R??sum?? : Les liens entre les maladies dermatologiques et les troubles de sant?? mentale, dont la d??pression, sont reconnus depuis longtemps. Cependant, peu d?????tudes de population ont examin?? cette probl??matique et aucune n???a ??t?? faite aupr??s des a??n??s. Le but de ce m??moire est d???explorer l???association entre les affections dermatologiques et les troubles d??pressifs chez les personnes ??g??es vivant ?? domicile. Pour ce faire, deux ??tudes ont ??t?? r??alis??es. La premi??re visait ?? d??crire les caract??ristiques dermatologiques de la population ?? l?????tude et la deuxi??me avait pour but de tester l???hypoth??se d???une association bidirectionnelle entre les probl??mes mentionn??s. Il s???agit d???une analyse secondaire des donn??es de l???Enqu??te sur la Sant?? des A??n??s (ESA) qui a ??t?? men??e aupr??s d???un ??chantillon repr??sentatif de la population ??g??e (??? 65 ans) vivant ?? domicile au Qu??bec. Des mesures r??p??t??es ?? un an d???intervalle (T1 et T2) ont ??t?? obtenues aupr??s de 2 cohortes successives fixes. Les donn??es de l???enqu??te ESA ont ??t?? appari??es ?? celles des registres de la R??gie de l???assurance maladie du Qu??bec (RAMQ). Les troubles d??pressifs ont ??t?? d??finis en se basant sur les crit??res du DSM-IV et les affections dermatologiques ont ??t?? mesur??es ?? partir de deux sources de donn??es (enqu??te et registres administratifs de la RAMQ). Des mod??les autor??gressifs bivari??s ont ??t?? utilis??s pour tester l???hypoth??se d???association bidirectionnelle entre les affections dermatologiques et les troubles d??pressifs. Nos r??sultats ont montr?? que pr??s de 13% et 21% des r??pondants ont rapport?? des affections dermatologiques auto-rapport??es ou avaient ??t?? diagnostiqu??s selon les registres de la RAMQ. En plus, pr??s de 6% des participants rapportaient un trouble d??pressif probable au T1 et au T2. Nos r??sultats sugg??rent la pr??sence d???une association synchronique (transversale) entre les affections dermatologiques et les troubles d??pressifs. Ce projet souligne l???importance d?????valuer et d???explorer la cooccurrence de ces deux pathologies afin d???am??liorer la prise en charge des individus atteints simultan??ment par ces deux probl??mes. Nous sugg??rons l'inclusion des affections dermatologiques dans les futures ??tudes ??pid??miologiques visant ?? explorer les liens entre les troubles de sant?? mentale et de sant?? physique chez les personnes ??g??es.//Abstract : The relationship between skin conditions and mental health disorders, which includes depression, has long been recognized. However, few population - based studies have examined this issue and none were carried out in older - adults. The aim of this project was to explore the associations between skin conditions and depressive disorders affecting the elderly living at home. To do this, two studies were conducted; the first aimed to describe the dermatological features of the study population. The second was designed to test the hypothesis of a bidirectional association between the conditions mentioned above. We carried out secondary data analyses from data collected in the Study on the Health of Seniors (ESA ) survey, which consisted of a representative sample of the elderly population (??? 65 years) living at home in Quebec. Two repeated measurements one year apart (T1 and T2) were obtained from two fixed successive cohorts. Participants in both phases of the investigation and with available health service information from Quebec???s health insurance plan agency (R??gie de l'assurance maladie du Qu??bec - RAMQ) were selected for this project. Depressive disorders were defined based on DSM - IV criteria and dermatological conditions were measured from two data sources (survey and administrative records). Cross - lagged panel models were used to test the hypothesis of association between the two mentioned conditions. Our results showed that nearly 13% and 21% of respondents have self - reported and diagnosed skin conditions, respectively. In addition, about 6% of participants reported symptoms that were consistent with a probable depressive disorder on T1 and T2. Our results suggested the presence of synchronous (cross - sectional) associations between skin conditions and depressive disorders in the elderly. This research highlights the importance of assessing and exploring the co - occurrence of these two conditions to improve the management of individuals who are affected. We suggest the inclusion of dermatological conditions in future/further studies exploring the comorbidity between mental and physical health in the older adults.

Simple robots are already being deployed and adopted by some consumers for use at home. The robots currently in development for home use are far more sophisticated. However, it was not know the extent to which humans would trust them. The purpose of this study was to identify factors that influence trust in domestic service robots across a range of users with different capabilities and experience levels. Twelve younger adults (aged 18-28) and 24 older adults (12 low technology users and 12 high technology users) aged 65-75 participated in a structured interview, card-sorting task, and several questionnaires. Most participants had heard about or seen robots, but indicated they had little experience with them. However, most had positive opinions about robots and indicated they would trust a robot to assist with tasks in their homes, though it was dependent on the task. Before making a decision to trust a robot, participants wanted to know a lot of information about the robot such robot reliability, capabilities, and limitations. When asked to select their trust preference for human versus robot assistance for specific tasks, participants had preferences for both human and robot assistance, although it was dependent on the task. Many participants defined trust in robots similar to definitions of trust in automation (Ezer, 2008; Jian et al., 2000). Additionally, they had high rates of selection for adjectives used to describe trust in automation and also selected some adjectives used to describe trust in humans when asked to select characteristics they most associated with trustworthy and untrustworthy robots. Overall, there were some differences between age and technology experience groups, but there were far more similarities. By carefully considering user needs, robot designers can develop robots that have the potential to be adopted by a wide range of people.

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.

Fall prevention is a serious issue in the health and aging fields, and much attention and research is now being focused on examining why older adults fall and ways to prevent them from falling. Although it has been well-documented that older adults benefit from programs designed to decrease falling by promoting exercise participation, balance training, and fall education; little research has focused on specifically examining how older minority women view preventive exercise programs. This qualitative study explores the experiences of older minority women participating in a fall prevention program. The specific aims of the study are to: 1) gain an understanding of older minority women’s experiences and perceptions about falling and fall prevention; 2) establish what factors influence older minority women to participate in fall prevention programs; and 3) explore participants’ perceived outcomes of program participation. Post-test interviews with 21 participants were analyzed using the method of grounded theory to identify common themes and outcomes associated with participation in a fall prevention program. Findings from this study provide an in-depth look into the factors motivating older minority women to participate in exercise and explore their beliefs regarding falling and fall prevention.

<p>Many older adults in the developing world rely on their adult children for financial, instrumental, and emotional support. The People's Republic of China (PRC), which will experience rapid population aging in the current century, is no exception. Many scholars and policy-makers are concerned that rapid economic, social, and demographic change in China is leading to a decline in traditional support for aging parents. This study examines the impact of family ties and economic resources on the receipt of support and the health of older adults across communities in China at different levels of economic development.</p><p> I analyze data from the 2002 and 2008 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) as well as the 2000 and 2005 1% Chinese Census. Initiated in 1998, the CLHLS interviewed older adults residing in a random sample of counties and cities in 22 provinces and municipalities of China. Additionally, in 2002 a subset of adult children of CLHLS respondents were also interviewed in a separate survey. Furthermore, the 2008-2009 wave collected additional data from middle-aged and older adults residing in specially designated "longevity areas" in China. In addition to the standard questionnaire and health exam, samples of blood and urine were also collected by medical personnel. </p><p> The first empirical chapter of this dissertation examines the association between filial piety/altruism and financial transfers to aging parents from adult children using factor analysis, binary logistic regression, and linear regression. The second paper looks at the socioeconomic-status health gradient using biomarker data among older adults residing in longevity areas using binary logistic regression analysis. The third paper examines both individual-level and community-level determinants of non-normative intergenerational coresidence - living with an adult daughter instead of an adult son-- through multilevel binary logistic models analyzing both survey and census data. </p><p> I find that (1) adult children's attitudes towards filial piety and family values are associated with both presence and amount of financial transfers to older parents, net of controls for adult child's socioeconomic status, parental need, parents' earlier life transfers to children, and whether elderly parents' provide instrumental support to adult children. (2) Similar to previous research in middle-income countries, many biomarkers were not associated with socioeconomic status but those that were demonstrated a reversed gradient - higher socioeconomic status was associated with worse health. (3) Greater numbers of daughters, higher levels of individual socioeconomic status, and residing in a more developed community was associated with greater likelihood of coresidence with adult daughters versus adult sons.</p> / Dissertation

Suicide in later life is a growing public health concern that is expected to increase as the baby boom generation reach late adulthood. In the general population, older adults have rates of suicide that are higher than any other age group. The rate of suicide is particularly higher for older men. In Canada, older men between 80 and 84 years have rates of suicide approximately six times greater than older women the same age. Older adults living in the community are a sub-set of the population that are at high risk for suicide yet are not typically a focus of suicide research. As a result they remain hidden from the view of mental health promotion and suicide prevention programs until a decline in mental status brings them to the attention of formal mental health care services. Improving our understanding of suicide in later life particularly among community-residing older men can inform suicide prevention strategies. To improve this understanding, the goals of this research were three-fold: to comprehensively describe the sociodemographic and clinical characteristics of community residing older adults who have experienced suicide-related behaviour; to describe the rates, risk and protective factors, and predictors of suicide-related behaviour among this population; and to compare these findings to a subpopulation of community-residing older adults with neurological conditions. To achieve these aims, this research utilized a secondary data analysis approach using health information from multiple linked datasets. The Canadian Institute of Health Information (CIHI) performed record linkages between Ontario hospital administrative data (Discharge Abstract Database, National Ambulatory Care Reporting System, and Ontario Mental Health Reporting System) and Ontario home care data (Home Care Reporting System). Home care data are sourced from the Resident Assessment Instrument–Home Care (RAI-HC) Assessment Instrument, the provincially mandated assessment tool used to identify the strengths, preferences and needs of all long-stay home care clients. The RAI-HC contains over 350 items across a wide range of domains including health, functional status and resource use. Linkages of these data records between home care and hospital sectors enabled the prospective examination of community-residing older adults with recent suicide-related behaviour. This is one of the first national and international studies to use the RAI-HC to examine older home care clients with experiences of suicide-related behaviour. The study samples consisted of Ontario home care clients aged 60 years or older assessed with the RAI-HC between April 2007 and September 2010. Clients’ initial RAI-HC assessment was examined followed by corresponding hospital records for suicide-related behaviour (N = 222,149). The prevalence of suicide-related behaviour for the sample was 1.01% (n=2,077) with higher rates for older men than women. Rates were examined across geographic regions of Ontario. Descriptive analyses demonstrated that older adults with suicide-related behaviour had more indicators of psychiatric distress (including cognitive impairment) and psychosocial dysfunction than the general home care population. Multivariate analyses showed significant effects for age and gender in the prediction of suicide-related behaviour after adjusting for risk and protective covariates. Tangible areas for intervention were revealed that may reduce future suicide risk such as managing alcohol use and dependence, managing pain, increasing positive social relationships, and reducing social isolation. Time-to-event analysis supported the multivariate regression findings. Analyses of two subpopulations of older adults with neurological conditions (dementia and Parkinson’s disease) demonstrated marked differences in suicide risk and protective factors compared to the general home care population. Findings suggest that a one-size-fits-all approach to suicide prevention and intervention is not appropriate for persons with these conditions, as their specific risk and protective factors need to be taken into consideration. This study based on provincial data covering the home care sector in Ontario defined high risk groups of older adults and provided evidence for risk and protective factors associated with suicide-related behaviour. Findings point to several areas that should be assessed by home care professionals to reduce risk in the older home care client population. This multi-dimensional profile of high risk older adults will assist in initiating a policy dialogue regarding the need for targeted suicide prevention strategies in Ontario’s home care sector.

For older adults, engaging in prosocial behaviours such as volunteering, caregiving, and informal helping, may contribute to self-perceptions of social usefulness. Limitations of past research on social usefulness include lack of a clear operationalization of the construct and lack of a psychometrically sound measure. To address these issues, study one was conducted to explore the construct of social usefulness through qualitative, semi-structured interviews with 20 older adults, with varying degrees of prosocial engagement. A thematic analysis illustrated various themes that were associated with perceptions of social usefulness that includes: (a) values and beliefs about social usefulness, (b) the personal need and motivation to be socially useful, (c) the amount of perceived personal social usefulness, (d) the perceived quality of personal social usefulness, and (e) the personal outcomes of social usefulness. These themes were used in study 2 as basis for item development for a scale of social usefulness. In study 2, social usefulness items were developed from the data extracts (i.e., quotes) and themes from study one. The items were administered to 408 older adults, along with preliminary validation measures. Exploratory factor analysis resulted in a three-factor solution that includes: (a) personal motivation to be socially useful, (b) psychological rewards of social usefulness, and (c) perceived network reliance on special social usefulness. The Older Adult Social Usefulness Scale demonstrated good construct validity, test-retest reliability, and internal consistency. The scale offers an empirically developed measure of social usefulness. The conceptual, theoretical, and practical implications of these findings, along with limitations and future research directions, are discussed.

Dysphagia, a condition commonly associated with older adults suffering from stroke or degenerative diseases, often requires a modified texture food diet. Although commercial pureed foods are available in Canada for treatment of dysphagia, little is known regarding their sensory, nutritional, and textural properties, and whether these foods are liked among consumers. The objectives of this research were to characterize the sensory, nutritional, and textural properties of commercial pureed carrot, turkey, and bread products and to determine their liking in two groups of older adults; non-dysphagic and pureed consumers. It was found that commercial pureed foods differed significantly across brands in these properties and liking differed between the two study populations. Future research should focus on creating standards for commercial companies to follow to ensure that all products are as safe as possible for swallowing. / OMAFRA, CIHR

The occurrence of total knee replacements is increasing in the United States for persons over the age of 45 because they are inexpensive and a very effective method for treating degenerative joint diseases. Rehabilitation requires regular access to a wide variety of resources and personnel and, as the demand for post-operative, rehabilitative care increases, the ability to marginally relieve the healthcare system by offloading resources to the patient is necessary. Tools to enable tracking a patient’s rehabilitative progress at home are an essential method to help unload the healthcare system. The purpose of this project is to design and develop a wearable home rehabilitation device for knee replacement. This thesis utilizes design ethnography tools such as expert interviews, rehabilitation observation, a participatory design workshop, iterative development, and an idea feedback study. Leveraging advancements in technology and the field of eTextiles, this study investigates the product feasibility and acceptance of discreet on-body sensors to provide a product that enables patients to better perform rehabilitation on their own, but also to allow for a feedback loop for physicians and therapists to view patient progress.

Bakgrund: Sömnen är en viktig del av en människas liv, man sover bort ca en tredjedel av sin livstid. Med det naturliga åldrandet förändras sömnen och man blir mer känslig för omkringliggande stimuli och vaknar då lättare på natten samt sover färre timmar. På en vårdavdelning finns det mycket som kan påverka sömnen, speciellt hos äldre människor. Ljud som man inte känner igen, en okänd säng att sova i samt andra människor i samma rum. Alla dessa faktorer kan ge uppkomst till sömnrubbningar under en vistelse på en vårdavdelning. Syfte: Syftet med denna litteraturöversikt var att beskriva faktorer som påverkar äldre vuxnas och äldres sömn på en vårdavdelning. Metod: I denna litteraturöversikt har databaserna CINAHL with full text och Medline använts. Totalt elva artiklar har granskats där åtta artiklar har varit kvantitativa och två kvalitativa, den sista artikeln var en mixad kvalitativ och kvantitativ studie. Utifrån resultaten har författarna sammanställt teman. Resultat: Fem teman uppmärksammades: sömnen på en vårdavdelning där sömnen påverkas av den okända miljön. Inre faktorer som påverkar patientens sömn där det emotionella tillståndet grundat i oro, sjukdom och avsaknad av anhöriga kan påverka sömnen. Miljöfaktorer stör sömnen, där ljus, ljud och personalens interaktioner stör sömnen. Skillnader mellan länder och könsskillnader som påverkar sömnen, där män och kvinnors sömnkvalitet ser olika ut i olika länder. Ljudreducerande åtgärder för sömnen, där betydelsen av inplanerad tysthet (Quiet time) tas upp samt vikten av ljus och ljud-reduceringsprogram för att främja sömnen. Diskussion: I metoddiskussionen har vi diskuterat om valen av artiklar och länder kan ha påverkat resultatet negativt, men diskuterar även för varför vi valt att använda dessa. I resultatdiskussionen har vi diskuterat Florence Nightingales teori om miljö och sömn kopplat till resultatet, samt vad som inte har tagits upp i resultatet. / Background: Sleep is an important part of a person’s life, you sleep away a third of your lifetime. With the natural aging there will be changes in the sleep pattern. You will become more sensitive to surrounding stimuli, wake up easier at night and sleep less hours. On a ward, there are a lot that can affect sleep, especially for elderly. Sound that you don’t recognize, an unknown bed to sleep in as well as other people in the same room. All these factors can make you get sleep disorders during sleep in a ward. Aim: The purpose of this literature review was to describe factors impact on older adults and older peoples sleep in a ward. Methods: In this literature review the databases CINAHL with full text and Medline have been used. A total of eleven articles were reviewed, eight articles had quantitative methods and two had qualitative methods, the last article were a mixed method with both qualitative and quantitative design. From the results, the authors had complied themes. Results: Five themes noticed: sleep in a ward, where the sleep is affected by the unfamiliar environment. Inside factors that affect sleep, where the emotional state of the patient caused by worry, disease and absence of relatives can affect the sleep. Environmental factors that disturb sleep, where light, sound and staff interactions contribute to disrupt sleep. Differences between countries and gender differences that affect the sleep, where men and women's sleep quality are different between countries. Noise reducing measures for sleep, where scheduled silence (Quiet Time), light- and sound reduction programs are important factors to promote quality sleep. Discussions: The methodological discussion we have discussed about the choices of articles and countries may have negatively affected the result, but also discusses why we chose to use them. The results discussion, we had discussed Florence Nightingale's theory of environment and sleep related to the result, and what has not been included in the results.