Urinary incontinence (UI) is a common complication of type 2 diabetes mellitus (T2DM) for older adults (≥65 years) that is associated with reduced quality of life and risk of institutionalization. This convergent, mixed methods research study, informed by a model of clinical complexity, explored the complexities for older adults living with UI and T2DM, and home-care nurses providing care to this population in Ontario. In the quantitative strand, the most recently completed Resident Assessment Instruments for Home Care from 2011-2016 for older home-care clients with diabetes were analyzed to determine the prevalence and correlates of UI. The qualitative strand used interpretive description methodology to explore the experiences of 18 older adults living with T2DM and UI receiving home-care services and the experiences of 15 home-care nurses caring for this population. These data sources were converged to describe the factors that contributed to complexity for older adults with UI and T2DM: (a) challenges of living with multiple chronic conditions (MCC), medical instability, and high care needs; (b) financial barriers; (c) lack of understanding of older adults’ values and preferences by health-care providers; (d) caregiver burden; and (e) functional impairments. The health-care system contributed to this complexity through: (a) inadequate and minimal provision of nursing and interprofessional home-care services; (b) task-focused structure of home care; (c) minimal interprofessional collaboration; (d) lack of an integrated communication system; and (e) lack of navigation to community resources. Providing health-promoting care for older adults with UI and T2DM requires a system-wide enactment of integrated care that takes both a person- and family-centred care and social determinants of health approach. Interventions for older adults with MCC should involve standardized and comprehensive assessment, care coordination, enhanced nursing service provision, and interprofessional team collaboration to attend to the dimensions of complexity and ensure the needs of older adults and their caregivers are met. / Thesis / Doctor of Philosophy (PhD) / Many older adults with diabetes have urinary incontinence that is emotionally and physically bothersome. These older adults also receive home-care services. In this study, older adults were asked about how they care for their diabetes and incontinence and how their home-care workers help them with this care. Nurse participants were asked how they help older adults with diabetes and incontinence and the challenges they face. The results of home-care assessments done in Ontario were also analyzed to learn how common incontinence is in older adults with diabetes and factors associated with having incontinence. The study found many factors, such as living with many chronic conditions and lack of finances, as well limited home-care service provision and the task-focus of home care created challenges for these older adults. The findings can help in making changes to home-care service delivery to improve care for older adults and their caregivers.

The advancement and incorporation of media in daily life continue to grow exponentially as the median age of humanity continues to rise. While there are media literacy education programs targeted toward children and adolescents, older adults are often left out of these initiatives. Based on ethnographic research conducted at two senior centers in Denton, TX, this thesis explores the way older adults analyze and interact with media. Data collection methods include participant observation and semi-structured interviews with senior center members over the age of 65. The research findings highlight how older adults navigate an expanding information society and how they lean on their community for support. These findings laid the foundation for the creation of a media literacy educational seminar given at both senior centers.

As falls and fall-related injuries are a major cause of injuries, the purpose of this study was to investigate whether, and to what extent, the stage combat fall technique training could reduce the impact forces of falls from standing. Twenty-six healthy young adults (14 males and 12 females) participated in our study, and were randomly assigned to either a training group or non-training (control) group. Both groups completed a pre-intervention and a post-intervention fall testing session, separated by two weeks, in which they performed naturalistic falls. The training group performed identical pre-intervention fall testing as the control group, and was then required to receive four 1-hour training sessions in the course of two weeks, led by a certified stage combat fall technique training instructor. The training group then completed a post-intervention fall testing session where they performed naturalistic falls and also falls using the fall technique they learned. Falls were induced in both forward and backward directions using a tether-release protocol. Differences between control and training groups at pre-training, and group differences in the change in dependent measures with training, were examined using Mann-Whitney U tests. The results showed that, following stage-combat fall training, the training group exhibited 32% and 35% reduction in median impact forces for forward and backward falls respectively, while the control group exhibited 5% and 2% reductions (p = 0.002 and <0.001). In addition, the training group showed shorter backward fall duration as well as longer impact time, larger impulse, and longer or larger center-of-pressure based measures for both directions of falling than the control group. However, training was not associated with reduced impact force during the naturalistic falls of the training group. To our knowledge, this was the first study to investigate the stage combat fall technique training and demonstrate its effectiveness as an intervention to reduce impact forces of falls, thereby exploring the potential to reduce the number of fall-related injuries. While these falls were induced from standing, whether these results would transfer to an unanticipated fall while walking due to a slip/trip remain to be explored. / Master of Science / As falls and fall-related injuries are a major cause of injuries, the purpose of this study was to investigate whether, and to what extent, the stage combat fall technique training could reduce the impact forces of falls from standing. Twenty-six healthy young adults (14 males and 12 females) participated in our study, and were randomly assigned to either a training group or non-training (control) group. Both groups completed a pre-intervention and a post-intervention fall testing session, separated by two weeks, in which they performed naturalistic falls. The training group was required to receive four 1-hour training sessions in the two-week intervention period, led by a certified stage combat fall technique training instructor. The training group then completed a post-intervention fall testing session where they performed naturalistic falls and also falls using the fall technique they learned. The results showed that, following stage-combat fall training, the training group exhibited nearly a 1/3rd reduction in impact forces for both forward and backward falls, while the control group only exhibited 5% and 2% reductions respectively. Our analysis also showed that the training group achieved this reduction in impact force by increasing the impact time and spreading out their bodies more, to distribute the impact over a larger area. To our knowledge, this was the first study to investigate the stage combat fall technique training and demonstrate its effectiveness as an intervention to reduce impact forces of falls, thereby exploring the potential to reduce the number of fall-related injuries.

Most individuals spend more than half their lives as single due to divorce, widowhood, and remaining single (Simpson, 2016). Singlehood, in general, has meant not being in a heterosexual relationship. Historically, lesbian women have been considered single because their relationships were not legally recognized. Single women and lesbian women have had more choices to live outside heterosexual marriage, financially and with social acceptability, in the later portion of the 20th century and in the early 21st century than previously. Single sexual minority women of the baby boom came of age during this time and are beginning to plan for and enter into old age. This study used qualitative methods to study how single sexual minority women of the baby boom cohort defined family and planned for their later years. Women from the baby boom cohort who are currently single and identify as a sexual minority were connected to their family of origin and extended families in their youth, focused on romantic relationships during adulthood, and currently identify their family as biological and chosen family. The women had formal and informal plans for their future as they continue to age. Limitations, future directions, and implications are also discussed. / Ph. D.

The growing older adult population has led to increased ageist tendencies among younger generations. Previous research suggests that ageism is associated with cognitive and physical decline among older adults. This mixed-methods research project examined changes in ageist perceptions among graduate student facilitators and undergraduate nutrition ambassadors after participating in a training that included information about healthy aging, addressing ageism, and communicating with older adults. Results from a secondary data analysis of pre-test/post-test data and thematic analysis of semi-structured interviews with facilitators of Socially Nutritious, a virtual nutrition education program for older adults, indicate that ageist perceptions decreased after the training, which was supported by positive experiences with intergenerational communication articulated by graduate student facilitators in the interviews. Training to address ageism and develop a positive perception of aging and intergenerational experiences sharing knowledge about foods and nutrition may decrease ageist beliefs among young adults.

This study will extend the current body of knowledge about how accessible and affordable information communication technologies (ICT; smartphones, tablets, and computers) can foster social interaction and reduce social isolation and loneliness in older adults aged 55 plus. The first study is a systematic literature review of existing studies on ICT and the willingness of older adults to use technology. The second study is quantitative research that investigates the trust and reasoning of older adults using ICT, like smartphones, tablets, and computers that foster social interaction and the level of technological ownership. The second study is conducted using research data through surveys conducted by Pew Research Center on behalf of Princeton University. Finally, the third study explores the level of ownership of technology and methods to reduce social isolation using ICT. The effectiveness of smartphones, tablets, and computers that foster social interaction were reviewed to create a sense of community to reduce social isolation.

Yes / Background: Anticholinergic medicines are associated with adverse outcomes for older people. However, little is known about their use in frailty. The objectives were to (1) investigate the prevalence of anticholinergic prescribing for older patients, and (2) examine anticholinergic burden according to frailty status. Methods: Cross-sectional analysis of Welsh primary care data from the Secure Anonymised Information Linkage (SAIL) databank including patients aged ≥65 at their first GP consultation between 1st January and 31st December 2018. Frailty was identified using the electronic Frailty Index (eFI) and anticholinergic burden using the Anticholinergic Cognitive Burden (ACB) scale. Descriptive analysis and logistic regression were conducted to 1) describe the type and frequency of anticholinergics prescribed; 2) to estimate the association between frailty and cumulative ACB score (ACB-Sum). Results: In this study of 529,095 patients, 47.4% of patients receiving any prescription medications were prescribed at least one anticholinergic medicine. Adjusted regression analysis showed that patients with increasing frailty had higher odds of having an ACB-Sum of >3 compared to patients who were fit (mild frailty, adj OR 1.062 (95%CI 1.061–1.064), moderate frailty, adj OR 1.134 (95%CI 1.131–1.136), severe frailty, adj OR 1.208 (95%CI 1.203–1.213)). Conclusions: Anticholinergic prescribing was high in this older population. Older people with advancing frailty are exposed to the highest anticholinergic burden despite being the most vulnerable to the associated adverse effects. Older people with advancing frailty should be considered for medicines review to prevent overaccumulation of anticholinergic medications given the risks of functional and cognitive decline that frailty presents. / NIHR / Research Development Fund Publication Prize Award winner, May 2023.

The growing number of video gamers over the age of fifty has sparked new interests in the transformative power of play and consequently, video games, for a larger demographic of citizens. Researchers have found that digital gaming can have positive effects on the physical, psychological and cognitive well-being of older adults. Of particular interest to this thesis is the potential of games to facilitate social connections between different generations of players. Intergenerational games have focused on improving relations between younger people and older adults by providing enjoyable interactions that can impart cognitive and physical benefits. While previous work has focused on enhancing intergenerational social connections between relatives, non-familial intergenerational encounters have scarcely been explored. Games often feature asymmetrical participation and require long term interest, all factors that can prove challenging to implement for public non-kin intergenerational gameplay. Previous works have shown that the successful use of games is dependent on a number of psychosocial and contextual factors that shape the player experience. One of them is the degree of familiarity between players. Familiarity has been linked to many of the core motivations associated with intergenerational play, exposing doubts of whether the same motivations can be used to inform the design of intergenerational games between strangers of different ages. In addition, for most socio-technical interventions designed for older adults, the characteristics of seniors have predominantly been framed around accessibility and decline. This limited perspective also tends to be true when discussing games designed for seniors. Finally, existing research on games for seniors has mainly focused on seniors who play conventional video games and self-identify as gamers, further marginalizing seniors who do not fit these descriptions. The current design of intergenerational games might not be ready for adoption by the broader society. In response to these gaps, this thesis presents a research through design project aimed to investigate how a general population of older people (who may not be composed of video-gamers) perceive and experience game and play, and map this knowledge to promising playful approaches of intergenerational encounters while at the same time promoting a positive image of older adults as active and sociable members of society. The methodology featured a participatory approach that involved interview studies, co-design workshops, and playtests that helped to articulate the general requirements for an intergenerational game to be played in public spaces. The result of these formative exercises produced Klang Verbindet (“Sound Connects”), an interactive playful system that supports embodied interaction and group exploration of spaces. Designed to be played through body movements, the system employs vision-based algorithms and sound synthesis to provide an age- agnostic space for public play. Interactions with the system were evaluated in two different public contexts, using direct observations, semi-structured group interviews, and post-game questionnaires. Based on these data and the design and implementation of the system, the thesis describes a number of important factors to be considered when designing and evaluating games for non-familial intergenerational interaction. The most important being, to design for short-term and low-entry engagements which are defined as “low-threshold intergenerational encounters”. Within this space, the thesis discusses the distinctive value of - ambiguity, appropriation, and curiosity as drivers of gameplay for rapid mixed-aged encounters in the public context.

Older Americans will soon outnumber children and younger adults. In 2022, there were 58 million older adults. By 2050, older adult numbers will grow to 82 million, and by 2060, 100 million. The National Institute on Aging calls for ongoing research on the impact that a historically large aging population will have on health, well-being, and quality of life. A key concern is how to meet needs while decreasing costs associated with institutional long-term care. Most of these elders reside in the community and wish to live in their homes throughout their lives, but they will experience an increased need for age-related healthcare and resources in their rural communities. There is little in the literature about these issues. A qualitative, descriptive, phenomenological study was undertaken to describe the availability of resources for aging in place through the lens of rural community service workers' lived experience and perceptions. The study was underpinned theoretically with Rural Nursing Theory and conceptually by principles of aging in place. Resulting themes included easily vs not easily accessible resources for aging in place, bridges or battles to support aging in place, and big dysfunctional puzzle of fragmented and scattered resources. By focusing on aspects of rural environments and concepts of aging in place, the study describes the contextual differences of rural aging in place, illuminates the reality of rural aging, and highlights the need for cost-effective expansion of age-related resources for rural aging in place.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25170号 / 医博第5056号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本 洋介, 教授 近藤 尚己, 教授 西浦 博 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM