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.

The prevalence of adults 65 years of age and older with significant pain is 25% to 50%, with many experiencing pain on a daily basis. The financial toll due to chronic pain is staggering; American's spend nearly $635 billion annually on health care. The purpose of this mixed methods study was to better understand the relationship between resilience, general health, and chronic pain in older adults. The quantitative question pertained to the relationship between resilience and both levels of chronic pain and general health in elderly chronic pain patients, and the qualitative question addressed participants' lived experiences of chronic pain. Resilience theory, which suggests that individual strengths enable people to rise above adversity, grounded the study. Participants were between ages 65 and 75 and were recruited from 3 pain centers and through the Survey Monkey participant pool; they included 55 older adults with chronic pain who responded to surveys (including Resilience scale, the Pain Impact Questionnaire-Revised (PIQ-R) Pain scale, and the Short Form 12 item (version 2) (SF-12v2) Health Survey, and 10 of them also participated in interviews. Regression analyses found no statistical relationships between resilience and either chronic pain or general health. Interview participants noted that to cope with pain they used personal strength, a positive outlook, religion, spirituality, pain management, physical activity, rest/sleep, managing their life, and religion and spirituality. Resilient behavior was inherent across various pain diagnoses, and participants appeared to place a great value in the social networks formed throughout life. These findings may help medical practitioners have a better understanding of the relationship between chronic pain and resilience in an aging, at-risk population.

As individuals age, their likelihood of experiencing mental and physical problems increases, as does their risk of developing social isolation. Behavioral, physiological, and/or psychological changes are common manifestations of social isolation. Increased morbidity and mortality are the outcome. Ecological systems theory and social baseline theory provided the framework to explore 10 older individuals' perceptions of risk for social isolation and their perceived barriers to social integration. Data for this interpretive phenomenological study were collected from participant diaries, interviews, the 6-item de Jong Gierveld Loneliness Scale (DJGLS-6), the Lubben Social Network Scale 6 (LSNS-6), a demographic survey, and a social support profile. The Colaizzi method and interpretive phenomenological analysis were used to analyze diaries and interviews. Participant demographics, DJGLS-6, LSNS-6, and social support profile data were used to enrich descriptions of the participants and find other themes. Results indicated that most participants like living alone. However, more than half reported periods of loneliness and 4 reported estrangement from an offspring. Experiences of negative age-related treatment were described by many participants and most reported that transportation and mobility issues were the biggest barriers to social integration. Additionally, many participants reported that access to planned social activities would alleviate social isolation. Implications for positive social change arise from this research in the form of increased awareness of the experiences and perceptions of older individuals at risk for social isolation. Additionally, these findings can inform future research, policy change, and strategies for social isolation interventions and prevention.

Social workers working for adult protective services (APS) face many clinical challenges to ensure the safety and well-being of older adult clients. APS social workers often interact with older adults who engage in self-neglecting behaviors that compromise their ability to function in a healthy and independent manner. The purpose of this research study was to explore challenges in direct social work practice to identify how APS services can be improved when working with the older adult population, particularly individuals who engage in hoarding behaviors. Using action research methodology, 2 focus groups were conducted to explore the experiences and knowledge of social workers who are trained in APS and in-home supportive services programs and work directly with the older adult hoarding population when investigating cases of self-neglect. The theoretical framework of cognitive behavioral theory guided the analysis of focus group data to provide insights into understanding the core manifestations of hoarding and how social workers working with this population can provide appropriate services. The overall findings of the study resulted in identifying improvements to APS service interventions. Study findings inform recommendations that allow APS social workers to effectively work with older adults who exhibit hoarding behaviors, while also advancing professional development in the field of social work. Understanding practice challenges to appropriately serve older adults that exhibit hoarding behaviors is essential in effecting positive social change in the lives of vulnerable and disadvantaged older adults, APS agencies, and communities.

Older adults of Mexican origin are often underserved, especially those residing in nursing homes. Their number has increased in the past 4 years. There is a gap in the research literature on Hispanic elders, specifically those of Mexican origin, residing in nursing homes along the Texas-Mexico border. Because Texas has one of the fastest growing populations of Mexican elders, it is important to better understand this population. This nonexperimental study evaluated the relationship among risk factors' such as gender, marital status, family support, activities of daily living (ADLs) and participation in nursing home activities. These relationships were evaluated with a demographic questionnaire, the Geriatric Depression Scale, and the Beck Anxiety Inventory. The sample consisted of 150 individuals of Mexican origin, 55 years of age or older, residing in nursing homes in a Texas-Mexico border city. Two multiple regression analyses were used to examine the relationships between these variables. The results indicated that the risk factors account for 9.1% of the variance in depression and 11.7% of the variance in anxiety. Of the predictor variables, activities of daily living made the only significant contribution. Thus, a high score on activities of daily living (i.e., needs complete assistance) predicted higher depression and anxiety, while female gender predicted higher anxiety, and frequent family support predicted low anxiety. This new knowledge gain through this study has implications for positive social change: (a) nursing home staff and physicians can do a better job in referring residents for psychological services, (b) mental health professionals can help nursing home staff better serve this population, and (c) nursing home staff may hold more family events to increase family involvement with their loved ones.

Background: As the number of older adults in Thailand continues to increase, along with increased incidence of surgical intervention that causes pain, the quality of pain care in older adults is needed. Nurses are primarily responsible for assessing and managing pain in older adults (Jose Closs, 2008; Prowse, 2007). The use of evidence-based practices (EBPs) improves quality of care and saves healthcare cost. However, in Thailand where empirical study of using EBP related to pain in older adults is limited, research to understand how Thai nurses use EBP acute pain in older adults is needed.Purpose:The purpose of this study is to describe current practices, perceived barriers and perceived facilitators of Thai nurses on using EBP for assessing and managing acute pain in postoperative older adults.Method:A descriptive exploratory survey was conducted in 8 mid and large-size hospitals in Thailand. The Acute Pain EBP Questionnaire (APEBPQ) (Suwanraj, 2009) was distributed to 240 Thai nurses. 236 questionnaires were returned with the response rate of 98.3 percent. Open-ended questions related to barriers and facilitators of using EBPs were coded to identify major themes. MANOVA was performed to explore the differences between years of nursing experience on perceived barriers and facilitatorsResultsThe majority of participants are female (96.8%) with mean age 35.5 years (range=23-54). Thai nurses reported using 51/53 recommendations from EBPG Acute Pain most of the time/always (95%). Using an equianalgesic table (1.80±1.16) and assessing MMSE in older adults with postoperative pain (1.74±1.15) were occasionally used. Research reports published in English was the greatest barriers. Nurses perceived greatest support from a Head ward than other colleagues. Nurses with 11-20 years of nursing experience had higher reported barriers than those with 1-10 years of nursing experience.Practice Implications: This study will provide important information on barriers and facilitators of using EBPs related to pain assessment and pain management in Thailand. The results of the study will be used to develop strategies to promote the use of EBPs acute pain among Thai nurses who provide nursing care for postoperative older adults.

Continuity of patient care is an essential element of primary care because it should result in better quality care and disease management, especially for older adults who often have multiple chronic illnesses. Even though continuity of care has been studied for decades, it remains difficult to define and quantify and, there is no consensus about best practices for assessing whether or not a patient experiences it or a practitioner provides it. Moreover, no theoretically-driven measures for the assessment of continuity of care exist, and there have been few rigorous evaluations of its association with subsequent health and health service utilization outcomes. The principal purpose of this dissertation research was to better understand continuity of care for older adults by identifying the components of the patient-provider relationship that are important from the patient perspective, understanding how commonly used provider-proxy continuity measures relate to the patient experience, and evaluating whether the patient experience or provider-proxy assessments are associated with improved health and health services utilization. I used survey data from the 2,997 Medicare beneficiaries who participated in the 2004 National Health and Health Services Use Questionnaire (NHHSUQ) linked to their Medicare claims for 2002-2009. The NHHSUQ contained patient-reported data on usual primary provider, usual place of care, and the quality and duration of the relationship with their provider. By linking this information to their Medicare claims, I was able to evaluate both patient-reported and provider-proxy (claims-based) measures of continuity of care from two years prior to the survey, and evaluate the impact of continuity on health and health service utilization for five years after the survey. Study results indicate that the older adult patient experience of continuity is reflective of both relationship duration and patient-provider interaction during the care visit, and that most provider-proxy continuity assessments did not relate to patient perceptions. And, the patient and provider-proxy experiences of continuity had different relationships with important health outcomes. These results enhance our understanding of continuity of care for older adults and inform policymakers and researchers about aspects of continuity that are important for the health of older adults and the appropriate use of health care resources.

Increasingly, computer and Internet usage play a vital role in connecting individuals to the larger society. Many factors may influence computer ownership and frequency of Internet usage by retired older adults. This thesis applies two theoretical frameworks, Cumulative Inequality theory and Intergenerational Solidarity theory, to explore major factors that may influence retired older adults' computer ownership and their frequency of Internet usage. Special attention will be paid to issues of social inequality: including retirement status (respondent and spouse), availability of an employer-paid pension (respondent and spouse), accumulated wealth, income, educational attainment, and employer-paid health insurance (respondent and spouse). In addition, this thesis will explore issues of intergenerational solidarity, specifically, number of children and number of children living in the household in relation to computer ownership and Internet usage, in particular. This study uses the Wisconsin Longitudinal Study (WLS) data that were collected through phone surveys that were conducted in 2004.

Title: What explains variability in blood pressure readings? Multilevel analysis of data from 8,731 older adults in 20 Ontario Communities Objectives: Despite universal healthcare and drug coverage for adults aged 65 and over in Ontario, hypertension, a treatable condition, remains uncontrolled among many older adults. Moreover, there are geographic disparities in blood pressure and hypertension within and across Canadian provinces and territories. Using baseline data collected on 8,731 older adults participating in the Cardiovascular Health Awareness Program (CHAP) in 20 randomly selected Ontario communities, we investigated associations between systolic blood pressure (SBP) and individual- and community-level characteristics, controlling for self-reported use of blood pressure medications. Method: Older adults were recruited via invitation by local family physicians, public advertising and word of mouth to attend community pharmacy sessions. During the sessions, trained older adult volunteers assisted participants to complete a cardiovascular disease risk factor questionnaire and blood pressure assessments using an automated blood pressure measuring device. The Postal Code Conversion File Plus was used to confirm residence within one of the 20 study communities. A multilevel linear regression analysis with participants nested within communities was used to determine which individual- and/or community-level characteristics were associated with measured systolic blood pressure level controlling for self-reported use of blood pressure medication. Results: 4,706 participants (53.9%) reported the use of blood pressure medication. Mean systolic blood pressure (SBP) levels varied among the 20 communities from 128.1 mmHg to 134.7 mmHg for participants not using blood pressure medication and from 131.9 mmHg to 139.0 mmHg for participants using blood pressure medication. The intraclass correlation coefficients were very small: less than 0.2% of the total variance was between communities. Among participants not using blood pressure medication, SBP was associated with the following individual- level characteristics: age, sex, body mass index , smoking, physical activity, stress, fruit/vegetable intake, and alcohol consumption and the following community-level characteristics: community size, community growth and the Rurality Index. Among participants using blood pressure medication, SBP was associated with the following individual-level characteristics: age, sex, body mass index, diabetes, fruit/vegetable intake, alcohol intake and one community-level characteristic: community size. The significance and magnitude of these associations were modified by the use of blood pressure medication. Conclusion: The majority of the variability in blood pressure occurs at the individual-level. There are specific individual- and community-level factors that explain variability in blood pressure readings among communities. These results can be used to inform health promotion strategies to decrease mean levels of blood pressure among older adults.

The purpose of this study was to explore the meaning of physical activity experiences to older women. A qualitative hermeneutic phenomenological design was used. A purposeful sample of 9 women, age 67 to 83 years old, enrolled in a group physical activity program participated in the study. Data was collected through in-depth semi-structured interviews, artifact documentation, and descriptive and reflective fieldnotes. The transcripts and significance of the artifacts were analyzed using thematic line-by-line analysis. Three themes emerged from the thematic analysis, trading roles, a happier me, and pride and delight. <p>Trading roles refers to the womens perceptions of a new era of their lives given the transition experienced in their life roles. Many of the things they considered stable in their lives changed. Friends dropped away, family moved, they no longer fulfilled the role of wife, and their active grandmothering period was ending. <p>The theme, a happier me, speaks of the impact their involvement in a physical activity program had on their social lives. Living as widowed or single women, they recognized that they could become isolated within their own homes. Engaging in a physical activity program provided a context where they could expand their social network. The interaction with others in a physical activity program brought a sense of happiness and well-being to their days.<p>The theme, pride and delight, captures the deep understanding of their own sense of well-being and took pride in planning and developing the physical activity program. The assumption that more knowledgeable others must plan, implement, and evaluate programs to meet the needs of older adults was challenged by these participants. <p>The meanings of the experiences were interpreted with the support of Weiss (1973) theoretical framework on loneliness. The results of the study highlighted the importance of the contacts made in the physical activity program to the social network of the women, including provisions of attachment, nurturance, and social integration. Physical activity programs for older adults have the potential to expand the social network of older adults and with further research may prove to be an effective intervention for social isolation and ultimately loneliness.