Older adults often experience hearing loss in one or both ears, and as a result, many participate in aural rehabilitation programs. Often these programs incorporate communication partners and train them to use compensatory strategies. One common compensatory strategy cited is encouraging communication partners to speak more clearly to their loved one with hearing loss. Clear speech often encompass several different strategies such as speaking slower, louder, or over articulating. However, it is unclear what acoustic changes talkers employ when cued to speak in these different ways. The present study evaluated the effect of different cues (i.e., control (habitual), clear, slow, loud, and over articulate) and speaking tasks (oral reading versus monologue) on the acoustic characteristics of speech produced by eight older adults with hearing in the normal range. All speech was recorded in a sound treated booth and analyzed acoustically along six dimensions: articulation rate, percent change in fundamental frequency from control, change in sound pressure level from control, voice range density area, vowel space density area, and cepstral peak prominence. Results revealed statistically significant acoustic changes between conditions for all six acoustic measures. There was also significant effect of task for three acoustic measures. Findings show both group trends as well as individual talker variability. Further research is needed to determine how the acoustic changes associated with different instructional cues negatively or positively impact listeners with hearing loss.

Class of 2011 Abstract / OBJECTIVES: The objective of this study was to create, implement, and evaluate an interactive educational program for older adults on the safe use of over-the-counter (OTC) medications. METHODS: This was a prospective, interventional study in which all subjects received a 40-minute session covering 12 OTC topics tailored to older adults and delivered by pharmacy students. Convenience sampling was used to recruit participants from five independent senior living communities in Arizona. Following the program, participants completed a questionnaire to address the helpfulness and share their intentions of behavior change. RESULTS: Of 88 older adults who attended the program, 64 met the inclusion criteria and voluntarily completed the anonymous survey. 91.8% of the participants indicated the intervention was either “very helpful” or “moderately helpful”. Upon score conversion, the average score for helpfulness among men and women were 2.35 and 2.37, respectively (p=0.922). 95.2% of the participants agreed they have better understanding about OTCs, and 98.3% reported they would recommend this program to a friend. The majority of the subjects stated they will make changes to the way they use OTCs (79.3%), talk with their pharmacist before purchasing OTCs (86.8%), and discuss OTC use with their providers (88.3%). The three most beneficial topics identified included vitamins/minerals, reading a drug label, and sleep medications. CONCLUSION: An interactive educational program on the safe use of OTC medications, tailored to older adults and delivered by pharmacy students, was helpful and generated positive intentions regarding behavior change in OTC use among participants.

Social isolation is a concern for the health of older adults in Canada. Community-engaged arts (CEA) programs are thought to support social inclusion but how such programs contribute to building community connections for older adults at risk of social isolation is poorly understood. This study, therefore, is aimed to explore the experience of community for this population in the context of a CEA program as well as the role the program plays in that experience. A qualitative study using ethnographic methods was conducted to answer two research questions: (1) What does community mean to seniors in the Arts, Health and Seniors program? (2) What is the role of the Arts, Health and Seniors program in the participants’ experience of community? Data were collected over a six week period using participant observation, semi-structured interviews and document analysis. The sample was a group of 20 urban-dwelling seniors at risk for social isolation who participated in a CEA program once a week. Regular group art sessions were observed by the researcher and extensive field notes were recorded. Interviews were conducted with five senior participants and four other key informants (including two artists, a senior worker, and an administrators), and documents related to the community were reviewed. Data were analyzed throughout the data collection process and interpretations were noted. Through immersion in the data and a movement between the data and interpretations, themes were developed. Connections between themes were explored and taken back to the data. Findings were presented as a detailed description of the participants’ experience of community. Community for the participants focused around the Seniors Centre where the program was held. The participants expressed that the meaningful relationships at the centre made it ‘another home’ and was a place they could find resources to adapt to challenges. The CEA program provided a unique experience of community through working together as a group and making new social connections. For health professionals working with older people at risk for social isolation, this research will add to the understanding of how community is experienced by older adults and how community is supported by CEA programs. / Applied Science, Faculty of / Nursing, School of / Graduate

With the growing number of older adults in the general population, there is also a concomitant rise in the number of older adults who require mental health services, making the measurement of psychological conditions in later life a priority. However, due to a lack of measures created for older adults, researchers and clinicians must often rely on measures created for younger populations. Three studies were designed to add to the field of evidence-based assessment and determine which anxiety measures possess strong evidence when used with older adults to warrant their use with this specific population. In the first study, I systematically reviewed the literature to identify the anxiety measures most commonly used with older adults. I reviewed each measure to examine its psychometric properties (e.g., internal consistency, test-retest reliability, inter-rater reliability, concurrent and discriminant validity) and the availability of age-appropriate norms in order to evaluate whether the instruments are appropriate for use with older adults. In the second study, I conducted a reliability generalization meta-analysis to estimate the mean reliability of each commonly used anxiety measure identified in the first study. Finally, in the third study, I examined whether the anxiety measures commonly used with an older population can be consistently and accurately categorized as evidence-based. The literature review and the reliability generalization study both revealed that most of the most commonly used measures lacked sufficient evidence to warrant their use with older adults. However, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults. This suggests that based on their overall level of reliability and previous psychometric evidence, both researchers and clinicians assessing anxiety in a geriatric population should consider these measures as likely to be the best currently available.

In Canada, out of the total Aboriginal populations, the older Aboriginal adult populations continue to increase and suffer disproportionately poor health compared to non-Aboriginal seniors. Despite these facts, there is a dearth of research concerning Aboriginal older adults, especially regarding their engagement with physical activity. My thesis is written in the publishable paper format and is comprised of two papers. Using a scoping study methodology in paper one, I demonstrate that intersecting factors such as colonialism, social inequities, and physical activity practices that are rooted in Western ideals and do not address Indigenous older adults’ needs, all contribute to Indigenous older adults’ lack of participation in physical activity. Using a case study approach in paper two, I demonstrate how Elders In Motion, a program offered by the Northwest Territories Recreation and Parks Association (NWTRPA), shows a shift in physical activity programs becoming more respectful of older Aboriginal adults’ cultures and communities; however, while the staff at the NWTRPA has made a strong effort to adapt a southern-based program for northern communities in the NWT, there are several program features that reaffirm colonial practices and support Westernized ideas of physical activity. Taken together, the papers in this thesis make apparent that physical activity programs and research concerning physical activity for older Aboriginal adults continue to be embedded in colonial practices. As a result, there is a demonstrated need for program development and research in this area to work towards reducing health disparities and challenging colonial practices.

Background: Declines in gait velocity, stride length, cadence, and postural stability are common with advancing age and have further been linked to heightened fall risk and functional decline. Physical activity can slow or prevent such gait declines in older adults. In young adults, Nordic walking (NW) training has been shown to increase stride length and gait speed, yet has demonstrated inconsistent findings regarding joint loading, with reports of both increases and decreases in this respect. Further, research of this facet has very minimally been examined as it pertains to older adults. Purpose: The aim of the present study was to determine both the initial effect, and the prolonged effect following an 8-week intervention, of Nordic walking (NW) on older adult gait performance and postural alignment and stability. Methods: Gait and postural alignment and stability during NW and conventional walking were assessed and compared following an 8-week NW program (2x/week) in 12 healthy older adults (age: 68 ± 6.8 years; 8 female, 4 male). Participants performed six 5m walking trials, 3 with poles and 3 without, followed by two 6 Minute Walk Test (6MWT) trials, one with poles (WP) and the other without (NP). Gait characteristics and trunk measures in the sagittal and frontal planes were quantified using a 6 inertial sensor accelerometry system (APDM, Oregon, USA) as well as an eight camera 3-dimensional motion capture system (Vicon, Oxford, UK) with 2 force platforms (Kistler, Winterthur, Switzerland) embedded within. All variables were assessed using two-way repeated measures ANOVAs to compare NW to conventional walking and before and after the intervention. Results: When comparing walking WP to NP at initial pre-testing, significantly longer stride length, slower gait speed, and increased double support time were found to coincide with decreases in power generation and absorption at the hip and knee WP. However, following prolonged practice, a longer stride length, faster gait speed, and increased power generation at pre-swing at the hip and power absorption during loading and terminal swing about the knee were found WP post-intervention. Conclusions: An initial 8-week training period is necessary for novice NW in order to develop technique and to restore gait and postural alignment to more “normal” standards following training. Additionally, since the acquisition of the skill requires proper allocation of attention between two tasks: walking and pole manipulation, NW should be done so in a relatively safe environment, free of distraction and obstacles. Finally, with frail elderly, a longer acquisition period may be necessary since facilitation of movement must first occur.

Objective: Mindfulness or the full attention state is a factor that contributes to the successful process of aging. This study aims to evaluate the evidence of validity, on the basis of the internal structure, convergent and discriminant validity, reliability and factorial invariance across gender, for the five items Mindful Attention Awareness Scale (MAAS-5) within a sample of older adults. Methods: The participants were 323 Peruvian older adults, consisting of 160 women and 163 men, whose average ages were 68.58 (S.D = 7.23) and 68.91 years (S.D = 7.12), respectively. In addition to the MAAS-5, the Satisfaction with Life Scale and the Patient Health Questionnaire-2 were administered. Results: The Confirmatory Factor Analysis indicates that the one-factor structure of the MAAS-5 presents adequate fit for the total sample (χ2 = 11.24, df = 5, χ2/df = 2.25, CFI =.99, RMSEA =.06 [90%CI:.01,.11]; and SRMR =.025), as well as for the sub-samples of men and women. This one-factor solution presents adequate internal consistency (ω = 80 [95%CI:.76 -.82]) and it is invariant across gender. Regarding convergent validity, high scores in the MAAS are associated with a greater satisfaction with life (r =.88, p<.01 [95%CI:.85,.95]) and less depression (r = −.56, p<.01 [95%CI: −.48, −.77]) in older adults. Conclusions: The preliminary results back the use of the MAAS-5 as a self-report measure of mindfulness that has an adequate unifactorial structure that is reliable and invariant across gender for measuring the full attention state in elderly Peruvians.

The high rates of obesity and impaired glycemia in older adults place these individuals at risk for developing diabetes. Dehydration, glucose tolerance, and insulin resistance are related. Many older adults do not achieve the Dietary Reference Intake (DRI) for water, and aging and dehydration are both associated with decreased glucose tolerance. Conversely, weight loss is associated with improvements in glucose tolerance. For older adults following a hypocaloric diet, additional water consumption may lead to greater weight loss. Furthermore, research suggests an association between insulin resistance and arginine vasopressin (AVP), the hormone responsible for regulating body water retention. Analysis of the association between plasma copeptin (an AVP derivative) and fasting glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) may provide further insight into the relationship between dehydration and diabetes risk. To our knowledge, few investigations have addressed this relationship between dehydration, impaired glycemia, and insulin resistance and how increasing water consumption may influence diabetes risk. Our purpose was to investigate the possibility that increased water consumption among older adults (n=29, BMI=31+1 kg/m2, age=62+1 years) could improve glycemia beyond that observed with weight loss, as well as associations between plasma copeptin and diabetes risk. Analysis of diabetes-related variables for subjects grouped according to study intervention group, amount of drinking water consumed, or pair-matched for weight loss and gender did not reveal significant differences between groups. Improvements in fasting insulin for water group participants, as well as correlations between hydration and insulin resistance support the need for future investigations. / Master of Science

BACKGROUND: Age-related deterioration in the nervous system results in the decline of motor and cognitive abilities, which both have been identified as contributing to fall risk in older adults. Dual-task gait, which involves walking while performing a secondary cognitive task, is a common way to assess the interactions between cognitive and motor function. Previous work has established associations between the cost of the cognitive load on gait parameters (e.g., velocity) and fall risk in older adults. However, to date, no study has explored the potential value of combining a direct measure of performance on the cognitive component of the dual-task with the gait measures in fall risk prediction modeling. RESEARCH QUESTIONS: Does including measures of performance on the cognitive task in dual-task walking with the gait velocity measures enhance the capacity to predict fall risk. Is this predictive capacity different in models employing dual-task gait velocity versus models including the cost of the cognitive load on gait velocity? METHODS: Thirty-two community-dwelling older adults (76 years ± 3.44) were classified as fallers (n = 17) and non-fallers (n = 15) based on self-report of having at least one fall in the past 12 months. They completed single-task and dual-task walking on a pressure-sensing electronic walkway system. A progressively enhanced series of logistic regression models were performed commencing with gait velocity during the dual-task (Loaded Gait Velocity, LGV) as the covariate in predicting fall risk. This model was subsequently augmented by adding a measure of cognitive performance covariate and then further augmented with the addition of the interaction variable between the LGV and the cognitive performance variables. This stepped series of modelling was then repeated with the dual-task cost gait velocity (DTCGV, difference in gait velocity between single and dual-task). RESULTS: With the addition of the cognitive measures (CM) and the interaction variables between the GV and CM variables, in both the LGV and DTC_GV models, the Nagelkerke’s R square increased as did the models’ respective sensitivity. Notably, the model including the LGV, CM and the interaction variables achieved 88.2% sensitivity, 80% specificity, with an overall classification accuracy of 84.4%. DISCUSSION: This study is the first to show that the ability to identify fallers and non-fallers is enhanced by using both gait and cognition measures as well as interaction variables between gait and cognition measures. Further, our findings suggest that the added value of the cognitive measures is best realized with LGV rather than DTCGV. It reasons that because DTC already encompasses the cost of the cognitive load on the motor performance (gait velocity), combining it with cognitive metrics does not enhance its predictive capacity. This work suggests there is clinical utility of including cognitive performance measures in fall risk modeling as well as it provides further evidence of the interplay between cognitive and motor function in fall risk. / Graduate

This study investigates the effects of priming participants with either negative or positive images of older adults and the impressions they form of a neutral image of an older adult after subsequent priming. Participants were first primed with 25 positive, 25 negative, or no images of older adults, then they were asked to write a short story about "a day in the life of' a neutral woman and to complete several surveys including the Fraboni Scale of Ageism (FSA), Marlowe Crowne, and the NEO-FF inventory. The primary dependent variable was participants' short stories; which were analyzed for linguistic indicators of prejudice toward older adults. Additionally, the data were analyzed to unveil variables that predict ageism. Although priming did not have a significant effect, participants without perceived social support of a grandparent or older adult scored relatively higher on the FSA. Ageism was also predicted by the terminology used in the narrative written to describe the older adult female in the image. Ageism, like other forms of prejudice, develops over a lifetime and cannot be expected to be elicited or eradicated in a few hours. The results of this study suggest perceived level of support from an older adult is more important to reducing ageism than exposure to positive images of older adults.