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Social isolation and loneliness are problems that affect the quality of life of many older adults. As the proportion of older people increases in Canada and other nations, studying factors that could improve the quality of life of older people becomes even more crucial. Two studies were conducted drawing on longitudinal data (1996 and 2001) from the Aging in Manitoba Project (Study 1 N = 760) and the Successful Aging Study 2003 (Study 2 N = 228). The main objective of Study 1 was to identify the characteristics of older individuals who differed in their loneliness trajectories over time, allowing for a comparison of those who became lonely, overcame loneliness, were persistently lonely, and were persistently not lonely. A discriminant function analysis examined the social, demographic, physical, and psychological factors as potential discriminators of the loneliness trajectories. When compared to those who were neither lonely at time 1 or time 2, the most important discriminators of persistent loneliness were: living alone, being in poor health, and having low perceptions of control. These predictors were found to be more important than people’s friendships or social activities, highlighting the complexity of loneliness in later life. Study 2 examined the longitudinal relationships between loneliness, health, physical activity, and mortality, and tested Fredrickson’s Broaden and Build Theory that positive emotions (happiness) might serve to “undo” the detrimental effects of negative emotions like loneliness. Regression analyses showed that loneliness longitudinally predicted health, physical activity, and mortality, underscoring the importance of socioemotional variables to health. Moreover, happiness moderated the relationships between loneliness and physical activity and loneliness and mortality. Thus, in support of Fredrickson’s hypothesis, results suggested that happiness has the power to “undo” the detrimental effects of loneliness on physical activity and even on mortality. Being happy may indeed offset the negative consequences of being lonely. Based on these two studies, it was concluded that future interventions could target positive emotions, perceptions of control, and loneliness as ways of ultimately enhancing the lifespan, healthspan, and wellspan of older adults.

With the growing number of older adults in the general population, there is also a concomitant rise in the number of older adults who require mental health services, making the measurement of psychological conditions in later life a priority. However, due to a lack of measures created for older adults, researchers and clinicians must often rely on measures created for younger populations. Three studies were designed to add to the field of evidence-based assessment and determine which anxiety measures possess strong evidence when used with older adults to warrant their use with this specific population. In the first study, I systematically reviewed the literature to identify the anxiety measures most commonly used with older adults. I reviewed each measure to examine its psychometric properties (e.g., internal consistency, test-retest reliability, inter-rater reliability, concurrent and discriminant validity) and the availability of age-appropriate norms in order to evaluate whether the instruments are appropriate for use with older adults. In the second study, I conducted a reliability generalization meta-analysis to estimate the mean reliability of each commonly used anxiety measure identified in the first study. Finally, in the third study, I examined whether the anxiety measures commonly used with an older population can be consistently and accurately categorized as evidence-based. The literature review and the reliability generalization study both revealed that most of the most commonly used measures lacked sufficient evidence to warrant their use with older adults. However, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults. This suggests that based on their overall level of reliability and previous psychometric evidence, both researchers and clinicians assessing anxiety in a geriatric population should consider these measures as likely to be the best currently available.

Social isolation and loneliness are problems that affect the quality of life of many older adults. As the proportion of older people increases in Canada and other nations, studying factors that could improve the quality of life of older people becomes even more crucial. Two studies were conducted drawing on longitudinal data (1996 and 2001) from the Aging in Manitoba Project (Study 1 N = 760) and the Successful Aging Study 2003 (Study 2 N = 228). The main objective of Study 1 was to identify the characteristics of older individuals who differed in their loneliness trajectories over time, allowing for a comparison of those who became lonely, overcame loneliness, were persistently lonely, and were persistently not lonely. A discriminant function analysis examined the social, demographic, physical, and psychological factors as potential discriminators of the loneliness trajectories. When compared to those who were neither lonely at time 1 or time 2, the most important discriminators of persistent loneliness were: living alone, being in poor health, and having low perceptions of control. These predictors were found to be more important than people’s friendships or social activities, highlighting the complexity of loneliness in later life. Study 2 examined the longitudinal relationships between loneliness, health, physical activity, and mortality, and tested Fredrickson’s Broaden and Build Theory that positive emotions (happiness) might serve to “undo” the detrimental effects of negative emotions like loneliness. Regression analyses showed that loneliness longitudinally predicted health, physical activity, and mortality, underscoring the importance of socioemotional variables to health. Moreover, happiness moderated the relationships between loneliness and physical activity and loneliness and mortality. Thus, in support of Fredrickson’s hypothesis, results suggested that happiness has the power to “undo” the detrimental effects of loneliness on physical activity and even on mortality. Being happy may indeed offset the negative consequences of being lonely. Based on these two studies, it was concluded that future interventions could target positive emotions, perceptions of control, and loneliness as ways of ultimately enhancing the lifespan, healthspan, and wellspan of older adults.

The purpose of this study was to determine if a ten week, twice weekly group exercise program using large amplitude movement and functional mobility training was effective at improving mobility and quality of life in old, older adults (i.e. average age 80 years) with Parkinson’s disease (PD). This exercise program builds on existing large amplitude movement training programs, but differs in that it is delivered in a group format, in an older cohort and incorporates functional training related to the tasks of daily living. To determine the long term training effects of the program, a follow up assessment was conducted at four months post intervention. Sixteen participants with PD with an average age of 80 years (range 69-91years) were recruited through a hospital-based Seniors Outpatient Clinic. Participants were assessed before starting (PRE) and upon completion (POST) of the intervention. To decrease the likelihood that the results would be affected by day-to-day fluctuations in mobility that are often seen with PD, 3 measures were gathered at both PRE and POST and then averaged to provide a single PRE and POST score. A single follow-up assessment was conducted four months after completion. Outcome measures included: Movement Disorder Society-Unified Parkinson’s Disease Rating Scale-Part III, Timed Up and Go, Berg Balance Scale, Sit-to-stand Test, gait characteristics (GaitRite system), Parkinson’s Disease Questionnaire – 39 and Goal Attainment Scale. Results indicate significant improvements from PRE to POST (p≤0.05) in all measures of physical function (effect sizes (ES) ranging from 0.35-0.87), Quality of Life (QOL) (mobility dimension, ES=0.34) and personal goal achievement (ES=2.12). Therefore this group exercise program was effective in improving mobility and QOL for an older adult population with PD. The program frequency and duration was adequate to achieve the desired training effects while being manageable for an old, older population to attend. Further, in those participants who continued to engage in ongoing physical activity, improvements were maintained at 4 months after completion of the program for MDS-UPDRS, TUG, gait velocity, QOL (bodily discomfort dimension) and GAS. / Graduate / 0382 / gallagher_karla@yahoo.ca

Objective: The purpose of this investigation was to examine the effect of implementation intentions on physical activity in older adults with stronger and weaker executive control resources (ECRs). Methods: One hundred and ten community dwelling older adults (Mage=74.42) were randomly assigned to receive either a physical activity implementation intention intervention, a control intervention, or no-treatment. Three ECR facets (inhibition, task-switching, working memory), baseline behaviour and baseline intentions were assessed during the initial laboratory session. During 4 weekly follow-up telephone interviews, participants reported physical activity behaviour for the previous week, and refreshed implementation intentions for each upcoming week. Results: A main effect of treatment condition on 1-month self-reported physical activity was observed, with those in the experimental group reporting significantly higher physical activity than those in the control or no-treatment conditions. In addition, a significant 2-way (intention strength by treatment condition) interaction emerged, with the experimental group showing higher intention-behaviour correspondence than the control and no-treatment groups. A marginal 2-way interaction of intention and behavioural inhibition was also detected; those with stronger behavioural inhibition had higher intention-behaviour correspondence relative to those with weaker behavioural inhibition across all three treatment conditions. Conclusions: Implementation intentions are effective in facilitating physical activity in healthy older adults. The findings also indicate that behavioural inhibition may be important for the moderation of intention-behaviour relationships in the context of physical activity, regardless of goal setting strategy.

It is well established that there are many intrinsic and extrinsic risk factors associated with falls in older adults. Less well-known is what risk factors predict falls in more vulnerable populations, such as those with neurological conditions living in long-term care homes or receiving home care services. Furthermore, evidence comparing those with neurological conditions to those without is lacking in the literature. The primary purpose of this thesis was to determine risk factors for falls in long-term care residents and home care clients with no recent history of falls to determine if risk factors differed between individuals with dementia or Parkinson’s disease and those without any neurological conditions. Secondary data analysis was performed on a database of standardized health assessments completed for long-stay home care clients and long-term care residents in Ontario. Within each major diagnostic group, observations were stratified based on ambulatory status (ambulatory vs. non-ambulatory). Bivariate analyses followed by generalized estimating equations were used to determine statistically significant predictors of falls in each group within each care setting. The results of multivariable analyses showed that there is not a distinct set of risk factors associated with falls in home care clients and long-term care residents with dementia or Parkinson’s disease that is systematically different from risk factors associated with falls in clients and residents not diagnosed with any of the neurological conditions in this study. These results suggest that a common set of risk factors may effectively predict falls in all clients and residents with no recent falls history, regardless of certain neurological diagnoses.

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.

This study combined quantitative and qualitative methods to investigate the relationship between Internet use and identity, particularly age-identity, in older Internet users. It has a theoretical basis in symbolic interactionism – particularly the theories of Erving Goffman – and conceptualizes identities as roles that are negotiated during social interaction. The focus on older users was motivated by the strong focus of prior Internet research on younger users. Few studies have examined older users specifically, and fewer still have examined age-identity. Thus, the focus in this study is on how changes in social interaction that occur due to Internet use affect the identity negotiation process. The research is focused around two key areas: whether older users experience the same kinds of online identity processes as younger users, and the impact exposure to novel audiences has on identity negotiation. The study consists of two phases. In the first, a quantitative survey was administered in which a measure of age-identity was assessed and compared with measures of audience novelty. Results showed that a significant increase in variance of ageidentity is associated with communication with people from other countries. This finding supports the theory that identity is formed in negotiation with the audience with whom one communicates, and that expanding this audience may lead to identity effects. To investigate this issue more deeply, a qualitative phase was conducted in which participants were interviewed using rapid ethnography techniques, and at the conclusion of which a model of the interaction between age-identity and Internet communication was developed. This model was then verified with follow-up interviews with key informants and with field observations from sites of online social interaction among seniors. The model developed during the qualitative stage identifies three ways in which ageidentity is influenced by social interaction on the Internet. First, the Internet is used in response to emotional or practical consequences of ageing. Second, older Internet users could take advantage of the ability to manage their personal front online to achieve agelessness, and third, the Internet is used as a backstage area to discuss ageidentity issues. The context of these claims is all-important; each individual’s unique circumstances, emotions and motivations influence the way in which they will use the Internet and respond to others encountered through it. The extension of Goffman’s dramaturgical metaphor to age- identity on the Internet and to include the concept of character development, in which identity evolves over time in response to inner tensions and external events, is a tentative but powerful finding. It poses a challenge for future research into the nature of identity change, both online and offline.