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Introduction: More than half a million Canadians are living with dementia and 260,000 of these individuals live at home. As dementia progresses, persons with dementia require more assistance from caregivers to meet their daily needs including stimulation and emotional support. However, caregivers receive little training in this role. Namaste Care is a program originally developed for use in long-term care homes promoting a structured routine, a slow pace of care, and multisensorial activities for persons with advanced dementia. The program has not yet been adapted or evaluated for use by caregivers of community-dwelling older adults with moderate to advanced dementia. The objective of this study is to explore the feasibility, acceptability and preliminary effectiveness of a version of Namaste Care adapted by caregivers. Methods: A multiphase mixed methods design was used. In the adaptation phase, six caregivers participated in workshop sessions to adapt Namaste Care for home use. In the evaluation phase, 12 caregivers received training to use the adapted program. Surveys were used to collect data on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Qualitative interviews at 3-month follow-up were also completed to assess the acceptability of the program and implementation facilitators and barriers. Findings: All caregivers used the program for a minimum of twice a week as planned and used a variety of program activities. The retention rate was 83%. Caregivers perceived that the program improved their relationships with persons with dementia. Implementation facilitators were receiving a Namaste Care Toolbox and written resources about Namaste Care. No statistically significant effects were found with regards to the outcome measures listed above. Conclusions: The adapted Namaste Care program was feasible and acceptable for use by caregivers. There is a need to conduct a larger trial to determine the extent of its effects. / Thesis / Doctor of Philosophy (PhD) / With the growing numbers of family and friend caregivers across Canada supporting people living with dementia at home, there is a need to better prepare caregivers for their role. The aim of this study is to adapt, implement and evaluate a sense-based, skill-building program called Namaste Care delivered by caregivers of older adults living with moderate to advanced dementia. First, workshops for caregivers were held to adapt the Namaste Care program for home use. Afterwards, 12 caregivers received training in using the adapted program and delivered the program for three months. Caregivers used the program at least twice a week as intended and delivered a variety of activities. The program improved relationships with persons with dementia. No significant changes for caregiver quality of life, positive beliefs of caregiving, burden, and confidence were found. Next steps are to further test the effects of the program in a larger trial.

Associations between greater perceived racial discrimination and both higher levels of depressive symptomology and higher blood pressure have been established in the literature. Research has found that depression is often comorbid with diabetes and individuals with type 2 diabetes are at an increased risk for depression as the prevalence of depression is 2 to 3 times higher in people with diabetes when compared to the general population. Additionally, individuals with type 2 diabetes are also at an increased risk for high blood pressure. Although these associations are present in the literature, no studies have been found that examine all of these variables in conjunction. The current study used data from the 2014 Health and Retirement Study to examine the associations among perceived racial/ethnic discrimination, depression symptoms, and blood pressure for older Latinx adults (ages 50+) with type 2 diabetes (n = 303) and without type 2 diabetes (n = 521), while controlling for sex, age, partner status, and education. Findings indicated diabetes status was positively associated with both depression symptoms (t(790) = 5.32, p < .001) and systolic blood pressure (t(703) = 2.74, p = .006). Racial/ethnic discrimination was positively associated with depression (r(206) = .14, p = .045); however, it was not associated with blood pressure. No statistically significant interactions were found. Discussion focuses on possible explanations for the research findings, future directions, and clinical implications.

This study examines the casual leisure activities of older adults and their potential to create flow experiences. Using a qualitative approach, the study found that participants often choose leisure activities based on the perceived enjoyment and potential benefits; maintaining physical and mental health, altruism, or maintaining relationships with friends and family. Analysis revealed that flow-like experiences were facilitated by participants’ purposeful choices and focusing their attention on the immediate task. If participants do not achieve flow, their leisure activities were chosen to contribute positively to their well-being and quality of life.

<p>Older adults with chronic health conditions experience limitations participating in everyday activities. Neighbourhood characteristics and social support can offset individual impairments and help to facilitate participation; however, gaps in this literature exist. This thesis presents the results of three studies that explore the influence of neighbourhood and social factors on participation in everyday activities among older adults with chronic health conditions. The first paper describes a scoping review of academic literature regarding neighbourhood influences on participation. The findings of the review indicated that neighbourhood economic status, amenities, problems, mobility barriers, cohesion, and safety may influence participation but the pathways through which this occurs are not clear.</p> <p>The second paper uses findings from a cross-sectional survey (n=248) that examined the relationship between perceptions of neighbourhood characteristics and satisfaction with participation among older adults with chronic health conditions. Path analysis showed that fewer neighbourhood problems directly predict higher participation while higher neighbourhood cohesion and safety indirectly predict higher participation.</p> <p>The third paper uses data from the same cross-sectional survey to examine the types of social support that most strongly predict satisfaction with participation. Regression analyses showed that participants who perceived greater tangible support and positive social interaction support had more satisfaction with participation than participants with lower levels of these types of support.</p> <p>The findings in this thesis extend previous research by showing that neighbourhood characteristics influence participation even after accounting for social and individual factors. This research identified a potential pathway from neighbourhood characteristics to participation that includes neighbourhood cohesion and social support and established a link between positive social interaction support and participation. The findings in this thesis help to better understand neighbourhood and social influences on participation. These influences may be addressed through clinical or policy interventions to facilitate participation in older adults with chronic health conditions.</p> / Doctor of Philosophy (PhD)

<p>[missing page:45]</p> / <p>BACKGROUND: Creatine monohydrate (CrM) supplementation during resistance exercise results in a greater increase in fat free mass (FFM), total body mass (TBM), and strength in young men and women. The purpose of the present investigation was to examine the interactive effects of creatine supplementation and resistance training on body composition, strength, and intramuscular total creatine concentration in older men and women.</p> <p>METHODS: Twenty-eight older men and women were randomly allocated, in a double blind fashion, to receive either CrM (n=14; CrM: 5g + 2g dextrose) or placebo (n=14; PL: 7g dextrose). Subjects participated in a 14 wk progressive, whole-body resistance training program. Pre-and post-training measurements included: 1 RM strength, isometric strength, body composition (TBM, FFM, %BF), muscle fiber area, and muscle total creatine and phosphocreatine.</p> <p>RESULTS: Training resulted in an increase in 1 RM strength for each of the 4 exercises (range = 26 - 60%) (p < 0.001), an increase in knee and dorsiflexion isometric strength (p < 0.001) and an improvement of performance on functional tasks (p < 0.001). Knee isometric strength was increased more for CrM (46.2%) as compared to PL (22.5%) (p < 0.05). Total body mass and lean body mass increased more for CrM (TBM: +1.2 kg; LBM: +1.7 kg) as compared to PL (TBM: -0.2 kg; LBM: 0.4 kg) (p < 0.05)</p> <p>CONCLUSIONS: We conclude that erM supplementation results in a greater increase in isometric knee extensor strength, total body mass and lean body mass during resistance training in older adults.</p> / Master of Science (MSc)

<p>Western democratic societies are currently experiencing an interesting convergence of trends: population aging and rapidly advancing technology. In our increasingly digital economy, it is important to be reflective on the effects of technological evolution in our institutions. Older adults have observed many changes as we have entered the information age. Their experience with this evolution has been documented in the literature in understanding the acceptance and use of information and communication technologies (ICT), most frequently the personal computer. This thesis contributes to and extends the existing interdisciplinary scholarship on older adults and technology, broadening the scope from that of the individual to the societal level. I examine how institutional changes in the public sphere, specifically technological advances in the financial system accompanying the digital economy, are perceived by older adults.</p> <p>A mixed methods study was conducted composed of a forty item mailed out questionnaire and twelve in person interviews recruited through the McMaster SHARE group. The analysis of this work was conducted with an interpretivist ontology, understanding the co-creation of technology and society. Theoretically, the life course perspective was important in framing this work. Analysis revealed three major themes that have been described in the thesis in individual chapters: ideas of subjective age, risk and trust, and gender and intersectionality.</p> <p>Consistently in this project, discussions of financial technologies blended with older adults’ perceptions of technology in a broader sense. This both evidenced the life course perspective and comments on the pervasive influence of technology in our society.</p> / Master of Arts (MA)