Orientador: Anita Liberalesso Neri / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-08T03:56:42Z (GMT). No. of bitstreams: 1 Sommerhalder_Cinara_D.pdf: 4445908 bytes, checksum: 5131854f0309950ff91889b079ecf237 (MD5) Previous issue date: 2006 / Resumo: Esse estudo objetivou investigar dois mecanismos reguladores utilizados por idosos para o ajustamento diante de eventos de vida estressantes: a religiosidade, avaliada em termos de freqüência de práticas intrínsecas e extrínsecas, e o suporte social percebido. Também avaliou como esses mecanismos interagiram com os sintomas depressivos. Os dados foram derivados do PENSA, um estudo sobre processos de envelhecimento saudável. Participaram 880 idosos de ambos os sexos, idade entre 60 e 99 anos, residentes na comunidade. Perder entes queridos ou vê-los doentes foi a maior fonte de estresse. Problemas pessoais de saúde, especialmente quedas também foi motivo de estresse intenso. Os idosos relataram praticar tanto religiosidade extrínseca como intrínseca, mas as práticas intrínsecas foram as mais citadas, entre elas, a oração. As mulheres foram mais assíduas em todas as práticas e os idosos de 80 anos e mais relataram menor freqüência a cultos. A maioria avaliou o suporte social como muito satisfatório. Sintomas depressivos estiveram presentes em um terço da amostra, com predomínio entre as mulheres e entre os idosos na faixa de 60-69 anos e acima dos 80anos. Os sintomas depressivos estiveram mais presentes no grupo com mais eventos de vida estressantes relatados. Os idosos que meditavam e faziam leituras religiosas tiveram escores mais baixos em depressão. O suporte social esteve inversamente associado à presença de eventos estressantes e a alta satisfação com o suporte social teve associação significativa com ausência de sintomas depressivos. Religiosidade e suporte social percebido foram confirmados como mediadores de sintomas depressivos na velhice, na presença de eventos de vida estressantes / Abstract: This research aimed at investigating two regulatory mechanisms older adults use to adjust to stressful life events: religiosity, with regard to frequency of intrinsic and extrinsic practices, and perceived social support. This study also assessed how such mechanisms interact with depressive symptoms. Our data come from PENSA, a study on successful aging processes. Participants included 880 community-dwelling older adults, stratified into gender and age (aged 60 to 99 years). Their main source of stress was the death or illness of a loved one. Personal health problems, especially falls, also caused severe stress. These older adults reported to practice both extrinsic and intrinsic religiosity, but intrinsic practices were mentioned more frequently and, among them, prayer. Women were more constant in both practices, and older adults aged 80 and above reported attending church less frequently. Most of the participants classified social support as very satisfactory. Depressive symptoms were present in one-third of the sample, prevailing among women and among older adults aged 60 to 69 and above 80. These symptoms were more frequent in the group that reported a larger number of stressful life events. Lower scores in depression were found among the older adults who used to meditate and read religious material. Social support was inversely associated with the presence of stressful events, and a high level of satisfaction with social support was significantly connected to the absence of depressive symptoms. Religiosity and perceived social support were confirmed as mediators of depressive symptoms in the old age in the presence of stressful life events / Doutorado / Psicologia, Desenvolvimento Humano e Educação / Doutor em Educação

O aumento no número de idosos nos últimos anos trouxe impactos sociais e econômicos. O processo de envelhecimento e/ou patologias específicas trazem consigo perdas progressivas sensoriais, motoras e de processamento central que estão relacionadas com o aumento das quedas com o avanço da idade. Estas perdas predispõem o idoso a sofrer com limitações físicas de mobilidade, medo de cair ou mesmo sofrer com quedas. Este quadro evoca a necessidade de atenção especial à qualidade de vida dos idosos, com novas intervenções e programas de reabilitação física. Dentre essas novas abordagens para melhorar o funcionamento do controle postural, temos a adição de informação háptica que contribui para reduzir a oscilação corporal durante a manutenção da postura ereta. Uma das formas de adicionar informação háptica ao sistema de controle postural é pelo sistema âncora. Este é uma ferramenta não rígida que consiste de dois cabos maleáveis com 125g de massa repousando no solo e com a outra extremidade segura pelas mãos (âncora tradicional). Considerando que o toque leve em diferentes partes do corpo reduz a oscilação corporal, é possível, da mesma forma, que o uso do sistema âncora em diferentes partes do corpo seja efetivo. Portanto, o objetivo desse estudo foi avaliar o efeito do uso do sistema âncora em diferentes pontos de contato (antebraço e ombro) sobre a oscilação corporal de idosos durante a manutenção da postura ereta Trinta idosos participaram do presente estudo. Eles permaneceram na postura ereta com os pés na posição semi tandem sobre uma plataforma de força para a obtenção do deslocamento do centro de pressão (CP). Cinco condições experimentais foram realizadas: sem âncora, âncora tradicional, âncoras nas mãos fixadas com presilhas, âncoras nos antebraços fixadas com presilhas e âncoras nos ombros fixadas com presilhas. Baseada nos dados fornecidos pelo deslocamento do CP foram calculadas as variáveis: área da elipse, amplitude média de oscilação e velocidade média de oscilação. Os resultados mostraram uma redução da área da elipse e da amplitude média de oscilação na direção anteroposterior nas condições com as âncoras posicionadas nas mãos (tradicional e presilha) e antebraços em comparação a condição sem âncora. Os resultados apontaram ainda uma redução da velocidade média de oscilação na direção anteroposterior na condição de âncoras nos antebraços em comparação a condição sem âncora. Na direção mediolateral, a velocidade média de oscilação reduziu nas condições de âncora fixada nas mãos e antebraços em comparação a condição sem âncora. O uso do sistema âncora na região dos ombros não trouxe redução da oscilação corporal. Em conclusão, o sistema âncora reduziu a oscilação corporal quando o sistema âncora foi posicionado nos antebraços da mesma forma que quando foi fixado/seguro nas mãos. A melhora observada com o uso das âncoras parece não estar relacionada com a quantidade de receptores táteis no ponto de contato dos cabos das âncoras / The increase in the number of older adults in recent years has brought social and economic impacts. The process of aging and/or specific diseases carries progressive sensory, motor and central processing losses that are related to the increased rate of falls with increasing age. These losses predispose the elderly to suffer from physical mobility limitations, fear of falling or even falls. This scenario evokes the need for special attention to the quality of life for older adults, with new interventions and physical rehabilitation programs. Among these new approaches to improve the functioning of the postural control system, we have the addition of haptic information which helps to reduce body sway during maintenance of upright posture. One way to add haptic information to the postural control system is the anchor system. It consists of a non-rigid tool with two flexible cables with 125g mass resting on the ground and with the other end secured by the hands (traditional anchor). Since light touch in different body regions reduces body sway, it is possible, likewise, that the use of the anchor system in different parts of the body to be effective in reducing body sway. Therefore, the aim of this study was to evaluate the effect of using the anchor system in different points of contact (forearm and shoulder) on body sway of older adults during maintenance of upright posture Thirty older adults participated in this study. They stood upright on a force plate to obtain center of pressure displacement (CoP) with their feet in the semi tandem position. Five experimental conditions were carried out: no anchor, traditional anchor, anchors on the hands secured with clasps, anchors on the forearms secured with clasps and anchors on shoulders secured with clasps. Based on data provided by the CP displacement, the following variables were calculated: ellipse area, mean sway amplitude and mean sway velocity. The results showed a reduction in the area of the ellipse and in the mean sway amplitude (anteriorposterior direction) for conditions with anchors hold on the hands and forearms compared to the no anchor condition. The results also indicated a reduction in the mean sway velocity (anterior-posterior direction) with the anchors on the forearms compared to the no anchor condition. For the medial-lateral direction, the mean sway velocity reduced with the anchor on the hands and forearms compared to the no anchor condition. The use of the anchor system in the shoulder region did not reduce body sway. In conclusion, the use of the anchor system reduced body sway when it was placed on the forearms in the same way as when placed/secured on the hands. The improvement observed with the use of anchors does not seem to be related to the amount of tactile receptors in the point of contact of the anchor cables

Estudos de treino de memória operacional (MO) para idosos mostraram que esta intervenção tem beneficío específico para a MO e, muitas vezes, efeito de generalização para outras habilidades cognitivas não treinadas. As questões sobre o impacto da escolaridade dos participantes, do número de sessões e da modalidade da intervenção (individual versus grupo) sobre o efeito do treino não foram respondidas em estudos anteriores. Esta pesquisa teve como objetivos: 1. traduzir e adaptar o protocolo de avaliação e treino de MO verbal desenvolvido por Borella et al. (2010); 2. examinar a influência da escolaridade dos participantes (quatro versus oito anos e mais), 3. da dose do treino (três versus seis sessões); e 4. da modalidade (individual versus grupo), sobre os efeitos do treino de MO verbal oferecido a idosos saudáveis. Para atingir esses objetivos, 129 idosos participaram de diferentes experimentos. O Experimento 1 (replicação) contou com 11 idosos randomizados na condição treino e na condição controle ativo, todos com escolaridade acima de oito anos. O Experimento 2 (efeito da escolaridade) incluiu os participantes do estudo de replicação que foram comparados à 7 idosos randomizados na condição treino e 13 na condição controle ativo, que tinham quatro anos de escolaridade, As intervenções nos Experimentos 1 e 2 foram realizadas em três sessões individuais. No Experimento 3, 23 idosos foram randomizados na condição treino com seis sessões e 27 na condição controle ativo com seis sessões, todos com oito ou mais anos de escolaridade, e esta nova amostra foi comparada às respectivas condições dos Experimentos 1 e 2 reunidas em uma única amostra. Por fim, os participantes do Experimento 1 foram comparados a uma nova amostra de idosos com oito ou mais anos de escolaridade,16 idosos randomizados na condição treino e na condição controle ativo, que realizaram o treino de três sessões em grupo. Os resultados do estudo de replicação mostraram efeitos semelhantes aos relatados por Borella et al. (2010), isto é, apenas a condição treino aumentou seu desempenho em testes de MO e em testes de função executiva e velocidade de processamento, mantidos após seis meses. Participantes com quatro anos de escolaridade mostraram ganhos semelhantes ao grupo treino com oito ou mais anos de escolaridade, no pós-teste e após seis meses. Os resultados sobre o número de sessões indicaram que o treino com três ou seis sessões gera ganhos cognitivos equivalentes, mas há maior possibilidade de generalização do efeito para outras variáveis no treino com seis sessões. Os resultados sobre a modalidade do treino (individual versus grupo) indicaram que não existe diferença entre as modalidades nas variáveis de desfecho no pós-teste e na avaliação de seguimento. Em conclusão, os experimentos sugeriram que o treino de MO desenvolvido por Borella et al. (2010) é eficaz em diferentes contextos sócio-culturais, entre participantes com escolaridade igual a quatro anos ou superior a oito anos. Os treinos realizados em três e seis sessões mostraram efeitos semelhantes para as variáveis de desfecho, assim como o treino realizado individualmente e em grupo, sugerindo que este treino em MO promove a plasticidade cognitiva dos participantes / Working memory (WM) training studies for older adults have shown specific benefit for WM and, often, generalization effect for other untrained cognitive abilities. Questions regarding the impact of schooling, number of sessions and intervention modality (individual versus group) on the training effect have not been answered in previous studies. This research aimed to: 1. translate and adapt the verbal WM training and evaluation protocol developed by Borella et al. (2010); 2. to examine the influence of schooling (four versus eight years and more), 3. dose of training (three vs. six sessions); and 4. modality (individual vs. group) on the effects of verbal WM training offered to healthy older adults. To answer these questions, 129 older adults participated of different experiments. Experiment 1 (replication) included 11 older adults randomized in the training condition and 15 in the active control condition, all with more than eight years of schooling. Experiment 2 (effect of schooling) included the participants in the replication study who were compared to the older adults with four years of schooling, composed of 7 older adults randomized in the training condition and 13 in the active control condition. The interventions in Experiment 1 and Experiment 2 had three individual sessions. In Experiment 3, 23 older adults were randomized in the training condition with six sessions and 27 in the active control condition with six sessions, all with eight or more years of schooling, and this new sample was compared to the respective conditions of Experiments 1 and 2 united in a single sample. Finally, the sample of Experiment 1 was compared to a new sample of older adults with eight or more years of schooling, 16 older adults in the training condition and 17 in the active control condition, who underwent three group sessions. The results of the replication study showed effects similar to those reported by Borella et al. (2010), that is, only the training condition increased performance in WM, executive function and processing speed tests, maintained after six months. Participants with four years of schooling showed similar gains to the training group with eight or more years of schooling, in the post-test and after six months. The results indicated that training with three or six sessions generates equivalent cognitive gains, but there is a greater possibility of generalization of the effect in the six-session training. The results on the training modality (individual vs group) indicated that there is no difference between the modalities in the outcome variables in post-test and follow-up evaluation. In conclusion, the experiments suggested that the WM training developed by Borella et al. (2010) is effective in different socio-cultural contexts, among participants with schooling equal to or greater than eight years. The three and six sessions showed similar effects for the outcome variables, as well as individual and group training, suggested that this WM training promove a cognitive plasticity on participants

O movimento de alcançar e de pegar objetos é amplamente utilizado nas atividades diárias. Desta forma, diversos estudos têm analisado e descrito este padrão de movimento em função de diferentes aspectos que influenciam seu controle. Da mesma forma, o movimento de andar é uma habilidade fundamental nas atividades diárias e tem sido estudado e descrito amplamente na literatura. Entretanto, pouco se sabe sobre quais são as alterações que ocorrem nessas habilidades motoras quando elas são combinadas. A realização combinada de habilidades motoras (ex., andar e pegar um objeto) está muito presente no dia a dia das pessoas, mas o entendimento do controle desse tipo de tarefa combinada ainda não foi elucidado. Adicionalmente, ainda não está claro quais são as modificações que ocorrem nestes movimentos em função do processo de envelhecimento e do histórico de quedas recentes em idosos. Desta forma, três estudos foram conduzidos para investigar o desempenho motor de adultos jovens e idosos com e sem histórico de quedas na marcha combinada com o movimento de preensão em função do nível de dificuldade da tarefa manual. O primeiro estudo investigou o desempenho motor dos adultos jovens na marcha combinada com o movimento de preensão. O segundo estudo comparou o desempenho motor entre idosos com e sem histórico de quedas na marcha combinada com o movimento de preensão. Ainda, o terceiro estudo comparou o padrão de coordenação entre idosos (com e sem histórico de quedas) e adultos jovens na marcha combinada com o movimento de preensão. Participaram desta tese, 45 indivíduos distribuídos em três grupos (n=15): adultos jovens, idosos sem histórico de quedas e idosos com histórico de quedas. Os indivíduos foram convidados a alcançar e pegar um objeto em duas tarefas (manutenção da postura ereta e marcha) e para cada uma, seis condições experimentais foram realizadas com diferentes níveis de dificuldade. Para analisar o movimento de preensão, movimentos do corpo todo e os parâmetros espaço-temporais da marcha, um sistema tridimensional de análise de movimento foi utilizado. Modificações na marcha e no movimento de preensão foram identificados quando combinados, especialmente para as condições mais desafiadoras da tarefa manual. A adição da tarefa de pegar o objeto provocou uma adaptação na marcha, pois os participantes adotaram uma estratégia mais conservadora para aumentar a estabilidade dinâmica durante a fase de aproximação. Assim é possível sugerir que o movimento de preensão foi sobreposto ao da marcha, embora as adaptações no comportamento motor sejam globais, pois ambos os padrões motores (marcha e preensão) foram modificados para realizar com sucesso a tarefa em função dos diferentes níveis de dificuldade da tarefa manual. Os idosos com histórico de quedas apresentaram um desempenho motor inferior aos idosos sem histórico de quedas na marcha combinada com o movimento de preensão, como por exemplo, redução na velocidade do passo, aumento na duração do passo, redução na velocidade do punho e na abertura entre os dedos. Além disso, os idosos com histórico de quedas apresentaram maior redução na velocidade do COM AP em comparação com os idosos sem histórico de quedas. Assim, o paradigma de tarefas combinadas desenvolvido no presente estudo identificou mudanças nas estratégias de controle motor em idosos caidores, sendo que estas alterações foram ainda mais evidenciadas nas condições manuais mais difíceis. Ainda, a adição da tarefa de pegar o objeto na marcha modificou o padrão de coordenação entre membros superiores e inferiores para os movimentos de flexão/extensão e abdução/adução. Assim, para os movimentos de flexão e extensão, um padrão mais em fase e menos fora de fase foi identificado na condição de preensão comparado com a marcha livre quando o ombro direito foi analisado em relação ao ombro esquerdo e quadril direito. Para os movimentos de abdução e adução, quando o movimento de ombro direito foi analisado em relação ao ombro esquerdo e quadril direito, foi observado um padrão menos em fase. Além disso, um padrão menos fora de fase foi observado para os acoplamentos entre ombro direito-ombro esquerdo e ombro direito-quadril esquerdo. Entretanto, estas mudanças no padrão de coordenação não foram afetadas pelo nível de dificuldade manual. Este resultado sugere que as mudanças no padrão de coordenação são mais globais, enquanto mudanças específicas no movimento de membro superior são necessárias para acomodar as diferentes demandas da tarefa manual. Finalmente, idosos com histórico de quedas apresentaram um padrão diferente de coordenação quando comparados com os adultos jovens, como por exemplo, um padrão mais fora de fase para o acoplamento entre ombro direito e quadril direito e um padrão menos fora de fase para o acoplamento entre ombro direito e quadril esquerdo na marcha combinada com o movimento de preensão. Desta forma, parece que os idosos com histórico de quedas desacoplam a tarefa da marcha combinada com o movimento de preensão, diferentes dos adultos jovens e idosos sem histórico de quedas. / Reaching-to-grasping an object is widely used in daily activities. Many studies have analyzed and described this movement pattern considering different aspects that influence how it is controlled. Likewise, walking is a fundamental skill in daily activities and has been studied and described widely in the literature. However, little is known about what are the changes that occur in these motor skills when they are combined. The combined performance of motor skills (e.g. walk and grasp an object) is very common in daily life activities, but the understanding of the control mechanisms of this type of task is lacking. In addition, it is not clear what are the changes that occur in these movements due to aging and changes in balance control as observed in older adults with history of falls. Thus, three studies were designed to investigate the motor performance of young adults and older adults with and without history of falls during walking combined with prehension. The first study investigated motor performance of young adults while performing the combined task of walk and prehension at different levels of difficulty of the manual task. The second study investigated the same combined task with different levels of manual task difficulty in older adults with and without history of falls. Yet, the third study investigated the interlimb coordination pattern in young and older adults with and without history of falls during the combined task of walking and prehension with different levels of manual task difficulty. Forty-five individuals, distributed in three groups (young adults; older adults without history of falls; older adults with history of falls), participated in this study. They performed the reach-to-grasp movement in two tasks (upright stance and gait) involving six experimental condition with different levels of manual difficulty. To analyze prehension, body movements and spatio-temporal gait parameters, a tridimensional movement analysis system was used. Modifications in gait and prehension were identified when they were combined, especially for the most difficult prehension conditions. The grasping task caused an adaptation in gait since participants preferred to adopt a more conservative strategy, increasing their dynamic stability during the approach phase and when grasping the dowel. Based on these results, it is possible to suggest that prehension was superimposed on gait, although the adaptations in motor behavior were global, since both motor patterns (i.e., walking and prehension) were changed to perform the task successfully with different levels of difficulty. It is possible to suggest that motor performance of fallers in the combined task of walking and grasping is more impaired than in no-fallers (for instance, decreased step velocity, increased step duration, decreased wrist velocity and peak grip aperture velocity). Moreover, older adults with history of falls presented a greater reduction in COM AP velocity when compared to older adults without history of falls. The combined task paradigm used in the present study showed some changes in motor control strategy of fallers older adults when performing walking and prehension combined. In addition, motor patterns (walking and grasping) of older adults (fallers and no-fallers) were modified in function of the level of manual task difficulty. The analysis of the relative motion allowed the quantification of the changes in the coordination pattern of the combined task involving walking and prehension for flexion/extension and abduction/adduction movements. For flexion/extension movements, a more in-phase and a less anti-phase pattern was identified in the grasping condition compared to walking through when right shoulder was analyzed relative to left shoulder and right hip. For adduction/abduction movements, when right shoulder was analyzed relative to left shoulder and right hip, it was observed less in phase pattern. In addition, we found a less anti-phase pattern for right shoulder-left shoulder and right shoulder-left hip couplings. However, the changes in motor coordination were not affected by the manual task difficulty for young adults and older adults with and without history of falls. This result suggests that changes in coordination are more general while specific changes in upper limb movement are necessary to deal with different task demands. Finally, older adults with history of falls presented a different pattern of coordination than young adults, such as, a more anti-phase pattern for right shoulder-right hip coupling and a less anti-phase pattern for right shoulder-left hip coupling during the combined task. Thus, it seems that older adults with history of falls decouple the walking and prehension tasks, differently of young adults and older adults without history of falls.

Context: Older adults’ everyday usages of tablet computers in a home environment are currently left out from today’s research. Current researches include many specialized focuses regarding tablet computer interfaces but a holistic view of how older adults experience usage of tablet computers in their everyday life is still to a large extent missing. Objectives: The aim of this study is to apply a use- and user-centred action research approach to explore how older adults experience the usage of tablet computers in their everyday life. Older adults are observed using tablet computers in their home environment in order to explore experienced issues and identify possible improvements for the older adults’ interaction and use of tablet computers. Methods: This study is a qualitative explorative case study using a grounded theory approach. The study consists a two week observation period beginning with an introduction and tutorial to tablet computers. Semi-structured interviews were conducted directly before and after as well as a long term follow up interview, few months after the observation period. The research body with the first two interviews and observation period was conducted using grounded theory iteration, allowing for analysis between each participant. The study involved 10 older adults and took place in the older adults’ natural everyday home environment and targeted older adults born 1960 or earlier. Results: The study used different ways to introduce tablet computers to the older adults, individually adjusted to their knowledge about information communication technology in general and tablet computers in particular as well as for them familiar subjects. Associations using their familiar subjects were used to help the older adults to remember the functionality of different icons. Some of the interaction issues encountered could be solved on the spot using accessibility options and accessories. The participants’ interest in tablet computers increased during the main body of the study, but later decreased again between the last two interviews. Conclusions: Many interaction issues were identified during the study where the main issues were related to accuracy, typing, gesture and terminology. Suggestions are made concerning how to solve some of the issues encountered, like a dynamic grid for icons and text on the tablet computer home screen and an ergonomic version of a touchscreen pen. Although there are interaction issues that are directly related to the interface, there are other important aspects too that affect the experienced interaction issues when interacting with and using a tablet computer in one’s everyday life home environment. Influencers affecting how older adults feel about tablet computers played a very important role. Having the observer functioning as a technical mentor, during the two week observation period, played a bigger role than expected, but the short time the older adults had with the mentor was not enough to keep them interested on a long term basis.

This study investigated older persons' perception of the negative impact of ill health, retirement, and widowhood in relation to the mobilization of relevant coping mechanisms. In addition, the relationship of coping mechanisms and dissatisfaction with current gender-role identity to seeking counseling was studied. A distributed questionnaire package provided demographic data as well as information pertaining to satisfaction in various areas of life, impact of live events, and coping style. Subjects were 54 males and 67 females aged 50 to 92. Safeguards were taken to ensure complete confidentiality and anonymity of response. Stepwise multiple regression (listwise deletion of data), multivariate and univariate analysis of variance and bivariate correlational analyses of the data were performed, suggesting that perception of negative impact of the events measured (ill health, widowhood, retirement) was related a) to employing numerous useful coping strategies, b) to low dyadic satisfaction, and c) to low life satisfaction. Analyses also suggested that variables which distinguished those in the sample who sought counseling were a) identity discrepancy (wherein Ideal exceeded Real) on the Masculine and Androgynous dimensions, b) employing fewer Coping with Health strategies, and c) employing more Coping with Retirement strategies. These variables also distinguished males who sought counseling, but only the variable Age, distinguished females, who sought counseling from those who do not.

Self-concept has been defined as being both contextual and multidimensional, varying with different situations and states of being. In this light, the Ecological Q-Sort was developed to measure the varying nature of self-concept in older persons. The purpose of this study is to determine what contextual selves are represented within the framework of the Ecological Q-Sort. The cards of the test were rated and Ward's Hierarchical Clustering technique was utilized to categorize the cards along two dimensional rating factors. Statistical analysis revealed that social, productive, physical, play, active, assertive, and nurturing selves are represented .by the instrument. Those selves are measured by the Loneliness/Sociability, Productive/Relaxation, Vitality/Instability, Initiative/Inefficacy, Confidence/ Uncertainty, and Nurturing/Loss categories.

L’utilisation des antipsychotiques (AP) pour une indication non approuvée autrement dite off-label, peut être associée avec des effets indésirables graves chez les ainés. Étant donné le peu d’études portant sur le sujet, cette étude vise à déterminer la prévalence et les facteurs associés à l’utilisation off-label des AP chez les ainés âgés ≥ 65 ans vivant dans la communauté au Québec. Des analyses secondaires des données provenant de 2 enquêtes «l’Étude sur la Santé des Aînés» (ESA) et ESA-Services, étaient effectuées sur un échantillon total de 4018 ainés. L’utilisation off-label d’AP était définie par l’absence d’une indication approuvée selon la liste d’approbation publiée par Santé Canada en juin 2016, durant la même année. Les diagnostics ont été repérés dans les registres administratifs des services médicaux et pharmaceutiques de la « Régie de l’Assurance médicale du Québec» (RAMQ) en utilisant les codes internationaux de maladies (CIM-9) validés par d’autres études, et les codes CIM-10 appropriés selon la formule de changement CIM-9/10 fournie par la RAMQ. Le cadre conceptuel d’Andersen & Newman conçu pour expliquer le comportement de l'utilisation des services de santé selon trois catégories de facteurs (prédisposant, facilitants et de besoin) a été utilisé pour étudier, avec des régressions multinomiales, l’utilisation off-label des AP comparée à la non-utilisation et à l’utilisation approuvée dite labeled. La prévalence d’utilisation d’AP dans cet échantillon d’ainés était estimée à 2.5%. Parmi les utilisateurs d’AP, 78% étaient considérés comme off-label. L’utilisation off-label des antipsychotiques comparée à la non-utilisation était associée à l’âge (RC : 0.46; 95%CI: 0.27-0.78) , le niveau de scolarité (RC: 2.68; 95%IC: 1.64- 4.40), le nombre de visites ambulatoires incluant les visites chez le médecin traitant (≥ 6) (RC: 2.39; 95%IC: 1.34- 4.25), l’utilisation d’antidépresseurs ou de benzodiazépines (RC: 5.81; 95%IC: 3.31- 10.21), et la présence d’un syndrome cérébral organique et de la maladie d’Alzheimer (RC: 5.73; 95%IC: 1.74- 18.89). L’utilisation off-label des AP comparée à l’utilisation labeled était associée avec l’insomnie (RC: 0.13; 95%IC: 0.02- 0.91) et la dépression majeure (RC: 0.02; 95%IC: <0.01-0.11). Cette étude a montré une prévalence élevée de l’utilisation off-label des AP chez les ainés vivant dans la communauté au Québec. En résumé, l’utilisation off-label des AP était associée à la présence de visites ambulatoires répétées, l’utilisation d’autres médicaments psychotropes et la présence d’un syndrome cérébral organique, reflétant potentiellement un profil des cas cliniques plus complexes. / Abstract: The risk of using antipsychotics (AP) for off-label indications may outweigh the benefits in older adults. Due to the scarcity of studies describing off-label use of AP in older adults, this study aimed to determine the prevalence of the off-label use of AP in Quebec, and to determine, using Andersen & Newman’s model of healthcare seeking behaviour, the predisposing, enabling and need factors associated with the off-label use of AP. We used data from a socio-demographically (age, sex, and postal code representing population density) weighted sample (n = 4018) of older adults living in the community and who participated in the «Enquête sur la Santé des Aînés» (ESA) and ESA-Services health studies. AP use was identified from the RAMQ pharmaceutical registry. The presence of off-label use of AP (yes/no) was identified from validated ICD-9/10 diagnoses codes found in the RAMQ and MED-ÉCHO medical services and hospitalisations databases. The off-label use of AP was defined by the absence, during the same one-year period, of an approved indication for a delivered AP, according to Health Canada’s approval database as of June 2016. Multinomial logistic regression was used to study the off-label use of AP as compared to both labeled use and non-use as a function of predisposing, enabling and need factors. In this study, the prevalence of AP use reached 2.5%, of which 78% was off-label. Compared to non-use, off-label AP use was associated with age (OR: 0.46; 95%CI: 0.27-0.78); education level (OR: 2.68; 95% CI: 1.64- 4.40), a higher number of outpatient visits including physicians visits (OR: 2.39; 95%CI: 1.34- 4.25), antidepressant or benzodiazepine use (OR: 5.81; 95%CI: 3.31- 10.21), and the presence of an organic brain syndrome & Alzheimer’s disease (OR: 5.73; 95%CI: 1.74- 18.89). Compared to labeled use, off-label use was less likely in those with major depression (OR: 0.02; 95%CI: <0.01-0.11) and insomnia (OR: 0.13; 95%CI: 0.02- 0.91). In summary, off-label use is highly prevalent among community living older adults using AP. Off-label use was associated with the presence of an organic brain syndrome & Alzheimer’s disease, other psychotropic drug use and with increased outpatient visits, suggesting the off-label use of AP in more complex and severe clinical cases. Future longitudinal studies should focus on health related changes among incident off-label users of AP.

The senior population is growing faster than any other population group, and life expectancy is increasing. E-mail and social media enable people of all ages to stay in touch, and find information, resources, and entertainment. Positive effects are associated with computer and internet use for older adults, but not all seniors have embraced technology and some seniors feel negatively about it. Several different methods have been used to teach seniors computer skills, including mentoring, lecturing, and providing instructions, but not many procedures have been evaluated for effectiveness. In the current study, we recruited three to five seniors, taught them to use Facebook using instructions and behavioral skills training as needed, and then tested their skills. This study investigated the effectiveness of instructions alone with supplemental behavioral skills training as necessary to improve community-dwelling seniors’ social media skills on Facebook.

Master of Science / Department of Human Nutrition / Valentina Remig / The use of computer-based and personal assistive technology is projected to increase as the boomer generation continues to age. Technology is infiltrating and improving the lives of older adults, including their education. This study determined older adults’ preferences toward the use of technology to learn about nutrition and health. The sample included 132 volunteer subjects, mostly female, white non-Hispanic, ranging in age from 65−92 years, recruited from local organizations, senior centers, churches, and senior apartments. All participants completed a newly developed, 32-item pilot tested questionnaire that included demographic and self-rated health characteristics, current use of technology, factors that motivate and/or influence attitudes and interest toward use of technology, and preferred formats and topics of interest for nutrition and health education information. The results indicated that, overall, these older adults self-rated their health as either excellent or good, and that those who were younger and among the higher income brackets and education levels were more likely to use computers than those who were older, with less income, and education levels. Findings also indicated that older adults were interested and willing to learn about technology, had positive attitudes toward it and showed a high demand for user-friendly programs and training. Finally, results show that although newsletters, magazines and television were mostly preferred by older adults, computers were also considered very helpful and were used to learn about nutrition and health information.