technology in general. We also explored the perceived advantages and disadvantages of using tablets, familiarity with, and barriers to interacting with tablets. In two of the focus groups, participants had previous computing experience (e.g., desktop), while in the other, participants had no previous computing experience. None of the participants had any previous experience with tablet computers. Results: The themes that emerged were related to barriers (i.e., lack of instructions and guidance, lack of knowledge and confidence, health-related barriers, cost); disadvantages and concerns (i.e., too much and too complex technology, feelings of inadequacy, and comparison with younger generations, lack of social interaction and communication, negative features of tablets); advantages (i.e., positive features of tablets, accessing information, willingness to adopt technology); and skepticism about using tablets and technology in general. After brief exposure to tablets, participants emphasized the likelihood of using a tablet in the future. Conclusions: Our findings suggest that most of our participants were eager to adopt new technology and willing to learn using a tablet. However, they voiced apprehension about lack of, or lack of clarity in, instructions and support. Understanding older adults’ perceptions of technology is important to assist with introducing it to this population and maximize the potential of technology to facilitate independent living. / The Dunhill Medical Trust [R359/0514].

Yes / Objective: To test the efficacy of a tablet computer training intervention to improve cognitive abilities of older adults. Design: Prospective randomized controlled trial. Setting: Community-based aging intervention study, Edinburgh, UK. Participants: Forty-eight healthy older adults aged 65 to 76 years were recruited at baseline with no or minimal tablet experience;43 completed follow-up testing. Intervention: Twentytwo participants attended a weekly 2-hour class for 10 weeks during which they learned how to use a tablet and various applications on it. Measurements: A battery of cognitive tests from theWAIS-IV measuring the domains ofVerbal Comprehension, Perceptual Processing,Working Memory, and Processing Speed, as well as health, psychological, and well-being measures. Results: A 2× 2 mixed model ANOVA suggested that the tablet intervention group (N = 22) showed greater improvements in Processing Speed (η2 = 0.10) compared with controls (N = 21), but did not differ in Verbal Comprehension, Perceptual Processing, or Working Memory (η2 ranged from −0.03 to 0.04). Conclusions: Engagement in a new mentally challenging activity (tablet training) was associated with improved processing speed.Acquiring skills in later life, including those related to adopting new technologies, may therefore have the potential to reduce or delay cognitive changes associated with ageing.It is important to understand how the development of these skills might further facilitate everyday activities, and also improve older adults’ quality of life. / Supported by the Dunhill Medical Trust (R359/0514). Funding from the BBSRC and MRC

No

Thesis advisor: Alyssa Goldman / As China encounters rapid aging transformation, information on the mental health of older adults is essential. This study examines the influence of social engagement and family support on depression levels among community-dwelling older adults in China. This study selects a sample of 5,187 respondents who participated in the 2018 China Health and Retirement Longitudinal Study (CHARLS) in order to investigate the relationships between these factors and mental health. The results show that both social engagement and family support are negatively associated with depression levels. Moreover, social engagement acts as a partial mediation effect between family support and depression levels. This demonstrates the role of an active social life in the prevention of mental health deterioration in older adults. The research findings contribute to the discussions about how social support such as social engagement and strong family tiese can alleviate depression in Chinese older adults. / Thesis (BA) — Boston College, 2024. / Submitted to: Boston College. Morrissey School of Arts and Sciences. / Discipline: Sociology. / Discipline: Departmental Honors.