Objectif : L’objectif de ce travail de thèse était de proposer une nouvelle approche pour appréhender l’accessibilité afin qu’elle offre des opportunités réelles aux personnes de se déplacer et de se développer. Cette orientation de recherche s’est appuyée sur l’approche par les capabilités qui fournit un cadre théorique pertinent et original pour atteindre une accessibilité capacitante, c'est-à-dire qui permette le développement des personnes. Dans cette thèse, le cadre applicatif de l’approche théorique est la mobilité des personnes vieillissantes.Méthodes : Après une présentation de l’approche par les capabilités, un état de l’art sur l’accessibilité et la présentation du contexte applicatif de cette thèse, nous présentons trois recherches, qui utilisent une combinaison de méthodes (i.e. atelier, observations, questionnaires, projection situationnelle, technique des incidents critiques).Résultats : Les résultats de ces recherches permettent de définir l’accessibilité capacitante et de concevoir un modèle pour l’appréhender en ergonomie. Ce modèle met en évidence des déterminants de l’accessibilité capacitante tels que les ressources et les facteurs d’usage (i.e. les facteurs de conversion et les facteurs de choix). De plus, il décrit le processus qui peut amener à des activités contraintes et/ou empêchées.Conclusion : En conclusion, une présentation du modèle développé dans ce travail est proposée ainsi qu’une définition de l’accessibilité capacitante. Ensuite, les perspectives de recherches portent d’une part sur les recherches en conception visant l’accessibilité capacitante, et d’autre part, sur les effets à long terme de l’accessibilité capacitante sur les activités méta-fonctionnelles. / Objective: The objective of this work was to propose a new approach for the understanding of accessibility. Through this approach, accessibility is considered as a number of qualities of environments or activities providing real opportunities for development to people. This line of research was based on the capability approach which provides a unique and relevant theoretical framework to achieve enabling accessibility (i.e. accessibility which offers real development opportunities to people). In this thesis, the application context of enabling accessibility is older adults’ mobility. Methods: After a presentation of the capability approach, a state of the art on accessibility and presentation of the application context of this research, we present three studies, which use a combination of methods (i.e. workshop, observations, survey, situational projection, critical incident technique). Results: The results of this research are used to define a model of enabling accessibility and to clarify its position in ergonomics. This model highlights a number of determinants of enabling accessibility (e.g. resources conversion factors, factors of choice). This model also describes a number of process which can constraint or hamper activity. Conclusion: In conclusion, a presentation of the model develops in this work is proposed as well as a definition of enabling accessibility. The prospects for research focuses firstly on the research design for enabling accessibility, and secondly, on the long-term effects of enabling accessibility on meta-functional activities.Keywords: enabling accessibility, capability approach, freedom of choice, older people, mobility

Purpose: Transitioning into retirement may be a suitable period to help adults establish an active lifestyle. One innovative approach to promote PA may be through multimedia-based programs. This experiment aimed to explore the feasibility DVD and videogame-based exercise programs in promoting physical activity (PA) in adults transitioning into retirement. Underlying motivations, functional fitness, quality of life, and elicited beliefs from participating in the exercise programs were also explored. Methods: Twenty-seven adults were randomized into either a nine-week exercise DVD (n = 9), exergame (n = 9), or waitlisted control group (n = 9). Main outcomes include adherence was based on attendance during the in-lab component and participant logs during the in-home component. PA levels were measured through accelerometery and assessed at baseline, four-, nine- and 12-weeks. Secondary outcomes related to motivation were assessed at baseline, three- and nine-weeks. Tertiary outcomes such as physiological/functional fitness and quality of life outcomes were assessed at pre- and post-intervention. Results: During the in-lab portion, t-tests showed that adherence was slightly higher in the exergame group than the DVD group (t16 = -0.06, p = .96; d = .31). Repeated measures of analysis showed that the group x time interaction for moderate-to-vigorous physical activity (MVPA) (F2,24 = 0.87, p = .52; η2 = .05), while overall PA saw negligible changes (F2,24 = 0.16, p = .85; η2 = .01). At the end of the intervention, overall adherence was similar between both exercise groups (t16 = -0.06, p = .96; d = .03). The group by time interaction effect yielded a moderate effect size for MVPA (F2,24 = 1.07, p = .36; η2 = .08) and overall PA (F2,24 = 1.11, p = .35; η2 = .08). Overall PA only increased in the exergame group (d = .74). The exergame group saw major decreases in instrumental attitude (d = .64), injunctive norm (d = .79), perceived behavioural control (d = .40) and intention (d = .90). Both exercise groups enhanced strength, mobility, and aerobic endurance outcomes (d = .33-.98), as well as several quality of life domains (d = .32-.89). At the post-intervention follow-up, both exercise groups were more active than the control group (d = .49-1.03). Two-thirds of the DVD group adopted DVD-based exercise, while a third of exergame group adopted videogame-based exercise. Conclusions: With a high adoption rate, DVD-based exercise programs may be a feasible and acceptable approach to promote PA levels. Participants in both groups were generally satisfied, indicating that the exercise program was enjoyable, comprehensive, and a simple and convenient way to exercise at home. Improvements to important functional and quality of life domains were also identified. Further research will be required to fully test the effectiveness of exercise DVDs and exergames on adherence and PA behaviour in adults transitioning into retirement. / Graduate / 0384 / christopher.yao7@gmail.com

Toilet grab bars were intended to facilitate independent and safe toilet transfer for people with different abilities. However, standard grab bars require too much effort from older adults who typically transfer to the toilet in a standing position rather than a sitting position. Among existing grab bars, grab bars on both sides of the toilet worked best for older adults because they allowed older adults to use both arms to get on and off the toilet. However, based on our observation, these grab bars were not effective to assist older adults to get in and out of the wheelchair. Additionally, these grab bars are too far apart that older adults have to use their shoulders rather than arms, which arise problems because shoulder are typically weaker than arms. This study intends to solve this problem by developing a new grab bar which would be safer, easier and more comfortable to use. Based on the literature review, analysis of existing grab bars and observation, a new concept of grab bars was generated and a functional prototype was constructed for user testing. The prototype was proved to be safe, easy and comfortable to use in the entire transfer process and it reduced the use of wheelchairs as well.

There is limited knowledge on provisions used to ensure swallowing safety, nutritional adequacy and sensory acceptability of pureed foods in long-term care homes (LTCHs). The overall aim for this research was to expand knowledge of pureed food production in LTCHs, to study the impact of varying ingredients and preparation on sensory and nutrition and to model perceived oral textures in pureed food. Qualitative interviews with dietary staff (n=53) in 25 LTCHs showed a variety of challenges and practices in production, affecting overall quality. Pureed turkey varying in added liquid, meat muscle and seasoning method and pureed carrots varying in thickener type were evaluated by a descriptive sensory panel (n=10). Results indicate that small formulation changes can have a significant impact on the nutrition and sensory properties of pureed food. Instrumental tests using a viscometer, line-spread test and texture analyzer showed different strengths in predicting variation in orally-perceived textures. / Funding for this project has been provided by Agriculture and Agri-Food Canada through the Canadian Agricultural Adaptation Program (CAAP). In Ontario, this program is delivered by the Agricultural Adaptation Council (AAC).

Au Canada, la proportion de la population âgée de 65 ans et plus a augmenté depuis 1980. Bien que la dénutrition ne soit pas inévitable avec le vieillissement, certains changements et facteurs physiopathologiques, environnementaux et psycho socio-économiques peuvent entraîner une détérioration des choix alimentaires et donc, de la qualité de vie des aînés [1]. Plusieurs études font le lien entre l’état nutritionnel et la morbidité ainsi qu’avec les capacités fonctionnelles [2]. Ces observations expliquent l'intérêt de la prévention et du traitement de la dénutrition afin d’optimiser la prise alimentaire et un meilleur état de santé de cette population. Objectifs :1) Explorer les barrières individuelles et socio-environnementales, réelles et perçues, qui peuvent mener à la détérioration des choix et de la qualité alimentaires et entraîner une dénutrition chez les personnes âgées vivant à domicile. 2) Examiner la distribution de ces facteurs dans la population à l’étude. 3) Étudier la relation entre ces facteurs afin de dresser un portrait plus éclairé des déterminants négatifs de l’alimentation chez les adultes âgés pour mieux comprendre les barrières à la prise alimentaire saine. Méthodologie : Il s'agit d'une analyse secondaire réalisée à partir des données recueillies auprès des participants (n=1 602), âgés entre 67 et 84 ans,de l’Étude longitudinale québécoise sur la nutrition et le vieillissement réussi (NuAge) débutée en 2003 et dont le suivi était prévu sur cinq ans [3]. Le but principal de NuAge était de déterminer le rôle de la nutrition dans l’accomplissement d’un vieillissement réussi. Les données comprennent des mesures socio-démographiques, nutritionnelles, fonctionnelles, sociales de même que biologiques et médicales. À partir d'un modèle théorique des déterminants de la prise alimentaire chez la population âgée, ces données ont été mises en lien avec la qualité alimentaire. Cette dernière a été déterminée selon l’adaptation canadienne de l’indice d’alimentation saine (C-HEI), calculé à partir des données alimentaires et nutritionnelles obtenues par le questionnaire de fréquence alimentaire administré aux participants au T1, soit à leur entrée dans l'étude. Résultats : Les barrières qui pourraient freiner la qualité alimentaire des femmes incluent un statut affectif fragile et un fonctionnement social limité. Ce qui ressort, comme étant des barrières au C-HEI chez les hommes, est un revenu perçu comme étant insuffisant pour satisfaire les besoins, le port de prothèses dentaires et le fait de manger souvent au restaurant. Étonnamment, le nombre d’attitudes positives relatives à l’alimentation et un score plus élevé de la composante mentale du SF-36 prédisent un C-HEI plus faible. La nature des réponses auto rapportées pourrait expliquer ces résultats. Conclusion : Les résultats de cette recherche permettent de mieux comprendre les barrières d’une saine alimentation au sein d’une population bien-portante. Il est souhaité que les résultats contribueront au développement d’interventions efficaces ciblant les personnes âgées pour favoriser un apport nutritionnel et un état de santé optimal. / In Canada, the proportion of the population aged 65 and over has increased since 1980. Although under nutrition is not inevitable with aging, some changes and physiological factors, environmental and psycho-socio-economic conditions may cause deterioration in food choices and in the quality of life of seniors [1]. Several studies show the link between nutritional status and morbidity as well as functional capacity [2]. These observations justify the importance of prevention and treatment of under nutrition so as to optimize food intake and improve the health of this population. Objectives : 1) Exploring individual and socio-environmental barriers, whether it is real or perceived that may lead to deterioration of choices and quality food and cause under nutrition in the elderly living at home. 2) Examine the connection of these factors in the population being studied. 3) Examine the relationship between these factors so as to be knowledgeable about the negative determinants of nutrition in older adults to better understand the barriers to a healthy food intake. Methodology: This is a secondary analysis conducted using data collected from participants (n = 1 602), aged between 67 and 84 years in the Quebec’s Longitudinal Study on Nutrition and successful aging (NuAge) that began in 2003 with follow-ups planned over the following five years [3]. The main goal of NuAge was to determine the role of nutrition in the achievement of successful aging. The data include nutritional, functional, social, medical and biological measurements. From a theoretical model of determinants of food intake in the elderly population, these data have been linked to food quality. This was determined by the Canadian adaptation of the Healthy Eating Index (C-HEI) calculated from data of food and nutrition obtained by food frequency questionnaire administered to participants at T1 or their entry into the study. Results : The barriers that might inhibit food quality in women include a fragile emotional status and limited social functioning. What emerges as barriers of the C-HEI among men is an income considered insufficient to meet one’s needs, the use of dentures and eating at restaurant repeatedly. Surprisingly, the number of positive attitudes about nutrition and a higher score of the mental component of SF-36 are predictors of a lower C-HEI. The nature of self-reported responses could explain these results. Conclusion : The results of this research allow the better understanding of the barriers to healthy eating within a healthy community-dwelling elderly population. It is hoped that the results will contribute to the development of effective interventions targeting the older population to promote nutritional and optimal health.

Multiple transitions between care settings have been reported to affect the quality of life of the older adults and their families. In Canada, there have been no studies that have examined transitions between care settings at the end of life in older adults who are on homecare. The aim of this thesis was to address this gap, and to describe transitions between care settings in older homecare clients towards the end of their life and examine what personal, health system and health service use factors predict these transitions. The sample used in this study was the cohort of individuals 65 years and older(n=7866) who died in Manitoba within the fiscal years 2003-2006, and who received homecare for at least 30 days in the last year of their life. The outcome variables in this study were transitions and independent variables included demographic (e.g., age, sex), health service use (homecare days) and system factors (e.g., hospital bed supply). The study involved secondary data analysis of anonymized administrative data (the hospital, homecare and personal care home (PCH) data), vital statistics data, health insurance registry, census data, and annual provincial statistical reports. Descriptive and inferential data analyses methods were used to analyze the data in the study. It was found in the study that more than half of the homecare clients had one or more transitions between care settings in their last month of life, and more than half of the homecare clients in the study died in hospitals. Homecare clients who were males, in the 75-84 years age group, received more homecare days and lived in regions of high hospital bed supply were more likely to have one or more transitions in the last month of their life, and those who were single, in the lower income quintile groups, lived in regions of high physician and PCH bed supply had lower odds of having one or more transitions. The findings suggest the need for increasing palliative care and homecare services to reduce transitions and hospital deaths at the end of life. Increasing physician supply, particularly in rural areas should also be considered. Future studies should also attempt to classify which of the transitions towards the end of life were essential or burdensome.

Background: Metabolic syndrome (MetS) is a clustering of traditional cardiovascular risk factors including central obesity, dyslipidemia, insulin resistance, and hypertension. The prevalence of MetS increases risk of cardiovascular disease and type 2 diabetes and increases with age. Purpose: To compare prevalence and correlates of MetS (and components) in Canadian and Korean older adults. Methods: This study consisted of secondary data analysis, using data from the Canadian Health Measures Survey (CHMS) (cycle 1) and the Korea National Health and Nutrition Examination Survey (cycle 4). The study sample included adults aged 60 to 79 years and who provided fasting blood samples. To compare prevalence of MetS between countries, the same diagnostic criteria (Harmonizing definition) were used. Similar measures of potential explanatory variables for MetS, such as physical activity, dietary patterns, comorbidity, gender, household income adequacy, education, marital status, alcohol consumption, smoking, psychological distress, and duration of sleep were also used where possible. Univariate and multiple logistic regression models were used to examine the cross-sectional relationship between these study variables and MetS. Principal component and cluster analyses were conducted to derive dietary patterns. Results: Included were 550 (weighted N=4,886,039) and 3,040 (weighted N=4,267,182) Canadians and Koreans aged 60 to 79 years, respectively. The prevalence of MetS was 42.0% and 52.2% in the Canadian and Korean sample, respectively (p<.0001). The prevalence of MetS in Korean women was 60.5% and explained the overall increased prevalence in the Korean sample. Results of the descriptive analysis, as well as the univariate and multiple logistic regression analyses indicated that the prevalence and pattern or joint distribution of explanatory variables differed across the two populations. In the Canadian sample, the final multivariate model comprised household income, marital status, alcohol consumption and psychological distress, with evidence of an interaction between adequacy of household income and marital status. In the Korean sample, the final multivariate model comprised comorbidity, gender, education, marital status, physical activity, and dietary pattern, with evidence of an interaction between comorbidity and marital status and between gender and education. Conclusions: Findings of this study provided insight into possible underlying mechanisms that might lead to between-country differences in prevalence of MetS and to inconsistent measures of association between MetS and an individual factor like physical activity or dietary intake across studies.

Many elderly patients visiting the emergency department for minor injuries are not assessed for functional status and experience functional decline 6 months post injury. Identifying such high-risk patients can allow for interventions to prevent or minimize adverse health outcomes including loss of independence. For the purpose of a planned clinical decision rule to identify elderly patients at high risk of functional decline a survey of physicians was conducted. A random sample of 534 Canadian geriatricians, emergency and family physicians was selected with half randomly selected to receive an incentive. A response rate of 57.0% was obtained with 90% of physicians considering a drop in function of at least 2 points on the 28-point OARS ADL scale as clinically significant. A sensitivity of 90% would meet or exceed 90% of physicians' requirements for a clinical decision rule to identify injured seniors at high risk of functional decline 6 months post injury.

The impact of transportation concerning older adults is under scrutiny as the number of older adults is expected to significantly increase in the coming years. The World Health Organization (WHO) spearheaded a world wide initiative that sought to examine what contributed to an “age-friendly community” in both developed and underdeveloped nations. This paper examines, in particular, the role that transportation plays in relation and contribution to an “age-friendly” community in Saanich, British Columbia, as an addition to the WHO initiative. Focus groups were conducted to ensure that information received was the lived experience of the individual. Results suggested that transportation was more than the ability to operate a vehicle, but in the ability to move safely within an environment. Additional information provided by participants spoke to the necessity of increasing awareness of licensing systems and improvements that could be implemented to ensure safety for older adult drivers and the community.

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.