Alzheimer’s disease (AD) is a rapidly growing public health concern causing severe challenges to the health care system. Affecting the lives of more than 5 million Americans, it is characterized by brain-related morphological changes coupled with decrements in performance on tasks involving cognitive function such as those assessing memory and problem-solving abilities. Fortunately, current scientific research provides evidence that this trend towards rapid cognitive decline in older adults is not immutable, but rather can be attenuated through a simple adjustment to regular engagement in aerobic exercise. To date, numerous studies have associated regular cardiovascular exercise to changes in brain function and structure. In particular, aerobic exercise has been shown to have a direct effect on the hippocampus (HC), one of the earliest regions of the brain to be affected in AD, which plays an important role in learning and memory. Scientific research on animal models has demonstrated increased adult hippocampal neurogenesis (AHN), or the birth of new neurons, in the dentate gyrus (DG) subregion of the hippocampus as a response to increases in aerobic exercise. Such findings have led to the hypothesis that aerobic exercise can improve cognitive performance, more specifically hippocampal-dependent learning and memory, through the formation of new hippocampal neurons. Similarly, in human studies, previous research has shown that significant improvements in cardiovascular fitness are positively correlated with increased hippocampal volume. Structural increases in hippocampal volume are thought to be mediated by increased angiogenesis, or the generation of new blood vessels, which in turn are correlated with significant improvements in spatial memory, a task determined by memory function. The benefits of aerobic exercise, nonetheless, are not limited to the hippocampus. As people age, atrophy of the brain is also inclusive of the prefrontal cortex, a region implicated in planning and decision making. Scientific literature has shown, that similar to the hippocampus, increases in aerobic exercise, directly result to increases in grey matter volume in the prefrontal lobe and increases in white matter volume in the genu of the corpus callosum. Such structural changes in the prefrontal lobe are correlated with enhanced decision making on cognitive tasks, an essential component of executive function. For the purposes of this study, an effective method of evaluating whether changes in brain structure due to higher cardiorespiratory fitness have an association with cognitive function was through the administration of the Digital Clock Drawing Test (dCDT). The dCDT is a recently developed cognitive test based on the traditional Clock Drawing Test (CDT) that uses a digital pen and allows for the measurement of several parameters such as “Ink time” and “Think time.” Recent scientific studies report that such parameters may have a potential enhanced sensitivity to detecting cognitive change as compared to the traditional CDT. Therefore, the dCDT has come forward as an advantageous approach for testing cognitive skills in aging individuals such as those assessing executive and motor function, and semantic memory, as it happens in real time. DCDT parameters such as total time to complete the clock drawing, total ink time, total think time, total ink length, and clock size have been shown to differ significantly among subjects of varying degrees of cognitive impairment such as AD, mild cognitive impairment (MCI), and healthy, non-demented controls. Patients who were clinically diagnosed as cognitively impaired spent a greater amount of time thinking and drawing on both the command and copy clocks conditions as compared to healthy, non-demented individuals. Similarly, patients affected by greater cognitive impairments, such as AD, tended to draw smaller clocks in terms of height and width of the clock face that required less total ink length to complete the clock drawing, when compared to healthy controls and MCI participants. Findings showed that AD patients appeared to be working longer (greater time of completion) though producing less output (smaller clock and shorted ink length) as compared to non-impaired individuals. Variations of graphomotor latencies in the dCDT performance, therefore, are associated with individual’s cognitive capacities. The goal of this study is to investigate the associations between cardiorespiratory fitness based on VO2 max testing and cognitive constructs such as memory, executive function, and gross motor processing speeds as measured by graphomotor latencies and drawing patterns using the dCDT in healthy, non-demented older adults. I hypothesize that greater cardiorespiratory fitness will be negatively associated with graphomotor timed latencies in various parameters of the dCDT, given that exercise has known effects on the brain regions responsible for executive function and memory. To test these hypotheses, cardiorespiratory fitness and dCDT data from 12 sedentary older adults between the ages of 55 and 85 years from a larger study in the Brain Plasticity and Neuroimaging Laboratory at Boston University were collected and analyzed. A multiple regression analysis was used to predict the dCDT measures from individual’s cardiorespiratory fitness using estimated VO2 max levels. Results showed that cardiorespiratory fitness in older adults is inversely associated with graphomotor times in both the command and copy test conditions as predicted by our hypothesis. In particular, greater cardiorespiratory fitness was associated with shorter total ink time for both clock drawing testing conditions. These results held when controlled for age, sex, and education; higher cardiorespiratory fit older adults performed better (a shorter time is needed to achieve the same outcome) on tasks requiring greater cognitive constructs such as memory, executive function, and motor processing speeds. Therefore, it can be concluded that cardiorespiratory fitness may be a neurodegenerative protector in aging adults supporting its beneficial role as a therapeutic agent for cognitive decline in older adults.

Older adults are encountering harsh recovery after disasters, and compounding this problem is the lack of research on older adults' perceptions on disaster preparedness as aging affects the ability to react to emergency situations. To partially address that gap, the purpose of this general qualitative research study was to use Rotter's spectrum of locus of control theory to examine the level of preparation regarding disaster preparation of older adults who were living independently in single-family homes in a state affected by Hurricane Sandy. Data were collected through a qualitative survey distributed to adults aged 65 to 80-years (N=88) and publicly available documents from federal and state emergency management agencies. These data were inductively coded and subjected to a thematic analysis procedure. Findings identified 3 themes that consisted of (a) delayed acceptance, (b) defective instinct, and, (c) unexpected effects of disasters. This study contributes to social change by helping emergency management officials understand the deficiencies in preparedness by an aging population which may in turn improve the quality of life for older adults by stressing proper preparation for sheltering in place or evacuation in the event of a disaster.

Medication complexity and nonadherence are significant risk factors for avoidable hospitalizations and health care spending for older adults in the United States. However, limited empirical research has investigated pharmacist-run telephonic medication management programs as a potential solution to the problem of reducing medication complexity while improving medication adherence. This quantitative study employed the behavioral change model to analyze archival data from a sample of 1,148 participants, examining the relationship of a pharmacist-run telephonic consulting program on medication adherence and medication complexity for one pharmacy benefit management firm's Medicare Part D recipients. The primary research questions investigated the relationship of medication therapy management programs to medication adherence and complexity. Data were assessed using correlation and regression analysis to determine the association between receiving pharmacist counseling, medication adherence, and medication complexity, and to assess the strength of any relationships identified. No linear relationship was found between pharmacists' counseling, medication complexity, and medication adherence. However, the study found a weak correlation between medication complexity and comorbidities, and between medication complexity and medication adherence. This study promotes positive social change by identifying information that can be used to reduce pharmaceutical industry liability by improving proper management of medications, by reducing the burden of comorbidities related to poor management of chronic disease, and streamlining health services and improving their outcom

An increasing number of older adults must continue working, which requires that they maintain their competencies and work skills, including use of mobile technology (MT). However, little is known about older adult adoption of MT in relation to work. This study used Rogers's diffusion of innovation theory and Davis's technology acceptance model as a framework. The purpose of this exploratory sequential mixed methods study was to examine the experiences of older adults' who adopted MT in the emergency communications (EC) field. Participants came from an emergency services LinkedIn group. Data sources included surveys completed by 85 respondents and interviews of a subset of 10 of the respondents. Phase 1 included survey analysis to develop descriptive statistics on the participants' placement in Rogers's stages of adoption, their perceptions of the usefulness, and the ease of use. Phase 2 included analysis of in-depth interviews, coding for themes and patterns. Survey results indicated that both perceived usefulness and ease of use affect the adoption of MT by older adult users in the EC field. The results of the interviews identified the usefulness and ease of use as factors for the participants. The social implications for employers include a deeper understanding of the specific factors that impact the adoption of MT by older adults. This study provides employers with a deeper understanding of the adoption of MT by older adults so they can develop stronger plans to help their older adults adopt mobile technology.

Lifestyle behaviors have been associated with better cognitive status and reduced risk of dementia. However, only individual or combinations of a few lifestyle behaviors have been studied. The present study examines the association between lifestyle behaviors and cognitive status in older adults including six lifestyle behaviors: cognitive activities, social activities, physical activities, religious involvement, diet, and alcohol consumption. The study population is a sample of 1,216 community-dwelling men and women age 65 years and older from Cache County, Utah. The present study is conducted using the extant data from the Cache County Study on Memory Health and Aging (CCSMHA), a prospective longitudinal study, which has been ongoing since 1995 with its focus on Alzheimer's disease and other forms of dementia. Data related to lifestyle behaviors, cognitive status, and dementia diagnosis in the third study wave were analyzed for the purpose of the present study. Three lifestyle patterns were identified based on the six lifestyle behaviors: the least engaged, the moderately engaged secular, and the most engaged religious. The most engaged religious pattern represented a healthy lifestyle on all lifestyle domains with exception to almost no use of alcohol. The moderately engaged secular pattern represented a moderately healthy lifestyle on all domains with least engagement in religious behavior. The least engaged pattern showed an unhealthy lifestyle on all domains with moderate engagement in religious behavior. The results showed that participants in the least engaged had a lower cognitive status and higher rate of being diagnosed with cognitive impairment or dementia compared to those with other two lifestyle patterns. The findings suggest that engaging in healthy lifestyle behaviors in later life might protect from or delay loss of cognitive ability and dementia risk.

Mindfulness-based interventions use meditation and other learning exercises to help individuals become more aware of their current physiological and emotional experiences. Benefits of practicing mindfulness include an increase in positive psychological outcomes (e.g., psychological well-being, emotion regulation) and a decrease in negative psychological outcomes (e.g., anxiety, depression). The vast majority of studies focus on younger rather than older adults—setting the stage for the current study, which involved delivering a five-session mindfulness-based intervention to older adults (i.e., 60 and older). The smaller literature focused on older adults is promising but generally lacks methodological rigor (e.g., lack of no-treatment control groups). The current study added to the existing literature by conducting a longitudinal quasi-experimental delayed treatment trial in a sample of older adults. First, it was hypothesized that there would be an intervention effect on several variables. Specifically, it was hypothesized that participants would experience decreases in depression, anxiety, and stress, as well as increases in the five facets of mindfulness, psychological well-being, and emotional regulation. Second, it was hypothesized that the mindfulness-based intervention would be feasible and acceptable, as indicated by low levels of intervention noncompliance and participant attrition as well as high scores in satisfaction and practice log completion rates. Participants were 19 older adults from a local retirement community. Participants were assigned to either an immediate treatment (n = 11) or delayed treatment (n = 8) group. All participants were assessed at the universal baseline, week 5 (i.e. intervention completion of immediate treatment group), week 10 (i.e. intervention completion of delayed treatment group), and at week 15. The 5-week mindfulness-based intervention included psychoeducation (e.g., mindfulness, stress, aging, values), discussion of all concepts, and mindfulness practice. A series of two (group) by four (time of assessment) analysis of covariance models were estimated to evaluate primary outcomes. Results indicated that there was no significant treatment effect on primary outcomes. However, the mindfulness-based intervention was feasible and acceptable. Gaining additional knowledge of how mindfulness-based interventions influence coping strategies in older adults will allow clinicians and researchers to influence interventions for older adults and facilitate older adults receiving adequate psychological treatment while managing common stressors associated with aging.

With age, more light is needed in order to function, but the effect of lighting on occupational performance has received little attention in occupational therapy. The purpose of the study was to determine if lighting affects older adults’ ability to perform selected occupational tasks, which require near vision and if lighting levels affects their perceived effort while performing selected occupational tasks. A quasi-experimental, repeated measures design was used with a convenience sample recruited from a retirement community. Thirty participants met the inclusion criteria, which included visual and cognitive screening. The mean age of the 30 participants was 83 years, and most (80%) were female. Participants completed three occupational tasks (reading a prescription label, sorting pills, and sorting dark colored socks) under three different lighting levels (low, M = 103; medium, M = 127; and high, M = 397 footcandles [fc]) presented in random order. Participants were placed in three groups based on order of lighting presentation and completed each set of tasks four times: a trial session, followed by three timed sessions. Participants were asked to rate their perceived effort under each lighting level using a self-report scale. Descriptive statistics were used to examine completion times, groups, and lighting levels. In general, participants required longer to complete occupational tasks and reported more effort when utilizing medium light levels (M = 127 fc) provided by ambient lighting and a floor lamp and performed best under high lighting levels (M = 397 fc) provided by ambient lighting as well as a floor lamp and task lamp. The results suggest lighting may have affected performance and perceived effort of older adults while completing the visually challenging tasks.

The aging population and burden of chronic conditions have led researchers and practitioners to develop, implement, and evaluate evidence-based programs (EBPs) for older adults. The Healthy Aging Regional Collaborative (HARC) was established to make EBPs including Diabetes Self-Management Program, Chronic Disease Self-Management Program, Matter of Balance, and EnhanceFitness (EF) accessible in south Florida. According to the REAIM model, reach, effectiveness, adoption, implementation, and maintenance determine the impact of EBPs. Evaluation of HARC demonstrated widespread adoption of EBPs by community organizations that reached diverse participants and effectiveness among participants attending the recommended number of sessions, but only 19% of EBP participants were male, and only 25% of EF participants met attendance criteria for adherence. This mixed-methods dissertation explored program instructor and coordinator perspectives on barriers and strategies related to male participation in EBPs, examined predictors of short-term and long-term adherence to EF, and applied a theoretical framework to explore participant and instructor perspectives on factors influencing adherence to EF. Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate findings. Themes among barriers to male participation included women outnumbering men in programs, incompatibility of programs with male gender roles, and preference for other activities. Themes among strategies included endorsement by male community leaders, advertisements featuring males, and content adaptation. Among 5,619 EF participants, logistic regression confirmed age, race/ethnicity, gender, and health status as significant predictors of adherence. The likelihood of short-term and long-term adherence increased with age and health. Black participants were less likely than whites to adhere short-term (OR=0.82, p=.05) but more likely to adhere long-term (OR=1.77, p=.000). Hispanics were more likely than whites to adhere short-term (OR=1.25, p=.008) and long-term (OR=1.30, p=.001). Men were more likely to meet the criteria for short-term (OR=1.47, p=.001) and long-term adherence (OR=1.19, p=.04). Interviews with 12 adherent EF participants and 10 instructors revealed cues to action, goals, beliefs, intentions, program factors, social factors, and benefits that supported adherence. Findings inform efforts to improve participation and adherence in EBPs and maximize their impact on health among older adults.

Indiana University-Purdue University Indianapolis (IUPUI) / Epilepsy is the most common chronic neurological condition in the United States, and it is incurable. Those who suffer from it must engage in both collaborative and independent management of their condition for the remainder of their lives. The treatment and care of those with epilepsy must therefore include not only medical interventions, which alone cannot cure the disorder or prevent the disability associated with it, but must also prepare persons for and facilitate their independent management—self-management—of the disorder. Self-management is a process that affects important outcomes including resource utilization, mortality, and quality of life. In the United States, those age 60 years and older have the highest incidence of new-onset epilepsy. Despite the high incidence of epilepsy in this population, coupled with the knowledge that self-management affects important outcomes, a thorough search of the literature suggests that self-management experiences of older adults diagnosed with epilepsy late in life have not been investigated. The purpose of the study was to examine, using a qualitative descriptive design, the self-management experiences of older adults diagnosed with epilepsy at or after age 60. Semi-structured interviews were used to generate data. A total of 20 older adults participated. Major findings indicate that older adults in the sample, and particularly the women, experienced a delay in receiving an epilepsy diagnosis. These older adults experienced multiple problems and life changes since diagnosis—some of which are unique to this population and many of which are amenable to intervention. These older adults devise and execute a variety of management strategies, within a system, that are classified as disease/treatment-focused and problem/life changes-focused. These strategies further are categorized as proactive or reactive, with proactive strategies being pre-planned and effective, and reactive strategies being unplanned and less effective. Knowledge generated from this study reveals the problems experienced by older adults with epilepsy, as well as their management needs. These findings will inform future studies, the aim of which will be to investigate more thoroughly these problems and needs and, ultimately, to inform interventions aimed at resolving this population’s problems and concerns while also improving outcomes.

Physical activity is a well-known protective factor against poorer mental health outcomes. Feelings of depression, social isolation, and stress have increased since the onset of the COVID-19 pandemic. Public health measures implemented to mitigate the spread of the virus have had some unintended consequences on older adults’ physical and mental health. Researchers and government officials recommend physical activity to minimize the negative psychological and physiological impacts of COVID-19. However, older adults have generally shown less moderate-to-vigorous physical activity and positive behavioural adaptations during the COVID-19 pandemic, highlighting a need for physical activity programs and strategies targeted for older adults. Filling this gap, the current study developed and implemented a remote exercise training program for older adults. Employing a measurement burst design with repeated ecological momentary assessments, the current longitudinal randomized control study examined the dynamic relationships of physical activity, depressive symptoms, social isolation, and COVID-19 related stress in older adults. The results from multilevel model analyses showed: (1) the exercise training program was effective in increasing physical activity; (2) sex, age, and group assignment were significant predictors of physical activity; (3) physical activity did not reduce depressive symptoms over time; (4) social isolation is directly associated with depressive symptoms; and (5) COVID-19 stress is inversely associated with depressive symptoms. At-home physical activity programming could be an effective way to increase physical activity among older adults; thus, more research into at-home physical activity programs is needed. / Graduate