Identifying depressive symptoms in community-dwelling elders has been problematic, due to a lack of resources and training for health clinicians. Previous researchers have indicated that older adults who engage in physical activities can prevent, or mitigate depression, but no model has included this variable in conjunction with factors such as lifestyle or sociodemographic characteristics. In this study, a predictive design was used with a regression analysis. The purpose of this quantitative study was to investigate the relationship between depressive symptoms and the different factors identified in the literature as significant contributors to its prevalence among older community-dwelling adults. Erikson's theory of psychosocial development, Beck's cognitive model of depression, and the learned helplessness model were used as the theoretical foundations to determine whether lifestyle activities, perceived social support, sociodemographic variables, and comorbidities can predict depressive symptoms. The sample consisted of 156 older adults who were 60 years of age and older and living in Northern Louisiana. Pearson correlation analysis and multiple regression analyses were used to investigate whether (a) daily lifestyle activities, (b) community setting (rural or urban), (c) gender, (d) perceived social support, (e) marital status, and (f) comorbidities can predict depressive symptoms. The 2 primary predictors of depression among older adults were low activity levels and low perceived social support. Positive social implications include improving counselors' and mental health practitioners' knowledge of the ways to lessen the depressive symptoms experienced by the elderly population.

Quality of life (QOL) is an important aspects of overall well-being in older adults. QOL is associated with functional, physical, and psychological health; all of which can be improved with increased physical activity. A high fall risk is associated with low physical function and QOL. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. Bingocize® is a health promotion program designed to promote health, health knowledge, physical activity, and social engagement among older adults. The purpose of this study was to determine the effects of the new version of Bingocize® on QOL and fall risk in community-dwelling older adults (N=36; mean age 73.63 ± 6.97). Participants were clustered and randomly assigned to (a) experimental (n=19; participating in Bingocize® program, which included the bingo game, exercise, and health education) or (b) control (n=17; only played bingo). Each group completed a 12-week intervention that consisted of two 45-60 minute sessions per week. Pre and post data assessments included the TUG, 30-second chair stand, 4-staged balance, handgrip strength, WHOQOL-BREF, PANAS, and a health knowledge quiz. A mixed design analysis of variance (ANOVA) was used to compare intervention effects. There were no significant interactions for any of the variables, with the exception of positive affect (PA) (F (1,34) = 5.66, p = 0.02, 𝜂𝑝 2 = 0.15, power = 0.64) and handgrip strength (F (1,34) = 8.31, p = 0.007, 𝜂𝑝 2 = 0.196, power = 0.80).. There was also a significant main effect for time for health knowledge. Post hoc analysis using independent samples t-tests were conducted on PA (t (33) = 2.39, p = 0.023, two-tailed) and handgrip strength (t (34) = 2.85, p = 0.007, two-tailed). Participating in the Bingocize® health promotion program can produce a meaningful and detectable change in handgrip strength and PA in community-dwelling older adults.

Individuals in certified nursing facilities (CNF) often experience social isolation and have limited opportunities to exercise. Bingocize®, an evidence-based healthpromotion program, is a combination of exercise and Bingo and provides opportunities for CNF resident interaction. Limited tools are available to quantify social engagement displayed by nursing home residents. Research suggests that intergenerational programming can positively affect social engagement. The present pilot study focused on the implementation of the Fun and Social Engagement (FUSE) evaluation to measure social engagement displayed by nursing home residents during Bingocize® sessions. The FUSE combined observation and self-report measures to yield a total social engagement score. Social engagement data were collected during Bingocize® sessions with university students interacting with residents and without student presence. Participants (M age = 82) included 35 residents from certified nursing facilities in Kentucky that receive funding from the Civil Money Penalty grant by Centers for Medicare and Medicaid Services. The purpose of this study was to determine if participants display increased positive social engagement during Bingocize® sessions when students are present versus when they are not, as well as if there is a difference between the participants’ self-report measure of engagement versus the observational report. Data were collected across four Bingocize® sessions, two with intergenerational programming and two without. Paired t-tests were conducted to determine overall participant engagement scores with and without student presence. Because of absenteeism, only two of the comparisons had a sufficient number of participants to analyze the effect of student presence. Comparing scores of the same residents, FUSE scores were higher in sessions with students present versus when students were not (p < .05). A two-sample t-test revealed that residents who reported happiness had higher observational scores than those who reported they were not happy. The results of this pilot study are tentative due to limited number of participants at some of the sessions. Future studies are needed to determine reliability of the FUSE. Nevertheless, this study suggests that the FUSE is a feasible tool for measuring fun and social engagement during Bingocize® and that university students have a positive effect on resident social engagement.

With medical advancement and technology, generations are living longer. The process of aging is accompanied by development of chronic disease, reduced physical function, and increased risk of mortality. Older adults do not meet dietary requirements for fruits and vegetables due to lack of access, early satiety, socioeconomic factors, etc. Without proper attainment of fruit and vegetable recommendations, older adults are placed at risk of chronic disease. Interventions exist to help bridge the gap between older adult nutrition and currently established dietary guidelines. Built environments, such as community gardens, have received attentions in the public health arena as a successful way to engage the older adult population with benefits ranging from improved dietary behaviors to increased socializations and improved mental health. Many services for older adults are financially supported through the Older Americans Act. Interventions between community and academic entities require collaborative effort of the researchers at the university, the community members, as well as cooperative extension. Successful interventions engage all levels of the socioeconomic model. Engagement of all program stakeholders as well as clear communication and group collaboration serve as critical necessities in supporting a sustainable intervention of this kind.

With a rapidly growing lesbian and gay older adult population, it is important to understand the attitudes and perceptions held by older adult service providers. A questionnaire was distributed to San Bernardino County's Area Agency on Aging's service providers with the purpose of exploring and assessing their attitudes and perceptions toward lesbians and gay clients. The study consisted of a secondary data analysis with a total of 145 cases. Results indicated that African American participants reported the most positive perceptions of how current agency clients might react toward their lesbian and gay peers whereas Latino/a participants reported the least positive perceptions. Participants that identified themselves as volunteers or students reported the lowest levels of awareness of lesbian or gay clients as well as the lowest levels of comfort in working with this population. Older participants reported the least positive perceptions of how agency staff would react to lesbian and gay clients. With the exception of the aforementioned results, participants' awareness of lesbian and gay clients within the agency, their perceptions of how staff and other clients would treat this population and their comfort levels reveals a general lack of understanding of the needs of the older adult lesbian and gay population regardless of participant ethnicity, gender, role within the agency and age. Recommendations include ongoing cultural competency training, the inclusion of sexual orientation in the intake assessment process, ensuring a safe environment, and the development of services aimed at responding to the needs of lesbian and gay older adults.

As older adults live longer, demand for supportive care will increase. Older adults will need a form of long-term care to manage their health and quality of life. As older adults age, they’re susceptible to having one or more chronic conditions. In taking measures to manage the chronic conditions of many older adults, in-home supportive services is a supportive program that provides non-medical personal and instrumental services to help older adults with their activities of daily living. An in-home supportive service allows an older adult to receive assistance and remain comfortably living in his or her home. However, an older adult of low-income status may not receive this information on supportive services. Therefore, this study was designed to assess the level of awareness low-income older adults have on in-home supportive services. This research design was quantitative focusing on measuring the level of awareness among low-income older adults. A survey instrument was created and given to older adults at a senior center of the County of San Bernardino. IBM SPSS Manual on Windows Software was used to input and analyze data. The findings of the study found a low level of awareness of the program called In-Home Supportive Services (IHSS) and participants understanding of in-home supportive services was unclear. This study provides recommendations for social workers to address the barriers of low-income older adults acquiring information on in-home supportive services.

Background: Antibiotic overuse/misuse has been documented in several reports to increase the risk of Clostridioides difficile (C.diff) infection and antibiotic resistance. The older adult population is more prone to use antibiotic medications than any other age group due to decreased immune function, use of urinary catheters, ventilation during hospitalization and other factors. Antibiotic resistance and C.diff are major public health problems. However, studies examining the trends of antibiotic use and the association between the antibiotic use and negative health outcomes among older adults in the outpatient and emergency department settings are limited. Objectives: The main objectives of this dissertation were to: 1) calculate the national antibiotic trends among community-dwelling older adults in the United State; 2) evaluate the antibiotic trends and antibiotic appropriateness among older adult patients visiting the geriatrics clinic and adult internal ambulatory care clinic at VCU Health; and 3) examine the antibiotic trends and antibiotic appropriateness among older adult patients and middle-aged patients visiting the emergency department at VCU Health. Methods: For the first objective, data were obtained from Medical Expenditure Panel survey (MEPS) a nationally representative dataset (2011-2015). Descriptive analyses were conducted and multiple logistic regression was performed to assess the association between the antibiotic use and demographic and sociodemographic characteristics. In the second objective, data were obtained from VCU Health outpatient clinics (geriatrics, and Internal medicine ambulatory care clinic only). Descriptive statistics were calculated and multiple logistic regression was performed to assess the association between antibiotic appropriateness and type of clinics and other demographic characteristics. In the third objective, the emergency department electronic medical records at VCU were used. Trend analysis was performed across the dissertation studies using the Cochran–Armitage test. All variables were considered statistically significant at an α level of 0.05. All the statistical analyses were conducted using the Statistical Analysis Software Version 9.4 (SAS v.9.4), (SAS Institute Inc, Cary, NC). Results: There were 105,762,134 prescriptions dispensed to older adults in the outpatient setting in the US from 2011 to 2015. Antibiotic prescriptions were more common among women (18%) compared to men (12%). White participants received more antibiotics (27%) than African Americans (1.77%) and others (1.4%). Among the 3,515 patients who visited either Geriatrics or Internal Medicine ambulatory clinic at VCU Health from 2012-2017, 1,534 antibiotics were prescribed. Potentially inappropriate antibiotic prescriptions were similar between the two clinics (30% in Geriatrics clinic and 28% in Internal Medicine ambulatory clinic) with p-value of 0.08. In addition, 6,343 middle-aged or older adult patients were dispensed and prescribed an antibiotic in the ED at VCU Health from (2012 to 2017). Eighteen percent of the antibiotic prescriptions received by middle age group were considered potentially inappropriate, compared to 9% among the older adult patient (p < 0.0001). Conclusions: The rate of antibiotic use overall remains unchanged despite the national and international efforts to reduce antibiotic prescriptions and eventually to reduce antibiotic resistance. The changes in the patterns of use in some of the antibiotic categories appear to be driven more by the safety concerns rather than reducing overall use. Future research is needed to strengthen antibiotic stewardship programs for older adults in outpatient settings.

With the rapid urbanization, the urban residents' demand for urban public parks is increasing. As a unique and representative age group, older adults put forward new requirements for the evaluation and rational planning of urban parks. Park accessibility is an important index reflecting the rationality of park layout, the accessibility of residents to the park and the social equity of park services. In this paper, buffer analysis and network analysis based on the ArcGIS platform were selected to analyze service accessibility and green transportation accessibility of The Villages metropolitan area of Florida respectively and then make a summary analysis. In particular, this paper chooses service area, common facilities, and recreational amenities as the evaluation factors of service accessibility. Besides, the coverage area of three modes of green transportation, namely walking, public transportation and bicycle, in different periods is selected as the evaluation factor of green transportation accessibility in this paper. The results show that: 1) The accessibility level of the study area is generally low, and more than half of the study area is not within the service scope of the park. 2) The urban parks serving the study area are relatively unevenly distributed; the road network is imperfect, and there are open circuit and blank area. 3) Park accessibility ratio of four modes of transportation in different time levels motor vehicles > bicycles > walking > public transportation. The research results can provide a reference for the optimization of the spatial layout of public parks in age-friendly cities.

Lack of trust in technology, personal preference, and perceived inability to use online services are possible reasons for lagged adaptation to electronic government (e-government) among older adults in the United States. Although e-government policies promote, or require, that many public services be provided electronically, it is unclear whether older adults are able, or willing, to access such services. The purpose of this qualitative, exploratory study was to gain insight from older adults (e.g., "individuals who are 65 years or older") about their ability and willingness to access e-government services in a mid-Atlantic County. The framework for this research was Roger's diffusion of innovation theory. Data were collected via interviews with 21 older adults and then inductively coded and subjected to a thematic analysis procedure. Most participants reported using e-government services in some capacity, while the remaining 10% did not because of vision issues, the overabundance of information, personal dislike of technology, and/or the belief that e-government was not conducive for self-management. However, 28% of the participants who had used e-government preferred face-to-face interactions with people instead of online servicing while also recognizing the benefits of e-government services in terms of convenience. Moreover, participants suggested that e-government usage might improve if explanations of online terminology, examples of services, and instruction on primary online services, such as web services, are offered. The study may contribute to positive social change by providing information that federal, state, and local government officials can use to develop policies for e-government accessibility, types of services, and alternative options for the aging population.

Falls and injuries related to falls are some of the most common and costly incidents that occur in the long-term care environment. Purposeful hourly rounding is a proactive way for nursing staff to identify patient needs and demonstrate positive fall prevention outcomes. This project examined a process improvement endeavor of a long-term care unit that experienced an increase in the number of falls over 3 months. The purpose was to evaluate whether staff education and implementation of an evidence-based hourly rounding program would affect the number of patient falls. The Johns Hopkins nursing evidence-based conceptual model, Kurt Lewin's change model, and the Shewhart cycle process improvement model were used to implement the change process as well as the Studer Group best practice hourly rounding tools. A sample of 40 residents was included in a quantitative descriptive design describing the implementation of hourly rounding. Staff were educated 30 days prior to implementation. Pre and post project fall rates were retrieved from the VA fall data management system and revealed a 55% decrease over 3 months post staff education. The use of evidence-based hourly rounding measures increased over the same time period. Nurse leaders must ensure rounding programs are evidence-based, clearly defined in policies, and include robust education plans. There are limited studies on the relationship between education and hourly rounding; therefore, future studies should focus on outcomes of initial and ongoing education for program success and sustainability. Falls are a healthcare concern nurses must address at any point-of-care to promote public safety through prevention and to facilitate positive social change by providing a safe hospital environment.