Diabetes mellitus affects 7.8% of the American population. National health statistic data and other research shows that racial/ethnic disparities exist in terms of prevalence and treatment outcomes. The present study investigated the role of patient health beliefs (i.e., locus of control, self-efficacy) and the doctor-patient relationship (e.g., satisfaction and collaboration with health care provider), as relative predictors of diabetic control (i.e., HbA1c levels) and overall satisfaction with diabetes care, in older adult participants with diabetes. Demographic, psychosocial, and diabetes-related data from the Health and Retirement Study (HRS) 2003 Diabetes Study were analyzed to compare treatment outcomes among non-Hispanic White, non-Hispanic Black, and Hispanic individuals with various types of diabetes. Non-Hispanic White individuals exhibited better diabetic control than their minority counterparts (F(2, 592) = 7.60, p < .001); however, no significant group differences were noted in terms of psychosocial factors. Diabetic control was best predicted by time since diagnosis (&#946; = -.21, p < .001), satisfaction with diabetes self-care (&#946; = .19, p < .001) and age (&#946; = .12, p < .01). In addition, satisfaction with provider care was best predicted by perceived collaboration with provider (&#946; = .44, p < .001), satisfaction with diabetes self-care (&#946; = .22, p < .001) and diabetes self-efficacy (&#946; = .08, p < .05). Recommendations for future research were discussed.

Meaningful social connections are an important part of our lives, especially as we age, and are associated with life satisfaction and psychological well-being. At the same time making friends and creating connections is known to be challenging in older age. In this thesis, we focus on studying how technology can help to collect information about older adults that can be useful for facilitating friendship formation and social interactions among users. We start by describing early work that shows the opportunities of technology in improving well-being of older adults. The conducted studies and review work highlights the potential of social interactions in motivating older adults for technology use and exercising. We then study factors affecting people's social connectedness and friendships. The study highlights that common life points are related to higher levels of connectedness and frequency of interactions. We then move the focus on studying friendship formation in later life, and specifically on how technology can help to facilitate friendship formation. From observations in the nursing homes we see that reminiscence is often used to collect information about a person’s history and values, we look at this practice as a way to identify information potentially useful to recommend friendships, especially in nursing homes context. We conduct Interviews and observations with nursing homes stakeholders and gerontology doctors to define requirements and opportunities of reminiscence conversational agent suitable to their current practices. We then conduct a study to explore how the concept of the bot and features are perceived by elderly, NH staff and doctors. Finally, we present the work carried out to define and validate the concept of a reminiscence-based conversational agent aimed at: i) conducting storytelling conversations that are engaging and natural and ii) being effective in collecting information about the user (e.g values, interests, places) that later can be used for recommending potential friends.

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Résumé : Introduction: Chez les aînés, la perte de dents et les difficultés masticatoires peuvent entraîner une réduction de la qualité de la diète et une perte de poids. Objectifs: Dans une population âgée vivant à domicile, nous voulons déterminer la cohérence interne et la validité de critère d’un questionnaire sur la perception de l’efficacité masticatoire. Nous désirons aussi vérifier la relation entre l’efficacité masticatoire et l’alimentation, notamment l’apport protéinique, l’apport en vitamine C et folate ainsi que la consommation de fruits et légumes. Méthodologie: Une analyse secondaire des données recueillies à l’entrée de l’Étude longitudinale québécoise sur la nutrition comme déterminant d’un vieillissement réussi (NuAge) a été réalisée. NuAge est une étude observationnelle (2003-2008) de 1793 hommes et femmes âgés de 68-82 ans, généralement en bonne santé lors du recrutement. L'échantillon total (n=1789) a été utilisé pour déterminer la cohérence interne puis un sous-échantillon (n=94), dont les participants ont passé un test clinique de l'efficacité masticatoire, a été utilisé pour mesurer la validité de critère du questionnaire. Le questionnaire contient 7 questions tirées du Oral Health Impact Profile (échelle de Likert, score total= 28 points). Le test clinique (Swallowing Threshold Test Index, score 0 à 100%) a été utilisé pour mesurer l'efficacité masticatoire. Pour ces deux instruments, un score élevé indique une bonne efficacité masticatoire (perçue ou mesurée). Les apports habituels de protéines, de vitamine C, de folate et de fruits/légumes ont été calculés à partir de 3 rappels alimentaires de 24 heures non-consécutifs. Résultats: Les scores moyens obtenus au questionnaire sont élevés [H:25.3;IC(24.7-25.9); F:24.3;IC(23.7-25.0)], indiquant une bonne efficacité masticatoire perçue. Les participants du sous-échantillon (50H, 63F) ont des scores moyens au test masticatoire de 60.8% [H:IC(57.3-64.2)] et de 61.2% [F:IC(57.7-64.7)]. La cohérence interne du questionnaire est considérée «satisfaisante» (Alpha de Cronbach= 0.803). Aucune relation significative n’a été observée entre l'efficacité masticatoire perçue et mesurée (r= -0.14; p= 0.22). Une prévalence élevée (78,9%) d'apports alimentaires insuffisants en fruits et en légumes (<7 portions/jour), se traduit par des niveaux élevés (53,9%) d'apports insuffisants en folate chez les femmes (<320μg/j). Après ajustement pour l'âge, le sexe, la scolarité et le revenu, le score d'efficacité masticatoire n'est pas significativement associé aux apports alimentaires. Conclusion: Malgré la bonne cohérence interne du questionnaire et la validité reconnue du test, il semble que les résultats de l'efficacité masticatoire perçue ne réflètent pas la «vraie» efficacité masticatoire mesurée avec le test. De plus, on n'observe aucune relation significative entre l'efficacité masticatoire et les apports alimentaires. Des tests masticatoires adaptés aux aînés et intégrant les impacts sur la déglutition et sur la digestion seraient à développer. // Abstract : Introduction: Among seniors, loss of teeth and chewing difficulties can cause diet's quality reduction and weight loss. Objectives: Among generally healthy seniors, we want to determine internal consistency and criterion validity of a questionnaire assessing the perception of masticatory efficiency. We also want to assess the relationship between masticatory efficiency and food intake (protein, Vitamine C, folic acid and fruits/vegetables). Methodology: This is a secondary cross-sectional analysis of the baseline data from the NuAge Study (Québec Longitudinal Study on Nutrition and Successful Aging). NuAge is a 5-year (2003-2008) observational study of 1793 men and women aged 68-82 years in good general health at recruitment. The total sample (n=1789) was used to determine internal consistency of the questionnaire. A subsample (n=94) of the cohort who underwent a clinical test measuring directly masticatory efficiency was used to determine criterion validity of the questionnaire. The questionnaire was a subset of the Oral Health Impact Profile (Likert-scale, total score= 28 points). Assessment of masticatory efficiency was carried out using a clinical test measuring the ability to chew a raw carrot, (Swallowing Threshold Test Index, score from 0 to 100%). For both measures (perceived or measured) a higher score indicates a better masticatory efficiency. Usual protein, Vitamin C, folic acid and fruits/vegetables intakes are calculated from 3 nonconsecutive 24h dietary recalls. Results: Internal consistency of the questionnaire was deemed «satisfactory» (Cronbach’s Alpha= 0.803). Mean scores of the questionnaire were generally high [M:25.3;IC(24.7-25.9); W:24.3;IC(23.7-25.0)], indicating a good perceived masticatory efficiency. In contrast, mean scores of the masticatory performance test were rather low [M:60.8%;IC(57.3-64.2); W:61.2%;IC(57.7-64.7)]. No significant relationship between perceived and measured masticatory efficiency has been observed (r= -0.14; p= 0.22). A high prevalence (78.9%) of inadequate dietary intake of fruits and vegetables (<7 servings/day), resulting in high levels (53,9%) of inadequate folate intake for women (<320μg/d). After adjusting for age, sex, education and income, the masticatory efficiency score was not significantly associated with food intake Discussion/Conclusion: Despite a good internal consistency of the questionnaire, and the recognized validity of the test, it seems that people's perception of their masticatory efficiency does not reflect "real" efficiency as measured by the test. Furthermore, no relationship was observed between masticatory efficiency and food intake. New masticatory tests, more related to impact on swallowing and digestion, should be developed.

Estimates suggest that 6% of adults aged 65 years and older reported binge drinking in the past month and 2.2% reported heavy drinking. This dissertation investigates the associations between stress, coping, and alcohol consumption specifically in older adults. The literature on the direct relationship between stress and drinking in older adults has yielded inconsistent results (i.e., some produced positive associations, others yielded negative or nonsignificant relations). Previous findings for the relationship between various types of coping and drinking in older adults have yielded more consistent results, with avoidant coping, alcohol outcome expectancy, and/or drinking to cope generally contributing to alcohol use either independently or in combination. The strengths and limitations of currently used alcohol screening instruments with older adults (e.g., Michigan Alcoholism Screening Test-Geriatric Version, CAGE Questionnaire, and Alcohol Use Disorders Identification Test) are also reviewed. Based on the literature, it was hypothesized that (a) lowering the definition of binge drinking to make it more age-sensitive to older adults would identify more individuals drinking at at-risk levels, (b) perceived stress, coping, and alcohol consumption would correlate with each other, and (c) coping would mediate the association between perceived stress and alcohol consumption. The study's sample consisted of 60 independent-living older adults (65 years of age and older), most of whom were White, female, and well educated. The results of this study only partially supported the hypotheses. Specifically, there was no clinically meaningful difference when the definition of binge drinking was lowered to a more age-specific classification on the Alcohol Use Disorders Identification Test - Consumption measure. Perceived stress and both task- and avoidant-focused coping were correlated, but perceived stress and alcohol consumption were not significantly correlated, nor were either task- or avoidant-focused coping and alcohol consumption correlated. Finally, neither task- nor avoidant-focused coping mediated the relationship between perceived stress and alcohol consumption. Limitations of the present study are discussed.

Ample evidence underscores the deleterious effects of loneliness on health and mortality. Therefore, it is important that loneliness risks are identified across all ages and appropriate measures are devised to address those risks. Although almost a third of the US older adult population lives alone, there is limited research on the social connectedness (or its lack thereof) in this subset of older adults. This dissertation specifically focused on understanding loneliness (its extent, variance, and sources of variance) in older adults who live alone and do not use the Internet. The results indicate that the loneliness reported in this subset of older adults is greater than that found in general older adult samples. Social isolation (measured by social network variables) and emotional well-being emerged as significant predictors of loneliness in this group. Demographics, personality, and technology experience did not predict variance in loneliness beyond that predicted by social isolation and emotional well-being. To understand if Internet adoption can provide greater opportunities for connectedness, a qualitative study was also conducted. This study focused on the subjective experiences of living alone, relationships with friends, family, and groups in the context of living alone, and the role of technology in supporting connectedness needs. Loneliness was the most commonly reported challenge associated with living alone and was often described in terms of lack of companionship or someone to share one’s feelings with. The older adult Internet users perceived usefulness of Internet-based social media as a compensatory tool for communication, but valued in-person interactions more. Together these studies provided insights into the social connectedness of older adults who live alone. The findings advanced the understanding of the complexities of living alone in older age and helped identify directions to best address social connectedness needs while also supporting older adults’ desire to continue to age in the living arrangement of their choice. Finally, the gaps in research on older adults’ use of social media and its potential to support connectedness for an aging population were also addressed.

Life-stories offer an approach to understanding personality processes within a larger, developmental context. This study examines the role that one area of a person’s larger context (namely romantic relationships) plays in that person’s life-story. Specifically, the study examines whether this role changes over the lifespan. Nineteen students from a consortium of colleges in southern California, and an equal number of older adults living in a nearby retirement community, were interviewed about their romantic relationship history. The interview was semi-structured and asked participants about past and current relationships, and their most meaningful relationship overall. The interviews were coded for the themes of agency, redemption, and contamination, reported self-growth, and an additional variable called unprompted discussion of sexuality that was added based on a series of unexpected occurrences during the interviews. The results showed significant differences in both agency and unprompted discussion of sexuality between the romantic relationship narratives of young and older adults. However, no significant differences were found between the age groups on any of the other three variables, or between the sexes on any of the five variables. The results not only help us to better understand the ways in which our stories about our romantic relationships change across the lifespan, but also suggest significant differences between how younger and older adults think about love and sex.

The United States, as well as other nations, is experiencing an increase in the older adult population. As a result of older adults living longer, mobile devices can be a major component in improving older adults' quality of life. However, older adults may encounter difficulties when using the mobile devices. This research examined the requirements in addressing the needs of older adults when using a mobile device. Specifically, the research focused on gathering the task and feature requirements for a mobile device tutorial for older adults. The approach was accomplished by the development of a mobile device questionnaire, which was first administered to a pilot group of older adults, to determine the questionnaire's comprehensiveness, then to an adequate sample size of older adults at four senior activity centers, located in Prince George's County, Maryland. Based on the responses to the specific research questions from the total population, two focus groups, consisting of a total of ten individuals, were selected. The focus groups, identified as focus group A and B, were created, based on how likely or unlikely the respondent would use a mobile device tutorial. Following the collection of the questionnaires from the total population and the two focus groups, the results of the data were analyzed. The quantitative findings for the total population for the task requirements found that e-mail had the highest mean (4.40%), followed by health, shopping, restaurant, and financial. The findings for the feature requirements found that photos had the highest mean (4.21%), followed by camera, contacts, reminders, and FaceTime. The researcher developed findings based on the qualitative analysis from the total sample population. The major qualitative findings consisted of the benefits, to include access, availability, accuracy and usefulness. The drawbacks consisted of ease of use, user concerns, and the inability to ask questions. In the analysis of the quantitative findings for the task requirements, focus group A was slightly different from the total population, with shopping having the highest mean (6.80%), followed by health, restaurants, e-mail and financial. The findings for the task requirements for focus group B, were similar to the total population, with e-mail and health having the highest means (1.60%), followed by restaurants and financial (equal), and shopping. The findings for the feature requirements for focus group A, were similar to the total population, with photos and reminders (6.80%), followed by camera, and FaceTime and contacts. The findings for the feature requirements for focus group B, were also similar to the total population and focus group A, with photos having the highest mean (1.80%), followed by reminders, and contacts, camera, and FaceTime (equal). In the analysis of the qualitative analysis for focus group A some of the benefits included availability and encouragement. For focus group B, some of the benefits included working at one's own pace, and understandability of the device. The qualitative analysis for the total population findings for the benefits of a mobile device tutorial included access to a tutorial, availability, skill set for a tutorial, and usefulness. The main responses pertaining to why the respondent would use a mobile device include the device's availability, ease to use, use at one's leisure, and using the device at one's own pace. In examining the qualitative findings for the two focus groups, the major areas for the benefits for focus group A, are similar to the total population. These areas include availability, encouragement, and listening to the tutorial several times. The major areas for focus group B, are similar to the total population and focus group A, to include listening to the tutorial several times. In exploring deeper into the focus groups' responses, the participants addressed specific questions regarding the task and feature requirements. For the specific task or feature requirements for which a respondent would likely use a mobile device tutorial for assistance, focus group A's responses were the features of FaceTime and the tasks of e-mail, photos, and contacts. Focus group B responses were the task requirement of health care and financial and feature requirements of camera and photos. The mixed method analysis supports the premise that older adults would desire instructions on the identified task and feature requirements for a mobile device tutorial. The recommendations of the research consisted of additional examination of collecting data across multiple senior activity centers, the Baby Boomer generation, and older adult computer classes. Designing a mock-up tutorial, using another mobile device, and the use of current Siri feature, are other possible research investigations. Lastly, the implications of the study, filled the gap regarding senior adults and mobile devices, by contributing to the research pertaining to mobile device tutorials that would accommodate older adults.

The purpose of this study was to determine if the amount and variety of fruit and vegetable intake increased among community-dwelling older adults participating in Kentucky’s congregate meal site program following a series of educational nutrition lessons. A convenience sample (n=35) of community-dwelling older adults at two intervention (n=19) and two control (n=16) senior centers in central Kentucky participated in this quasi-experimental pre-post pilot study. Following the intervention there was a trend towards increased self-reported intake in the variety of fruit and vegetables among the intervention group (range:0.03±3.31 to 1.32±2.75 servings per week); a significant increase in the number of days participants incorporated at least 4.5 servings of fruits and vegetables per day intake; significant increases in the incorporation of fruits and vegetables in evening meal, and all meals (p≤0.05); and phytochemical knowledge (p≤0.05). Actual fruit and vegetable intake at the congregate meal increased post-intervention among the intervention group only (p≤0.05) as measured by plate waste. The mean Phytochemical Index score was 25.4, with participants consuming 79% of the phytochemical- rich component to their meal. These results indicate that theory-based educational nutrition lessons among older adults is linked to favorable trends towards increased fruit and vegetable consumption and phytochemical knowledge.

This thesis investigates the Out-of-Box Experience (OoBE) of interactive consumer products for older adults, with a view to improve the User Experience (UX) of a product by manipulating factors of the OoBE. This research emerges in the context of current demographic trends, which see people living longer and in better health, and the increasing ubiquity of technology in modern life. The OoBE describes the very first stages of interaction with a new product, including acquisition, unpacking and setup. This crucial initial experience has the potential to influence product acceptance and therefore determine its future use. Creating a positive OoBE requires an empathic understanding of the intended users, as well as contextual knowledge about current practices. A review of the literature revealed that many of the difficulties older adults experience with technology concern elements of the OoBE, such as complicated documentation, technical jargon and inadequate support for inexperienced users. However, the absence of research on how to engage older adults during the OoBE of new technology reinforced the need for further research. To this end, two user studies were conducted with older people, followed by a design study with designers. The first study explored older adults relationship with technology and their current practices of the OoBE, using the Technology Biography method. The second study used cultural probes to investigate the social side of UX and its effect on personal feelings of independence. Data from these two studies were used to create four personas, which were used in the design study. This third and final study focused on whether the construct of social benefits could be operationalised within the OoBE of new technology. Collectively, the findings indicated that the involvement of other people during the OoBE can be a strong motivator for older people to take up and use technology. Far from impinging on individual perceptions of independence, some older people actively manipulate the OoBE in order to derive social benefits. This research thus contributes to the discussion of how Inclusive Design can evolve through the incorporation of social benefits, in order to generate desirable and successful future products.