Yes / The COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and to reduce their well- being. Aims: To explore how social support service use by older adults, carers and PLWD, and their mental well-being changed over the first 3 months since the pandemic outbreak. Methods: Unpaid dementia carers, PLWD and older adults took part in a longitudinal online or telephone survey collected between April and May 2020, and at two subsequent timepoints 6 and 12 weeks after baseline. Participants were asked about their social support service usage in a typical week prior to the pandemic (at baseline), and in the past week at each of the three timepoints. They also completed measures of levels of depression, anxiety and mental well-being. Results: 377 participants had complete data at all three timepoints. Social support service usage dropped shortly after lockdown measures were imposed at timepoint 1 (T1), to then increase again by T3. The access to paid care was least affected by COVID-19. Cases of anxiety dropped significantly across the study period, while cases of depression rose. Well-being increased significantly for older adults and PLWD from T1 to T3. Conclusions: Access to social support services has been significantly affected by the pandemic, which is starting to recover slowly. With mental well-being differently affected across groups, support needs to be put in place to maintain better well-being across those vulnerable groups during the ongoing pandemic. / University of Liverpool COVID-19 Strategic Research Fund, National Institute for Health Research Applied Research Collaboration North West Coast, The University of Bradford QR Research Fund / Research Development Fund Publication Prize Award winner, Jan 2021.

By the year 2020, it is projected that 30% of the United States population will be comprised of people age 65 and older (Administration on Aging, 2004). Individuals over age 65 will continue to constitute a larger proportion of the total population because people are living longer and healthier lives. With older adults living longer, this senior population leads very active lives and often has great interest in modern technology such as the Internet (Nielsen, 2002). Given the use of computers in the workplace and homes and the increase in the number of older adults in the next 20 years, the use of computers by older adults is a significant issue that should be addressed (Czaja, 1996). Computer tasks involve cognitive skills that may be challenging for older adults. Most of the literature suggests that cognitive skills decline as individuals age (Baddeley, 1981; Foos, 1989; Salthouse, 1996; Welford, 1985). Decrements in working memory could place older adults at a disadvantage when performing computer-interactive tasks. To increase the success of older workers' performance with computer technology, web-based training programs designed to accommodate age-related cognitive declines may be an effective avenue to deliver computer training to younger and older adults. The objectives of this study were to explore computer self-efficacy differences between younger adults (18-24 years old) and older adults (65 and older) and to determine if the design of a web-based training system affects individual performance when completing a computer task. Four hypotheses were tested in this study: older adult-centered web-based training program would yield better performance for both younger and older adults; older adults would have lower computer self-efficacy than younger adults; participants with higher computer self-efficacy would perform better on a computer task; and participants with higher usability ratings would perform better on the computer task. Results of the study did not directly support any of the hypotheses. However, age-related differences were evident in training time, task completion time, performance score, and usability ratings. The older adult participants had longer training and task completion times, lower performance scores, and higher usability ratings. Results were discussed in terms of limitations and implications of older-adult centered training programs. / Master of Science

No / Background: Falls are the most common safety incident reported by acute hospitals. NICE recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim: Determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute NHS hospitals in England. Design: Realist review and multi-site case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (N=50), patient and carer interviews (N=31), and record review (N=60). Setting: Three Trusts, one orthopaedic and one older person ward in each. Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored: (1) Leadership: Wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared Responsibility: A key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: Assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient Participation: Nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions: (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) Shared Responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) Facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) Patient Participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) Mixed method and economic evaluations of patient supervision; (3) Evaluation of engagement support workers, volunteers, and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. / This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in the Health and Social Care Delivery Research Journal.

This study examines the technology and appointment scheduling habits of older adults over the age of 55 through an exploratory sequential three phase mixed methods study. Phase One of this study examined features of ten existing mHealth applications through a qualitative content analysis, then a mHealth wireframe was developed from the app to replicate in addition to a redesigned version. Phase Two of the study was a thirty-four questions survey with 40 participants that inquired about their background with appointment scheduling, prior experience with technology, and demographics. After that, the mHealth applications were revised into two mHealth application prototypes. Lastly, Phase Three conducted a user test with the two mHealth prototypes through A/B testing with 15 participants. Findings from the survey showed the preferred method of scheduling an appointment among participants was primarily in-person or by phone. The user test revealed that some participants were willing to use a mHealth application to schedule an appointment if it was deemed easy to use. Recommendations for future research suggests that the iterative design process of a prototype with an underserved population would garner feedback inclusive of those older adults who are less tech savvy. The major contribution of this research was the development of the mHapps Framework which will be tested in a future study.

Loss is an inevitable part of life. The actual process of grieving is unique and can be hard to quantify. Grief interventions can address the relationship quality and attachment status between the griever and the deceased and how memories are interpreted and carried into the present and future. This three-essay dissertation explores variations of loss and the factors that contribute to a resilient recovery.

No / Department of Health

Intervention trials that reduce visual impairment in older adults have not produced the expected improvements in reducing falls rate. We hypothesised that this may be caused by adaptation problems in older adults due to changes in magnification provided by new spectacles and cataract surgery. This study assessed the effects of ocular magnification on adaptive gait in young and older adults. Methods: Adaptive gait was measured in 10 young (mean age 22.3 ± 4.6 years) and 10 older adults (mean age 74.2 ± 4.3 years) with the participants' habitual refractive correction (0%) and with size lenses producing ocular magnification of ±1%, ±2%, ±3%, and ±5%. Adaptive gait parameters were measured when participants approached and stepped up onto a raised surface. Results: Adaptive gait changes in the young and older age groups were similar. Increasing amounts of magnification (+1% to +5%) led to an increased distance of the feet from the raised surface, increased vertical toe clearance and reduced distance of the lead heel position on the raised surface (p < 0.0001). Increasing amounts of minification (¿1% to ¿5%) led to the opposite of these changes (p < 0.0001). Adaptation to ocular magnification did not occur in the short term in young or older adults. Conclusion: The observed adaptive gait changes were driven by the magnification changes provided by the size lenses. The raised surface appeared closer and larger with magnification and further away and smaller with minification and gait was adjusted accordingly. Magnification may explain the mobility problems some older adults have with updated spectacles and after cataract surgery.

Yes / Falls on stairs are a significant cause of morbidity and mortality in elderly people. A simple safety strategy to avoid tripping on stairs is increasing foot clearance. We determined whether a horizontal–vertical illusion superimposed onto stairs to create an illusory perceived increase in stair-riser height would increase stair ascent foot clearance in older participants. Methods.: Preliminary experiments determined the optimum parameters for the horizontal–vertical illusion. Fourteen older adults (mean age ± 1 SD, 68.5 ± 7.4 years) ascended a three-step staircase with the optimized version of the horizontal–vertical illusion (spatial frequency: 12 cycles per stair riser) positioned either on the bottom or top stair only, or on the bottom and top stair simultaneously. These were compared to a control condition, which had a plain stair riser with edge highlighters positioned flush with each stair-tread edge. Foot clearance and measures of postural stability were compared across conditions. Results.: The optimized illusion on the bottom and top stair led to a significant increase in foot clearance over the respective stair edge, compared to the control condition. There were no significant decreases in postural stability. Conclusions.: An optimized horizontal–vertical visual illusion led to significant increases in foot clearance in older adults when ascending a staircase, but the effects did not destabilize their postural stability. Inclusion of the horizontal–vertical illusion on raised surfaces (e.g., curbs) or the bottom and top stairs of staircases could improve stair ascent safety in older adults.

For older couples facing a skin cancer diagnosis, the experience is stressful, not only for the individual with the diagnosis, but also for the healthy partner. Couples may use various types of coping and styles of support to deal with the stress, including relationship-focused support, which addresses the needs and coping efforts of both partners in response to and in conjunction with one another. The current study examined associations between perceptions of three styles of relationship-focused partner support, namely active engagement, protective buffering, and overprotection, and body image of the partner with skin cancer and quality of life of the partner with skin cancer and the healthy partner. Using data collected from 30 older couples (Mage = 70; SD = 7.25) with diagnoses of melanoma (n = 14; 47%) or nonmelanoma (n = 16, 53%), linear regression models, adjusted for the stressor appraisal by both partners, revealed that when partners with skin cancer reported receiving higher active engagement support, they were more likely to have a positive body image (B [unstandardized] = 35.54, p = .04). A significant interaction was found between active engagement support used by both partners (B = -8.78, p = .05), indicating that active engagement from healthy partners appears to benefit the body image of the partner with skin cancer when they themselves use less active engagement support. Both protective buffering and overprotection support were not associated with body image. Multivariate actor-partner interdependence models (APIM) assessed the relationships between support received by each partner and its association with their quality of life (actor effects) and their partner's quality of life (partner effects). Results suggest that active engagement support perceived by either partner was not associated with quality of life. In contrast, overprotection perceived by partners with skin cancer was significantly associated with their quality of life (actor effect: B = -10.81, p < .001), but was not associated with the healthy partners' quality of life. Additionally, protective buffering perceived by healthy partners was associated with their own quality of life (actor effect; B = -6.91, p = .05) as well as their partner with skin cancer's quality of life (partner effect; B = -8.15, p = .01). Nuances based on the sex of the person with skin cancer, type of skin cancer, the stage of skin cancer and couple's appraisal of the stressors of skin cancer are also discussed. Findings suggest that actively engaging with the stressors of skin cancer can contribute to positive views of one's body, whereas ignoring or avoiding conversations about skin cancer and overprotection provided by healthy partners might lead to poorer quality of life for both partners. These findings illustrate the influence of healthy partners, highlighting that how they give support when their partner is facing a skin cancer diagnosis may affect the overall quality of the couple relationship and couple outcomes. / Ph. D. / The experience of facing a skin cancer diagnosis is stressful, both for a person with the diagnosis, but also for his or her romantic partner. As an increasing number of older adults will experience a skin cancer diagnosis at some point in their lifetimes, partially due to the link between cumulative sun exposure and age, it is important to understand how couples provide support to one another. This study examined three styles of support, active engagement, protective buffering, and overprotection that partners can use to support one another, and how the support partners perceive can be related to the body image of the person with skin cancer and quality of life of both the partners. Thirty couples, with an average age of 70 years, participated in this study. One partner in each couple had received a diagnosis of either melanoma (N = 14; 47%) or nonmelanoma (n = 16, 53%) in the previous two years. Findings showed that when partners with skin cancer reported receiving higher active engagement support, they were more likely to have better body image, especially when they were using less active engagement support themselves. Neither protective buffering nor overprotection support were associated with body image. Next, this study examined whether support from one’s partner is associated with his or her quality of life (actor effects) and with the partner’s quality of life (partner effects). Receiving active engagement support was not associated with quality of life for either partner. Conversely, protective buffering perceived by healthy partners was associated with poorer quality of life for themselves and their partners. Similarly, overprotection support perceived by partners with skin cancer was associated with poorer quality of life of themselves. Findings from this study suggest that if couples can actively engage with the stressors of the skin cancer diagnosis such as through open discussions about their fears or worries, the partner with skin cancer may experience a positive view of his or her body. In contrast, avoiding or ignoring concerns about the skin cancer may not be related to body image, but can have a negative impact on the relationship. This study also highlights the important impact healthy partners can have when facing skin cancer. While receiving active engagement support was not related to partners’ quality of life, receiving protective buffering and overprotection support from healthy partners was associated with poorer quality of life for both partners. How the healthy partner provides support appears to affect both people, and may also be important for the couple’s relationship quality.

Adults aged 50 years and older are a growing segment of the population and are more likely than their younger counterparts to experience significant stressors such as the death of a relative or friend, onset of chronic conditions, and increased health burden. The current studies use Pearlin's stress process model to evaluate the impact of these stressors on outcomes of depression. Study 1 used Wave 1 data from the ORANJ BOWL research panel of 5,688 New Jersey residents aged 50 and older to explore the relationship between relational life events, private religious practices, and depressed mood. Cross-sectional structural equation modeling was used to evaluate these relationships. Results showed that relational life events had a significant positive influence on depressive symptoms and this relationship was partially mediated by private religious practices. Findings indicate that non-personal life events are important sources of stress that may otherwise be overlooked when assessing risk factors among older adults. Study 2 used data from 640 men from the Research on Older Adults with HIV (ROAH) study to evaluate the impact of HIV-related health burden on depressed mood and to assess the mitigating effects of social support adequacy. Structural equation modeling showed that greater health burden was associated with more depressive symptoms; this relationship was significantly partially mediated by emotional support adequacy, which was a measure of unmet social need. Findings indicate that health burden has a cumulative impact on psychological health and programs and supports that target social wellness can improve this relationship. These studies point to the importance of understanding sources of risk and resilience among older people and in an attempt to improve overall health outcomes. / Ph. D. / Older adults constitute a growing portion of the population in the United States and around the world. Better understanding of challenges older adults face, including stressful life events and changes in health, could contribute to better outcomes in their later years. Two studies were designed to: (1) understand the relationship between events that affect one’s friends and family (i.e., relational life events) and feelings of depression, and explore whether religious expression is useful in reducing stress; and (2) evaluate the influence of health burden on feelings of depression in older adults with HIV and understand how social support can reduce stress from living with HIV. Data for this work come from the ORANJ BOWL research panel of interviews with 5,688 New Jersey adults and the Research on Older Adults with HIV (ROAH) study of 914 New York City residents aged 50 and older with HIV in 2005. Findings from the first study show that relational life events are associated with more depressive symptoms and more private religious expression. Thus, relational life events are an important risk factor to which family members and health service providers should pay attention. Findings from the second study demonstrate that more health difficulties in people with HIV is associated with more depressive symptoms. This is especially true when self-rated health is poorer and the number of overall chronic conditions are greater. Social support is an important resilience factor that lessens the influence of health burden on psychological health, so relatives and service providers should promote social wellness in addition to HIV treatment-specific interventions. Together, the results of these studies reveal numerous risk and resilience factors to consider when working to improve the lives of older people.