At the Nutrition and Physical Activity Research Centre for Optimal Health and Functionality through Life (NUPARC), a research gap was uncovered regarding the concept optimal functionality based on the older adult’s own perspective. The overall aim was to explore the concept of optimal functionality among older adults and the possibility of creating and developing an ICT-platform to measure it. Method: An existing cohort from NUPARC was used for recruitment in studies I-III and to some extent study IV. A scoping study design and framework was adopted for the inclusion of the articles in Study I. Study II had a descriptive design. Six focus group discussions were conducted and analysed using qualitative deductive content analysis to extend the qualitative understanding. Study III used a phenomenological approach describing the experience of mental health and its impact on the ability to function as optimally as possible. Six interviews were analysed using Giorgi’s phenomenological approach. Study IV was a feasibility study and included 8 older adults using an ICTplatform for a period of four weeks. Results: Optimal Functionality comprises three major corner stones: Body-related factors, Self-related factors and External factors (I) accompanied by nine aspects, and according to older adults it is a matter of functioning as optimally as possible (II). The three major cornerstones are intricately linked and all but the mental aspects were included in the discussions (II). Life situations affecting mental health, consequences of mental health and strategies for maintaining good mental health were described by older adults as having an impact on mental health and affecting their ability to function as optimally as possible (III). The older adults managed the usage of an ICT-tool well and it was perceived as meaningful (IV). Conclusion: Optimal functionality is holistic, subjective, dynamic and applicable to all older adults. Identification of the factors involved can help the older adults on their path to health. An ICT-platform can facilitate the identification of the factors for optimal functionality and the eventual measurement of it.

Falls and injuries related to falls are one of the most common health problems among older people and are becoming increasingly more frequent. Regular exercise has been identified as one of the most effective fall-prevention activities for older people; however, awareness of the impact of exercise programmes and adherence to recommended exercise among the elderly population is generally low. Research examining how an exercise programme is administered to and experienced by elderly community-dwelling people is needed. The overall aim of this thesis was to investigate the feasibility, experiences and effects of and adherence to the fall-preventive Otago Exercise Programme (OEP) with or without motivational interviewing (MI) among community-dwelling people aged 75 years or older. Four studies were performed from October 2012 to May 2016 in a sample of 175 people. Both quantitative and qualitative research methods were used. The methods included the feasibility for conducting a randomized controlled trial (RCT) (I), individual face-to-face interviews (II), an RCT (III) and a prospective cohort study (IV). The intervention was given to two groups. The participants who received OEP with or without MI were compared with a control group that received standard care. The feasibility of performing an exercise intervention with or without MI was acceptable from the perspective of the participating physiotherapists. From the perspective of the older participants performing the exercise with behavioural change support, the inclusion of monitored exercises in everyday life and daily routines was important. The participants also expressed experiencing more strength, improved physical functioning and greater hope for an extended active life during old age. From the short-term perspective, there were significant improvements within the OEP combined with MI group in terms of physical performance, fall self-efficacy, activity level, and handgrip strength. Improved physical performance and fall self-efficacy were also found within the control group; however, corresponding differences did not occur in the OEP group without MI. There were no significant differences between the study groups after 12 weeks of regular exercise. Adherence to the exercises in the pooled exercise group was 81% at the 12-week follow-up. At the 52-week follow-up, the behavioural factors being physically active and obtaining behavioural support in terms of MI had a significant association with adherence to the exercise programme. These studies provide some support for the combination of OEP with MI as the addition of MI was valuable for achieving adherence to the exercise programme over time in older community-dwelling people.

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.

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.

Studiens syfte var att beskriva arbetsterapeuters kliniska resonemang vid användande av hundassisterad intervention på korttidsboenden och särskilda boenden för äldre personer. Genom ett ändamålsenligt urval valdes fem arbetsterapeuter med tre till sex års erfarenhet av hundassisterad intervention ut som deltagare i studien. Deltagarna deltog i enskilda narrativa intervjuer. Den insamlade datan analyserades därefter genom en narrativ metod. Analysen av datan resulterade i tre teman som benämndes hundassisterad intervention är en mångfacetterad åtgärd, vårdhunden motiverar till delaktighet i aktivitet samt omgivande faktorer påverkar användningen av hundassisterad intervention. Hundassisterad intervention är utifrån arbetsterapeuters kliniska resonemang en mångfacetterad åtgärd som kan användas för att skapa motivation till delaktighet i aktiviteter som både rehabiliterar och ger äldre personer en känsla av meningsfullhet. Omgivande faktorer såsom resurser i form av tid och ekonomi samt den fysiska och sociala miljön kan både begränsa samt skapa möjligheter för användande av hundassisterad intervention. Utifrån studiens resultat skulle hundassisterad intervention som används i en främjande miljö kunna leda till en förbättrad livskvalité hos äldre personer som befinner sig på korttidsboenden och särskilda boenden. Det finns dock ett fortsatt behov av forskning för att stärka evidensen för användandet av hundassisterad intervention. Studiens resultat ger arbetsterapeuter ny kunskap om interventionens terapeutiska värde och hur hundassisterad intervention kan användas i den kliniska verksamheten samt vilka faktorer som påverkar dess användning. / The aim of this study was to describe the clinical reasoning of occupational therapists when using dog-assisted therapy in residental settings for older adults. Five occupational therapists with three to six years of experience in dog-assisted therapy were purposefully selected as participants in the study. Data was generated by individual narrative interviews and analysed using a narrative analysis. The analysis of the data resulted in three themes called dog-assisted therapy is a multifaceted intervention, the care dog motivates participation in activities and surrounding factors affect the use of dog-assisted therapy. Dog-assisted therapy, based on the clinical reasoning of occupational therapists, is a multifaceted intervention that can be used to create motivation for participation in activities that both rehabilitate and give older adults a sense of meaningfulness. Surrounding factors such as time and economy resources as well as the physical and social environment can both limit and create opportunities for using dogassisted therapy. Based on the results of this study, dog-assisted therapy used in a promotional environment could lead to an improved quality of life for older adults in residential settings. However, there is a continuing need for research to strengthen the evidence for the use of dogassisted therapy. The result of the study give occupational therapists new knowledge about the therapeutic value of the intervention and how dog-assisted therapy can be used in the clinical setting and what factors affects its use.

Loneliness is a significant problem for older adults and can lead to negative health and social outcomes. Having a companion pet is beginning to be recognized as a way loneliness can be reduced for older persons. The purpose of this descriptive study was to determine the effect of pets on the level of loneliness in persons 60 years old or older who live alone and independently in a large metropolitan community in the North Central Texas area. Using a non-random snowball sample of older individuals (N = 252), who met the study criteria, each subject was administered the researcher-developed demographic data survey instrument containing the following variables: (a) pets - having a pet/wanting a pet, (b) age, (c) gender, (d) marital status, (e) living alone, (f) losses within the last six months, (g) interactions with family members, (h) interactions with others outside of the family, (i) highest educational level achieved, (j) employment or volunteer involvement in the community, (k) religious participation, and (l) self perceived health status. The UCLA Loneliness Scale Version 3 was used to obtain the loneliness scores. Prediction of loneliness and relationship with the independent variables was tested using frequency, correlation, analysis of variance (ANOVA), and multivariate analysis using ordinary least-squares (OLS) regression analysis. The findings from this study showed that those older adults living alone who did not have a pet but would like to have a companion pet had higher levels of loneliness (p<0.05). Other findings suggested that older adults' loneliness was less if they had moderate religious participation and interactions with others (p< 0.05). Future studies are needed to examine the effects that pets have on feelings of loneliness and the ability of older individuals to cope effectively with those feelings.

Federally qualified health centers (FQHCs) that harness the reinforcing nature of collaborative efforts with aging services can better prepare for the future of older adult populations. The purpose of this research was to identify collaborative efforts between FQHCs and aging services and distinguish perceptions and knowledge regarding older adult populations. Executive directors, medical directors and social service directors (N=44) at 31 FQHCs across the state of Texas completed surveys measuring structural, procedural and environmental components of the health center setting. The 2007 Uniform Data System and 2000 US Census provided additional data on health centers use and services. Descriptive statistics analyzed independent variables of health center characteristics. Bivariate analysis determined significance of association between independent variables and levels of collaboration with aging services. Results found that all health centers collaborated with at least one aging service, with more informal than formal partnerships. Respondents indicated major barriers to providing services to older adults, including inadequate transportation, inadequate insurance, and limited funding. Respondents also indicated overloaded staff as a major barrier to collaborating with aging services. Aging topics for staff development and perceptions about older adults were also identified. Health center tenure (p=0.005, lambda=1.000), professional tenure (p=0.011, lambda=1.000), leadership in aging services (p=0.002, lambda=1.000), recent gerontological training (p=0.002, lambda=0.500), formal gerontological training p=0.002, lambda=1.000), strategic planning (p=0.002, lambda=1.000), and having older adults on governing boards (p=0.002, lambda= 1.000) were significantly associated with informal collaboration with aging services. Health center tenure (p=0.006, lambda=0.500), leadership in aging services (p=0.004, lambda=0.500), recent training (p=0.010, lambda=0.500), formal training (p=0.005, lambda=0.500), the designation of health center staff older adult services (p=0.025, lambda=0.250), strategic planning (p=0.011, Iambda=0.500), and older adults on governing board (p=0.009, lambda=0.500) were significantly associated with formal collaboration with aging services. In conclusion, FQHCs' efforts at partnering with aging services should include an investment in key staff and board development, the designation of staff to older adult programs, and strategic planning.

No description available.

Aims/Objectives: The objectives of this thesis were to examine and discuss the existing information and communication technology (ICT) tools used in the healthcare sector for older adults with dementia, the benefits and challenges of using these ICT tools from the perspective of older adults with dementia and their health care providers. Research methods: Data was collected using semi-structured interviews with older adults with dementia and health care providers and managers at a nursing home in Nigeria. All interviews were audio recorded with the consent of the research participants and then transcribed verbatim. All interview transcripts were analyzed using qualitative content analysis using the deductive approach. The coding scheme used for data analysis was derived from an existing framework called the Human-Organization-Technology fit (HOT) Framework. In addition, existing literature were reviewed on the use of ICT tools by older adults with dementia, their caregivers and their health care providers. Empirical findings: A total of six participants were interviewed for this study: two older adults with dementia, two nurses and two managers (one senior manager and one manager from the medical team). One older adult was 72 years old and was diagnosed with dementia one year ago. The other older adult was 70 years old and was diagnosed with dementia two years ago. The nurses that I interviewed have been working at this nursing home for 3 and 4 years respectively. The mangers that I interviewed have also been working at this nursing home for 3 and 4 years respectively. Two ICT tools are currently being used at this nursing home: 1) a GPS tracker and 2) a device that assists older adults with their daily activities. Eight themes emerged from the interviews: system quality, service quality, user satisfaction (perceived usefulness), system use, user expectation, organization structure, organization environment and net benefits. Conclusion and Future research: This study demonstrated that older adults with dementia and their caregivers (i.e. nurses) perceived the GPS tracker and the ADL assistant as userfriendly and helpful for supporting the daily activities. Most of the existing research on ICT tools used for dementia care have been conducted in North America and Europe. Therefore, there is a need for more research in Africa.

Äldre vuxna tillhör en målgrupp som har en bred inomgruppsvariation som framställs från en negativ stereotyp; en målgrupp i behov av hjälp. Samhället har förutfattade meningar att äldre vuxna är “resistenta” till teknologi med anledning av deras åldersrelaterade funktionsvariationer inom kognition och motorik. Detta resulterar till att de exkluderas från framtagning av ny teknologi. Att sträva efter tillgänglig design blir mer vanligt samtidigt som praktiker anser att tillgänglig design bidrar till tråkig och ointressant design, samt en begränsning i deras kreativitet. EU införde ett webbtillgänglighetsdirektiv som följer World Wide Web Consortium (W3C) etablerade designriktlinjer för tillgänglighet, mer känt som WCAG. Web Accessibility Initiative “WAI” plockade ut riktlinjer från WCAG som bidrar till bättre webbdesign för äldre; WAI-AGE. Fyra designriktlinjer för navigation valdes ut från WAI-AGE för att implementeras inom en prototyp som ska testas på äldre vuxna i ett användarupplevelsetest på distans med anledning av COVID-19. Inför testet sattes fem användarupplevelse- och användbarhetsmål för att bedöma upplevelsen från WAI-AGE riktlinjer. För studien rekryterades fyra testdeltagare i åldrarna 60-65 år. Deltagarna fick genomföra två scenarier och besvara tre enkäter. Studien tillämpade metodtriangulering för att stärka upp datainsamlingen med hjälp av tänka högt-metoden och observation. Data insamlad från testet genomgick en deduktiv analys som granskades från ett holistiskt perspektiv. Resultatet påvisade att WAI-AGE riktlinjer för navigation främjar en positiv användarupplevelse med majoriteten av satta mål uppnådda. Då rekryterade deltagare var snarlika varandra inom behov och vanor finns det fortfarande utrymme att testa på äldre vuxna från 65 år och uppåt. Detta examensarbete strävar efter att uppmärksamma äldre vuxnas behov att inkluderas vid framtagning av ny teknik. / Older adults belong to a target group that has a broad intra-group variation that is presented from a negative stereotype; a target group in need of help. Society has preconceived notions that older adults are "resistant" to technology due to their age-related declines in cognition and motor skills. This results in them being excluded from the development of new technology. Striving for accessible design is becoming more common at the same time as practitioners believe that accessibility contributes to boring and uninteresting design, as well as a limitation in their creativity. The EU introduced a Web Accessibility Directive that follows the World Wide Web Consortium (W3C) established design guidelines for accessibility, better known as WCAG. Web Accessibility Initiative “WAI” picked out guidelines from WCAG that are said to contribute to better design for older adults; WAI-AGE. Four design guidelines for navigation were selected from WAI-AGE to be implemented within a prototype to be tested on older adults in a remote user experience test due to COVID-19. Prior to the test, five user experience goals were set to be able to assess whether WAI-AGE guidelines work. For the study, four test participants aged 60-65 years were recruited. The participants had to complete two scenarios and answer three questionnaires. The study applied method triangulation to enhance data collection using the think aloud-method and observation. Data collected from the test underwent a deductive analysis that was examined from a holistic perspective. The results showed that WAI-AGE guidelines for navigation promote a positive user experience with a majority of goals achieved. As the participants had similar needs, there is still room to test on older adults aged 65 and up. This thesis strives to draw attention to the need for older adults to be included in the development of new technology.