Medication reconciliation is a systematic and comprehensive review of medication regimens during care transitions aiming to prevent adverse drug events. Poorly executed transitions negatively impact patient welfare and cause financial burden. Medication-related problems (MRPs) experienced during transitions to an assisted living facility (ALF) were evaluated. Data was collected from pharmacy records for transitions to an ALF over three months, including demographics, medications, potentially inappropriate medications, and MRPs. MRPs were categorized and summarized using descriptive statistics. Forty-five patients (71% female) experienced 59 transitions. Average age was 85.6 years. Median length of stay away from the ALF was three days. There were averages of 18.3 pre-transition medications, 12.5 medications in the discharge orders and/or upon ALF admission, and 15.9 final medications. 979 MRPs were identified, mostly no indication documented, followed by underuse, overuse, and non-adherence. Many of the identified MRPs are potentially preventable. Interventions are needed to reduce MRPs during ALF transitions.

Introduction: Aging, comorbid conditions, and use of medications render older adults more susceptible to alcohol-disease or alcohol-drug interactions that may lead to harmful outcomes. In this dissertation project the risk profile of alcohol and medications use among older adults was investigated. Considering the rise in CNS-acting medication use and the adverse effect profile linked to CNS-acting medications, it was also of interest to find if older adults were at risk of falling due to interactions between alcohol and CNS-acting medication. Objectives: The objectives were as follows: 1) to determine the prevalence, pattern and factors associated with at-risk drinking, 2) to determine the prevalence and pattern of potential concurrent use of CNS-acting medication and alcohol, and to identify factors associated with alcohol use among CNS-acting medication users, 3) to assess the effects of potential concurrent use of CNS-acting medications and alcohol on the risk for falls in older adults. Methods: The study population comprised a nationally representative sample of community-dwelling older adults aged 65 years or older. The 2009 Medicare Current Beneficiary Survey (MCBS) data (n=7163) were employed to determine at-risk drinking based on the Comorbidity Alcohol Risk Evaluation Tool (CARET) and to assess the effects of potential concurrent use of CNS-acting medication and alcohol on the risk for falls. The National Health and Nutrition Examination Survey (NHANES) 2005-2010 data (n=3220) were employed to determine potential concurrent use of alcohol and CNS-acting medications. The effect of combined use of alcohol and CNS-acting medications on risk of falls was assessed using logistic regression modeling and adjusting for confounders. Alcohol consumption was measured by the quantity-frequency method and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommended drinking limits were utilized in all analyses. Results: In the MCBS study, 5.6% of the older adults were identified as at-risk drinkers. Adults aged between 65-74 years, being male, non-married, former or current smoker, and having no comorbid conditions were factors associated with at-risk drinking. In the NHANES study, 8.9% reported potential concurrent use of alcohol and CNS-acting medication. Use of at least one CNS-acting medication and drinking excessive alcohol, or binge drinking, was significantly associated with odds of falling. Conclusion: Hazardous alcohol use is common among older adults. A substantial proportion of older adults may concomitantly consume alcohol and CNS-acting medications. Odds of falling are greater in the presence of high alcohol intake and CNS-acting medication use. It is important for health care professionals to warn patients against excessive alcohol consumption. Increasing awareness of this issue among older adults and caregivers may help prevent falls. Contributions from healthcare professionals in the form of screening for potentially harmful alcohol use, prescription monitoring, and initiating counseling may help to reduce older adults’ risk for falls or other adverse effects.

Background: Dietary supplements (DS) use has increased in the U.S. in the past 20 years. More than half of the U.S. population reported using DS. There are few studies to our knowledge that have assessed DS use specifically for older adults. In this study we purposed to evaluate the trend of using DS among older adults and to test the association between using DS and several demographics, socioeconomics and health characteristics. The second objective was to evaluate the reasons behind using DS among older adults using a nationally representative database. Methods: This is a cross sectional study using the most recent National Health and Nutrition Examination Survey (NHANES) database 2009-2012. It is a nationally representative sample of noninstitutionalized adults in the U.S. Frequency and weighted percentage (standard error) were reported for dichotomous variables. Multiple logistic regressions model analyses were used to evaluate the predictors of DS use after testing model assumptions, multicollinearity, and outliers. P values 0.05 were considered significant. All the statistical analyses were conducted using SAS software version 9.4. Results: Out of 2625 older adult participants (65 years and older) 70.5% of them reported using DS in the past 30 days. Female, non-hispanic white, obese, overweight and excellent and very good self-reported health status participants were more likely to use DS. Multivitamin-multiminerals (MVMM), calcium and vitamin D were the most commonly reported supplements among older adults. 71% of oldest old (80≥ years) reported taking DS and prescription medication in the past 30 days concomitantly and 73% of polypharmacy users reported using DS. To stay healthy, to improve overall health and for bone health were the most commonly reported reasons behind using DS. Conclusion: majority of older adult participants reported using DS in the past 30 days. Health care professionals need to evaluate the dietary supplement information from older adults in order to improve health care.

The work presented in this dissertation focuses on the association between sleep medication use, poor sleep, and falls in community-dwelling adults 65 years or older. Sleep complaints and the consumption of medications to aid sleep are common in older adults. Psychotropic medications, such as sedative hypnotics, are associated with risk of falls in older adults. However, very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls in community-dwelling older adults. In the first project, a cross-sectional analysis of the Health and Retirement Study (HRS) 2010 data was conducted to determine the prevalence of sleep problems, sleep medication use and falls; and to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. A multiple logistic model adjusted for covariates was used. In the sample of community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the older adults. Older adults who had sleep problems and took sleep medications had a significantly higher risk of falls compared with older adults who did not have sleep problems and did not take sleep medications. The other two groups, older adults who had sleep problems and did not take sleep medications, and those who did not have sleep problems and took sleep medications also had a significantly greater risk for falls. The second project was a prospective cohort study of independently-living older adults from senior congregate housing. The effect of combined poor sleep quality and sleep medication use on risk of falls was assessed using logistic regression modeling. In this study of 113 community-dwelling older adults, 46.9% had at least one fall, and 62.8% had poor sleep quality. Sleep medication use was reported by 44.2% of the older adults. Older adults with poor sleep quality and sleep medication use had a significantly increased risk of falls compared with older adults with good sleep quality and no sleep medication use. Older adults with good sleep quality and sleep medication use, and those with poor sleep quality and no sleep medication use did not have a significantly greater risk for falls. In conclusion, poor sleep added to sleep medication use significantly increased the risk of falls in community-dwelling older adults. The research undertaken in this dissertation was the first to evaluate the associations between poor sleep, use of sleep medications, and falls in community-dwelling older adults.

A mixed methods approach was used for this study. The setting was a low-income, subsidized housing apartment building for community-dwelling older and younger disabled adults identified as a health care hot spot due to high rates of ambulance use. The study purpose was to identify reasons for ED use and problems during transition from ED to home, predictors of zip code 23220 (health care hot spot) in emergent and non-emergent ED visits, and predictors of total ED costs in community-dwelling older adults living in a health care hot spot. Semi-structured interviews with residents who used the ED, an existing database from an interprofessional care coordination and wellness program for residents, and community-dwelling older adults’ electronic medical record and billing data from 2010-2013 ED visits from an academic medical center were used. The Gelberg-Andersen Behavioral Model for Vulnerable Populations was utilized. A total of 14 interviews were conducted. Themes related to ED use included: high use of ambulance services, timely use of the ED or attempt at self-care, and lack of communication with a health care provider prior to ED visit. Themes related to care transitions were: delay in medication receipt after discharge, lack of a current medication list and personal health record, PCP follow-up instruction, and education on warning signs of a worsening condition. The interprofessional program’s care coordination activities were education, disease monitoring, referral for PCP visit, and discrepancy reconciliation. A total of 7,805 ED visits were included, of which 3,871 were non-emergent and 1,179 were emergent. Common primary ED visit diagnoses were chest pain and abdominal pain. White race, a Charlson Comorbidity Index score of 3, and a total disease count of 10 or more were significant predictors of zip code 23220 in non-emergent ED visits. White race was a significant predictor of zip code 23220 in emergent ED visits. Significant predictors of total ED costs were white or other race, arrival by ambulance, emergent visit type, and year of visit. Pain was a common reason for ED use. Care transition problems related to medication management and follow-up care indicate an area for targeted interventions after ED discharge.

A large percentage of Americans own pets which may impact their health. This study examines pet ownership’s effect on well being in older adults looking at race/ethnicity. A sample of 6,565 older adults (>60) was selected from the Third National Health and Nutrition Survey. Pet owners comprised 28.3% of the sample. The theories of symbolic interaction and social integration were used to examine pet ownership’s effect on physical components of well-being. The descriptive results showed statistically significant differences in age, education, income, and marital status between pet owners and non-pet owners. Pet owners were younger, more educate, higher income and married. Similar results were found for Caucasians, African Americans and Mexican Americans. Logistic regression for the entire sample revealed pet owners were more likely to have a positive self perception of health, normal blood pressure, improved function, less chronic conditions, improved function and more falls. Multiple regression revealed pet owners had more hospital stays, but fewer physician visits and nursing home stays than non-pet owners. When examined by race/ethnicity differences were found between pet owners and non-pet owners that differed from the general sample results. This research revealed that pets overall positively impact their owners’ health but it appears to differ based on race/ethnicity. Further research is needed on pet ownership’s effect on older adults specifically in regards to race.

Smartphones are innovations that currently provide immense benefits and convenience to users in society. However, not all the users of society are accepting and using smart phones, more specifically, for this research study older adults (50+) are a demographic group displaying such an attitude. Currently, there is minimal knowledge of the reasons that older adults adopt and use smartphones. Bearing this in mind, this research study aimed to identify, examine and explain the adoption and usage of smartphones in the UK within the 50 years old and above population. For this purpose, a conceptual framework, a Model of Smartphone Adoption (MOSA) was formed drawing factors from the theories of Unified theory of Acceptance and Use of Technology (UTAUT), the Diffusion of Innovations theory (DoI) and Technology Acceptance Model 3 (TAM3). Seven variables from the theories were brought to consideration, which were Observability, Social influence, Compatibility, Effort expectancy, Facilitation conditions, Performance expectancy and Perceived enjoyment. For the research method, a quantitative approach was selected to examine and apply MOSA that involved the data collection method of an online questionnaire survey that resulted in 204 completed replies during the pilot phase of this research and 984 in the final phase. The collected data was analysed using SEM-PLS where the results found that six of the eight formed hypotheses were supported, and the factors of Compatibility, Effort expectancy, Facilitation condition, Performance expectancy and Perceived enjoyment were important for the adoption of smartphones. From these results, it was understood that older adults used smartphones because they have enough knowledge, time and money to use. They also think that smartphones are easy to use, provide benefits including enjoyment and are compatible with their lifestyles. In terms of usage, older adults frequently used the basic features of smartphones such as making a phone call, SMS, email, and browsing. Older adults are also likely to use their devices for seeking information about their health and for appointments with their doctors; however, from this research it was found that more than half of the 50 years old and above adults did not use smartphones for health and well-being purposes. The contributions of this research are viewed to be the identification and understanding of the factors that encourage or inhibit smartphones use within the older adult population. Secondly, this research can inform smartphone manufacturers and developers of factors pertinent for the design of computing devices and applications specific to silver surfers. Finally, this research can enlighten policy makers when forming decisions that encourage the adoption and use of smartphones within the older adult population. Regarding limitations, these existed in the form of finance and time. To overcome the limitations, this research recommends further studies that apply qualitative research and/or to provide a comparison between western and eastern countries.

This study explored how the structural aspects of a social network (that is, number of social ties, frequency of contact, as well as social participation), along with the functional aspect (social support), relate to mental health. Using data from the baseline questionnaire for the tracking cohort of participants in the Canadian Longitudinal Study on Aging, community-dwelling older adults aged 65-85 years old were studied. Cluster analysis was used to group individuals into different clusters, based on their structural social network characteristics. Six clusters were found, ranging from most socially integrated, to moderately integrated, to socially isolated. Univariate analyses indicated that as level of social integration decreased, individuals fared increasingly worse in terms of their mental health outcomes. Furthermore, a series of mediation analyses showed that social support mediated the relationship between social integration level, and mental health, an effect that was strongest for the most socially isolated individuals. / May 2016

Abstract Background: Frailty is a physiological condition caused by aging which increases the risk for adverse health problems and extended need for health and social care. This condition can be prevented, and to some extent treated, with physical activity. But research shows that older adults spend as much as 62 to 86 percent of their waking time sedentary. However, there is a lack of research, national studies in particular, looking into what specifically motivates older adults to physical activity. Purpose:The purpose of this study was to gain a better understanding of which aspects, and why, that motivated physically inactive older adults to become physically active.  Method: The study was conducted with a qualitative study design in the form of four focus groups interviews. The 19 respondents consisted of older adults with a physical inactive lifestyle. The Health Belief Model was used as a theoretical framework. A thematic content analysis with a deductive approach was used when processing collected data. Result: 16 subcategories were found answering the research questions and four of these were more prominent than the others: Companionship and social health, Possibilities to choose, Physical Activity on Prescription (FaR®) and No fear and worries. The theme Barriers stood out compared to the others themes since containing a larger number of subcategories. Conclusion: There were aspects within both health and social care as on a societal- and personal level that motivated the respondents to an increased physical activity. Further research is however needed within this area. Not only looking into what motivates older adults to an active lifestyle in general, but also what especially motivates those who are at greatest risk for frailty or already being frail. / Sammanfattning Bakgrund: Skörhet (frailty) är ett åldersrelaterat fysiologiskt tillstånd som ökar risken för allvarliga hälsoproblem och ett ökat behov av hälso- och sjukvård. Detta tillstånd kan förebyggas, och i viss mån behandlas, med fysisk aktivitet. Forskning visar dock att äldre vuxna spenderar så mycket som 62 till 86 procent av sin vakna tid stillasittande. Men det saknas forskning, speciellt nationella studier, på vad som specifikt motiverar äldre vuxna till fysisk aktivitet. Syfte: Den här studiens syfte var att öka förståelsen för vilka aspekter, och varför, som kunde motivera fysiskt inaktiva äldre vuxna till att bli fysisk aktiva. Metod: Studien genomfördes med en kvalitativ forskningsdesign i form utav fyra stycken fokusgruppsintervjuer. De 19 respondenterna bestod av äldre vuxna med en fysiskt inaktiv livsstil. The Health Belief Model utgjorde studiens teoretiska referensram. En tematisk innehållsanalys med en deduktiv ansats användes när det insamlade datat processades. Resultat: 16 subkategorier hittades som svarade på forskningsfrågorna och fyra av dessa var mer framträdande än de andra: Kamratskap och social hälsa, Valmöjligheter, Fysisk Aktivitet på Recept (FaR®) och Ingen rädsla eller oro. Temat Hinder stod ut jämfört med övriga teman då det innehöll ett större antal subkategorier. Slutsats: Det fanns aspekter inom både hälso- och sjukvård samt på samhälls- och individnivå som påverkade deltagarnas motivation till en ökad fysisk aktivitet. Ytterligare forskning behövs dock inom det här området. Inte enbart på vad som generellt motiverar äldre vuxna till en aktiv livsstil, utan också vad som specifikt motiverar de individer som är i störst risk för skörhet eller redan är sköra.

Résumé : Les liens entre les maladies dermatologiques et les troubles de santé mentale, dont la dépression, sont reconnus depuis longtemps. Cependant, peu d’études de population ont examiné cette problématique et aucune n’a été faite auprès des aînés. Le but de ce mémoire est d’explorer l’association entre les affections dermatologiques et les troubles dépressifs chez les personnes âgées vivant à domicile. Pour ce faire, deux études ont été réalisées. La première visait à décrire les caractéristiques dermatologiques de la population à l’étude et la deuxième avait pour but de tester l’hypothèse d’une association bidirectionnelle entre les problèmes mentionnés. Il s’agit d’une analyse secondaire des données de l’Enquête sur la Santé des Aînés (ESA) qui a été menée auprès d’un échantillon représentatif de la population âgée (≥ 65 ans) vivant à domicile au Québec. Des mesures répétées à un an d’intervalle (T1 et T2) ont été obtenues auprès de 2 cohortes successives fixes. Les données de l’enquête ESA ont été appariées à celles des registres de la Régie de l’assurance maladie du Québec (RAMQ). Les troubles dépressifs ont été définis en se basant sur les critères du DSM-IV et les affections dermatologiques ont été mesurées à partir de deux sources de données (enquête et registres administratifs de la RAMQ). Des modèles autorégressifs bivariés ont été utilisés pour tester l’hypothèse d’association bidirectionnelle entre les affections dermatologiques et les troubles dépressifs. Nos résultats ont montré que près de 13% et 21% des répondants ont rapporté des affections dermatologiques auto-rapportées ou avaient été diagnostiqués selon les registres de la RAMQ. En plus, près de 6% des participants rapportaient un trouble dépressif probable au T1 et au T2. Nos résultats suggèrent la présence d’une association synchronique (transversale) entre les affections dermatologiques et les troubles dépressifs. Ce projet souligne l’importance d’évaluer et d’explorer la cooccurrence de ces deux pathologies afin d’améliorer la prise en charge des individus atteints simultanément par ces deux problèmes. Nous suggérons l'inclusion des affections dermatologiques dans les futures études épidémiologiques visant à explorer les liens entre les troubles de santé mentale et de santé physique chez les personnes âgées.//Abstract : The relationship between skin conditions and mental health disorders, which includes depression, has long been recognized. However, few population - based studies have examined this issue and none were carried out in older - adults. The aim of this project was to explore the associations between skin conditions and depressive disorders affecting the elderly living at home. To do this, two studies were conducted; the first aimed to describe the dermatological features of the study population. The second was designed to test the hypothesis of a bidirectional association between the conditions mentioned above. We carried out secondary data analyses from data collected in the Study on the Health of Seniors (ESA ) survey, which consisted of a representative sample of the elderly population (≥ 65 years) living at home in Quebec. Two repeated measurements one year apart (T1 and T2) were obtained from two fixed successive cohorts. Participants in both phases of the investigation and with available health service information from Quebec’s health insurance plan agency (Régie de l'assurance maladie du Québec - RAMQ) were selected for this project. Depressive disorders were defined based on DSM - IV criteria and dermatological conditions were measured from two data sources (survey and administrative records). Cross - lagged panel models were used to test the hypothesis of association between the two mentioned conditions. Our results showed that nearly 13% and 21% of respondents have self - reported and diagnosed skin conditions, respectively. In addition, about 6% of participants reported symptoms that were consistent with a probable depressive disorder on T1 and T2. Our results suggested the presence of synchronous (cross - sectional) associations between skin conditions and depressive disorders in the elderly. This research highlights the importance of assessing and exploring the co - occurrence of these two conditions to improve the management of individuals who are affected. We suggest the inclusion of dermatological conditions in future/further studies exploring the comorbidity between mental and physical health in the older adults.