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.

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We investigated the concurrent effects of arousal and encoding specificity as related to background music on associative memory accuracy. Extant literature suggested these factors affect memory, but their combined effect in musical stimuli was not clear and may affect memory differentially for young and older adults. Specifically, we sought to determine if music can be used as a mnemonic device to overcome the associative memory deficits typically experienced by healthy older adults. We used a paired-associates memory task in which young and older adults listened to either highly or lowly arousing music or to silence while simultaneously studying same gender face-name pairs. Participants' memory was then tested for these pairs while listening to either the same or different music selections. We found that young adults' memory performance was not affected by any of the music listening conditions. Music listening, however, was detrimental for older adults. Specifically, their memory performance was worse for all music conditions, particularly if the music was highly arousing. Young adults' pattern of results was not reflected in their subjective ratings of helpfulness; they felt that all music was helpful to their performance yet there was no indication of this in the results. Older adults were more aware of the detriment of music on their performance, rating some highly arousing music as less helpful than silence. We discuss possible reasons for this pattern and conclude that these results are most consistent with the theory that older adults' failure to inhibit processing of distracting task-irrelevant information, in this case background music, contributes to their elevated memory failures.

Adjustment to assisted living does not always proceed smoothly, making it imperative to identify predictors of transition difficulties, such as personality factors. The sample for this cross sectional study included 64 older adults from ten assisted living communities in the southeast. The primarily white, well-educated, and female sample had an average age of 86 years. Correlation was used to examine relationships between individual personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and adjustment. Factor analysis determined both the predictor variables and outcome variables for inclusion in regression analyses. The regression analyses examined the predictive capacity of personality relative to other associated indicators on adjustment. Hermeneutic phenomenological analysis of responses to an open-ended question regarding subjective adjustment was also conducted. Regression analysis found that participation in community activities, satisfaction with food quality, and ability to set one’s daily schedule were important predictors of adjustment. Above and beyond these predictors, neuroticism was found to predict adjustment, indicating that personality does play a role in determining adjustment to assisted living. The responses to the open ended question echoed these results and revealed additional salient issues and barriers related to resident perceptions of adjustment. Implications for practice and future research are discussed.

Rationale and study aims: Persons with mild cognitive impairment (MCI) experience declines in everyday functioning and cognitive performance greater than what is experienced in normal aging but less than that of dementia. Daily stress and daily memory complaints associated with cognitive deficits may contribute to greater psychological distress in the day-to-day experiences of persons with MCI. However, research examining the occurrence of daily stressors, daily memory complaints and psychological distress in MCI is limited, and it is not clear how the daily processes of stress and affect in persons with MCI compare to cognitively healthy older adults. This dissertation examined the occurrence of daily stressors, daily memory complaints, retrospective and daily well-being in persons with MCI compared to cognitively healthy controls. Main analyses examined whether daily stressors and daily memory complaints were associated with worse daily affect in MCI participants compared to controls, and whether increased daily stress was associated with a greater number of memory complaints. Methods: The study used a short-term repeated measures design, and included MCI and control participants recruited from a university-based memory clinic. The interviews consisted of a baseline interview and up to eight consecutive days of brief daily phone interviews. The interviews included both retrospective and daily measures of psychological well-being, daily stressors, daily memory complaints, and open-ended questions about daily experiences. Results: Persons with MCI reported a greater number of daily memory complaints and worse psychological distress, as measured by both retrospective and daily reports. There were no significant differences between MCI and control participants, however, in the frequency of daily stressors. In both unadjusted and adjusted analyses, on days when a participant reported more daily stressors, they had higher negative affect. The stress-negative affect relationship was stronger for MCI participants compared to controls. MCI and control participants who reported more memory complaints, on average, had higher negative affect. Discussion: Daily stressors were disproportionally associated with greater psychological distress in MCI participants as compared to cognitively healthy controls. Interventions targeting the potential distress associated with daily life may be beneficial for psychological well-being in persons with MCI. Future research should examine other potential mechanisms of distress in daily lives of persons with MCI in order to inform relatives and caregivers of persons with MCI, clinicians who give diagnoses to their patients, and individuals providing community support for individuals living with MCI.

This study examined the impact of oncology social workers’ expectations regarding aging and expectations regarding aging with cancer on their emotion and clinical judgment using path analysis. The data was collected via an on-line survey distributed through the Association of Oncology Social Workers’ listserv. Participants were randomly assigned one of four vignettes that described a patient diagnosed with lung cancer. The vignettes differed by the age (78 or 38) and gender (female or male) of the patient, while the content remained the same. Oncology social workers’ expectations regarding aging were measured to provide an understanding of their beliefs about the aging process with respect to physical health, mental health, end-of-life, and cancer and mental health. These responses were utilized to predict oncology social workers’ clinical judgment during three judgment phases, i.e. anticipatory, diagnostic and treatment. Emotion was evaluated as a possible indirect effect between expectations regarding aging and clinical judgment. Age differences across gender were examined. Overall, the research supported the hypothesis that practitioners’ expectations regarding aging and expectations regarding aging with cancer influence their emotion and clinical judgment. However, the results suggest a disconnection between diagnosis and treatment judgment. Though practitioners were able to diagnose depression and prioritize it highly, the prioritization of treatment for this depression was very low. Moreover, this research suggests that “preparation for end-of-life” and “mental health with cancer” are viable components of the “expectations regarding aging” construct. The results of this study have implications for social work education, practice, policy and research. / text

BACKGROUND: Streptococcus pneumoniae is the primary causative agent of pneumonia in older adults. Vaccination is the only tool to protect against pneumococcal infection; however, vaccination rates remain far below the Healthy People 2010 objective of 90% coverage. The number one reason for such low rates is attributed to controversy over the protective efficacy of the vaccine in preventing nonbacteremic pneumonia (eg, community-acquired pneumonia [CAP]). OBJECTIVES: The primary objectives of this study were to assess the incidence of pneumonia, pneumonia requiring hospitalization, and pneumonia hospitalization costs. METHODS: In this retrospective cohort study of Medicare beneficiaries aged 65 years in 2003, subjects were selected based on exposure status. Exposure was defined as receipt of the 23-valent pneumococcal polysaccharide vaccine (PPV23). Vaccinated persons were then matched 1:1 on gender and the presence of any comorbidity to unvaccinated persons. Subjects were followed up for 1 year (January 1, 2004 through December 31, 2004). The primary outcomes were pneumonia, pneumonia requiring hospitalization, and hospitalization costs. Mantel-Haenszel chi-square or logit was used to estimate the relative risk (RR) associated with vaccination and each outcome and Proc Ttest was used to test the difference between mean hospital costs of the vaccinated and non-vaccinated. RESULTS: During the follow-up period, 443 patients were diagnosed with pneumonia; 266 had previously been vaccinated and 177 had no documented receipt of prior vaccination. Results of the Chi-square analysis revealed a significant association between vaccination and the risk of pneumonia, as the vaccinated were 50% more likely to develop pneumonia than were the non-vaccinated (Adjusted RR: 1.50; 95% CI: 1.25, 1.81). Approximately 67% of patients diagnosed with pneumonia required hospitalization; of which, 183 were previously vaccinated and 115 had no documented receipt of prior vaccination. There was no association between vaccination and risk of pneumonia requiring hospitalization (P value 0.4001). However, the vaccine was associated with a significant reduction in hospital costs (P value 0.004). CONCLUSIONS: The results of this study suggest that use of the vaccine may be associated with cost savings due to a reduction in hospitalization.

Increases in the proportion of older people in Canada have focussed needed attention on the issues and concerns for this group. One prevalent issue is the nature of experiences of intimate partner violence (IPV) for older adults. These experiences have been overlooked in the domestic violence theory and research where the focus has been on the needs of younger women and also within the elder abuse research and literature where the emphasis has been placed on aging (dementia) and caregiving. As a result, less is known about the experiences of older adults in intimate relationships and how the power and control dynamics manifest and shift within the context of long-term relationships. How do these dynamics change or remain the same in intimate relationships of older adults? How do the victims resist the violent and controlling tactics of perpetrators and how does this resistance influence and shift the nature of power and control in these intimate relationships? Using techniques borrowed from grounded theory, this study was undertaken with the aim of exploring power and control dynamics in intimate relationships of older adults in long-term abusive relationships. The findings demonstrated by the victims reported that their partners used different forms of violent tactics in the early years of these intimate relationships and typically used more nonviolent coercive controlling tactics in later years. In some of the relationships, control continued past the period of separation and divorce. Victims presented themselves as active agents and demonstrated resistance that was more overt in the early years, which became more subtle and discreet as these relationships matured. For victims, resisting their partners’ efforts to control them provided them with some momentary power in the relationship; however, the participants’ control was mostly situation-specific and temporary. For victims who were still living with their abusive partners, resistance allowed them to set boundaries with their partners and provided them with some space of their own within their relationships to engage in activities of their choice. These boundaries, however, are under constant scrutiny by the abusive partners and although victims demonstrate resistance to assert their dignity, the overarching control continued to be with the abusive partner. Narratives also provided by the participants also demonstrated the impacts of intimate partner violence to their sense of health and well-being. / October 2015

Life review involves a systematic, chronological review of an individual’s life from birth to death as well as an examination of the meaningfulness of life experiences and events. The purpose of the current study was to discover the effects of life review on happiness and life satisfaction in the older population. Participants from 71 to 85 years of age completed a demographics questionnaire, the Subjective Happiness Scale (SHS) and the Satisfaction With Life Scale (SWLS). SHS and SWLS were completed every other day from the beginning to the end of the data collection process. Once a consistent baseline was reached for the individual, the life review process began. Participants shared experiences from childhood and adolescence, adulthood, and older adulthood during the course of three sessions. At the end of the third session, participants were asked to write a letter to their younger self. It was hypothesized that engaging in the life review process would increase life satisfaction and happiness in the elderly. Results revealed that the life review intervention did not affect participants’ levels of life satisfaction and subjective happiness, with the exception of participant four who displayed increases in these variables.

Studies in countries across the globe and in Canada show that people from minority communities generally tend to be in poorer health, experience a greater burden of disease and disability than the general population. A 2008 World Health Organization (WHO) report on the Social Determinant of Health stressed that the high burden of disease and disability around the world is due to a great extent, to poor and unequal living conditions which are the consequence of deeper structural conditions such as poor social policies and programmes, inequitable economic structures, and deficient politics. In Canada, there is a growing body of evidence suggesting a negative impact of health disparities on Official Language Minority Communities (OLMCs), especially on Francophones outside of Quebec. In order to better describe and understand the situation of Official Language Minorities (OLMs), especially of Minority Francophone older adults living outside of Quebec, two national surveys were used: The 2006 Canadian post-census Survey on the Vitality of Official Language Minorities (SVOLM) and the 2007 Canadian Community Health Survey (CCHS). Descriptive, and multivariable analyses were conducted, followed by minority Francophone community members’ feedback on the findings. A qualitative analysis of provincial/territorial French-language (English in Quebec) services policies or legislations was subsequently conducted with an in-depth focus on the Government of Saskatchewan French-language Services Policy and an assessment of the potential impact of these policies on the health of OLM older adults. This study showed that minority Francophone older adults consistently rated their health more poorly than their counterparts in the general population but the study failed to demonstrate an association between OLM status and self-rated health, due to low representativity of the OLM population in the sample. However, the sense of belonging to, and vitality of minority community were constructs associated with better self-rated health for minority Francophone older adults while high concentration of minority group was associated with poorer self-rated health. Feedback from Francophone community members emphasized the detrimental role of assimilation, systemic and structural inequities, and unfavourable policies as contributing significantly to the low vitality of their communities and eventually to health disparities. Adopting new sampling approaches for OLMs, addressing minority Francophones’ contextual realities, enhancing access to health services in French, improving the linguistic environment, and developing more supporting policies, would help improve the condition of minority Francophone older adults in Canada.