Intraocular lenses (IOLs) provide distance and near refraction and are becoming the standard for cataract surgery. Multifocal glasses increase the variability of toe clearance in older adults navigating stairs and increase fall risk; however, little is known about the biomechanics of stair navigation in individuals with multifocal IOLs. This study compared clearance while ascending and descending stairs in individuals with monofocal versus multifocal IOLs. Eight participants with multifocal IOLs (4 men, 4 women; mean age = 66.5 yr, standard deviation [SD] = 6.26) and fifteen male participants with monofocal IOLs (mean age = 69.9 yr, SD = 6.9) underwent vision and mobility testing. Motion analysis recorded kinematic and custom software-calculated clearances in three-dimensional space. No significant differences were found between groups on minimum clearance or variability. Clearance differed for ascending versus descending stairs: the first step onto the stair had the greatest toe clearance during ascent, whereas the final step to the floor had the greatest heel clearance during descent. This preliminary study indicates that multifocal IOLs have similar biomechanic characteristics to monofocal IOLs. Given that step characteristics are related to fall risk, we can speculate that multifocal IOLs carry no additional fall risk.

Abstract available through Physical Therapy.

By 2040, 79.7 million older adults will live in the US, and nearly 40% will need nursing home services that are primarily funded by Medicare and Medicaid. Researchers have underscored the importance of leadership in quality healthcare care delivery, suggesting that nursing home administrator turnover could influence resident quality of life, causing ill-health for the residents and preventable medical costs for taxpayers. In spite of the suggested association, little research has specifically examined the role of administrator turnover on resident quality of life. As such, the purpose and central research questions of this case study were designed specifically to address the relationship between nursing home administrator turnover and resident quality of life. The Donabedian health services quality model was the framework for the study. Data were collected from 14 nursing homes, and included semistructured interview data with 7 nursing home administrators, and a review of other documents related to quality of care including site visit reports and surveys. An iterative process of coding and constant comparison was used to identify themes and categories from the data. The findings indicate that turnover likely caused an adverse impact on the nursing home overall, which was expected. The study also determined, however, that high turnover itself was not perceived to be associated to low resident quality of life. The implication for social change is that nursing home stakeholders may develop processes to retain competent administrators which in turn could reduce absent leadership presence in nursing homes. Consistent leadership presence may lead to improvement in quality of life regulatory compliance and reduction in unnecessary Medicare and Medicaid spending by nursing home residents.

Residents in nursing facilities are more prone to falls than those living in the community. Injuries resulting from falls impact residents, their families, and healthcare costs. The gap in nursing practice was the lack of a comprehensive fall-prevention program in a long-term care facility that had experienced high fall rates among residents. This project addressed whether an educational program using the American Medical Directors Association's clinical practice guideline and the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, & Injuries) toolkit for fall- prevention improved the self-efficacy of direct-care staff in preventing falls among residents in a long-term care facility. The practice-focused question focused on whether education on the use of an integrated multifactorial fall-prevention guideline would increase confidence of long-term care staff in reducing falls in long-term care residents. The evaluation used the 11-item Self-Efficacy for Preventing Falls-Nurse scale for 5 licensed nursing staff and the 8-item Self-Efficacy for Preventing Falls-Assistant scale for 21 nursing assistants. The positive change in self-efficacy scores of nurses and nursing assistants after the education program was greatest for face-to-face team communication regarding fall risk and individual resident prevention plans. The use of best-practice guidelines that improve fall risk-assessment and use of fall precautions to decrease the number of falls and falls with injury has the potential to bring about positive social change by improving the nursing care of nursing home residents, resulting in improved resident safety and quality of life.

The present knowledge of factors associated with older adults’ physical activity behaviour is limited. Therefore, this study trialled an innovative physical activity program for older adults, investigating effective recruitment and retention strategies, and exploring the adults’ perceptions of physical activity. A total of 573 subjects were recruited into the quasi-randomised controlled trial, located in 30 intervention and 30 control neighbourhoods in the Perth metropolitan area. The initial response rate was 74% (260/352) in the intervention group and 82% (313/382) in the control group. Self-reported questionnaires administered at three time points (baseline, 3-months, 6-months) measured physical activity levels, personal and demographic information, including perception of financial struggle, proximity to friends, and other psychosocial data. Descriptive statistics, repeated measure analysis of variance, logistic regression and generalised estimating equations were used in the analysis. Qualitative data on the participants’ perceptions of physical activity were collected through one-on-one interviews (n=16). The results showed that: 1. This cost-effective recruitment procedure facilitated the selection of a reasonably representative sample of 65 to 74 year olds from the Perth metropolitan area. Names of 7378 older adults were obtained from the Federal Electoral Roll, then 6401 potential subjects were matched to telephone numbers and phoned with subjects meeting the screening criteria invited to join the program (n = 4209). From this sample, 573 subjects were recruited. More females (63%) than males (37%) were recruited. / The study attracted a greater proportion of ‘obese’ older adults (27%) relative to state averages. 2. Over the intervention period there was a significant increase in participants’ total physical activity of 2.25 hours per week (p >.001). The General Estimating Equation analysis confirmed significant increase in physical activity from baseline to midpoint (p=.002) and to post intervention (p=.0031). Perceptions of financial struggle (p=.020) were positively correlated with physical activity time spent by participants, whereas having friends or acquaintances living nearby (p=.037) had a significant negative correlation with physical activity time. 3. At the end of the intervention, 32% of the intervention group and 25% of the control group had dropped out, resulting in an overall drop out rate of 28%. Most of the attrition occurred in the first 3 months (77%). Characteristics of individuals lost to attrition (n=86, 35%) were compared with program completers (n=162, 65%). Logistic regression analysis showed that those lost to attrition came from areas of lower socio-economic status, were overweight, were less physically active, and had a lower walking self-efficacy score and a higher loneliness score. The results suggest that to improve retention and to avoid potential bias, early assessment of these characteristics should be undertaken to identify individuals at risk of attrition. 4. Based on the finding of this research, future intervention studies should consider: the role of tertiary students as a skilled resource; the use of volunteers to contain costs; the importance of a tailored program; the appropriateness of walking as a form of physical activity for this age group; the enjoyment associated with a walking group; and the usefulness of social support. / This practical program is potentially effective and sustainable for mobilizing physically inactive older people. 5. Qualitative research highlighted the need for older adults to receive more specific information on: the benefits of physical activity; the role of pain management in physical activity; and the concept that involvement in physical activity in younger years leads to involvement when older. The older adults also expressed a desire to engage in less age appropriate activities. These results suggest that the intervention was successful in recruiting older adults into and retaining them in the intervention, documenting a need for early identification of individuals at risk of attrition. The program significantly increased the participants’ weekly mean time for physical activity and identified factors that affect their commitment to physical activity programs. This program was practical and could be used as a model for physical activity programs aimed at older adults.

Secretory immunoglobulin-A (S-IgA) in saliva may reflect levels of immune defence at other mucosal sites. Reduced levels of salivary S-IgA have been associated with an increased risk for upper respiratory symptoms (URS) in athletes. Previously, the consumption of a nutrition supplement, bovine colostrum (BC) by distance runners, was shown to significantly increase levels of salivary S-IgA compared to baseline; however the mechanism was not known. The immunomodulatory effect of BC is investigated further in these current studies. Twenty-five swimmers (12 males [M], 13 females [F], age 14-23 years) training at an elite level, 28 lightly-exercising students (9M, 19F, age 18-27 years), and 45 healthy older adults (20M, 20F, age 65-76 years), consumed a supplement of either BC or placebo for ten weeks. Saliva samples were collected at baseline, weekly for four weeks during supplementation and post-supplementation. Blood samples were collected at baseline, monthly during supplementation and post-supplementation. No significant changes were seen in levels of S-IgA in either BC or placebo groups within any of the cohorts. There was a trend towards a significant difference in URS reportage between BC and placebo groups in the swimmers cohort, but not in the students or older adults. There was also a trend towards a difference in the number of swimmers reporting URS. Fewer numbers of swimmers consuming BC reported URS compared the placebo (P=0.062) after consuming BC for four weeks compared to those consuming the placebo. Post-exercise plasma cortisol results were significantly reduced in the BC subgroup compared to the placebo (P=0.004). These results do not support the findings of previous intervention studies investigating the immunomodulatory effect of BC in athletes. However the reduced reportage of URS, among swimmers consuming the BC supplement, suggested there was some benefit to their health. A possible explanation is that BC has impacted on non-infectious causes of URS. Growth factors present in BC may enhance intestinal repair which could be advantageous to athletes recovering from bouts of prolonged intensive exercise. The effect of gastrointestinal disturbances on local and systemic immunity may be minimised which benefits immune protection. However an inconsistent effect of BC supplementation on immune protection in athletes means further research is still required. In these studies there was no benefit to immune protection in the student or older adult cohort. Further investigation into the safety of BC for all population groups is still required.

In this study, we contrasted socioemotional selectivity theory (SST; Carstensen, 2006) with dynamic integration theory (DIT; Labouvie-Vief, 2003) using trajectories of quantitative and qualitative social support in later life. SST is a lifespan theory of motivational development (Carstensen, Isaacowitz, & Charles, 1999). There is a normative decline in social support networks in later life. In other words, individuals who perceive the limitation on time left for their future are likely to decrease the quantitative social support and compensate for this decrease by improving qualitative social support with emotionally meaningful social partners. The theory also postulates that age is the primary proxy for perceived limitation of individuals' lives (Carstensen, Fung, & Charles, 2003). Further, self-reported health and functional status are factors that affect older adults' perception of limitation of time left in their lives (Carstensen, 2006). In contrast, DIT is a neo-Piagetian theory that emphasizes the presence of individual differences in quantitative and qualitative social support in later life depending on individuals' levels of cognitive resources that are associated with educational levels (Labouvie-Vief & Diehl, 2000). Despite these different arguments on the trajectories of quantitative and qualitative social support in later life, SST and DIT have not been tested within a same study. The current study examined the trajectories of frequency of social contact (quantitative social support) and reliance on family members and close friends (qualitative social support) in later life. Participants were drawn from the Normative Aging Study (NAS; N = 1,067, M[subscript age] = 60.83, SD = 8.08) who completed social support surveys three times from 1985 to 1991. Using unconditional and unconditional analyses (Raudenbush & Bryk, 1986), growth models of frequency of social contact with and reliance on family members and close friends were tested. Within subject analyses found that the trajectory of frequency of social contact was a U-shaped curve with the age of 54 years at a peak, while the trajectory of reliance on family and friends were stable and linear. Random effects of age for the intercept and slope were significant in both models of frequency of contact and reliance on family and friends, although the random effect for the latter were small in both models. Between subjects analyses were conducted to examine whether cognitive resources, marital status, health status, and functional status predicted variance in the intercept and slope of both types of support. As SST hypothesized, having better self-reported physical health predicted higher levels of frequency of contact over age. Being married was associated with higher quantity of social support. However, contrary to our hypothesis based on SST, having poorer functional status predicted more frequent social contact over age. The random effect of intercept was still significant after controlling for these psychosocial predictors. The evidence to test the DIT hypotheses was examined in the model of the qualitative social support. Having memory problems predicted decreasing reliance on social partners. However, marital status and education did not significantly predict change in qualitative social relationships. Contrary to the hypothesis based on SST that posited poor self-reported health was associated with higher qualitative social support, it was better self-reported health that predicted higher qualitative social support. The random effects for the intercept and slope were still significant after controlling for these psychosocial factors. Taken together, the findings of the current study suggest that SST and DIT can be used as theoretical frameworks that are complementary rather than contradictory in their predictions of socioemotional development in later life. SST is useful to illustrate the overall trajectory of quantitative social support in a normative development in late life. DIT's stance better explains the individual differences in qualitative social support in non-normative contexts. The findings also suggest that having memory problems and poor self-reported health as non-normative developmental outcomes may be risk factors of older adults' ability to seek for social support. / Graduation date: 2012

Using Hebb’s (1961) paradigm, it has been shown that older adults (OAs) fail to learn recurrent visuospatial supra-span sequence information (Turcotte, Gagnon, & Poirier, 2005); a deficit which has not been demonstrated on verbal versions of the same task or in younger adults (YAs). Since the Hebb paradigm is thought to rely on working memory and thus attention (Conway & Engle, 1996), one interpretation concerns an OA’s capacity to allocate the necessary attentional resources to carry out the various components of the task. Five studies investigated this proposal. The first three (Article 1) examined attention in a general manner by reducing the amount of attentional resources that a YA could devote to carrying out the visuospatial Hebb supra-span sequence learning task through the implementation of a verbal dual task (DT) procedure. The fourth (Article 2) further investigated the role of attention by using a DT induced at retrieval that overlapped extensively with the requirements (spatial and response features) of the visuospatial Hebb task. The final study (Article 3) aimed to use our previous findings to demonstrate learning among OAs in a visuospatial Hebb learning paradigm in which the motor response was replaced by a verbal response. Our findings confirm that attentional resources employed at the retrieval phase of the task appear to be particularly important for the demonstration of visuospatial sequence learning. The inclusion of a spatial and motor based DT at recall eliminated learning of the repeated sequence in YAs. Interestingly, the learning deficit of OAs was partially eliminated when the motor and spatial requirements at retrieval were reduced. Our findings offer strong support to the contention that supra-span learning of the Hebb type is not altered by the effect of age. However, learning deficits can be observed among OAs when the retrieval component of the task overly taxes attention-related processes. In the case of the visuospatial sequences, the basis of the deficit likely concerns an individual’s capacity to discriminate between responses made to previously presented sequences versus those that need to be made in reaction to the just seen sequence.

Using Hebb’s (1961) paradigm, it has been shown that older adults (OAs) fail to learn recurrent visuospatial supra-span sequence information (Turcotte, Gagnon, & Poirier, 2005); a deficit which has not been demonstrated on verbal versions of the same task or in younger adults (YAs). Since the Hebb paradigm is thought to rely on working memory and thus attention (Conway & Engle, 1996), one interpretation concerns an OA’s capacity to allocate the necessary attentional resources to carry out the various components of the task. Five studies investigated this proposal. The first three (Article 1) examined attention in a general manner by reducing the amount of attentional resources that a YA could devote to carrying out the visuospatial Hebb supra-span sequence learning task through the implementation of a verbal dual task (DT) procedure. The fourth (Article 2) further investigated the role of attention by using a DT induced at retrieval that overlapped extensively with the requirements (spatial and response features) of the visuospatial Hebb task. The final study (Article 3) aimed to use our previous findings to demonstrate learning among OAs in a visuospatial Hebb learning paradigm in which the motor response was replaced by a verbal response. Our findings confirm that attentional resources employed at the retrieval phase of the task appear to be particularly important for the demonstration of visuospatial sequence learning. The inclusion of a spatial and motor based DT at recall eliminated learning of the repeated sequence in YAs. Interestingly, the learning deficit of OAs was partially eliminated when the motor and spatial requirements at retrieval were reduced. Our findings offer strong support to the contention that supra-span learning of the Hebb type is not altered by the effect of age. However, learning deficits can be observed among OAs when the retrieval component of the task overly taxes attention-related processes. In the case of the visuospatial sequences, the basis of the deficit likely concerns an individual’s capacity to discriminate between responses made to previously presented sequences versus those that need to be made in reaction to the just seen sequence.

This study investigated whether age differences in deceit detection are related to impairments in emotion recognition. Key cues to deceit are facial expressions of emotion (Frank and Ekman, 1997). The aging literature has shown an age-related decline in decoding emotions (e.g., Malatesta, Izard, Culver, and Nicolich, 1987). In the present study, 354 participants were presented with 20 interviews and asked to decide whether each man was lying or telling the truth. Ten interviews involved a crime and ten a social opinion. Each participant was in one of three presentation conditions: 1) visual only, 2) audio only, or 3) audio-visual. For crime interviews, age-related impairments in emotion recognition hindered older adults in the visual only condition. In the opinion topic interviews, older adults exhibited a truth bias which rendered them worse at detecting deceit than young adults. Cognitive and dispositional variables did not help to explain the age differences in the ability to detect deceit.