Older adults with sensorineural hearing loss have greater difficulty understanding speech than younger adults with equivalent hearing (Gates & Mills, 2005). This increased difficulty may be related to the influence of peripheral, central auditory processing or cognitive deficits and although this has been extensively debated the relative contribution to speech understanding is equivocal (Working Group on Speech Understanding and Aging, 1988). Furthermore, changes to the speech mechanism that occur as a result of age lead to natural degradations of signal quality. Studies involving hearing impaired listeners have not examined the influence of such naturally degraded speech signals. The purpose of this study was to determine: (1) whether older hearing impaired listeners demonstrate differences in speech understanding ability or perceived effort of listening on the basis of the age of the speaker and the predictability of the stimulus, and (2) whether any individual differences in speech understanding were related to central auditory processing ability. The participants included nineteen native speakers of New Zealand English ranging in age from 60 to 87 years (mean = 71.4 years) with age-related sensorineural hearing loss. Each participant underwent a full audiological assessment, three measures of central auditory processing (the Dichotic Digits Test, the Random Gap Detection Test and the Staggered Spondaic Words Test), and completed a computer-based listening experiment containing phrases of high and low predictability spoken by two groups: (1) young adults (18 – 30 years) and (2) older adults (70 years and above). Participants were required to repeat stimulus phrases as heard, with the researcher entering orthographic transcriptions into the custom-designed computer programme. An Analysis of Covariance (ANCOVA) was used to determine if significant differences existed in percentage words correct scores as a factor of speaker group (young versus older speakers) and stimulus predictability (high predictability versus low predictability phrases), with level of presentation (dB) as a covariate. Results demonstrated that although there were no significant differences in percentage words correct with regards to speaker group as expected, lower scores were achieved for low predictability phrases. In addition, increased listener effort was required when listening to the speech from the older adult group and during the low predictability phrase condition. Positive correlations were found between word understanding scores and tests of dichotic separation, which suggests that central auditory processing deficits contribute to the speech understanding difficulties of older adults. The implications of these findings for audiological assessment and rehabilitation are explored.

Despite having fewer cognitive resources, older adults regulate their emotions as well as, if not better than, younger adults. This study aimed to (1) test the limits of older adults’ emotion regulation capacity and (2) gain a better understanding of how older adults use their more limited resources to regulate their emotions. Participants included 48 healthy older adults aged 65-85 from the community and 50 healthy younger adults aged 18-25 from the student population. They were randomly assigned to one of four experimental groups involving an initial activity that was high or low in self-regulatory demand followed by a test task of emotion regulation or attention regulation. As expected, older adults performed equally as well as younger adults on the emotion regulation test task, though worse on the attention regulation test task. Using resting heart rate variability (HRV) as a physiological measure of self-regulatory capacity, older adults appeared to allocate more resources toward the emotion regulation task compared to the attention regulation task, and relative to younger adults. The results suggest that older adults maintain their emotion regulation capacity in part by allocating more resources toward emotion regulation goals.

Most individuals indicate a strong preference to remain in their homes and communities as they age. Aging in place can offer both economic and health benefits. As the population continues to age, it is especially critical that communities facilitate aging in place. This study aims to inform local policy by addressing two goals. First, determine potential unmet needs of older adults in Fulton County, Georgia through conducting a descriptive analysis; and second, determine predicting factors of community satisfaction through estimating a logistic regression model, based upon an adaptation of Bronfenbrenner’s social-ecological framework. Descriptive findings showed that local senior centers and meal services are prevalent. However, potential unmet needs include housekeeping, home repair, transportation, social involvement, and awareness of a senior resource hotline. The regression model revealed home repair services and demographics including marital status, education, race, and income were statistically significant predictors of overall community satisfaction in this study.

Purpose: To examine the relationship between social engagement (SE) and health care use (HCU) in baby-boomers (age 45-64) and older adults (65+). Methods: Data from the Wellness Institute Services Evaluation Research III was used. SE was assessed using measures of formal, informal, and civic activities. HCU was assessed using administrative health care records (hospital use and length of stay, overall general and family physician use). Results: Higher formal SE indicated higher contact with physicians in general, higher hospital visits, and longer lengths of stay in hospital. Higher informal SE indicated shorter lengths of stay. Results were found while controlling for demographic variables, chronic conditions, and self-rated health. Older adults had higher HCU overall, compared to baby-boomers. Conclusion: While further research is necessary, this study has implications in determining the impact that certain types of SE can have on the health care system for different age groups.

Purpose: To examine the relationship between social engagement (SE) and health care use (HCU) in baby-boomers (age 45-64) and older adults (65+). Methods: Data from the Wellness Institute Services Evaluation Research III was used. SE was assessed using measures of formal, informal, and civic activities. HCU was assessed using administrative health care records (hospital use and length of stay, overall general and family physician use). Results: Higher formal SE indicated higher contact with physicians in general, higher hospital visits, and longer lengths of stay in hospital. Higher informal SE indicated shorter lengths of stay. Results were found while controlling for demographic variables, chronic conditions, and self-rated health. Older adults had higher HCU overall, compared to baby-boomers. Conclusion: While further research is necessary, this study has implications in determining the impact that certain types of SE can have on the health care system for different age groups.

Older adults in residential care often lead sedentary lifestyles despite physical and cognitive activities being crucial for their well-being. Care facilities face the challenge of encouraging their residents to participate in leisure activities, but as the impact of age-related changes grows, few activities remain accessible. Video games in general – and motion-based games in particular – hold the promise of providing mental, physical and social stimulation for older adults. However, the accessibility of commercially available games for older adults is not considered during the development process. Therefore, many older adults are unable to obtain any of the benefits. In my dissertation, this issue is addressed through the development of motion-based game controls that specifically address the needs of older adults. The first part of this thesis lays the foundation by providing an overview of motion-based game interaction for older adults. The second part demonstrates the general feasibility of motion-based game controls for older adults, develops full-body motion-based and wheelchair-based game controls, and provides guidelines for accessible motion-based game interaction for institutionalized older adults. The third part of this thesis builds on these results and presents two case studies. Motion-based controls are applied and further evaluated in game design projects addressing the special needs of older adults in long-term care, with the first case study focusing on long-term player engagement and the role of volunteers in care homes, and the second case study focusing on connecting older adults and caregivers through play. The results of this dissertation show that motion-based game controls can be designed to be accessible to institutionalized older adults. My work also shows that older adults enjoy engaging with motion-based games, and that such games have the potential of positively influencing them by providing a physically and mentally stimulating leisure activity. Furthermore, results from the case studies reveal the benefits and limitations of computer games in long-term care. Fostering inclusive efforts in game design and ensuring that motion-based video games are accessible to broad audiences is an important step toward allowing all players to obtain the full benefits of games, thereby contributing to the quality of life of diverse audiences.

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers' perceptions of loved ones' end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones' physical, emotional, and existential suffering, current frequency of thoughts about loved ones' suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers' psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants' perceptions of their spouses' emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones' suffering. High stress-reactive rumination was an important predictor of bereaved spouses' psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones' end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions.

The main goal of this project was to enhance the use and usability of Interactive Voice Response Systems (IVR) for older people. The objective of study one was to examine older people’s perceptions of the technology and identify the most common difficulties experienced by older people when interactive with IVR using focus groups. Twenty-six people aged 65 and older took part in the study. Data were analyzed using frequency and chi square analyses. The results revealed negative attitudes towards the technology. Long menus, frustration about not being able to reach an operator and absence of shortcuts were some of the most common difficulties reported by participants. Study two examined the cognitive factors predicting successful IVR interaction in four commercially available IVR systems in a sample of 185 older adults. Linear regressions were performed on the data. Results indicated that working memory and auditory memory were the best predictors of successful IVR interaction. Using the same sample of participants as study two, study three examined older adults’ attitudes towards the four IVR systems in relation to their success in interacting with the technology. The study also evaluated the impact of gender on success and attitudes towards IVR. There was a significant positive correlation between success with IVR and favorable attitudes towards the technology. No gender differences emerged in both performance on IVR tasks and attitudes towards the technology. Study four evaluated the feasibility of using a voice-activated IVR to administer and score three short neuropsychological tests using a sub sample of the original sample of 185 older adults involved in study two and three. One hundred and fifty eight participants took part in the study. Results showed high correlations between the IVR and clinician scoring of the three tests. Nevertheless, a number of discrepancies and technical issues were discovered.

This thesis explores the transition experiences of 21 older adults who moved to the Cridge Village Seniors’ Centre, an assisted living facility in Victoria, BC. A review of other studies on the transition to seniors’ housing revealed that most new residents of assisted living facilities did not feel at home in their new residence. Using Ritual Process Theory as a framework through which to analyze participant interviews, this qualitative study examines the factors which aided new residents of the Cridge in making a full transition and developing a sense of home in their new residence. Positive social relationships, the ability to develop routines and personal rituals, furnishing suites with personal possessions, the ability to exercise control over their daily lives and a noninstitutionalized environment were found to be important factors in Cridge residents’ successful transitions to assisted living.

The importance of economic and social capital for health has been well-documented. However, their impact on age-related differences in health is less clear. To address this issue, this study examined the impact of several individual level indicators of economic and social capital on selected health outcomes in middle and later life. Data for the analysis were drawn from the 2008 General Social Survey (Cycle 22) conducted by Statistics Canada. Using a study sample of those aged 45 and over (n=12,135), multivariate regression analyses assessed main, mediating and moderating effects of economic and social capital measures on chronic conditions, health or activity limitations, and self-reported health. The findings indicated that individual level economic capital and structural social capital were positively associated with health status in middle and later life. In addition, the findings revealed the importance of both bonding and bridging forms of social capital in middle and later life. As well, the findings suggest that individual level structural social capital is a more upstream social determinant of health than economic capital in middle and later life as economic capital was found to mediate the social capital-health relationship, but not vice versa. Lastly, no evidence was found for an individual level interaction between economic capital and structural social capital in middle and later life. The theoretical, empirical, and policy implications of these findings are outlined. / Graduate / 2013-12-14