This feasibility study reports on the first experimental experiences with the BASt bicycle simulator. Since older cyclists represent an important target group in road safety due to their increased vulnerability, both cyclists aged 65 and over (experimental group: EG) and, by way of comparison, middle-aged test subjects aged 25--50 (cont.rol group: CG) were included in the study. The study aims to gain initial insights into the prerequisites, possibilities and limitations for using the bicycle simulator to observe cycling behaviour. In addition to the actua1 test ride the three preceding pra.ctice rides were also evaluated. A comparable study with older adults has already been conducted with the BASt car simulator.

Winter conditions, characterized by snow and lowered temperatures, can make travel by foot difficult. Older adults aged 65 and above are especially at risk of slipping and falling on icy or snowy surfaces. Minor falls can result in severe injuries due to their frailty. Traditional methods of reducing this risk, like plowing or using sand and salt, may not always be effective preventive measures. Several municipalities in Sweden have taken action to combat this issue and introduced subsidized ice cleat distribution programs for older adults. It is unclear how these programs are designed and whether they are effective in promoting the use of ice cleats. This thesis uses a mixed-method approach drawing on data collected from multiple sources to analyze and evaluate the programs. Paper I presents a program theory model, outlining the essential components required for implementing a program and describing the causal connections from the program's introduction and necessary conditions to its anticipated impact. Survey data from intervention municipalities suggest that about 40% of the target group participated by retrieving a pair of devices, and 90% of all ice cleats were eventually distributed. Paper II presents an outcome evaluation suggesting that individuals exposed to a distribution program increase ice cleat use. Analyses of the self-reported data on ice cleat use show an increase of 7.5 percentage points. Estimations suggest that general use could be 17.3% if one pair of cleats were distributed to all eligible citizens. Future research is needed to investigate the programs' effect on fall-related injuries on ice and snow. In addition, in-depth interviews with program policymakers should be considered to provide further insights into the design and implementation of these programs. / Vinterförhållanden, som kännetecknas av snö och låga temperaturer, kan göra det svårt att resa till fots. Äldre vuxna, i åldern 65 och äldre, löper större risk att halka och falla på isiga eller snöiga ytor, där även mindre fall kan leda till allvarliga skador på grund av deras sårbarhet. Traditionella metoder för att minska denna risk, som snöplogning eller spridning av sand och salt, kanske inte är tillräckligt effektiva. Flera kommuner i Sverige har vidtagit åtgärder för att bekämpa detta problem och infört subventionerade program som delar ut broddar till den äldre befolkningen. Det är oklart hur dessa program är utformade och om de är effektiva när det gäller att främja användningen av broddar. Denna avhandling använder en blandad metod som bygger på data som samlats in från flera källor för att analysera och utvärdera programmen. I Paper I presenteras en programteoretisk modell som beskriver de väsentliga komponenter som krävs för att implementera ett program och beskriver orsakssambanden från programmets introduktion och nödvändiga förutsättningar till dess förväntade effekt. Undersökningsdata från interventionskommuner tyder på att cirka 40 % av målgruppen deltog i programmen genom att hämta upp ett par broddar, och 90 % av alla halkskydd distribuerades. Effektutvärderingen som presenteras i Paper II tyder på att exponering för ett distributionsprogram ökar användningen av broddar. Självrapporterade data om användning av halkskydden tyder på en ökning med 7,5 procentenheter, och ytterligare skattningar visar att den totala användningen kan bli 17,3% om ett par broddar distribuerades till alla berättigade medborgare. Framtida forskning behövs för att undersöka programmens effekt på fallrelaterade skador på is och snö. Dessutom bör djupintervjuer med programpolitiska beslutsfattare övervägas för att ge ytterligare insikter om utformningen och genomförandet av dessa program. / Several Swedish municipalities have introduced subsidized ice cleat distribution programs to combat the risk of fall-related injuries on icy or snowy surfaces, especially among older adults aged 65 and above. Using a mixed-method approach and data collected from multiple sources, the thesis evaluates the effectiveness of these programs. The thesis presents a program theory model outlining the components required for implementing a program and its anticipated impact. Survey data from intervention municipalities show that 40% of the target group participated in the programs by retrieving a pair of devices, and 90% of all ice cleats were distributed. The outcome evaluation suggests that exposure to a distribution program increases ice cleat use by 7.5 percentage points. If one pair of cleats were distributed to all eligible citizens, about 17.3% would use the devices. The thesis calls for future research to investigate the programs' effect on fall-related injuries and suggests in-depth interviews with program policymakers to provide further insights into the design and implementation of these programs.

The present study examined the divided attention effects of three non-speech tasks on concurrent speech motor performance. These tasks targeted linguistic, cognitive, and manual motor activity. Participants included 60 healthy adults separated into three different age groups of twenty participants each: college-age (20s), middle-aged (40s), and older adults (60s). Each participant completed a speech task once in isolation and once concurrently with each of the three non-speech tasks: a semantic decision task, a quantitative comparison task, and a manual motor task. The non-speech tasks were also performed in isolation. The speech task involved repeating a target phrase each time a beep sounded, for a total of fourteen repetitions. Dependent measures for speech were derived from lip kinematic recordings from a head-mounted strain gauge system. Dependent measures for the other tasks included timed response counts and accuracy rates. Results indicated significant divided attention effects, impacting speech and nonspeech measures in the linguistic and cognitive conditions, and impacting speech measures in the manual motor condition. A significant age effect for utterance duration was also found, as well as a divided attention interaction with age for cognitive task accuracy. The results add to what is known about bidirectional interference between speech and other concurrent tasks, as well as age effects on speech motor control.

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INTRODUCTION: Continuing Education (CE) courses for allied health professionals do not consistently reflect the needs of adult learners and may not result in practice changes. In areas of allied health practice with a strong evidence base, poor quality CE courses stunt the dissemination of information which could improve the quality of life of clients. One such area is improving safety and independence of older adults with low vision, who are at increased risk of falls and functional limitations as a result of their visual impairments. DESCRIPTION OF DOCTORAL CAPSTONE: The aim of this doctoral capstone was to discuss the theory and evidence for the creation of effective, learner-centered CE courses and to apply these findings to the creation of CE courses for allied health professionals on the topic of community-dwelling older adults with low vision. RESULTS: The resulting CE courses were compared to the guidelines for a theory-driven, evidence-based course and were found to adhere to quality standards of: use of a needs assessment, reflection of the real-life context of learners, incorporation of active learning and reflection components, inclusion of visible pedagogy, and evaluation of the translation of learning to practice. CONCLUSION: CE courses that adhere to evidence-based, learner centered methods produce better learning and satisfaction outcomes for participants. CE course creators should adhere to these guidelines and advertise the use of theory and evidence to enable clinician participants to identify high-quality continuing education courses. Clinicians who gain knowledge in the areas of low vision diagnoses, screening, referrals, interventions, and resources, through attendance at a well-designed CE course, will be better able to identify clients with low vision and provide evidence-based care which has been found to improve client safety and independence.

Identifying modifiable correlates of older adults’ preventive behaviors is contributable to the prevention of the COVID-19 and future pandemics. This study aimed to examine the associations of social-cognitive factors (motivational and volitional factors) with three preventive behaviors (hand washing, facemask wearing, and physical distancing) in a mixed sample of older adults from China and Germany and to evaluate the moderating effects of countries. A total of 578 older adults (356 Chinese and 222 German) completed the online cross-sectional study. The questionnaire included demographics, three preventive behaviors before and during the pandemic, motivational factors (health knowledge, attitude, subjective norm, risk perception, motivational self-efficacy (MSE), intention), and volitional factors (volitional self-efficacy (VSE), planning, and self-monitoring) of preventive behaviors. Results showed that most social-cognitive factors were associated with three behaviors with small-to-moderate effect sizes (f 2 = 0.02 to 0.17), controlled for demographics and past behaviors. Country moderated five associations, including VSE and hand washing, self-monitoring and facemask wearing, MSE and physical distancing, VSE and physical distancing, and planning and physical distancing. Findings underline the generic importance of modifiable factors and give new insights to future intervention and policymaking. Country-related mechanisms should be considered when aiming to learn from other countries about the promotion of preventive behaviors.

<p>  </p> <p><strong>Background:</strong> Older adults have a higher prevalence of pain compared to other age groups and are more likely to become long-term opioid users. The clinical benefits of long-term opioid therapy (LTOT) are not clearly known, however, LTOT has been found to increase the risk of all-cause mortality, opioid overdose, constipation, fractures, and myocardial infarction. </p> <p><br></p> <p><strong>Objective: </strong>The study was conducted to estimate the incidence of LTOT and risk factors associated with LTOT in older adults aged 65 years and older.</p> <p><br></p> <p><strong>Methods:</strong> This was a retrospective cohort study based on Medicare claims data obtained from Research Data Assistance Center (ResDAC). Opioid naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome was LTOT which was defined as an opioid use episode lasting longer than 90 days and having more than 60 cumulative days of supply. The independent variables (risk factors) were patient characteristics (demographics, comorbidities, substance use disorders), characteristics of initial/index opioid dispensed (opioid type, duration of action of opioid, opioid dose, number of days’ supply, concomitant medications), and pain conditions. Multivariable logistic regression was performed to assess the association between the risk factors and LTOT. To address statistical interactions among variables, secondary analyses were conducted after stratifying the dataset by pain conditions.</p> <p><br></p> <p><strong>Results:</strong> Among 162,287 opioid naive patients, 10,296 (6.3%) transitioned to LTOT. Demographic characteristics associated with LTOT were age greater than 85 years (adjusted odds ratios [AOR]: 1.1, 95% confidence interval [CI]:1.03-1.18) and being black (AOR: 1.11, 95% CI: 1.01-1.22). Risk factors related to substance use disorders included drug use disorder (AOR: 1.59, 95% CI: 1.30-1.95), alcohol use disorder (AOR: 1.26, 95% CI: 1.06-1.49), tobacco use disorder (AOR: 1.33, 95% CI: 1.21-1.45), and a history of opioid use disorder (OUD) (AOR: 1.63, 95% CI: 1.34-1.98). Patients with more than 5 comorbidities had 1.56 times higher odds (95% CI: 1.46-1.66) of LTOT compared to patients with 0-2 comorbidities. Characteristics of initial/index opioid associated with LTOT were dispensing long-acting opioids (AOR: 1.73, 95% CI: 1.22-2.46), concomitant use of benzodiazepines (AOR: 1.19, 95% CI: 1.11-1.28), gabapentinoids (AOR: 1.59, 95% CI: 1.49-1.69), and non-steroidal anti-inflammatory drugs (NSAIDs) (AOR: 1.23, 95% CI: 1.16-1.30). Starting therapy with tramadol increased the odds of LTOT compared to hydrocodone in patients with osteoarthritis and joint pain (AOR: 1.22, 95% CI: 1.06-1.41) as well as abdominal and bowel pain (AOR: 1.53, 95% CI: 1.05- 2.22). However, starting therapy with oxycodone decreased the odds of LTOT in patients with osteoarthritis and joint pain (AOR: 0.69, 95% CI: 0.53-0.90). For all pain conditions, initial opioid supply of ≥30 days led to 10-16 times higher odds of LTOT compared to days’ supply of 1-3 days.</p> <p><br></p> <p><strong>Conclusions:</strong> Higher age, black race, comorbidities, substance use disorders, and history of OUD are the patient-related risk factors of LTOT in older adults. Moreover, specific patterns of initial/index opioid prescription/dispensing such as greater number of days’ supply, dispensing long-acting opioids, and concomitant use of benzodiazepines, gabapentinoids, and NSAIDs increase the odds of LTOT. Prescribers should take these factors into consideration when prescribing opioids to older adults.</p>

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The aim of this study was to compare effects of an individualized with a standardized risk assessment for adverse drug reactions to improve drug treatment with antithrombotic drugs in older adults. A randomized controlled trial was conducted in general practitioner (GP) offices. Patients aged 60 years and older, multi-morbid, taking antithrombotic drugs and at least one additional drug continuously were randomized to individualized and standardized risk assessment groups. Patients were followed up for nine months. A composite endpoint defined as at least one bleeding, thromboembolic event or death reported via a trigger list was used. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. In total, N = 340 patients were enrolled from 43 GP offices. Patients in the individualized risk assessment group met the composite endpoint more often than in the standardized group (OR 1.63 [95%CI 1.02–2.63]) with multiple adjustments. The OR was higher in patients on phenprocoumon treatment (OR 1.99 [95%CI 1.05–3.76]), and not significant on DOAC treatment (OR 1.52 [95%CI 0.63–3.69]). Pharmacogenenetic variants of CYP2C9, 2C19 and VKORC1 were not observed to be associated with the composite endpoint. The results of this study may indicate that the time point for implementing individualized risk assessments is of importance.