Objetivo: verificar associação independente entre subnutrição e óbito em idosos brasileiros domiciliados. Métodos: pesquisa epidemiológica, observacional, longitudinal, retrospectiva e analítica, baseada no Estudo SABE: Saúde, Bem-estar e Envelhecimento, realizado nos anos 2000 e 2006, no município de São Paulo. Foram estudados 1170 idosos ( 60 anos), de ambos os sexos, residentes habituais em domicílios particulares da área urbana do município de São Paulo. As variáveis analisadas foram: óbito, subnutrição, sexo, renda, força muscular reduzida, fratura de quadril, hábito de fumar, câncer, depressão, diabete melito, doença coronariana, doença pulmonar crônica, doença vascular cerebral e hipertensão, sendo a maioria relatada pelos idosos ou por seus proxis, com exceção do óbito (averiguado pelo Sistema de Informações sobre Mortalidade de São Paulo), da subnutrição (Miniavaliação Nutricional®), da depressão (Escala de depressão geriátrica) e da força muscular reduzida (força de preensão manual). Realizou-se, segundo grupos etários (60-74 anos e 75 anos), análise multivariada hierarquizada por regressão logística, baseada em modelo teórico proposto, selecionando as variáveis cujo p foi < 0,05. Resultados: constataram-se 332 óbitos, com maior proporção no grupo 75 anos (41,8%) que 60-74 anos (18,3%) (p < 0,001). A subnutrição foi identificada em 2,4% dos idosos e, assim como para óbito, verificou-se maior proporção no grupo 75 anos (2,5% e 2,4%, respectivamente). Em idosos de 60-74 anos, 6,7% daqueles que morreram eram subnutridos e, no grupo etário 75 anos, 3,9%. Tanto em idosos de 60-64 anos (OR = 6,17; IC = 5,89-6,47), como 75 anos (OR = 2,82; IC = 2,57- 3,10), a subnutrição foi fator de risco independente para óbito (p < 0,05). Exceto fratura de quadril e doença vascular cerebral, em ambos grupos etários, e hipertensão, em idosos de 60-74 anos, todas as outras variáveis também explicaram o óbito, porém, com menor efeito. Conclusão: a subnutrição representou fator de risco 6 independente e mais fortemente associado ao óbito em idosos brasileiros domiciliados dentre as variáveis consideradas, com efeito mais pronunciado no grupo de 60-74 anos. / Objective: to verify the independent association between undernutrition and death in older Brazilian adults community-dwelling setting. Methods: epidemiological, observational, longitudinal, retrospective and analytical study based in Health, Wellbeing and Aging survey realized in the years 2000 and 2006. This study included 1170 older adults ( 60 years) both gender that living in private households in São Paulo urban area. The variables analyzed were: death, undernutrition, sex, income, low muscle strength, hip fracture, smoker, cancer, depression, diabetes, coronary heart disease, chronic lung disease, cerebral vascular disease and hypertension being the majority self reported by older adults, except death (investigated in the Mortality Information System of the São Paulo city), undernutrition (Mini-nutritional Assessment®), depression (Geriatric Depression Scale) and muscle strength (handgrip). Hierarchical multivariate analysis by logistic regression was performed according to age groups (60-74 years and 75 years) based on a proposed theoretical model. The p-values < 0.05 were considered significant. Results: were identified 332 death being the highest proportion in the age group 75 years (41.8%) that 60-74 years (18.3%) (p < 0.001). Undernutrition was identified in 2.4% of older adults and as well as for death, there was a higher proportion in the group 75 years (2.6 and 2.4, respectively). In the older adults from 60-74 years, 6.7% died and were undernutrition and the older adults 75 years, 3.9%. Undernutrition was independent risk factor for death (p<0.05) both in the age group 60-74 years (OR = 6.17; CI = 5.89-6.47) and in the age group 75 years (OR = 2.82; CI = 2.57-3.10). Except hip fracture and cerebral vascular disease in both age groups and hypertension in age group from 60-74 years, the other variables also explained the death in older adults, however, the effect of these variables was lower. Conclusion: undernutrition represented the independent and the most strongly risk factor to death in older 8 Brazilian adults in the community-dwelling setting among the variables considered in this study with effect more pronounced in older adults from 60-74 years.

Older adults are increasingly using social networking sites such as Facebook to maintain social relationships. A growing body of literature indicates that frequent communication with family members and close friends influences successful ageing. Consequently, the purpose of this study is to establish the nature of the relationship between the impact of Facebook communication and successful ageing on older adults living in the rural municipality of Hagfors. This study defines an older adult as a person aged 55 years and above. Self-reported life-satisfaction, social engagement and social trust are used as indicators of successful ageing. Predictions about Facebook communication and successful ageing are tested by theories of socio-emotional selectivity and social capital. This is based on 15 semi-structured interviews conducted with older adults living in the municipality of Hagfors. The results indicate that having small social connections and frequently exchanging privately composed communication with family members and close friends promotes successful ageing. Facebook is found to be a potential source of social capital.

Word finding difficulties (WFD) and slowing down both in linguistic comprehension and production are standard characteristics of people as they grow older. WFD also commonly occur in aphasia and are considered one of the most pervasive symptoms affecting stroke participants’ everyday communication. Research on older adults’ WFD has traditionally focused on production of single words when completing picture naming tasks, while very little is known about how much these WFD can compromise connected speech. Similarly, while picture naming tasks have typically been used for assessing and treating word finding problems in clinical practice, there is a dearth of studies in the aphasiological literature investigating the relationship between confrontation naming and connected speech tasks. The thesis investigated whether a newly-developed method/treatment targeting both speed and accuracy (‘repeated increasingly speeded presentation’ - RISP) in picture naming was more effective in (a) speeding up participants without compromising accuracy, and (b) improving the use of the trained/treated names in connected speech, compared to a standard method/therapy (‘standard presentation’ - SP) which targeted accuracy alone. English-speaking, elderly participants (n=27 at Chapter 3, n= 21 at Chapter 4) and participants with aphasia of varying severity and subtype (n=5 at Chapter 5 and n=20 at Chapter 6) were asked to carry out picture naming tasks/picture naming treatments and composite picture description tasks where the composite pictures included the trained/treated items. As for the neurotypical participants, words which were retrieved more quickly in picture naming tasks were also those which were more readily available and produced in connected speech tasks. Compared to SP, RISP was found to be significantly more effective in significantly reducing picture naming latencies without inducing a speed-accuracy trade-off and with lasting effects. Finally, SP was as effective in promoting retrieval in connected speech as RISP. As for the clinical population, compared to SP, RISP was significantly more effective in improving picture naming accuracy and in maintaining the reduced RTs in the long term. In comparison to the SP, RISP crucially led to significantly higher carry-over of targeted items to connected speech. The thesis findings underlined the effectiveness of a more demanding single word training method/treatment in improving lexical retrieval in confrontation naming for neurotypical participants and in enhancing connected speech for participants with aphasia.

This study aimed to investigate the inter-relationships between self-stigma, loneliness, and culture among older adults with mental illness residing in nursing homes. This study also explored how this population experiences self-stigma and loneliness within the context of their cultural backgrounds. A mixed-methods approach was utilised. The first phase involved a quantitative face-to-face questionnaire survey (n=16). More than half of the study participants reported low levels of self-stigma (56.3%), yet a substantial number of them scored high on the self-stigma scale (43.8%). The analysis identified a statistical relationship between stereotype endorsement and marital status (sig. =.010). No relationship was identified between Internalised Stigma of Mental illness constructs (ISMI) and age, gender, religiousness, and educational level. Loneliness was identified to be prevalent among more than half of the sample (68.8%). There was also a positive correlation between loneliness, age (sig.=.062) and religiosity (sig.=.044). The second phase involved a qualitative hermeneutic phenomenological approach involving one-to-one semi-structured interviews (n=10). Seven themes emerged: ‘social loneliness’, ‘emotional loneliness’, ‘emotional reactions’, ‘coping mechanisms’, ‘insight into illness’, ‘understanding and view towards mental illness’, and ‘behavioural reactions’. Overall, the qualitative findings supported the quantitative results but also revealed additional theoretical and conceptual insight. Most participants were collectivistic-oriented, and most experienced both social and emotional loneliness. The degree of insight into mental illness played a key role in how self-stigma was experienced, while gender and culture were found to influence how loneliness was experienced. Based on the results of both phases, a new theoretical framework is posited that explains the relationships between the concepts of loneliness and self-stigma among this population. The study also evidences and discusses a wide range of methodological issues associated with the successful recruitment of nursing homes in older adult research.

The older adult population in the United States is rapidly expanding both because of longer life expectancies as well as the aging of the baby boomers. While vision impairment is a growing concern among older adults, there have been few, mostly small studies, of the impact of vision impairment on this population. The present study uses a national data set, the Second Supplement on Aging (1994 -1996) from the National Health Interview Survey, in a cross-sectional study of 9,447 civilian non-institutionalized persons, aged 70 years and over at the time of their interview. The SOA II has been studied in the context of a social theory of aging that emphasizes interdependence through the life course using a stress process model that has been refined into a disability model. Disability is understood as a social construction outcome rather than as a medical outcome. Vision impairment is the stressor which is mediated by health (falls, functioning and self-health report), financial resources (education, income and having only public health insurance) and social support (marital, living along, having no living children, social activities in number and intensity). Depression is a possible, but not a necessary result of vision impairment. Disability may result when a medical pathology leads to an impairment which results in a functional limitation and finally a social disability. This secondary analysis used a multinomial logistic regression for both the whole sample as well as separately for each gender. For the whole sample the results indicate that a typical profile of a vision-impaired older adult depressed some/all of the time, would be a younger-old White woman (aged 70-74 years old) who has fallen in the past 12 months, has difficult with one or more Activities of Daily Living or with both one or more Activities of Daily Living and Instrumental Activities of Daily Living, has a poor to fair self-heath report, a family income under $20,000, a high school or less education, lives alone, has a living child and lacks social activities in number and intensity. In the gender samples, only the female sample at the some/all of the time depression category is significant. Older vision-impaired adults, especially older women who have more social supports are less likely to be depressed and so disabled. There is a need for social policies that will educate, encourage and support older vision-impaired adults as they seek to compensate for the loss of vision, often late in life.

Depression is a common clinical and subclinical psychiatric disorder in the middle-age to older adult population. This study examined the relationship between depression and activities of daily living (ADLs) in middle-age to older adults. This study examined longitudinal data from the 1998, wave 4, and 2000, wave 5, of the Health and Retirement Study (HRS), a National Panel Study sponsored by the National Institute on Aging. A negative cross-sectional and longitudinal relationship between higher ADL scores and depression was hypothesized. A goal of the present study was to determine the temporal precedence of these two constructs using a cross-lag panel design to first examine the cross-sectional relationship between ADLs and depression at time-one and at time-two, and then the time-one to time-two longitudinal relationships to examine temporal precedence possible causal relationships. Finally, differences in these correlational relationships by retirement status and then by marital status were tested. There were several interesting findings, including those who were retired in both 1998 and 2000 reported fewer ADLs (i.e., worse functioning), but also reported better health than those who were working in both 1998 and 2000. Similarly, those people who were not married in both 1998 and 2000 reported fewer ADLs but better health than those who were married in both 1998 and 2000. Married individuals reported fewer depressive symptoms than those who were not married.

Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression.

The issue of rising number of disasters, the overwhelming increase in number of older adults, and historically flawed evacuations presents real challenges. Disasters can strike anywhere, any time, and have devastating consequences. Since 1900, the number of Americans 65 and older has increased 12 times (from 3.1 million to 36.3 million). During the next two decades, the number of American baby boomers, now aged 45-64, who turn 65, will increase by 40%. As evidenced by recent disasters, the imperfections and vulnerabilities of flawed evacuations for older adults are still present. This study examined the level of willingness to evacuate among older adults in the event of a disaster. Despite the extensive literature on disasters and evacuation, some significant questions regarding evacuation and older adults have not been addressed. This study addressed the following concerns: (1) What is the willingness among older adults to evacuate when asked to do so by emergency management officials? (2) Does the call to evacuate being mandatory versus voluntary influence the willingness of seniors to evacuate? (3) Do preconditions (Gender, Marital Status, Age, Ethnic Origin, and Education Levels) influence the willingness to evacuate among older adults? The sample population consisted of 765 voluntary participants aged 60 years and older from thirty senior/community centers within seven counties in the State of Oklahoma. A group administered survey (The Disaster Evacuation Survey) included a total of 15 questions. This study revealed the following findings: older adults are more likely to comply with a mandatory evacuation order. Individuals with college degrees are more likely to comply with mandatory evacuations. African Americans are more likely to comply with a voluntary request. American Indian/Alaskan Native are more likely to comply with mandatory evacuation orders from emergency officials. Important practical implications for emergency officials responding to vulnerable older adults in disaster situations are also provided.

The purpose of this study was to explore the effects of participants' abused or nonabused status as it interacted with their age and gender in producing different patterns of Hand Test responses as a function of the age or gender of the card. Participants, 61 young adults (M age = 23) and 60 older adults (M age = 73), were presented with the original Hand Test cards, as well as four alternate versions (e.g., young male, young female, older male, and older female). Expected effects varying by age, gender, and abuse status were not found. Results indicated main effects for participant abuse status, which were largely consistent with previous Hand Test research. Significant interaction effects were also found for participant age by participant abuse status (p < .05), as well as participant age by participant gender by participant abuse status (p < .05). An interaction effect was also found for Hand Test version by participant abuse status (p < .05), Hand Test version by participant age by participant abuse status (p < .05), as well as Hand Test version by participant gender by participant abuse status (p < .05). These results suggest that the alternate forms of the cards may pull for certain responses among abused participants that would not have been identified otherwise via the standard version of the Hand Test, clinical interviews, or other projective and self-report measures of personality. Overall, the variations in Hand Test stimuli interact with participants' abuse status, and warrant the use of alternate versions of the Hand Test as a viable projective measure.

Concern beliefs in medicines are patients' anxieties about the harmful effects of a specific prescribed medication. Three papers examined the importance of concern beliefs in medicine, specifically its relationship to patient outcomes such as self-reported adverse drug events (ADEs) and symptom attribution, and the factors that might drive a change in concern beliefs over time. For the first and second paper, a cross-sectional internet survey of Medicare enrollees who were English speakers, 65 years and older and enrolled in the Medicare Part D program was done. In the third paper, a longitudinal internet survey of the same sample was done before Medicare Part D in 2005 and after Medicare Part D in 2007, and adults 40 years and older with physical limitations were interviewed using telephone. Multiple logistic regressions showed that having stronger concern beliefs in medicine and more symptoms was related to self-reported ADE, rather than using an inappropriate medicine or the number of inappropriate medicines used. Using independent sample t-tests, concern beliefs in medicine were found to be unrelated to symptom attribution for any causal reason, irrespective of whether there was patient-clinician agreement on attribution. Multiple linear regressions showed that concern beliefs changed over time for some older adults and having an ADE in the past year was related to this change. Among adults with physical limitations, though concern beliefs changed for some individuals; only one factor included in this study, changes in number of medicines, was related to this change. Establishing the importance of concern beliefs in medicines as a socio-psychological variable to consider in medication use outcomes will enhance the understanding of clinical researchers and practitioners concerning the mechanism of ADEs and symptom reporting.