The present study explored how older adults adapt to the negative changes that often occur as people age. This study sought to provide a comprehensive investigation of how the positive psychology variables of hope, optimism, resilience, and self-efficacy might work together to serve as protective factors against the potentially deleterious impact of negative environmental variables on the subjective well-being of older adults. The negative environmental variables examined in this study included declining health status, lower social support, and negative life events (e.g., loss of spouse, reduced income, etc.). In this study, the subjective well-being in older adults is defined as an overall sense of satisfaction with life, high positive affect, and low negative affect. This study examined three primary hypothesized models, each investigating how positive internal dispositional factors (as measured by taking the composite of hope, optimism, resilience, and self-efficacy), work together to mediate the relationship between the components of subjective well-being and a different environmental variable for each model. Several alternative path analyses models were also run based on modifications to the model that achieved good fit, with the goal of evaluating whether the individual positive psychology constructs either fully or partially mediated between certain environmental variables and each of the components of subjective well-being. Although no adequate fits were attained for the models evaluating social support and negative life events, results of this study showed an adequate fit for the model evaluating the positive psychology cluster as a mediator between health status and the subjective well-being components; more specifically, the positive psychology cluster was shown to mediate the relationship between perceived health and two of the three components of subjective well-being (life satisfaction and positive affect). In addition, correlation analyses revealed that the positive psychology variables were all significantly correlated with each other, as well as with the participant reports of life satisfaction, positive affect, and perceived health. These findings suggest that participants who reported higher levels of the positive psychology constructs experienced higher satisfaction with life and positive affect, and perceived themselves as having a lower occurrence of health problems. Overall, these results provide additional evidence for the protective role that hope, optimism, resilience, and self-efficacy may play in maintaining the well-being of older adults.

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.

Purpose: The purpose of this project was to implement a screening program that would identify older adults with depressive symptoms. Data Sources: The Mini Mental Status Exam (MMSE) is a baseline cognitive screen used to identify which depression screening tool should be used for the patient. The Geriatric Depression Scale-15 is used to screen patients with a MMSE score of 19 or higher. The Cornell Scale for Depression in Dementia is used for patients with a MMSE of 18 or below. Conclusions: This project had a small, convenience sample size (n=17). All (n=17) patients were given the cognitive screening. Due to inability to obtain consent, only 70% (n=12) were screened for depression. All 17 patients shared a total of five providers, who were contacted on two different occasions to notify them of the screening results and asked to complete the six-item survey. Two providers responded to the notification and completed the survey. Providers who completed the Likert survey strongly agreed that the depression treatment and tracking (DTT) form: (1) was helpful in documenting depression in the long-term care patients, (2) was easy to use, (3) decreased time spent per patient visit, and (4) was the one they would like to see used in the facility. Implications for Practice: Implementing a depression screening program through the use of a depression treatment and tracking form will assist staff with ease of documenting and communicating screening results to the patient’s primary care provider. The DTT form supports improved health outcomes for the long-term care patients by giving primary care providers a quick and easy-to-use form they can evaluate to determine if further evaluation and treatment is needed.

Social isolation is a concern for the health of older adults in Canada. Community-engaged arts (CEA) programs are thought to support social inclusion but how such programs contribute to building community connections for older adults at risk of social isolation is poorly understood. This study, therefore, is aimed to explore the experience of community for this population in the context of a CEA program as well as the role the program plays in that experience. A qualitative study using ethnographic methods was conducted to answer two research questions: (1) What does community mean to seniors in the Arts, Health and Seniors program? (2) What is the role of the Arts, Health and Seniors program in the participants’ experience of community? Data were collected over a six week period using participant observation, semi-structured interviews and document analysis. The sample was a group of 20 urban-dwelling seniors at risk for social isolation who participated in a CEA program once a week. Regular group art sessions were observed by the researcher and extensive field notes were recorded. Interviews were conducted with five senior participants and four other key informants (including two artists, a senior worker, and an administrators), and documents related to the community were reviewed. Data were analyzed throughout the data collection process and interpretations were noted. Through immersion in the data and a movement between the data and interpretations, themes were developed. Connections between themes were explored and taken back to the data. Findings were presented as a detailed description of the participants’ experience of community. Community for the participants focused around the Seniors Centre where the program was held. The participants expressed that the meaningful relationships at the centre made it ‘another home’ and was a place they could find resources to adapt to challenges. The CEA program provided a unique experience of community through working together as a group and making new social connections. For health professionals working with older people at risk for social isolation, this research will add to the understanding of how community is experienced by older adults and how community is supported by CEA programs.

Little research documents the impact of communication on the relationship between the physical therapist and the older patient. As key health professionals, physical therapists need to know the degree to which a therapeutic relationship is occurring with the older adults they treat, and what aspects of the communication process can be improved to effectively meet the needs of this unique patient population. This exploratory study examines the relationships between older adults’ perceptions of physical therapists’ patient-centered communication (PCC), and their satisfaction with communication and physical therapy treatment (SPT). The sample consisted of 40 participants from 4 different physical therapy sites, including a hospital-based outpatient department, an outpatient aquatics practice, a sports-based outpatient clinic, and a home health company. The findings indicate that physical therapists’ use of PCC behaviors, especially clarity, empathy, listening, humor, and immediacy was positively associated with older adults’ satisfaction with communication and with physical therapy care.

This study is proposed to examine the relationship between individual and socio-economic factors and subjective quality of life (SQOL) among the Chinese oldest-old. Data was collected from the latest wave of Chinese healthy longevity survey in 2002. The sample of this survey consisted of 11,175 oldest-old who were aged 80 and above at the time of the survey. Kruskal-Wallis test and Mann-Whitney U test were used to examine age, gender, and living arrangements differences in SQOL among Chinese oldest-old. Multiple regression analysis was conducted to understand the influences of individual and socio-economic factors as four groups of predictor variables in SQOL among the oldest-old. The results showed that living with offspring, having children¡¯s frequent visits, living in an institution, participation in activities, higher self-rated health, and higher MMSE scores were positively related to SQOL. Living alone, in rural areas, and having better ADL functions were negatively related to SQOL among Chinese oldest-old. Centenarians and nonagenarians were found to have higher ratings of SQOL than octogenarians. This study may provide insights on how social, cultural, and familial factors influence subjective well-being in the very old age. Study findings may have policy implications for the promotion of quality of life for older adults, specifically, the oldest-old in China.

The significant role of case managers in improving the health status of clients and in achieving cost-containment has been increasingly recognized. However, very few studies have touched on the emerging group of case managers who work exclusively with frail older adults. The purpose of this study was to determine the level of overall job satisfaction and some of its determinants among case managers of the Visiting Nurse Health System, Atlanta, Georgia, working primarily with older adults in two community-based programs. The objectives were to learn: (1) the level of overall job satisfaction among these case managers; (2) how these case managers perceive their role; and (3) what factors facilitate their work, what factors present barriers to their job performance, and what policy or procedural changes they feel would improve their performance. An established job satisfaction scale was employed to assess job satisfaction among the case managers. The overall job satisfaction scores ranged from 109 to 198 (out of a maximum possible score of 216), with a mean of 158.2, which is considerably higher than the theoretical mid-point of the scale (126). Nine subscales of job satisfaction, ordered by the satisfaction level from highest to lowest were, Coworkers, Supervision, Nature of Work, Communication, Contingent Rewards, Fringe Benefits, Operating Conditions, Pay, and Promotion. Case managers in the Older Group (aged 45 and older) showed higher overall satisfaction compared to those in the Younger Group (younger than 45). Furthermore, satisfaction levels with Fringe Benefits and Operating Conditions were significantly higher in the Older Group than in the Younger Group. No significant difference was found in job satisfaction between case managers in the two programs (CCSP and CBSP). Case managers with longer experience (at least 4 years) showed a higher satisfaction level with Pay compared to those with shorter experience (less than 4 years) in their current program. No significant difference in job satisfaction was found between social worker and nurse case managers, except that nurse case managers were significantly more satisfied with Fringe Benefits than social worker case managers. Qualitative analysis of the interview found that case managers tended to describe their role in terms that were either related to program objectives or activities. They viewed their role more as providing or ensuring services to their clients than as cost-containment. At the same time, initial assessment appeared to be the most important component of their role compared to other activities, such as evaluation or contact with service providers. Nature of the work, management, and coworkers are the three major sources of facilitating factors reported. On the other hand, the majority of deterring factors, related to operating procedures, pay, promotion, supervision, funding, and management, fell in the category of organizational factors. Deterring factors related to individual factors were related to communication and coworker relationship. Long-term study is needed to learn the job satisfaction among case managers working primarily with older adults and to determine what contributes to or undermines their job satisfaction. Policy changes might be needed at the organizational level to enhance job satisfaction among case managers.

Vulnerability to adverse health outcomes can be intrinsic (e.g. illnesses, disability, frailty, genetics) or extrinsic (e.g. physical and social environments). The contribution of social factors to extrinsic vulnerability in older adults is the subject of this thesis. Social vulnerability is the degree to which a person’s overall social situation leaves them susceptible to further insults, either health-related or social. This thesis begins with an exploration of how various social factors are associated with health and can be considered to contribute to a holistic concept of social vulnerability. Using a social ecology perspective, seven domains of social vulnerability (engagement, contextual socio-economic status, social support, living situation, self-esteem, mastery, and relations with others) are defined. A social vulnerability index is then developed, in which social factors from all of these domains are combined into a single index, allowing the complexity of social circumstances experienced by older people to be embraced. Social vulnerability, defined using this index, is then studied in relation to health, and is found to be associated with frailty, mortality and cognitive decline. The important impact of social vulnerability on the survival of the fittest older adults (those who are not at all frail) is studied as a special case. How social vulnerability changes over time is then examined using a transitions model based on a parametric Markov chain, with the finding that older people tend to accumulate social deficits over time, but that, importantly, this relentless accumulation of social problems is not a universal experience. The thesis then turns to consideration of frontal lobe cognitive function as a possible mechanism for the association between social vulnerability and health, given the importance of the frontal lobes to social interaction in humans. It finds that the most socially vulnerable people have impaired performance on tests of frontal lobe cognition, but that performance on non-frontal tasks is not similarly associated. The findings presented in this thesis support the importance of social factors for health of older people, and suggest that the social vulnerability index shows potential as a measure which embraces the complexity of older adults’ social circumstances while reducing dimensionality.

There is literature based on masters athletes and their involvement in sports at the later stages of life. Masters athletes are exercise-trained individuals who compete in athletic events at a high level well beyond a typical retirement age (Tanaka & Seals, 2008). These athletes vary widely in age but are typically older than 35 years, with many more over the ages of 50 and well into old age. The research questions guiding this study included; (a) what are the media representation of masters athletes, and how are they used to generate meanings around aging, sports and the aging body and (b) what are the implications of these meanings on how the aging body is represented to the audience. A qualitative (i.e., case study) approach was used to explore what meanings were generated around aging and sports through media narratives in relation to aging successfully. Media data in the form of sports magazines (i.e., Runner’s World and Lexis-Nexis data base) were compiled for the data analysis. This research focused specifically on two cases, 81year old Ed Whitlock, a Canadian long distance marathon runner, and 77 year-old Jeanne Daprano, an American masters track and field athlete. The data included (n=41 Ed Whitlock, n= 17 Jeanne Daprano). The data were analyzed via an inductive thematic analysis (see Braun & Clarke, 2006). The following central themes emerged a) life-long involvement in sports (higher order themes: earlier sporting experience, triumphant return, uninterrupted engagement), (b) performance narratives (serious contenders, reasoning for performance, systematic training, an individualized approach), and (c) decline narratives (resistance to declines in old age, sports related injuries, maintenance of performance). This study highlights how both athletes were depicted in the media narratives, demonstrating that their involvement in sports in later life provided an alternate way to view the aging process. The findings from this study seek to extend the understanding of masters athletes, by contextualization how they challenge some of the decline narratives associated with old age.

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