This qualitative, exploratory study uses an interpretive case study design to elucidate key factors influencing the attitudes and behaviors of older adults with regard to public education funding in the context of rapid demographic change. The research was conducted in three first-ring suburbs of Philadelphia, Pennsylvania, where the older population is predominately White, and students in the districts come from diverse racial backgrounds. The study examines how social networks and physical environment relate to older people’s attitudes and behaviors with respect to public education funding. Current literature about older adults in neighborhoods focuses primarily on them as recipients of service. In contrast, this study examines older people as political actors and provides a robust and nuanced discussion about how they themselves frame issues of school funding. The project makes a timely contribution to research on the relationship between the growing racial generation divide and support for public education among older adults. It also provides strategy recommendations designed to increase older people’s support for public education funding. / Urban Studies

Background. Many older stroke survivors live with multiple (> 2) chronic conditions (MCC), resulting in the need for care by multiple health and social service providers from multiple organizations and sectors. Managing the physical, social and psychological needs related to stroke in addition to other chronic conditions is a complex process that is best served by an interprofessional team of health care providers working collaboratively toward common goals. Interprofessional education (IPE) has been promoted by numerous organizations as a method to enhance collaborative practice. However, many home care providers have not received formal IPE or training to support collaborative practice. Providing IPE in the home care setting is challenging because providers rarely work in a common location, often work in isolation, and spend much of their time driving to provide care to clients in their homes. Moreover, the effectiveness of IPE on collaborative practice for stroke rehabilitation in the home care setting is undetermined. New approaches to IPE for practicing health care providers working in the home care setting are needed. The purpose of this study was to examine the feasibility and acceptability of implementing a new theory-based, IPE intervention, and to explore its effects on collaborative practice in home care for older adult stroke survivors with MCC. Method. This feasibility study involved the use of both a qualitative descriptive and a quantitative (one-group repeated measures) design. The IPE intervention was developed and evaluated within the context of a larger pragmatic randomized controlled trial (RCT), which evaluated the effectiveness of the Aging Community and Health Research Unit Community Partnership Program (ACHRU-CPP). Informed by the W(e) Learn Framework for Interprofessional Education, the National Interprofessional Competency framework, and the literature, the IPE intervention consisted of four key components: (a) an initial three-hour standardized IPE training session; (b) standardized training for care coordinators; (c) collaborative practice reflective huddles; and (d) outreach visits. The primary outcome was the feasibility of the IPE intervention (enrollment rate, attrition rate, implementation barriers/facilitators). Secondary outcomes included the acceptability of the IPE intervention, the feasibility of the study methods (recruitment/retention rates and procedures, eligibility criteria, data collection and analysis methods), and potential effectiveness of the intervention based on three-month changes in collaborative practice, as measured by the Collaborative Practice Assessment Tool (CPAT) and the 19-Item Team Climate Inventory (TCI). Feasibility and acceptability outcomes were based on descriptive statistics for enrollment and attrition rate and qualitative descriptive analysis of focus group content, field notes, and evaluation of training. The potential effectiveness of the IPE intervention was explored using paired t-tests and Cohen’s d, with the results expressed using descriptive statistics and effect estimates (95% confidence intervals). Results. A total of 37 home care providers from two provider agencies and one Community Care Access Centre (CCAC) in Ontario, Canada participated in the study. Participants included registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators as well as nursing, rehabilitation and personal support worker supervisors. Participants viewed the intervention as feasible and acceptable. It was effective in improving three domains of collaborative practice as measured by the CPAT (communication/information exchange; community linkage and coordination of care; decision-making and conflict management) and one domain of collaborative practice, as measured by the TCI (task orientation) at six months post initial training. Participants perceived many benefits to the intervention, including improved communication and collaboration within their teams, enhanced role understanding, increased learning with and from each other, and increased appreciation and valuing of the expertise of all team members. Facilitators to implementing the intervention included: funding from the larger trial, support from key stakeholders including agency leadership, provision of key resources (e.g., Team Charter, sample agenda), and continuity of the care coordinators. Barriers included unanticipated delays in recruitment of older adult stroke survivor participants into the larger trial, and higher than expected attrition rates. The study methods were feasible and effective in reaching the target population. We established that the intervention could be delivered as planned. Conclusion. The results of this study provide preliminary evidence for the feasibility, acceptability and preliminary effects of the IPE intervention on collaborative practice for an interprofessional stroke-specific team in home care caring for older adult stroke survivors with MCC. The results also provide knowledge of the facilitators and barriers to successfully implementing and sustaining the intervention into home care practice. Further research is warranted to test this intervention in other chronic populations and settings. / Thesis / Doctor of Philosophy (PhD) / This feasibility study used qualitative and quantitative methods to evaluate the implementation of a new theory-based, Interprofessional Education (IPE) intervention and explored its effects on collaborative practice in home care for older stroke survivors with multiple chronic conditions. The IPE intervention was developed and evaluated within the context of a larger pragmatic randomized controlled trial (RCT), which evaluated the effectiveness of the Aging Community and Health Research Unit Community Partnership Program. The six-month IPE intervention consisted of four key components: (a) an initial three-hour standardized IPE training session; (b) standardized training for care coordinators; (c) collaborative practice reflective huddles; and (d) outreach visits. Participants included 37 home care providers including registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators, and nursing, rehabilitation and personal support worker supervisors from two service provider agencies and one Community Care Access Centre (CCAC) in Ontario, Canada. The intervention was effective in improving collaborative practice (e.g., communication within teams, role understanding, team decision-making and conflict management). Facilitators to implementing the intervention included: funding from the larger trial, leadership support, provision of key resources, and continuity of the care coordinators. Barriers included unanticipated delays in recruitment of older adult stroke survivor participants into the larger trial, and higher than expected attrition rates. This study offers preliminary evidence that the intervention is feasible to deliver, acceptable to providers, and may improve collaboration within an interprofessional stroke-specific team. Further research is necessary to test this intervention in other chronic populations and settings.

This paper examines the caring experiences of 7 LGBT older adults in Southwestern Ontario. Up to 2 90-minute interviews were conducted with 7 participants which were then transcribed and analyzed using interpretive phenomenological analysis (IPA). Participants described life histories of discrimination and isolation, as well as contemporary experiences of medical discrimination. As a result, participants were highly skeptical of the formal care system, with only one indicating they would be willing to enter long term care. Analysis was conducted according to four themes that were identified while engaging in the interpretive phenomenological process. The research was influenced by life course theory and cultural scripts: specifically, that the current cohort of LGBT+ older adults is perhaps the first to age openly in their identity and as a result lack cultural scripts as to what they should do as they age. Questions were open-ended and asked participants about their experiences giving or receiving care, life histories of discrimination, and how their care experiences influence their plans for the future. Although no questions were directly asked about the HIV/AIDS epidemic, the legacy of the HIV/AIDS epidemic on contemporary LGBT older adults became a major theme of this paper. Other themes identified include the role that stigma and concerns about autonomy play in their plans for the future, the importance of political advocacy and community caregiving for LGBT older adults, and how LGBT older adults have developed resiliency and the practice of holding loved ones in personhood in order to cope with medical issues and death. / Thesis / Master of Arts (MA) / This paper examines the experiences of LGBT older adults giving and receiving informal care for physical or mental health conditions. It highlights themes of stigma and autonomy, the relationship between community caregiving and political advocacy, the legacy of the HIV/AIDS epidemic, and how LGBT older adults hold each other and the dead in personhood. Seven LGBT older adults from Southern Ontario were interviewed about their experiences with care, and the relationship between social structures and discrimination and their personal experiences with the medical system.

Driving is the preferred mode of transportation among community-dwelling older Canadians. Unfortunately, drivers aged 70+ have a high risk of being injured or killed in a collision. Many collisions are caused by poor driving habits, which could be avoided by improving their behind-the-wheel behaviours. The manuscripts in this thesis describe the development of an evidence-based and user-informed driver training program aimed at refreshing older adults’ driving skills. First, a systematic review of older driver training programs was undertaken to examine evidence specific to the impact of this training on improving road safety knowledge, self-perceived driving abilities, and on-road performance. Results highlighted the breadth of approaches used to train older drivers. Interventions were most effective when feedback was tailored to the specific needs of an aging driver. The second manuscript outlines a qualitative descriptive analysis exploring older adults’ motivations to participate in driver training with key stakeholders (i.e., older drivers and service delivery providers). Findings indicated having insight into one’s driving abilities, experiencing a near-miss or crash, as well as an openness to improving behind-the-wheel skills were factors that could influence seeking out and participating in such training. Stakeholders also emphasized considerations for educating older drivers. The final manuscript describes the design and evaluation of a driver training program. In this randomized controlled trial, older drivers watched either a video of tailored feedback on their driving or a generic video on aging-in-place. When the on-road performance was compared between treatment groups, those who received tailored feedback significantly reduced the number of errors they made behind-the-wheel. Ensuring driver training programs are designed to consider the specific needs and preferences of older adults is critical, which can lead to innovations that help maintain driving ability and community mobility in later life. / Thesis / Doctor of Philosophy (PhD) / Being able to drive is important to many older Canadians. Unfortunately, drivers aged 70+ have a high risk of being injured or killed in a car crash. Many crashes could be avoided by improving their driving skills. This thesis describes the development of an older driver training program. The first study examined research evidence on such programs where tailoring feedback was key to improving on-road performance. In the second study, older adults and other stakeholders identified what was important when designing training for aging drivers. They felt the focus should be on areas of improvement as well as strengths when behind-the-wheel. In the final study, older drivers underwent training where they watched either a video with feedback on their driving or a generic video on aging-in-place. Those who received feedback made fewer mistakes behind-the-wheel. Findings emphasize the importance of including older adults’ needs and preferences when designing driver training programs.

Mobility is essential to healthy aging and is closely related to health and overall quality of life. Mobility impairment is an early predictor of disability, and is intimately linked to falling injuries, loss of independence, hospitalization, and mortality. Mobility Assistive Devices (MADs), such as canes, walkers, and wheelchairs, provide support to older adults to improve their balance, coordination, and strength. Despite the acknowledged benefits of MADs for the older adult population research shows that as many as 75% of older adults are non-adherent to prescribed MADs. As non-adherence is a contributing factor to declines in mobility and overall quality of life, it is important to consider the reasoning behind it. Therefore, this doctoral project took a psychosocial perspective and investigated the psychosocial factors that predict non-adherence to MADs among older adults. This study considered a sample of older adult MADs users from long-term care units at the Perley Health Centre in Ottawa with different types of mobility limitations. The study examined the role of psychosocial variables using the Psychosocial Impact of Assistive Devices Scale (PIADS), social support using the Medical Outcomes Study Social Support Survey (MOS-SS), and the demographic variable of sex in the prediction of MADs non-adherence. Predictor variables that were associated with non-adherence in a univariate regression analysis were subsequently entered into a multiple regression analysis. Of the 96 residents invited to participate in the study, 49 gave their consent to participate, and out of this number, 48 completed the study, for a response rate of 51%. The data from the 48 residents (26 females and 22 males), with a mean age of 86.8 (Standard Deviation (SD) = 10.2, age range= 66 - 101), were therefore available for analysis. The most common reported mobility limitations were due to balance problems and leg weakness (29.17% for each). The most common device used was a walker (47.92%), followed by a manual wheelchair (33.33%). No statistical difference was detected between the groups of sexes regarding any of the study variables (P≥0.05). In the univariate regression analysis, the three PIADS subscales, namely, Competence, Adaptability, and Self-esteem, were significantly correlated with non-adherence (p < 0.001). Sex was an insignificant variable, while social support was significantly correlated with Competence, Adaptability, Self-esteem, and non-adherence. In the multiple regression analyses, only Self-esteem showed significant associations (p < 0.05), and the Self-esteem multivariate model explained 43.5 - 54.3% of the variance in non-adherence. This study revealed that the Self-esteem construct, which includes several concepts related to psychological wellbeing, was the only significant predictor of non-adherence among the studied sample of older adults. The theoretical and clinical implications of the findings are subsequently discussed.

No description available.

Heart disease is a leading cause of death in the United States, and older adults are at highest risk of being diagnosed with heart disease. Consistent physical exercise is an effective means of deterring onset of heart disease, and physical activity tracking devices can inspire greater activity in older adults. However, physical activity tracking device abandonment is quite common due to limitations on what can be learned from the activity data that is collected. Better data visualization of physical data presents an opportunity to surpass these limitations. In this thesis, a task-based human subject study was performed with three different data visualizations to gain insight into how the format of physical activity data visualizations impact older adults’ abilities to infer meaning from physical activity data. Participants (n = 30) interacted with a prototype data visualization as well as two data visualizations from popular fitness tracking applications (Fitbit and Strava) and used these visualizations to complete 11 tasks. Results from these tasks show each visualization was able to facilitate users answer some task questions effectively, though no visualizations exhibited strong performance across all tasks. From the successes and shortcomings of each visualization, three key design recommendations for the design of data visualizations for physical activity data were made: 1) make exact values available, 2) summarize data at multiple timescales, and 3) ensure accessibility for the entire population of users.

Yes / Activities running in community-based-settings offer a method of delivering multimodal interventions to older adults beyond cognitive training programmes. This systematic review and meta-analysis investigated the impact of randomised controlled trials (RCTs) of ‘real-world’ interventions on the cognitive abilities of healthy older adults. Database searches were performed between October 2016 and September 2018. Forty-three RCTs were eligible for inclusion with 2826 intervention participants and 2234 controls. Interventions to enhance cognitive ability consisted of participation in activities that were physical (25 studies), cognitive (9 studies), or mixed (i.e., physical and cognitive; 7 studies), and two studies used other interventions that included older adults assisting schoolchildren and engagement via social network sites. Meta-analysis revealed that Trail Making Test (TMT) A, p =  0.05, M = 0.43, 95% CI [-0.00, 0.86], digit symbol substitution, p =  0.05, M = 0.30, 95% CI [0.00, 0.59], and verbal fluency, p =  0.04, M = 0.31, 95% CI [0.02, 0.61], improved after specific types of interventions versus the control groups (which were either active, wait-list or passive controls). When comparing physical activity interventions against all control groups, TMT A, p =  0.04, M = 0.25, 95% CI [0.01, 0.48], and digit span forward, p =  0.05, M = 0.91, 95% CI [-0.00, 1.82], significantly improved. Results remained non-significant for all outcomes when comparing cognitive activity interventions against all control groups. Results therefore suggest that healthy older adults are more likely to see cognitive improvements when involved in physical activity interventions. In addition, TMT A was the only measure that consistently showed significant improvements following physical activity interventions. Visuospatial abilities (as measured by TMT A) may be more susceptible to improvement following physical activity-based interventions, and TMT A may be a useful tool for detecting differences in that domain. / Velux Stiftung, Switzerland, (Project No. 1034)

Yes / Objective: We conducted a U.K.-wide survey to collect information on people's beliefs, fears, perceptions, and attitudes to cognitive aging. Methods: This community-based aging survey included 3,146 adults aged 40 years and over. Results: Respondents believed memory might be the earliest cognitive skill to decline (mean: 59.4 years), followed by speed of thinking (mean: 64.9). Those in their 40s were more pessimistic, because they estimated cognitive changes would start up to 15 years earlier than respondents aged over 70. Having a purpose in life, healthy eating, challenging the mind, sleep, and physical activity ranked higher in terms of perceived importance for maintaining or improving cognitive skills. However, less than 50% engaged in any of these activities. Although 91% believed there are things people can do to maintain or improve their cognitive skills, more than 40% were unsure or did not know how to do so. Respondents who strongly agreed that changes in cognitive skills might be a sign of something more serious were significantly more likely to do various activities to benefit their cognitive skills. Conclusion: Results suggest that people are less aware of the potential cognitive benefits of certain activities, such as exercise and diet. It is important to build awareness about the benefits of lifestyles and activities for cognitive health. / Velux Stiftung (Project No. 1034).

Trip-induced falls are a leading cause of injuries among adults aged 65 years or older. Perturbation-based balance training (PBT) has emerged as an exercise-based fall prevention intervention and shown efficacy in reducing the risk of trip-induced falls. The broad goal of my PhD research was to advance the application of this so-called trip training through three studies designed to address existing knowledge gaps. First, trip training is commonly conducted with the aid of costly specialized treadmills to induce trip-like perturbations. An alternative version of trip training that eliminates the need for a treadmill would enhance training feasibility and enable wider adoption. The goal of the first study was to compare the effects of non-treadmill training (NT), treadmill training (TT), and a control (i.e., no training) on reactive balance after laboratory-induced trips among community-dwelling older adults. After three weeks of the assigned intervention, participants were exposed to two laboratory-induced trips while walking. Results showed different beneficial effects of NT and TT. For example, NT may be more beneficial in improving recovery step kinematics, while TT may be more beneficial in improving trunk kinematics, compared to the control. While the first study showed the effects of PBT on laboratory-induced trips, little is known about how such training affects responses to real-world trips. Responses to real-world trips may be captured using wearable inertial measurement units (IMUs), yet IMUs have not been adequately validated for this use. Therefore, the goal of the second study was to investigate the concurrent validity of IMU-based trunk kinematics against the gold standard optical motion capture (OMC)-based trunk kinematics after overground trips among community-dwelling older adults. During two laboratory-induced trips, participants wore two IMUs placed on the sternum and shoulder, and OMC markers placed at anatomical landmarks of the trunk segment. Results showed that IMU-based trunk kinematics differed between falls and recoveries after overground trips, and exhibited at least good correlation (Pearson's correlation coefficient, r > 0.5) with the gold standard OMC-based trunk kinematics. The goal of the third study was then to explore differences in tripping kinematics between the laboratory and real world using wearable IMUs among community-dwelling older adults. Participants were asked to wear three IMUs (for sternum and both feet) and a voice recorder to capture their responses to real-world losses of balance (LOBs) during their daily activities for three weeks. Results showed a higher variance in laboratory-induced trips than real-world trips, and the study demonstrated the feasibility of using IMUs and a voice recorder to understand the underlying mechanisms and context of real-world LOBs. Overall, this work was innovative by evaluating a non-treadmill version of trip training, establishing the validity of IMUs in capturing kinematic responses after overground trips, and applying IMUs and a voice recorder to assess tripping kinematics in the real world. The results from this work will advance the use of PBT to reduce the prevalence of trip-induced falls and to investigate the real-world effects of such trip training in future studies. / Doctor of Philosophy / Trips and falls are a major health problem especially among older adults who are aged 65 years or older. Researchers have developed an innovative exercise-based fall prevention training program, which has shown to be helpful in reducing trips and falls. The broad goal of my PhD research was to advance the use of this so-called trip training through three new research studies. First, specialized treadmills are commonly used for trip training to simulate trip-induced falls. An alternative version of trip training without a treadmill would allow more people to receive benefits from this training. The goal of the first study was to compare the effects of non-treadmill training (NT), treadmill training (TT), and no training on balance recovery after tripping in the laboratory. Older adults living in the local community were recruited as research participants and completed NT, TT, or no training over three weeks. After that, they attended a laboratory session where they were tripped twice while walking on a walkway. Results showed that NT helped to take a longer and faster recovery step, while TT helped to limit trunk forward bending during tripping, both of which are important movements to prevent falling after tripping. While the first study showed benefits of trip training in the laboratory, not much is known about the benefits of trip training in the real world. Wearable sensors called inertial measurement units can record body movements without laboratory motion capture cameras, but their ability to record dynamic body movements during tripping needs to be tested. The goal of the second study was to evaluate the capabilities of these wearable sensors on recording trunk movements during tripping and compare them to those recorded by laboratory motion capture cameras. Participants were tripped twice in the laboratory, and their trunk movements were recorded by several wearable sensors and laboratory motion capture cameras. Results showed that these wearable sensors can distinguish between fallers and non-fallers after tripping, and that the trunk movements recorded by the wearable sensors were associated with those recorded by the laboratory motion capture cameras. With this confirmation, the third study was designed to compare balance recovery after tripping between the laboratory and real world using wearable sensors. Participants were asked to wear three wearable sensors and a voice recorder during their daily activities for three weeks. The wearable sensors recorded their trunk and feet movements, while the voice recorder was used for participants to provide detailed explanations of balance losses they experienced. Results showed a higher variability in balance recovery from the laboratory trips compared to the real-world trips. In addition, this study demonstrated that wearable sensors and a voice recorder can be used to study how people reacted to a balance loss and what they did to recover (or fall) from it. Overall, my PhD research work suggested a new version of trip training that does not require a treadmill, proved that wearable sensors can be used to record important body movements during tripping, and demonstrated the method to study balance recovery responses in the real world using wearable sensors. The results from the three studies will promote the use of trip training and provide guidelines for evaluating benefits of trip training in the real world.