Research acknowledges that older adults residing in long-term care facilities are at risk for social isolation, depression, and functional decline (Mezuk et al., 2014; Ouyang et al., 2015). The health risks associated with long-term care facilities may lead to poor health outcomes and poor quality of life. However, current evidence-based literature demonstrates ways in which to counteract the health risks associated with long-term care facilities through a holistic approach addressing the social, emotional, and physical health of an individual as they relate to quality of life. The aim of this doctoral project is to create an evidence-based and theory-driven program that supports older adults in long-term care facilities. The project explores the various factors impacting quality of life and provides recommendations and a potential solution to improving overall quality of life of older adults in long-term care facilities. E.D.U.C.A.T.E is a 7-step web-based resource for occupational therapy practitioners that utilizes a health and wellness approach and empowerment principles to improve quality of life of older adults residing in long-term care facilities. The objectives of E.D.U.C.A.T.E. are to foster occupational therapy practitioners employing a health and wellness approach to practice, increase older adults’ participation in meaningful occupations and social engagements, and increase older adults’ feelings of self-efficacy through an empowerment approach. By following the 7-step resource, occupational therapy practitioners may promote overall quality of life of older adults by addressing the social, emotional, and physical components impacting health outcomes. In order for this program to be implemented, additional information is included related to program evaluation, funding plans, and dissemination plans.

Taking a social design approach to aging, we relate earlier work in age-friendly communities, aging in place and social isolation to landscape design. Identifying the critical principles of social participation and how these needs can be met through landscape intervention, we formulate a set of criteria, through which the landscape architect can design healthy and sustainable communities for active, rural, older adults. We begin by breaking down some common social issues of modern-day older adults and conclude that to begin improving the lives of this sector of the population we must seek to reduce social isolation. Social participation chosen as the antithesis of isolation is then broken down into three main principles: autonomy, social opportunity and health. These main principles are developed into a set of physical design criteria to be implemented through the redevelopment of a historical school within the rural community of Pulaski, Virginia. Further discussing elements related to site-scale design, this project wraps up with the creation of a standard evaluation form, designed to give feedback for not only the current project, but those wishing to develop communities that encourage social participation among older adults. / Master of Landscape Architecture / Taking a social design approach to aging, we relate earlier work in age-friendly communities, aging in place and social isolation to landscape design. Identifying the critical principles of social participation and how these needs can be met through landscape intervention, we formulate a set of criteria, through which the landscape architect can design healthy and sustainable communities for active, rural, older adults. We begin by breaking down some common social issues of modern-day older adults and conclude that to begin improving the lives of this sector of the population we must seek to reduce social isolation. Social participation chosen as the antithesis of isolation is then broken down into three main principles: autonomy, social opportunity and health. These main principles are developed into a set of physical design criteria to be implemented through the redevelopment of a historical school within the rural community of Pulaski, Virginia. Further discussing elements related to site-scale design, this project wraps up with the creation of a standard evaluation form, designed to give feedback for not only the current project, but those wishing to develop communities that encourage social participation among older adults.

Bakgrund: Läkemedelsbehandling är den vanligaste medicinska behandlingsformen för äldre personer och det är viktigt att sjuksköterskor har kunskap om den äldres känslighet för läkemedel för att kunna identifiera läkemedelsbiverkningar. Multisjuka sköra äldre och polyfarmaci är en utmaning för den kommunala hälso- och sjukvårdens sjuksköterskor som ska bedöma om dess symtom beror på sjukdom eller biverkningar. Syfte: Att beskriva sjuksköterskor erfarenheter av att identifiera läkemedelsbiverkan hos multisjuka sköra äldre inom kommunal hälso- och sjukvård. Metod: En kvalitativ induktiv ansats användes. Datainsamlingen gjordes genom semistrukturerad intervju och en manifest analys utfördes. Resultat: Ett övergripande tema, kompetens och säkerhet framkom med tre underkategorier, sjuksköterskans kunskap samverkan med andra professioner samt att arbeta säkert med tydliga rutiner. Sjuksköterskans erfarenheter, engagemang och kunskap var viktiga faktorer för att kunna identifiera läkemedelsbiverkningar. Samverkan i team med andra professioner ansågs som viktigt för att kunna arbeta säkert med läkemedel, under förutsättning att samarbetet var välfungerande. Tydliga läkemedelsrutiner saknades, men man hade goda kunskaper om den årliga läkemedelsgenomgången. Slutsats: För att kunna identifiera läkemedelsbiverkningar krävs goda kunskaper och erfarenheter hos sjuksköterskor, men det behövs även ett bra samarbete med andra professioner och läkemedelsrutiner behöver synliggöras för en säkrare läkemedelshantering inom den kommunal hälso- och sjukvården. / Background: Drug treatment is the most common form of medical treatment for older adults and it is important that nurses have knowledge of the older adults’ sensitivity to drugs in order to identify drug side effects. Multimorbid frail older patients and polypharmacy are a challenge for the municipal health care nurses who must assess whether the symptoms are due to illness or side effects. Purpose: To describe nurses’ experiences of identifying drug sides effects in frail multimorbid older adults in municipal health. Method: A qualitative inductive approach was used. Data collection was done through semi-structured interviews and a manifest analysis was performed. Results: An overarching theme, competence and safety emerged with three subcategories, the nurse´s knowledge and collaboration with other professions and working with clear routines. The nurse´s experience, commitment and knowledge were impotent factors in being able to identify drug side effects. Cooperation in teams with other professions was considered impotent to be able to work safely with medicines, but this was something that did not always work. Clear medication routines were missing, but there was good knowledge of the annual medication review. Conclusion: In order to be able to identify drug side effects, good knowledge and experience is required on the part of nurses, but a good collaboration with other professions is also needed and drugs routines need to be made visible for safer drug handling within the municipal healthcare system.

ABSTRACTPreoperative Activity Level and Outcomes in Older ¨Adult Cardiac Surgery Patients: A Pilot StudyDon Howard Sorensen Jr.College of Nursing, BYUMaster of SciencePurpose: To assess the relationship between preoperative physical activity levels and health related quality of life on intra- and post-hospital outcomes following scheduled cardiothoracic surgery in older adults.Rationale/Background: Adults age 50 and older tend to accumulate more sedentary time and are less physically active. Sedentary behavior is linked with early morbidity and death and may predispose patients to postoperative complications. Preoperative activity levels and its relationship to surgical outcomes is an underexplored area. Insight on this topic could influence how to optimize interventions prior to surgery to improve outcomes. Methods: Seven participants were fitted with an ActiGraph GT3X+ accelerometer to measure preoperative activity levels for 1 week and complete the RAND Short Form-36 health-related quality of life tool. This process was then supposed to be repeated during the first and last weeks of cardiac rehabilitation (rehab). This information, along with demographics, was then correlated with information pulled from the Society of Thoracic Surgeons database on post-surgical outcomes and the 6-minute walk tests (6MWT) done during rehab. Results: The only statistically significant result was participants who experienced some type of intra-hospital complication also scored low in emotional wellbeing (r = -0.928, p = 0.003) as reflected in the quality of life score. Other findings with p values > 0.05 but <<> 0.1 were noted as œareas needing further exploration. Such areas for further exploration included: participants who spent more time in light physical activity reported less role limitations due to physical health (r = 0.864, p = 0.059), higher preoperative activity levels related to higher postoperative 6MWT (r = 0.830, p = 0.082), increased body mass index related to a decrease in postoperatively 6MWT (r = -0.869, p = 0.056). Implications: Exploring the relationship between preoperative activity levels and post-surgical outcomes could provide insight optimizing interventions before surgery to improve surgical success and rehab outcomes.

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By 2030, the Government of Canada predicts that over 9.5 million (23%) Canadians will be 65 years of age or older. For this growing demographic of older adults, intelligent home health technologies have been proposed as one beneficial avenue to support and maintain health and wellness as they begin experiencing ageing-related health effects. However, many ethical concerns have been raised regarding the design and deployment of these technologies in ageing-in-place settings such as long-term care and nursing homes. This thesis aims to better understand the ethical concerns that long-term care stakeholders have with a subset of intelligent home health technologies known as Ambient Assistive Living (AAL) technology. To obtain this understanding, a Systematic Literature Review (SLR) was conducted to gather the different ethical concerns that long-term care stakeholders have with AAL technology and to observe the various ethical design and engineering frameworks used to develop AAL technology for aging-in-place settings. 41 publications were analyzed to identify various ethical concerns held by ageing-in-place stakeholders and the different ethical design and engineering frameworks used to address these concerns. The findings from the SLR identified 17 ethical concerns that influenced how the research was conducted with long-term care facility stakeholders. Following the SLR, a Participatory Design methodology in the form of workshops and interviews was developed and implemented with 30 long-term care facility stakeholders to understand their ethical concerns with two AAL devices: the Hexoskin ProShirtTM - a wearable device used to monitor and collect vital signs, and the AWS DeepLensTM camera - a machine-learning enabled video camera used to make predictions. Through data analysis, 35 topics were identified and grouped into 12 main ethical concerns for both devices. Once a better understanding of long-term care stakeholders' ethical concerns with the two devices was gained, a prototype of an ethical design tool - the Ethical DataSheet - was proposed. An Ethical DataSheet is meant to support researchers, engineers, designers, and others in developing a better understanding of the ethical concerns they must consider when designing and developing AAL technology for ageing-in-place applications. To create the Ethical DataSheet prototype, a snowball sampling literature review was conducted. By conducting the second literature review, inspiration from different ethical design tools was used to develop the prototype. The Ethical DataSheet prototype was then used to create Ethical DataSheets for the Hexoskin ProShirt™ and AWS DeepLens™, which present the top ethical concerns that were identified through the workshops and interviews with long-term care facility stakeholders. The findings of this research will be shared with the PATH research community, who are dedicated to providing nationwide testing and services for home health technologies that will accelerate the availability of appropriate smart systems (i.e. AAL technologies) for seniors' and patients' home healthcare.

The study's purpose was to identify the perceived needs and concerns of three generations in a family with an older adult aging in place in Mississippi. This mixed-methods study used snowball sampling in addition to recruitment by community leaders such as Extension agents to collect data through semi-structured interviews and structured questionnaires that asked about current and future problems among aging adults in rural communities in Mississippi. Three generations of Mississippians participated in the study, including older adults (G1; n = 22), adult children (G2; n = 23), and young adult grandchildren (G3; n = 19). Quantitative data were analyzed using SPSS Statistics, while qualitative data were managed with MaxQDA. Physical and mental health concerns were identified across all three generations. Financial concerns, including paying for basics such as food, medical and health care costs, and transportation issues, were most often reported by the two younger generations rather than the older adults. Services that assist with caregiving of older adults, including respite care, home health, and adult daycare options, were identified as services G2 and G3 family members reported as families currently needed or anticipated to need soon. Implications of the findings for families, community leaders, policymakers, non-profit organizations, and for-profit businesses are provided.

Abstract Background: Physiotherapists’ knowledge, attitude and practice patterns in falls prevention are studied mainly in middle- and high-income countries. This study aims to develop and validate a questionnaire for studying the attitude, self-reported knowledge and clinical practice of Rwandan physiotherapists in falls prevention of older adults.  Method: In a cross sectional design the content, face and cross-cultural validity was tested on four Swedish experts and four Rwandan physiotherapists. Test-retest was performed with 20 Rwandan physiotherapists and descriptive data was summarized for these physiotherapists. Content validity index (CVI) was calculated per item and scale, and face validity index with face validity index (FVI) per item and scale. Interviews complemented the face validity scorings for cross-cultural validation. Test-retest was analysed with intraclass correlation coefficient(ICC). Results were categorized into individual, behavioural and environmental factors, in line with the Social Cognitive Theory.  Results:  The questionnaire attained a satisfactory degree of content validity with content validity index per item(I-CVI) and scale-level content validity index based on the average method (S-CVI/Ave) of 0.96. Questionnaire had satisfactory face validity with a face validity index per item (I-FVI) and scale-level face validity index based on the average method (S-FVI/Ave) of 0.89. The questionnaire was shown to be pertinent to Rwandan physiotherapists’ context. The test-retest stability of the questionnaire was non-significant. Most physiotherapists emphasized individual rather than environmental or behavioral risk factors for falls and in falls prevention treatment.  Conclusion: The content and face validity as well as cross-culture validity of preliminary questionnaire of falls prevention were acceptable. Further research in this area is essential to complete validation and to improve the reliability of the questionnaire. The study highlights the importance of application of social cognitive theory in studying how physiotherapists consider the complexity of factors contributing to falls.

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