Yes / Social isolation in older adults is associated with morbidity. Evaluating interventions to promote social engagement is a research priority. Methods: A parallel-group randomised controlled trial was planned to evaluate whether telephone friendship (TF) improves the well-being of independently living older people. An internal pilot aimed to recruit 68 participants by 30 September 2012, with 80% retained at 6 months. Randomisation was web based and only analysts were blind to allocation. A service provider was contracted to train 10 volunteer facilitators by 1 April 2012 and 10 more by 1 September 2012. Participants were aged > 74 years with good cognitive function and living independently in an urban community. The intervention arm of the trial consisted of manualised TF with standardised training: (1) one-to-one befriending (10- to 20-minute calls once per week for up to 6 weeks made by volunteer facilitators) followed by (2) TF groups of six participants (1-hour teleconferences once per week for 12 weeks facilitated by the same volunteer). Friendship groups aimed to enhance social support and increase opportunities for social interaction to maintain well-being. This was compared with usual health and social care provision. The primary clinical outcome was the Short Form questionnaire-36 items (SF-36) mental health dimension score at 6 months post randomisation. Qualitative research assessing intervention acceptability (participants) and implementation issues (facilitators) and an intervention fidelity assessment were also carried out. Intervention implementation was documented through e-mails, meeting minutes and field notes. Acceptability was assessed through framework analysis of semistructured interviews. Two researchers coded audio recordings of telephone discussions for fidelity using a specially designed checklist. Results: In total, 157 people were randomised to the TF group (n = 78) or the control group (n = 79). Pilot recruitment and retention targets were met. Ten volunteers were trained by 1 September 2012; after volunteer attrition, three out of the 10 volunteers delivered the group intervention. In total, 50 out of the 78 TF participants did not receive the intervention and the trial was closed early. A total of 56 people contributed primary outcome data from the TF (n = 26) and control (n = 30) arms. The mean difference in SF-36 mental health score was 9.5 (95% confidence interval 4.5 to 14.5) after adjusting for age, sex and baseline score. Participants who were interviewed (n = 19) generally declared that the intervention was acceptable. Participant dissatisfaction with closure of the groups was reported (n = 4). Dissatisfaction focused on lack of face-to-face contact and shared interests or attitudes. Larger groups experienced better cohesion. Interviewed volunteers (n = 3) expressed a lack of clarity about procedures, anxieties about managing group dynamics and a lack of confidence in the training and in their management and found scheduling calls challenging. Training was 91–95% adherent with the checklist (39 items; three groups). Intervention fidelity ranged from 30.2% to 52.1% (28–41 items; three groups, three time points), indicating that groups were not facilitated in line with training, namely with regard to the setting of ground rules, the maintenance of confidentiality and facilitating contact between participants. Conclusions: Although the trial was unsuccessful for a range of logistical reasons, the experience gained is of value for the design and conduct of future trials. Participant recruitment and retention were feasible. Small voluntary sector organisations may be unable to recruit, train and retain adequate numbers of volunteers to implement new services at scale over a short time scale. Such risks might be mitigated by multicentre trials using multiple providers and specialists to recruit and manage volunteers. / Funding for this study was provided by the Public Health Research programme of the National Institute for Health Research.

Yes / Many older adults face challenges that prevent them from accomplishing common daily activities such as moving around, home maintenance, and leisure activities. There is still a need to examine and understand how environmental factors impact daily participation across gender. This study sought to make a qualitative comparison of gender differences regarding environmental barriers to participation in daily occupations from the perspectives of older adults who live alone in Puerto Rico. Twenty-six Hispanic older adults, 70 years or older participated in this study. We used a descriptive qualitative research design in which researchers administered an in-depth interview to each participant. The results elucidated that women were more likely than men to experience restricted participation due to lack of accessibility of the built environment and transportation systems. The findings could help with the development of tailored, occupation-based, preventive interventions that address gender specific environmental barriers and promote greater participation among both women and men. Further research is required to explore whether these environmental barriers to occupational participation remain consistent across living situations, socioeconomic status and ethnicity. / Research reported in this publication was supported by the National Institute of Health (NIH), National Institute of Minority Health and Health Disparities (NIMHD), Clinical Research Education and Career Development (CRECD) [R25MD007607] in collaboration with Puerto Rico Clinical and Translational Research Consortium (PRCTRC) [8U54 MD 007587-03].

Yes / Hypertension is the leading driver of cardiovascular disease deaths in Africa. Its prevalence is highest in older populations. Yet, this group has received little attention in many African countries. We conducted a systematic review and meta-analysis (PROSPERO registration: CRD42017056474) to estimate the prevalence of hypertension in older adults living in Africa. Methods: We searched grey literature and major electronic databases including PubMed and Embase for population-based studies and published between 1 January 1980 to 28 May 2018 reporting the prevalence of hypertension for adults aged ≥50 years living in Africa. We employed a random effects model to estimate the pooled prevalence across included studies. Findings: We screened 10,719 articles and retrieved 103 full-text articles to evaluate for inclusion in the review. Thirty-four unique studies providing 37 data points on 43,025 individuals in 15 African countries were analyzed. The prevalence of hypertension ranged from 22.3% to 90.0% from the individual studies while the overall pooled prevalence was 57.0% (95% CI 52%-61%). The prevalence was not statistically significantly different by sex, residence, or African sub-region. In individual studies, older age and overweight/obesity were independently associated with hypertension. Twenty-nine (78%) data points were deemed to be of low- or moderate-risk of bias. Eliminating high-risk bias studies made little difference to the pooled estimate of hypertension. Sensitivity analyses, omitting one study at a time, identified three studies with significant but relatively small impact on the pooled estimate. We observed substantial heterogeneity (I2 = 98.9%) across the studies which was further explored by meta-regression analyses. Overall, the GRADE assessment suggested moderate quality evidence in the results. Conclusion: The persistent high prevalence of hypertension among older adults in Africa, even in rural populations warrants more attention to the cardiovascular health of this group by public health authorities

The purpose of this study was to examine resident policies in assisted living facilities and to recommend consistent policies for resident handbooks. To accomplish this purpose, in the first phase, a mail survey form was developed to determine current resident policies provided in existing assisted living facilities in Virginia. In the second phase, the researcher analyzed each policy from the eight participating assisted living facilities and then compared the policies to determine which policies should be included in resident handbooks. Policies with similar content, but with different names were categorized together. The study employed the content-analysis method, which is oriented to qualitative research. The number of resident policies dealt with in this study totaled 56. The framework for analyzing resident policies was divided into three sections: 1) policies related to administration, 2) policies related to resident services, and 3) resident activities listed in the handbooks. As a result of content analysis and evaluation of policies as they related to the aging process, a total of 27 recommendations were suggested. Two recommendations were suggested based on the findings of the resident handbooks survey, and 25 recommendations were suggested from analysis of the handbooks. The recommendation of resident policies can help staff to manage assisted living facilities efficiently, and the handbooks will be able to offer prospective residents clear information as they make decisions among various assisted living facilities. Moreover, current residents will benefit from lucid and consistent resident handbooks in that they will provide explicit information about policies and services. / Master of Science

It is important to utilize training that facilitates the best learning and performance on real tasks. Much research has been conducted to develop theories of learning and determine beneficial training characteristics. Still, this research often remains as separated characteristic recommendations and is not used to ascertain the best training method. This occurs even though most individuals simply use a training method and do not bother to go into the literature for recommendations each time they are looking to train or teach something. Generalizability is also often a factor lacking in research on training methods. This lack of research performed includes those that could determine whether or not a specific training method is generalizable to older adults. Minimalism is a training method that could potentially alleviate some of the problems older adults experience when training. Yet, up to the time of this study, no empirical evidence had been gathered to compare minimalism to traditional training methods for older adults. This study attempted to gain empirical data to test the hypothesis that minimalism is more beneficial as well as to gain initial subjective data from participants. This study also endeavored to conduct a preliminary examination of individual difference factors and their affects on performance and subjective reports in a training environment. Results indicated that, although significant results were not obtained, minimalism may still be an area worth pursuing for training older adults. Effects of interactions, which included gender and learning style, are discussed. Implications, as well as recommendations and conclusions, of the study are presented. / Master of Science

The present study used a linear mixed model analytic approach to assess the association between a combined respondent and spousal exercise score and cognitive outcomes of older adult respondents drawn from a nationally representative dataset, The Health and Retirement Study. Informed by the Scaffolding Theory of Aging and Cognition (STAC), the present study sought to understand the role of both an individual and their spouse's aerobic physical activity in an individual's cognitive outcomes and trajectories. Utilizing longitudinal survey data collected across twelve years (N=3,189), the combined exercise status of a married couple was found to be a significant predictor of cognitive outcomes; when an interaction between time and couple exercise status was included in the model, this was also found to be a significant predictor of four specific cognitive outcomes. The highest cognitive benefit was identified among individuals where both they and their partner participated in the recommended amount of aerobic physical activity, suggesting an additive effect. These findings and their implications are discussed further. / Master of Science / The present study explores how the combined exercise behaviors of a married older adult couple may predict the cognitive outcomes of one partner. Data was analyzed across twelve years and included married individuals between the ages of 65 and 95. Findings showed that the combined couple exercise status predicted outcomes in cognitive function of the respondent. Additionally, the interaction between time and the couple exercise status significantly predicted cognitive outcomes. The addition of a spouse's aerobic physical activity was beneficial to the cognitive outcomes of their partner. The cognitive benefit was highest among couples where both partners participated in aerobic physical activity. These findings and their implications are discussed further.

Older adults represent the fastest growing demographic of cannabis users, and they endorse cannabis use for a variety of reasons including modulation of chronic pain, mental health symptoms, and sleep concerns. Despite escalating patterns of use, current evidence leaves questions of efficacy unanswered among these groups of users. Goals of the present study were to examine the role of medicinal cannabis within subjects at the daily level on the interrelated symptoms of depression, anxiety, sleep, and pain. A final sample of 106 medical cannabis users were recruited nationwide, ranging from 55 to 74 years of age (66.67% female, 82.86% white). A fully within-subject multilevel structural equation model was conducted with use patterns and symptomology broken into four temporal epochs. Subjective intoxication (Epoch 1) averaged across the day was used to predict subsequent anxiety, depression, and pain levels (Epoch 2), which then were used to predict sleep that night (Epoch 3), then subsequent anxiety, depression, and pain levels the following day (Epoch 4) prior to initiation of cannabis use. Results indicated that subjective intoxication negatively predicted post-use anxiety, depression, and pain. There was also a significant indirect effect from subjective intoxication to sleep quality through post- use anxiety. These findings provide evidence of momentary improvement in symptomology, but do not speak to long term changes. Findings are limited by measures used and potential expectancy effects but may help practitioners and patients determine windows for therapeutic use and identify potential development of problematic use as reinforced by momentary improvements in symptomology. Despite its limitations, the results of this study contribute to a growing body of research evaluating the efficacy of medicinal cannabis use for older adults.

Yes / Background: Falls sustained when descending stairs are the leading cause of accidental death in older adults. Highly visible edge highlighters/friction strips (often set back from the tread edge) are sometimes used to improve stair safety, but there is no evidence for the usefulness of either. Objective: To determine whether an edge highlighter and its location relative to the tread edge affect foot placement/clearance and accidental foot contacts when descending stairs. Method: Sixteen older adults (mean ± 1 SD age; 71 ± 7 years) with normal vision (experiment 1) and eight young adults (mean ± 1 SD age; 24 ± 4 years) with visual impairment due to simulated age-related cataract (experiment 2) completed step descent trials during which a high contrast edge highlighter was either not present, placed flush with the tread edge, or set back from the edge by 10 mm or 30 mm. Foot placement/ clearance and the number of accidental foot contacts were compared across conditions. Results: In experiment 1, a highlighter set back by 30 mm led to a reduction in final foot placement (p b 0.001) and foot clearance (p b 0.001) compared to a highlighter placed flush with the tread edge, and the percentage of foot clearances that were less than 5 mm increased from 2% (abutting) to 17% (away30). In experiment 2, a highlighter placed flushwith the tread edge led to a decrease in within-subject variability in final foot placement (p = 0.004) and horizontal foot clearance (p = 0.022), a decrease in descent duration (p = 0.009), and a decrease in the number of low clearances (b5 mm, from 8% to 0%) and the number of accidental foot contacts (15% to 3%) when compared to a tread edge with no highlighter present. Conclusions: Changes to foot clearance parameters as a result of highlighter presence and position suggest that stairswith high-contrast edge highlighters positioned flushwith the tread edgewill improve safety on stairs, particularly for those with age-related visual impairment.

Att djur kan utgöra en betydande roll i människors liv är ett växande intresse inom forskningen kring relationen mellan människor och djur. Allt fler väljer att integrera djur i vardagen. Tidigare forskning påvisar gynnsamma hälsofördelar av att ha djur i sin närhet, särskilt vid ohälsa. Syftet med studien var att undersöka vilken betydelse som djur har i att främja hälsa och välbefinnande hos individer över 50 år. Åtta semistrukturerade intervjuer genomfördes med husdjursägare och/eller yrkessamma inom olika djurverksamheter. Resultaten tematiserades utifrån fem induktivt analytiska teman vilka belyste djurens hälsofrämjande betydelse: Emotionellt och socialt stöd, social kontakt och samhörighet, fysisk aktivitet och rörlighet, reducering av negativa känslor och tillstånd samt positivt tänkande och förhållningssätt. Sammanfattningsvis indikerar resultatet att djur spelar en avsevärd roll i främjande av hälsa och välbefinnande hos intervjudeltagarna. Diskussionen lyfter fram att grunden för hälsofrämjandet kan förklaras av djurens närvaro samt deltagarnas unika och meningsfulla relation till dem.

Some people experience cumulative advantages or disadvantages at birth and during their lifespan that determine future life course outcomes. Health disparities and systemic inequity can define a negative trajectory for some minority and underserved communities. Without intervention, such inequity can spiral and eventually affect more and more areas of an older person's life, much like cumulative disadvantages. This research proposes that older adults can improve their situation through targeted support factors that systematically improve lifespan areas. Eventually, more adults can experience the cumulative advantage effect as life progresses. The dissertation consists of a systematic literature review to evaluate literature that isolates degree-level education as a predictor of successful retirement transition planning. This foundational information is used as a basis for identifying constructs in two follow-on studies of the longitudinal National Health and Aging Trends Study (NHATS) Wave 9 public dataset. We explore factors supporting readiness for retirement and retirement transition in later life using data of older adults aged 65+. Multiple regression, exploratory factor analysis, and partial least squares structural equation modeling (PLS-SEM) are used to gain a multi-angle view. The results showed that degree-level education influences higher salaries, improved healthcare access, and financial literacy. In addition, old age has an increased risk of physical pain and chronic diseases that affect activities of daily living and independence in retirement, regardless of financial resources. Declining health can lead to social isolation and depression for older adults.