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.

Powered wheelchairs offer a means of independent mobility for older adults who are unable to walk and cannot propel a manual wheelchair. Unfortunately, cognitively impaired older adults may be denied this means of independent mobility. There is concern that these adults are unable to drive a powered wheelchair safely or properly. Intelligent wheelchairs offer an approach to address this problem. This research outlines the development and evaluation of an Intelligent Wheelchair System (IWS) that is proposed to make powered wheelchairs safer and easier to use for cognitively impaired older adults. The IWS has anti-collision and navigation functions. Hardware results show a 1000% increase in computational speed compared to the previous IWS. Clinical results with dementia patients show that the IWS has the potential to increase safety by reducing frontal collisions, and by promoting safe completion of movement tasks. Usability of the system may be an issue.

The onset of dysphagia (swallowing difficulty) is associated with increasing age and the diseases that frequently occur with increasing age. Dysphagia increases the risk of dehydration and malnutrition with subsequent declines in body composition, physical health, and quality of life. The purpose of the present study was to administer a set of valid objective and perceptual measures to document (a) physical health, and (b) nutrition and hydration, relative to (c) swallowing function in 15 self-reported healthy older women in a Continuing Care Retirement Community. Statistically significant (p < 0.05) correlations were identified between perceived physical health, emotional well-being, and reflux symptoms and objective measures of breathing capacity, blood oxygen level, and tongue strength and endurance. The consumption of a regular, unrestricted diet was significantly associated with Eating Duration and Eating Desire on the Swallowing Quality of Life (SWAL-QOL) survey. Objective measures and participants’ responses on the SWAL-QOL identified a subgroup of older adults who were experiencing swallowing difficulties. Results confirm the importance of including both objective and perceptual measures of physical health, nutrition, hydration, and swallowing function in a screening protocol for older adults in residential care to identify those at-risk for developing dysphagia. / Thesis (M.S.)--Wichita State University, College of Health Professions, Dept. of Communication Sciences and Disorders

Powered wheelchairs offer a means of independent mobility for older adults who are unable to walk and cannot propel a manual wheelchair. Unfortunately, cognitively impaired older adults may be denied this means of independent mobility. There is concern that these adults are unable to drive a powered wheelchair safely or properly. Intelligent wheelchairs offer an approach to address this problem. This research outlines the development and evaluation of an Intelligent Wheelchair System (IWS) that is proposed to make powered wheelchairs safer and easier to use for cognitively impaired older adults. The IWS has anti-collision and navigation functions. Hardware results show a 1000% increase in computational speed compared to the previous IWS. Clinical results with dementia patients show that the IWS has the potential to increase safety by reducing frontal collisions, and by promoting safe completion of movement tasks. Usability of the system may be an issue.

Social cognition is a fundamental aspect of human experience that enables us to have relationships with and understanding of other people. Social relationships have been shown to mitigate cognitive decline in old age and benefit cognitive functioning, and the social interaction on which these relationships rely requires an extensive network of cognitive processes, and by extension neural systems, that have not, as of yet, been widely studied in older adults. Nor has the function of these systems been tied to social relationships in the real world. Here, I will compare self-reports of real-world quality and extent of social networks with behavioral and neural measures of other-regard in the laboratory. It is hoped that by so doing we will be able to link social neuroscientific measures in the laboratory with persons’ perceptions of the quality and extent of their social relationships. In this study, other-regard in older adults was operationalized with a reaction-time measure in an implicit turn-taking task, neural measures were provided by dense array EEG, and all participants also completed self-report measures of empathy subscales and of the quality and extent of their social networks. I found that measures of empathic personal distress decreased with increased other-regard (r = -0.36, p = 0.01, beta = 0.47), while increased quality and extent of social networks associated marginally with increased other-regard (r = 0.20, p = 0.11, beta = 0.39). Neural analyses are ongoing and are expected to show differential activation consistent with cognitive processes such as theory of mind, empathy, joint attention, and executive control.

Many researchers have explored the way younger people perceive weight ratios using a variety of methodologies; however, very few researchers have used a more direct ratio estimation procedure, in which participants estimate an actual ratio between two or more weights. Of the few researchers who have used a direct method, the participants who were recruited were invariably younger adults. To date, there has been no research performed to examine how older adults perceive weight-ratios, using direct estimation or any other technique. Past research has provided evidence that older adults have more difficulty than younger adults in perceiving small differences in weight (i.e., the difference threshold for older adults is higher than that of younger adults). Given this result, one might expect that older adults would demonstrate similar impairments in weight ratio estimation compared to younger adults. The current experiment compared the abilities of 17 younger and 17 older adults to estimate weight ratios, using a direct ratio estimation procedure. On any given trial, participants were presented with two weights, and were asked to provide a direct estimate of the ratio, with the heavier in relation to the lighter. The results showed that the participants’ perceived weight ratios increased as a linear function of the actual weight ratios and that compared to younger adults, the older adults overestimated the weight ratios. The age-related overestimation was especially pronounced at higher weight ratios.

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.