Urban First Nations and Inuit older adults are aging in a Western-centric sociopolitical environment that is experiencing significant social change due to population aging and urbanization. Consequently, urban communities are facing increasing pressures to respond to the needs of the growing older adult population. As a result of these pressures, older adults are urged to “age well” to reduce their “burden” on society; however, older adults do not all define aging well in the same way and they do not all have the same opportunities to age well. Through my research, I aimed to address a gap in the academic literature concerning urban-dwelling First Nations and Inuit older adults and aging well. Ultimately, my goal was to identify how First Nations and Inuit older adults living in Ottawa could be supported to age well in ways that reflect their urban Indigenous identities, cultural perspectives, and life course. My specific research questions are four-fold: 1) Are Indigenous older adults marginalized through dominant aging well frameworks?; 2) how do community-dwelling First Nations and Inuit older adults (aged 55 years and over) living in Ottawa, Canada, define and negotiate aging well in an urban environment?; 3) what community-level factors contribute to First Nations and Inuit older adults (aged 55 years and over) feeling supported to age well in the city of Ottawa?; and 4) how do community stakeholders in Ottawa produce understandings of supporting urban Indigenous older adults to age well? Informed by a postcolonial theoretical framework, I conducted this research using a community-based participatory research (CBPR) methodology in Ottawa, Ontario, Canada, in partnerships with the Odawa Native Friendship Centre and Tungasuvvingat Inuit. To address my research questions, I conducted semi-structured interviews with nine First Nations older adults, focus groups with 23 Inuit older adults, and photovoice with two First Nations older adults. Additionally, I conducted 13 semi-structured interviews with community stakeholders (i.e., decision-makers and service providers. My doctoral research makes novel contributions to the fields of kinesiology and gerontology by expanding postcolonial theory to issues related to aging research with urban Indigenous older adults; contributing to the emerging literature that brings diverse perspectives into conversations on aging well; challenging assumptions related to urban Indigenous populations and aging well; illustrating the tensions within aging well initiatives that intended to be available for all older adults; and revealing the tensions within efforts to address reconciliation with Indigenous older adults.

The purpose of this qualitative pilot study is to explore the patient perspectives about what it is like to receive a bed bath. Examining studies of bath basins versus alternative methods has shown a decrease in the spread of nosocominal infections. However, there is not sufficient evidence evaluating the patient perspectives of assistive bed bathing and interactions with nurses and nursing support staff. This information can provide healthcare providers, especially nurses, with a better understanding of patient perspectives and values. It also supports the national healthcare approach towards patient-centered care.

Evidence-based recommendations for interventions to reduce fall risk in older adults with visual impairment are lacking. Adapted tango dance (Tango) and a balance and mobility program (FallProof) have improved mobility, balance, and quality of life (QOL) in individuals with movement impairment. This study compared the efficacy of Tango and FallProof for 32 individuals with visual impairment (age: M = 79.3, SD =11 [51–95 years]). Participants were assigned to Tango or FallProof to complete twenty, 90-min lessons within 12 weeks. Participants underwent assessment of balance, dual-tasking, endurance, gait, and vision-related QOL. The balance reactions of participants in both groups improved (p < .001). Endurance, cognitive dual-tasking, and vision-related QOL may have improved more for Tango than FallProof. Group differences and gains were maintained across time. Both programs could be effective options for motor rehabilitation for older adults with visual impairment because they may improve mobility and QOL while reducing fall risk.

Objective: Depression is a significant global public health burden, and older adults may be particularly vulnerable to its effects. Among other risk factors, interpersonal conflicts, such as perceived criticism from family members, can increase risk for depressive symptoms in this population. We examined family criticism as a predictor of depressive symptoms and the potential moderating effect of optimism and pessimism. Methods: One hundred five older adult, primary care patients completed self-report measures of family criticism, optimism and pessimism, and symptoms of depression. We hypothesized that optimism and pessimism would moderate the relationship between family criticism and depressive symptoms. Results: In support of our hypothesis, those with greater optimism and less pessimism reported fewer depressive symptoms associated with family criticism. Conclusion: Therapeutic enhancement of optimism and amelioration of pessimism may buffer against depression in patients experiencing familial criticism.

abstract: Advances in health care have resulted in an increase in life expectancy causing a rapid growth in the number of older adults at a global level. At the same time, socioeconomic development is transitioning family structures and social relationships. With reduced family engagement, many older adults are more at risk for physical and psychological health issues including loneliness, which is considered a public health issue affecting their quality of life and well-being. This descriptive, exploratory study aims to describe the significance of loneliness in three northern regions of the Sultanate of Oman. The purpose of this study is to examine the prevalence and correlates of loneliness and the relationship of loneliness to health statuses among older Omani adults aged 60 years and above. A demographic data questionnaire, the UCLA loneliness scale, and SF-12-v-1 health status instruments were used for data collection. The sample includes 113 Omani older adults, male (n = 36) and female (n = 77), who experienced a mixture from low to high and severe levels of loneliness. Among these older adults, 34.5% perceived low level, 34.5% moderate level, 22.1% high, and 8.8% were severely lonely. The main demographic factors that were associated with the older adults level of loneliness were female gender, older age 80 years and above, living with others who were not a family member, and being unemployed. When controlling for demographic and environmental factors loneliness was a significant predictor (p < .001) for lower mental health status but not for physical health status (p > .05). / Dissertation/Thesis / Doctoral Dissertation Nursing 2019

Background: Posttraumatic-Stress Disorder (PTSD) is less common in older adults than in younger adults, and little is known about specific risk factors for PTSD in older adults. We investigated the association between self-esteem in late adolescence and PTSD in older adults. Method: Using a cohort design, 1,436 individuals who had been assessed approximately 40 years earlier in their junior and senior year of high school with the Rosenberg Self-Esteem Scale (RSES) were evaluated for PTSD using the PTSD Checklist (PCL-17). Results: Fully controlled logistic regression models indicated that lower self-esteem in late adolescence predicted PTSD in the overall sample of older adults but not in the veterans-only subgroup. Limitations: The main limitations include self-completed measures to estimate PTSD diagnosis and lack of specific information on traumatic events. Conclusions: Our findings suggest that lower self-esteem from a young age may be a risk factor for PTSD in older age.

Medication-related problems (MRPs) are a common issue that lead to suboptimal healthcare outcomes and increased healthcare cost. Overall, older adults have a high risk of experiencing MRPs due to large medication consumption and recession of biological functions. One approach to reduce such a risk is for elderly patients to use comprehensive medication reviews (CMRs), the fundamental service of Medication Therapy Management (MTM). The Centers of Medicare and Medicaid (CMS) has been promoting CMRs among Medicare Part D beneficiaries since 2009, such as offering of an annual free CMR to eligible MTM beneficiaries and making “CMR completion rate” a quality rating (Star) measurement for Part D plans. However, statistics from the report of CMS 2017 Star rating measures showed that the CMR completion rate among MTM eligible was still low. Even though Medicare Part D beneficiaries ultimately make the decision, there are insufficient U.S. studies examining patient perceived factors affecting their use of CMRs. Thus, there is critical need to better understand decision making for using CMRs from a consumer perspective. This dissertation project aimed to explore Medicare Part D beneficiaries’ perceptions on using a CMR, using a conceptual framework adapted from consumer decision making, which consisted of internal need, external influence, perceived risks of using CMRs, and alternative comparison. The dissertation project also aimed to describe how CMR recipients and non-recipients were different and to identify main factors associated with Medicare Part D beneficiaries’ decision making for using CMRs. To achieve these objectives, this study used an exploratory sequential mixed-method approach in a cross-sectional setting. Semi-structured personal interviews were conducted as the qualitative phase followed by self-administered mailed survey as the quantitative phase. Both interview questions and survey items were developed based on the conceptual framework, though findings from qualitative phase informed the survey item generation as well. Survey items and administration were further refined using a panel of expert review and pilot study. A convenient sample consisted of older adults recruited from one pharmacy in Iowa and a senior registry maintained by University of Iowa was used for the qualitative phase (n = 13). The quantitative study sample were randomly selected from each sampling frame: 1) elderly residents of the States of Florida (n = 320), Washington (n = 320), Wisconsin (n = 320), and Pennsylvania (n = 320) covered in a commercial mailing list; and 2) older adults included in the same senior registry used for the qualitative phase (n = 460). The study inclusion criteria were: 1) must be at least 65 years old in 2016, 2) must be taking at least one prescription currently, and 3) must be a Medicare Part D beneficiary. A thematic analysis was conducted for qualitative data, using MaxQDA version 12. Descriptive analysis and multiple logistic regression modeling were used to analyze data of the quantitative phase, using SAS version 9.4. A total of 13 study participants were included in the qualitative analysis, of which 5 were CMR recipients. The thematic analysis yielded five themes, which supported the use of the conceptual framework (i.e. internal need, external influences, perceived risks of using CMRs, and alternative comparison) to understand Medicare Part D beneficiaries’ decision making for using CMRs. Plus, consumers who received a CMR expressed a positive attitude towards them. Safety worriers or knowledge seekers appeared more likely to use CMRs while physician believers or privacy worriers are more likely to not use CMRs. Meanwhile, awareness of CMRs remains low after being available for 7 years, possibly due to an infrequent marketing activity. An overall usable response rate of 26.8% and an overall completion rate of 89.4% were obtained in the mailed survey phase. Of the study sample, 381 respondents who were Medicare Part D beneficiaries, were using at least one prescription, and returned a complete survey were included for analysis. There were 27.56% respondents (n = 105) reported that they had a CMR in 2016 or before, which was consistent with the low CMR completion rate nationwide. Meanwhile, about two thirds of respondents never heard of CMRs, supporting findings from the qualitative phase. CMR recipients and non-recipients had several characteristics differences in the domain of internal need, external influences, and perceived risks of using CMRs. Compared to CMR non-recipients, CMR recipients took slightly more prescription medications (p = 0.0299), were self-reported less healthy (p = 0.0009), had better provider communication in previous pharmacy encounters (p < 0.0001), had higher overall satisfaction in previous pharmacy encounters (p = 0.0053), perceived more seriousness of MRPs (p = 0.0016), perceived more susceptibility of MRPs (p < 0.0001), expected more positive outcome from suing CMRs (p < 0.0001), were more likely influence by a physician’s opinion (p = 0.0184) or a pharmacist’s opinion (p < 0.0001) when considering the use of CMRs, were more likely received a physician recommendation (p < 0.0001) or a pharmacist recommendation (p < 0.0001), had less concern of psychological risk (p = 0.0170), functional risk (p < 0.0001), and social risk (p = 0.0016). The regression modeling further determined that a pharmacist or a physician recommendation, pharmacist’s communication in previous pharmacy encounters, perceived susceptibility of MRPs, and positive outcome expectancy were positively associated with Medicare Part D beneficiaries’ decision making for using CMRs at a significant level of .05, when holding other variables fixed. Meanwhile, perceived functional risk, access to general counseling in previous experiences, and family/friends influence were negatively associated with Medicare Part D beneficiaries’ decision making for suing CMRs at a significant level of .05, when holding other variables fixed. This study is the first to adapt consumer behavior frameworks to explore factors affecting Medicare Part D beneficiaries’ decision making for using CMRs. Unfortunately, it was found that CMR awareness among older population was still low after years’ of promotion efforts among Medicare Part D beneficiaries. Findings of this dissertation suggested that policy makers should not entirely focus on promoting CMRs through Part D plan sponsors, but seek for collaborations from healthcare professionals, particularly community pharmacists and physicians. Meanwhile, addressing key components and benefits of CMRs in an understandable way to general older population could help them establish a link between benefit expectation and their demand. Furthermore, using short surveys or phone interviews to obtain self-perceived internal need among older population could be used by Part D plans or other stakeholders to target potential CMR users more effectively.

As the number of older adults experiencing homelessness continues to increase, understanding the experiences of older homeless adults is necessary. Although housing first initiatives are vital to removing individuals from homelessness, the psychosocial aspects of homelessness are often neglected. The efforts to end and prevent homelessness among older adults require interagency collaboration to include counseling professionals who can assist with the psychosocial aspects of the phenomenon. In an effort to provide a platform for older adults experiencing homelessness to inform researchers and practitioner alike, a phenomenological qualitative study was conducted to explore their lived experiences and their human and social capital. The findings of the study suggest that the experiences older adults participants of this study ranged from maladaptive behaviors (e.g., poor decision making) to positive outlooks for their future. Overall, both their human and their social capital are impaired, and they require interventions that address psychosocial aspects of homelessness, such as loss of social ties and financial insecurity.

Episodic future thinking is defined as the ability to mentally project oneself into the future into a specific time and place. Episodic future thinking has been explored extensively in neuroscience. However, it has not been determined whether the measurement of episodic future thinking might be valuable in a clinical neuropsychological setting. The current study examined the relationship between episodic future thinking and instrumental activities of daily living (IADLs), which is a domain of adaptive functioning frequently assessed by neuropsychologists to examine independent living potential including the ability to handle finances, prepare food, complete household duties, and manage medications. A secondary aim was to examine whether episodic future thinking is related to IADLs over and above standard measures of cognition. 61 older adults with heterogeneous neurological conditions and 41 healthy older adults completed a future thinking task (the adapted Autobiographical Interview), two measures of IADLs (an informant report measure called the Everyday Cognition Scale and a performance-based measure called the Independent Living Scales), and standard measures of memory and executive functioning. Episodic future thinking was significantly associated with performance-based IADLs when accounting for age, education, gender, and depression (r=.26, p=.010). Episodic future thinking significantly predicted performance-based IADLs over and above executive functioning (R2=.025, p=.030). Episodic future thinking was not predictive of performance-based IADLs over and above memory (p=.157). Episodic future thinking was not significantly associated with informant reported IADLs when accounting for age, education, gender, and depression (p=.284). This study suggests that episodic future thinking is significantly associated with IADLs, beyond what can be accounted for by executive functioning. Episodic future thinking may provide information about IADLs to clinical neuropsychologists so they can improve their recommendations for independent living.

Increasing physical activity levels of older adults is a public health priority given the associated risks with sedentary lifestyles. Exercise such as walking may positively affect older adults as they age decreasing the risk of heart disease, stroke, or death. The purpose of this study was to examine physical activities of older adults in senior housing and to determine if age correlates with the amount of physical activity. Physical activity studies on older adults are limited due to time and resources. The health belief model and transtheoretical model frames this study theorizing that older adults will take positive steps towards achieving recommended physical activities based on their perceived threats and benefits. A correlational research design provided systematic information about physical activities of older adults in senior housing and aided in determining if age relates to the amount of physical activity. The study used a convenience sampling of 62 older adults in senior housing and data collected from the Community Health Activities Model Program for Seniors questionnaire. The make-up of the sample included 36 females and 26 males aged 65 to 84 years old. The age of older adults in a senior housing community is not related to the amount of physical activity completed per week. The results of the descriptive analyses show that 53% of older adults in senior housing are not meeting physical activity guidelines of at least 150 minutes of physical activity per week. However, this is not statistically significant since all p-values for physical activity are greater than .05% level of significance at .776. Additional services such as providing leisure activity support to older adults through peer monitoring or adequate recreational facilities in the community can aid in helping older adults achieve physical activity recommendations.