Longitudinal methods have become an improved and essential means of measuring intra-individual change over time. Yet one of the greatest and most hazardous drawbacks studying participants over multiple sessions can be the loss of participants over time. This study attempts to illuminate the problem of attrition in longitudinal research by estimating the mean effect sizes for participant loss across 57 studies published in 13 prestigious journals which regularly use older participants. Results estimate overall attrition to be around 34% of the original sample. The subsequent break down of attrition into its subtypes yield mean effect sizes for attrition due to Refusal (8%), Loss of contact (10%), Illness (6%), and Death (14%) in studies sampling from adults 50 years or older. Analyses were then conducted via meta-analytic one-way ANOVA and weighted regression to identify possible moderators of overall attrition and their four subtypes.

Embora o uso do sistema âncora reduza a oscilação corporal em idosos, ainda não está claro como a informação háptica adicional interage com os outros sistemas sensoriais. Assim, o objetivo deste estudo foi avaliar a contribuição do sistema âncora na oscilação corporal de idosos durante a postura ereta semi estática com diferentes manipulações sensoriais: visão (com e sem) e somatossensação (superfície rígida e de espuma). Trinta idosos participaram desse estudo. Eles foram instruídos a ficar em pé sobre uma plataforma de força, com os pés afastados na largura do ombro. Três fatores foram manipulados: uso do sistema âncora, disponibilidade de visão e textura da superfície de suporte. O sistema âncora é constituído de dois cabos flexíveis seguros pelas mãos com cargas de 125 g conectados a cada extremidade que fica em contato com o solo. Nas tentativas sem visão, os participantes fecharam os olhos e uma venda foi colocada sobre os olhos. Na situação de olhos abertos os participantes fixaram o olhar em um alvo posicionado na altura dos olhos. Para a manipulação da textura da superfície, uma espuma com as dimensões da plataforma de força foi colocada sobre a mesma. Na condição de superfície rígida, os participantes permaneceram em contato diretamente com a superfície da plataforma de força. Com base no deslocamento do centro de pressão (CP), foram calculadas as seguintes variáveis: área da elipse contendo 95% dos dados do deslocamento do CP, amplitude média de oscilação (AMO) e velocidade média de oscilação (VMO) para quantificar a oscilação corporal. Os resultados da análise estatística para a área da elipse e para a VMO revelaram efeito principal de âncora (p<=0,0001), visão (p<=0,0001) e superfície (p<=0,0001), assim como interação entre visão e superfície (p<=0,0001) e âncora e superfície (p=0,002). Para a AMO os resultados revelaram efeito principal de âncora (p<=0,0001), visão (p<=0,0001) e superfície (p<=0,0001) e interação entre visão e superfície (p<=0,0001). O uso da âncora reduziu a oscilação corporal nas três variáveis analisadas. Por outro lado, a ausência de visão e a superfície de espuma aumentaram a oscilação corporal. O uso da âncora não contribuiu para reduzir a oscilação corporal na superfície rígida. Porém, na superfície de espuma o uso da âncora reduziu a oscilação corporal. O sistema âncora contribuiu para reduzir a oscilação corporal e essa redução foi mais efetiva quando o participante estava sobre a superfície de espuma. Portanto, conclui-se que em situações mais desafiadoras o uso do sistema âncora parece ser mais efetivo / Although the use of the anchor system reduces body sway in older adults, it is not clear how the additional haptic information interacts with other sensory systems. The purpose of this study was to evaluate the anchor system contribution to postural sway in older adults during a quiet standing task with different sensory manipulations: vision (with and without) and somatosensation (with and without a foam on the support surface). Thirty individuals participated in this study. They stood on a force plate, with their feet apart at shoulder width. Three factors were manipulated: use of the anchor system, vision availability and support surface texture. The anchor system consists of two flexible cables hold by the hands with loads of 125 g connected to each end that is in contact with the ground. In the trials without vision, participants closed their eyes and a blindfold was placed over their eyes. In the eyes open condition, participants fixed their gaze on a target positioned at eye level. For the manipulation of texture of the surface, a foam with the dimensions of the force plate was placed over it. In the rigid surface condition, participants stood directly over the surface of the force plate. Based on center of pressure (CP) displacement, the following variables were calculated: 95% ellipse area, mean sway amplitude (MSA), and mean sway velocity (MSV). The statistical analysis results for the ellipse area and MSV showed main effect of anchor (p<=0.0001), vision (p<=0.0001) and surface (p<=0.0001), as well as interaction between vision and surface (p<=0.0001) and anchor and surface (p=0.002). For MSA, the results revealed main effect of anchor (p<=0.0001), vision (p<=0.0001) and surface (p<=0.0001) and interaction between vision and surface (p<=0.0001). The use of the anchor reduced body sway in all three variables analyzed. Moreover, the absence of vision and the foam surface increased body sway. The use of the anchor did not contribute to reduce body sway on the rigid surface, but on the foam surface the use of anchor reduced body sway. The anchor system helped reducing body sway and this reduction was more effective when the participant was on the foam surface. Therefore, it follows that in more challenging situations the use of the anchor system appears to be more effective.

Older adults (65+) are one of the fastest growing segments of the population in the United States. Chronic pain is common among this population, and chronic low back pain (CLBP) in particular is the number one pain complaint among older adults. In addition to larger societal and fiscal costs, CLBP is associated with a host of personal negative consequences such as physical disability, poor psychosocial functioning, and decreased quality of life. Despite being a leading health problem in older adulthood, little is known about how older adults actually experience this type of pain. Thus, the purpose of this dissertation was to understand older adults’ lived experience of CLBP. To improve understanding of CLBP in this understudied population, a qualitative study using a phenomenological method was conducted. Phenomenology, rooted in existential philosophy, is the study of the nature and meanings of phenomena, in which experiences related to the phenomena are the main source of insight. van Manen’s Phenomenology of Practice method specifically guided the investigation with regard to study conception, data collection, and data analysis. Participants were 21 older pain clinic patients living with CLBP who engaged in one-on-one in-depth interviews. Findings suggest that CLBP is an all-encompassing presence in participants’ lives. Seven main themes include: (1) Living a life full of pain; (2) Pain affects everything; (3) With others but a lone in my pain; (4) With pain comes sorrow; (5) Aging painfully; (6) Managing the incurable; (7) You just have to keep going. Implications for social work practice, research, and policy are discussed. By building a deeper understanding of older adult’s experiences and personal meaning of CLBP, social workers may be more able to provide meaningful and effective psychosocial services in the context of interdisciplinary CLBP management.

Older adults account for 20% of new HIV infections in the U.S and 50% of people living with the disease. In part, this is due to people living longer with HIV, greater sexual activity in later life, a lack of condom use, and little understanding about HIV/AIDS. Evidence suggests that healthcare providers can play a key role in the dissemination of information about HIV/AIDS to older adults. The purpose of this study was to examine the impact of patient-provider communication of HIV/AIDS on older adults’ intentions to use condoms. The mediating relationships of knowledge of HIV/AIDS, perceived threat, subjective norms, and self-efficacy were also examined. This study utilized a cross-sectional, web-based survey, administered to adults aged 50 years and older (N=427). Forty-one percent of participants reported no communication with the healthcare provider about HIV/AIDS, yet 87% reported future intentions to use a condom with a new sexual partner. Participants demonstrated high knowledge of HIV/AIDS (M=14.7 out of 18), believed their sexual partner would be agreeable to using condoms (M=24 out of 36), and 91% believed they had the ability to properly use a condom. However, participants did not believe HIV/AIDS posed a threat to their health (M=8 out of 36). Mediation analysis yielded non-significant results. Healthcare providers can provide tailored prevention recommendations to higher risk older adults in order to curb the number of new infections. Additional research is needed with older adults who identify as LGBT, MSM, and older adults of color.

This study examined the contribution of several variables to the prediction of perceived freedom in leisure (PFL) and life satisfaction in older adults. Demographic, health and socioeconomic variables were compared with participation in recreation programs, church involvement and PFL. Church involvement was viewed as a leisure activity rather than a measure of religiosity. The survey instrument incorporated all these variables and was pretested and revised before use in the study. The sample consisted of 198 persons 60 years of age and older who were members of two Southern Baptist churches. Subjects were randomly selected, but persons considered by church staff members to be incapable of completing the survey were eliminated. Surveys were hand delivered and picked up by volunteer workers, and a 38 percent return rate was obtained. Alpha reliability for the church involvement, PFL and life satisfaction scales in the instrument were .87, .94, and .77, respectively. Frequency counts and percentages or means and standard deviations were calculated for the demographic variables. Subjects were categorized by level of involvement in church and community recreation programs. Persons involved in community but not church recreation programs were underrepresented in the sample. A selective sampling procedure was utilized to obtain more respondents in this category, but the data from these individuals were analyzed separately. Stepwise multiple regression analyses were utilized to ascertain the impact of different variables upon PFL and life satisfaction. Three predictors of PFL emerged— participation in recreation programs, church involvement and satisfaction with health. Correlations between these variables and life satisfaction were consistent with the findings in the literature. Inclusion of church involvement, participation in recreation programs and, for the life satisfaction analysis, PFL raised the percentage of variance explained. Thus, greater predictive power emerged using these variables than when only demographic, health and socioeconomic variables were included.

Thesis advisor: Karen S. Lyons / Background: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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The diploma thesis focuses on education of older adults in relation to quality of life. The aim of the thesis is to identify the association between the participation of the elderly in education and their subjective quality of life. The study focused on identification of the association between quality of life and education at the university of the third age is designed based on theoretical and empirical findings. The quality of life is assessed using the WHOQOL-BREF and WHOQOL-OLD instruments. Quality of life assessment scores of 645 participants of the university of the third age are compared with normative scores for older adults. The study also examines the association between selected aspects of participation in the university of the third age, participation in other educational activities and quality of life of the elderly. The results confirmed that the education at the university of the third age is associated with subjective quality of life. The results also display that participation frequency and the number of semesters attended is not associated with the quality of life and that the contact with other university members and participation in other educational activities has very weak association with quality of life. These findings are discussed according to the theoretical resources and...

The standard first aid for a heart attack resulting in cardiopulmonary arrest is effective cardiopulmonary resuscitation (CPR). Chest compressions are most commonly performed on a flat surface with the rescuer kneeling next to the victim with one hand on top of the other on the sternum and elbows straight. This technique of being on the ground may be challenging for those without the mobility and strength to get up and down from the ground. In 2005, the American Heart Association (AHA) Guidelines listed “pedal”, or heel, compression as an acceptable alternative to standard chest compressions (Trenkamp & Perez, 2015). That same year, the recommended depth of a compression increased from 3.8 cm to 5.0 cm (Trenkamp & Perez, 2015). To attain such a depth, extra force and strength arerequired. The heel method may be especially reasonable for those rescuers who cannot attain the floor and those who do not have the cardiovascular or muscular strength to perform traditional chest compressions. The purpose of this study was to evaluate the effects of performance of hands only (HO) versus the combination (CO) of hands only plus pedal CPR on the electrocardiogram, including heart rate and heart rhythm. The subjects utilized in this investigation were six men and nine women between 56 and 71 years of age from San Luis Obispo County in California. Subjects underwent two trials with at least a 15 hour rest period in between but no more than one week. Subjects were randomly assigned to either the Combination (CO) trial or the Hands Only (HO) trial. When they came back for their second trial, they did the trial that they did not do the first time. On average, participants were able to sustain the combination of HO plus pedal CPR longer (9.47 minutes) than they were able to perform standard HO CPR (9.02 minutes) but this difference was not statistically significant (p=0.16). Mean maximum heart rate was 133 ± 23.7 bpm during the CO trial and 125.4 ± 21.9 bpm during the HO trial (p=0.12). Mean percentage of the HR reserve was 75.1% during the CO trial and 61.1% during the HO trial (p=0.09). Mean RPE was not significantly different between CO and HO trials (p=0.2124), nor between genders (p=0.42090). However, for both trials combined the mean RPE was significantly greater at 5 minutes of CPR (4.45 ± 0.53) than at 2 minutes of CPR (3.38 ± 0.31), (p It may take time for individuals to accept pedal CPR as a viable resuscitation method. With the majority of sudden cardiac arrests occurring in the home among older adults in society, it is important to recognize that pedal CPR is an acceptable method and that a rescuer may have this choice if they either need a break from standard CPR or if they can not attain the ground.

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