Objectives: The primary objective of this research was to inform the criterion validity of the single self-report depression screening question in the interRAI-Contact Assessment (CA) against the validated Depression Rating Scale (DRS) in the RAI-Home Care (HC) instrument. To achieve this objective, two overarching research questions were addressed: 1) What is the DRS cut-point best suited for the detection of a possible depressed mood state?; and 2) What are the consistencies in the prevalence rates of the CA’s single self-report depression question and the HC’s DRS detection measure? A secondary objective of this research was to explore the relationships of multiple depression-related outcomes with selected possible predictor variables to indirectly aid in the identification of a possible depressed mood state. Methods: Four datasets were obtained from the interRAI organization to inform this research. Three datasets, which house and concurrently administer both the self-report item and the DRS, were used to determine the best-suited DRS detection threshold through both univariate and bivariate analyses. The validity of the CA’s self-report item was informed through bivariate analyses with the HC’s DRS measure using the phi-correlation and the c statistic from the bivariate logistic regression model. Spearman and point biserial correlations and bivariate logistic regression modeling informed the relationships of the possible predictor variables with the depression-related outcomes. Results: The DRS one-plus threshold was determined to be the cut-point best-suited for the detection of a possible depressed mood state. Several predictor variables proved statistically significant but were not consistent across the three datasets. The CA’s single question did not evidence a strong association with the HC’s DRS measure. Conclusions: According to the resulting significance of the predictor variables, the experience and expression of depression across the three explored samples differ; the results from one sample cannot be generalized to explain the experience of the other samples. The DRS one-plus threshold is supported for the detection of a possible depressed mood state. However, the validity of the single self-report question in comparison to the DRS measure cannot be supported with the study’s results. However, due to recognized study limitations, the overall validity of the measure is not conclusive. Future research directions are recommended.

Introduction: Colon cancer is the third leading cause of cancer death among women in Canada. Although regular screening beginning at age 50 years can significantly decrease risk of colon cancer mortality, many eligible Canadian women have never obtained screening. Cancer screening rates among immigrant women to Canada are even lower than for native-born women. Disparities in the use of preventive cancer services by immigrants have been linked to limited acculturation and speaking a language other than English. Poor prose comprehension may frustrate access and use of preventive cancer information by older ESL immigrant women to Canada. In order to develop useful and actionable cancer prevention information, it is necessary to understand the barriers ESL immigrant women face in obtaining and using health and cancer information. Therefore, the primary objective of this research was to assess the relationship of acculturation on the prose comprehension of older ESL immigrant women to Canada. Methods: Interviews were conducted with 78 older adult Spanish-speaking immigrant women (aged 45 to 73 years) residing in Kitchener-Waterloo, Ontario. Acculturation was inferred by length of Canadian residency and measured using the Bidimensional Acculturation Scale (BAS). Several measures were used to assess comprehension including the shortened Test of Functional Health Literacy in Adults (S-TOFHLA), the Rapid Estimate of Literacy in Medicine (REALM), the Newest Vital Sign (NVS), and a modified Cloze procedure. The modified Cloze procedure was constructed using a one-page colon cancer information sheet created for the public by the Canadian Cancer Society. Four multiple linear regression analyses were used to test the relationship between the independent variables of acculturation (BAS) and length of Canadian residency, age, Spanish language education, employment, and media variables (television and internet use) on each measure of prose comprehension (i.e., dependent variables of scores on S-TOFHLA, NVS, REALM and Cloze). Logistic regression was used to test whether acculturation and comprehension predicted screening intentions. Semi-structured interviews were conducted to identify the women’s cancer information needs and preferences as well as the barriers they experienced in obtaining and understanding English language cancer information. Results: Three significant models predicting comprehension of colon cancer and health information were identified. The independent variables BAS, Spanish language education and television viewing explained 23% of the variation in Cloze comprehension scores (F=6.76; df=3; p < 0.01; R2= 0.23). Approximately 42% of the variation in S-TOFHLA scores among older ESL immigrant women was explained by the independent variables BAS, age, television viewing and internet use (F=12.13; df=5; p < 0.01; R2=0.42). Using REALM as the dependent measure of comprehension, BAS and television viewing explained 17% of the variation in scores (F=7.54; df=2; p<0.01; R2=0.17). BAS was the only significant predictor of the dependent comprehension measure NVS (F=5.36; df=1; p=0.02; R2=0.07). Logistic regression models predicting colon cancer screening intentions were not significant. Qualitative data analyses revealed that women’s colon cancer information needs, preferences and perceived barriers accessing English language information did not vary according to BAS score or duration of residency in Canada. All women requested actionable information that was community and culturally specific. Additional factors related to older ESL immigrant women’s comprehension of cancer information were identified. These included self-efficacy, social networks and mode of information delivery. These additional modes of information delivery included receiving health information orally as compared to written information. Conclusion: Acculturation (as measured by BAS) significantly predicted prose comprehension by older ESL Spanish speaking immigrant women across four separate measurement tools (Cloze, S-TOFHLA, REALM, NVS). Yet, the proportion of the variance in comprehension scores explained by acculturation and other demographic variables was low to modest, ranging from 7-42%. In addition to acculturation, self-efficacy and social networks may also be associated with prose comprehension. Low self-efficacy among older ESL immigrant women may be a barrier to information seeking and perceived comprehension. However, strong social networks may provide women with the confidence and resources necessary to access health information and services. These results highlight the need for the additional research regarding the influence of self-efficacy on ESL immigrants’ ability to find and use health and cancer information. Recommendations: This research has important implications for public health educators. Health educators are encouraged to develop cancer and health information for ESL speakers in Canada that is community, culturally and linguistically specific and which provides actionable information. This is especially salient given the changing demographic and cultural profile of Canadians. Also, among older ESL immigrants who struggle with language barriers, receiving health information orally may be preferred.

Persons 65 years or older are the fastest growing demographic in Canada (Government of Canada, 2011) and the need for 24-hour care and LTC support will continue to rise. An association is typically drawn between death and dying and the movement into LTC homes. Leisure can alternatively be important for promoting “living” and supporting wellness in residents. The notion of “living” in LTC shifts emphasis away from illness and death to placing value on wellness. This participatory action research (PAR) study aims to understand wellness from residents’ perspectives and the role leisure plays in their wellness. PAR stakeholders (family/care partners, staff, and residents) collaboratively discuss how to best attain, interpret, and disseminate resident perspectives on wellness and required supports. The PAR process highlights the necessity for academics and practitioners to involve residents in decisions about their care experience. Guiding questions include: (1) What does wellness mean to residents living in LTC? (2) What does a ‘well’ LTC home look like to residents? (3) What is the nature of the relationship between leisure and wellness from a resident perspective? (4) How can those involved in LTC support resident wellness? From the perspectives of residents living in LTC homes, findings inform a resident wellness model and provide insights into how wellness and “well” LTC homes can be better supported. Thus, filling a gap in the literature and shifting focus to living ‘well’ in LTC.

Fall-related injuries in adults over the age of 65 pose an important public health issue especially with an increasing number of older adults living in retirement homes and nursing homes. Safety floors have been developed as an intervention to reduce the risk of these injuries. However, their effects on balance control reactions had never been tested during certain activities of daily living in retirement home dwellers. This research investigated how balance reactions are affected by the mechanical properties of safety flooring in older adults. The safety flooring showed minimal impact on the balance reactions while retaining force attenuation properties. There were two studies as part of this thesis. The purpose of the first study was to determine whether the Nintendo Wii Balance Board (WBB) can be used as an appropriate substitution for a force plate when measuring balance reactions during common tests used to assess balance in older adults. Specifically, I characterized the technical specifications of the WBB and compared them to those of the force plate, showing that the two devices yielded similar responses during balance measures of quiet stance. The second study investigated the effect of two traditional floors and three safety flooring systems on balance control mechanisms (based on changes in underfoot centre of pressure) during sit-to-stand and quiet stance tasks in retirement home-dwellers. The results of this study provided evidence supporting the potential for safety floors to reduce fall-related injury risk without impairing balance and mobility of users. Additional research may want to assess WBB performance during dynamic tasks involving shear forces. The results from this study supports prospective clinical investigations of pilot installations of safety flooring in retirement and nursing home settings to evaluate their real life effects on fall related injuries.

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.

<p> Retirement is the quintessential transition from mid-life to late-life for many working Americans. However, questions about the positive and negative effects of retirement have sparked widely divergent empirical findings. Developmental theories of self-regulation may add to the understanding of the subtle differences and transitions within retirement. Retirement may be viewed as a transition in resources (e.g., psychological, social, and financial), so that individual mental health outcomes are linked to how well these resources are reallocated. According to goal disengagement perspectives, failure either in disengagement from past goals or reengagement in new goals can lead to decreased well-being and increased depression. Further, as individuals enter late-life, their focus may turn away from growth and achievement and more toward preventing losses and maintaining current resources. In the present study, it was hypothesized that when pre-retirement individuals were compared against early and late post-retirement individuals, engagement in developmentally relevant goals (e.g., self, family, and leisure) in retirees would be associated with better mental health outcomes while retirees who reported continued engagement in less developmentally accessible goals (i.e., occupational and financial) would report worse outcomes.</p><p>A total of 100 study participants (aged 50 to 84) were interviewed about their current goals and completed self-report measures of depression, well-being, social support, physical health, and regulatory focus. Interview data were coded for goal content as well as for regulatory focus. Findings did not support the hypotheses, as there were no significant differences among the 47 pre-retirement, 29 early post-retirement, and 24 late post-retirement participants in their goal content or regulatory focus. Goal content also was not associated differentially with depression or well-being among the three groups. However, the interview data did provide valuable information about the heterogeneous and fluid nature of retirement. Retirement, rather than a clear loss in certain resources (i.e., financial and occupational) and a clear gain in others (i.e., time and personal freedom), seemed to be a renegotiation of those resources. Furthermore, even pre-retirement participants named retirement goals, suggesting that, if a goal transition did occur, it may have been a more conscious, gradual process.</p> / Dissertation

It is widely held among cognitive aging researchers that older adults are at a disadvantage with respect to the division of attention between two or more concurrent tasks. Some researchers have attributed dual-task performance decrements to reduced processing speed with age while others have attributed declines in dual-task performance to the reduced efficiency of task coordination and control processes. Few researchers, however, have considered the possibility that age-related differences in dual-task performance may be related to underlying differences in the learning mechanisms supporting component task performance. Three studies were conducted which differed in the type of single-task training provided to young and old adult participants: Consistently mapped (CM), variably mapped (VM) and attenuated priority (AP) training. Skilled dual-task performance was then assessed as a function of both component task learning and age through a) the examination of initial and end-level skilled dual-task performance, b) transfer of learning to novel task combination and c) retention capability. It was predicted that type of component task training would moderate age-related differences in skilled dual-task performance. The results were confirmatory, however, were not completely consistent with initial predictions.

Homes that can collaborate with their residents rather than simply provide shelter are becoming a reality. These homes such as Georgia Techs Aware Home and MITs house_n can potentially provide support to their residents. Because aging adults may be faced with increasing mental and/or physical limitation(s) they may stand to benefit, in particular, from supports provided by these homes if they utilize the technologies they offer. However, the advanced technology in these aware homes often makes use of sensing devices that capture some kind of image-based information. Image-based information capture has previously been shown to elicit privacy concerns among users, and even lead to disuse of the system. The purpose of this study was to explore the privacy concerns that older adults had about a home equipped with visual sensing devices. Using a scenario-based structured interview approach I investigated how the type of images the home captures as well as the physical and mental health of the residents of the home affected privacy concerns as well as perceived benefits. In addition, responses to non-scenario-based open ended structured interview questions were used to gain an understanding of the characteristics of the influential variables. Results suggest that although most older adults express some concerns about using a visual sensing device in their home, the potential benefits of having such a device in specific circumstances outweigh their concerns. These findings have implications in privacy and technology acceptance theory as well as for designers of home based visual monitoring systems.

Regular walking has several physical and psychological benefits for frail older people. However, many residents in long-term care facilities are too sedentary to achieve these benefits. Indoor walking appears to be a feasible way to promote active living among these residents and yet, there is little research that has been done in this regard. The researcher conducted two studies in Central Texas to explore how corridor design features influenced indoor walking behaviors among assisted living residents. In the first study, the researcher carried out six focus groups with 50 assisted living residents, discussing how they perceived the indoor corridor as "walkable." Residents reported that a walkable corridor should be safe, comfortable, and having beautiful/interesting things to see. In the second study, the researcher further examined the relationship between the built environment and walking behaviors among 326 residents from 18 facilities in a major city of Texas. The results indicated that 'perceived looped corridor' and 'number of stories' were significantly associated with residents' frequencies of indoor recreational walking. In addition, the availability and quality of sitting space around mailbox areas influenced the number of "walking to mailbox" trips. This research provides empirical evidence to develop activity-friendly facility design guidelines, and to create environmental interventions to facilitate active lifestyles among long-term care residents.

Aging is a global phenomenon. Ways to sustain older adults' aging-in-place in the 'community at-large' (defined as traditional communities where most people live) have been overlooked. Consciously engaging in physical activity helps older adults to remain healthy and gives them the ability to access daily-life services, and thus extend their independent years at home. Nearby outdoor environments on residential sites and in the neighborhoods may influence older adults' independent living through physical activity. This study surveyed 206 older adults in 11 assisted-living facilities in Texas regarding their past physical activities when they lived in their own homes and perceptions of the residential site and neighborhood environments. Older adults are shown to have long-term recall ability and capable of reliably estimating their physical activities that occurred up to ten years ago. Geographic Information System (GIS) was used to verify the survey responses and further examine the objective measurements of environments on a subset of 117 participants' residences. Bivariate tests, factor analysis, and multivariate logistic regression modeling were conducted to identify environmental variables correlated to yard activities, neighborhood walking, and years of independent living at home. After controlling for personal and social factors in multivariate logistic modeling, three site features (transitional-areas, connecting-paths, and levels of pleasant indoor sunshine) have been found to influence yard activities; two site features (yard landscaping and corner lot location) and three neighborhood features (walking destinations, safety from crime, and sidewalks) have been found to influence neighborhood walking; one site features (transitional-areas) has been found to influence older adults' years of independent living in the community. Based on the results, guidelines were developed for designing friendly environments for older adults' active and independent living. Nearby outdoor environments on residential sites and in the neighborhoods appear to be important for older adults. The roles of residential site environments in shaping older adults' behavior and independence need more attention. To better understand environmental influences on older adults and promote aging-in-place, more empirical studies and longitudinal research are needed.