Chronic diseases such as diabetes have become increasingly prominent around the world. Diabetes care requires a combination of medication, exercise, diet, self-management education, and psychosocial care to reduce the risk of long-term complications. Following this strict regimen can have an adverse effect on the patient's quality of life. Quality of life is a broad concept that is difficult to define and study. This study focused on the health-related component of quality of life. Diabetes is reaching epidemic proportions in Kuwait. While the incidence of the disease is documented, little is known about its effect on the life of the Kuwaiti population. This is partly due to the lack of valid Arabic versions of health-related quality of life (HRQOL) instruments. The purpose of this study was to investigate the construct validity of two HRQOL measures in a sample of older adults in Kuwait with Type 2 diabetes. The two measures were the Short Form 36-Item Health Survey version 2.0, a generic measure, and the Problem Areas in Diabetes survey, a disease-specific measure. A total of 240 Kuwaiti citizens over the age of 55 years living in Kuwait City participated in this study. Participants were divided into two groups: the Diabetes Group included 120 older adults with diabetes and the Control Group included 120 older adults without diabetes. Three approaches were used to assess the construct validity of the Arabic versions of the SF-36v2 Health Survey and the Problem Areas in Diabetes survey: factor analysis, correlation, and known-group method. The results of this study support the use of the Arabic versions of the two surveys to measure HRQOL of older adults in Kuwait with Type 2 diabetes. Standards for construct validity were well met, with few exceptions. / Physical Therapy

Optimizing meaningful engagement of older adults with multimorbidity and their caregivers as partners in health care research / Background: The importance of engaging older adults (> 65 years) with multimorbidity and their caregivers as partners in health care research has been widely recognized. Inclusion of patients as research partners has resulted in largely positive effects. However, little is known about how best to engage and support them in this role. The objective of this study was to examine how to optimize meaningful engagement of older adults with multimorbidity and their caregivers as research partners. Methods: The research objective was addressed using the persona-scenario method. Study participants were older adults with previous experience as a research partner or a research participant. Participants worked in pairs to create a persona and a scenario about how their persona(s) was involved on the research team. Analysis was conducted in two phases: (a) identification of themes, subthemes, and codes using a qualitative descriptive approach, and (b) interpretation of themes and subthemes into design specifications (actions and products). Results: Four persona-scenario sessions were held with 8 patient participants. Three major themes emerged from the data: (a) recruitment of patient or caregiver research partners (PCRPs); (b) planning for meaningful engagement; and (c) establishing collaborative relationships. These major themes contained 15 corresponding subthemes, and design specifications (52 actions and 37 products). Findings highlight key factors influencing the engagement of older adults with multimorbidity and their caregivers as research partners, such as the need for: early engagement of PCRPs; clarification of PCRPs’ roles and responsibilities; a flexible patient-centred approach to PCRP involvement; identifying and addressing barriers to their engagement (e.g., caregiving support, transportation); training about research; and continued dialogue and feedback to clarify roles and manage expectations. The results are important for identifying ways to promote greater patient engagement in research and ensure that the research reflects the needs of the patients it strives to serve. / Thesis / Master of Science (MSc) / The importance of engaging patients with multimorbidity and their caregivers as partners in health care research has been widely recognized. However, little is known about how to best engage and support them in this role. The objective of this study was to examine how researchers can best engage and support older adults with multimorbidity and their caregivers as research partners in health care research teams. The persona-scenario method was used for participants to create fictional stories. These stories were analyzed to shed light on specific strategies that can support older adults and their caregivers as partners on health care research teams, such as a patient-centred approach, identifying and addressing barriers to engagement, and clarifying roles and responsibilities on the research team. The results from this study can be used to inform research, policy, and education on supporting older adults with multimorbidity and their caregivers as research partners.

Sex and gender considerations are influential on psychosocial and physiological determinants of cardiovascular health in individuals with and without stroke. The first study of this thesis explored gender-based differences in exercise self-efficacy, outcome expectations for exercise and motivation for exercise post-stroke. Gender identity was assessed using the Bem Sex-Role Inventory-12 and a gender role index was created using established gender-related roles. The Self-Efficacy for Physical Activity Scale was used to assess self-efficacy for exercise, the Short Outcome Expectations for Exercise Scale assessed outcome expectations for exercise and a Relative Autonomy Index was calculated to assess motivation for exercise. We found that masculine gender identity was associated with highest ratings of exercise self-efficacy, whereas feminine gender identity was related to the lowest exercise self-efficacy [F(3, 9)=5.36, p<0.05]. Gender identity was not associated with outcome expectations [F(3,8)=0.86, p=0.50) nor motivation for exercise [F(3,4)=0.67, p=0.61)]. Additionally, there were no associations between gender roles and self-efficacy (n=13, r=0.10, p=0.73), outcome expectations (n=13, r=-0.13, p=0.68), or motivation for exercise (n=8, r=0.09, p=0.83). The second study of this thesis examined the associations between global cognitive function (Montreal Cognitive Assessment, MoCA), arterial stiffness (carotid-femoral pulse wave velocity) and sex, and between global cognitive function, walking capacity (6-Minute Walk Test, 6MWT) and sex in older male and female adults with and without stroke. There was no association between global cognition and arterial stiffness, and sex did not moderate this association. However, cognitive function was positively associated with 6MWT, and with the addition of sex, Sex*6MWT, age and history of stroke, explained 21% of the variance of the MoCA score. Our findings provide insight into the importance of sex-and gender-based considerations in clinical research and may inform future larger-scaled studies aiming to increase the generalizability of their findings to males and females and individuals of all gender identities. / Thesis / Master of Science Rehabilitation Science (MSc) / The roles that an individual undertakes, and how they see themselves and are seen by others may be related to exercise participation. In addition, a person’s biological makeup may impact their health and ability to think. In the first study of this thesis, we found that individuals with stroke seeing themselves as women had lower beliefs about their abilities to exercise, but their beliefs about the benefits of exercise or their motivation for exercise were similar to individuals who identify as men. There were no differences in beliefs about exercise abilities, outcomes, or motivation between individuals with stroke who took on masculine vs. feminine roles. In the second study, we found that walking distance, but not arterial health, was related to the ability to think in males and females. Overall, this work provides information of the importance of biological, social roles and behaviours on health.

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based on the revised definition of the European Working Group on Sarcopenia in Older People 2. Binomial logistic and multivariate linear regression models as well as dose-response analyses were applied and adjusted for demographics, accelerometer wear time, lifestyle factors, and chronic health conditions. RESULTS: Oldest-old adults with higher total volumes of moderate to vigorous physical activity (MVPA) (OR=0.74, 95% CI 0.62 to 0.89) showed a lower likelihood for a probable sarcopenic condition in the primary sample. Likewise, patterns of higher accumulated time spent in MVPA bouts of less than 10 minutes (OR=0.78, 95% CI 0.64 to 0.95) and MVPA bouts of at least 10 minutes (OR=0.78, 95% CI 0.63 to 0.98) were also related with lower odds of probable sarcopenia. A 2.1 times (95% CI 1.01 to 4.35) higher likelihood for confirmed sarcopenia was observed among participants who spent 60 minutes more per day in sedentary behavior (SB). Furthermore, 2.9 times (95% CI 1.05 to 8.02) greater odds of severe sarcopenia were identified following each 0.1 higher active-to-sedentary transition probability (ASTP). Focusing on individual sarcopenic components, higher total activity counts, higher MVPA, higher light intensity physical activity (LIPA), lower SB, and lower ASTP were related with better gait speed. CONCLUSION: The total volume of MVPA, whether accumulated in short sporadic bouts or prolonged bouts, was associated with lower odds of probable sarcopenia. Higher LIPA, lower SB, and a less fragmented activity pattern might also be related with a lower likelihood of sarcopenia status and better physical performance among oldest-old adults.

This dissertation investigates videoconference technology adoption by aging-in-place organizations to facilitate the social engagement of older adults. It comprises three studies that examine the initiation and coordination of technology adoption by aging-in-place organizations and addresses the factors associated with successful adoption of relational videoconference technology by older adults. The first study is a systematic literature review exploring the role of aging-in-place organizations in social engagement of older adults through videoconference technology. The second study is a survey of adult relatives and friends of older adults regarding videoconference technology adoption by older adults during the COVID-19 pandemic and their experience with facilitating resources. It applies technology adoption theory and a structural equation model to characterize the role of aging-in-place organizations. The third study is a pilot test of a new online platform called Circular that is designed to support social engagement of older adults. Through these studies, this research extends the existing body of knowledge regarding modes to facilitate adoption of relational technology by older adults and to empower senior centers and other aging-in-place organizations as they seek to socially engage the aging members of their communities.

Obesity is associated with deficits in cognitive function, particularly within the domain of executive function (EF). EF refers to higher order cognitive processes that regulate our ability to sustain attention, inhibit subconscious tendencies, remember and manipulate information for immediate use, and remain cognitively flexible. Deficits in EF in overweight and obese individuals may impact the success of weight loss and maintenance efforts. Therefore, understanding the biological links between obesity and EF, as well as the ability to reverse EF deficits with weight loss, is imperative. The first study aimed to determine the effect of weight loss in overweight and obese, middle-aged and older adults on serum brain-derived neurotrophic fact (BDNF), S100 calcium binding protein B (S100B), and glial fibrillary acidic protein (GFAP). Serum samples (n=21; 50-75 years, BMI 25-40 kg/m2) were pooled from two prior weight loss studies. Fasting blood measurements were taken before and after 8- or 12-weeks of hypocaloric diet-induced weight loss (1200 or 1500 kcal/d). Body Mass Index (BMI), body weight, waist circumference, and percent body fat (All p<0.001) decreased with weight loss. Serum BDNF (p=0.871), S100B (p=0.898), and GFAP (p=0.506) did not change following weight loss. The second study aimed to determine the correlation between the magnitude of change in serum BDNF, S100B, and GFAP and the magnitude of improvement in EF performance on three computer-based tests. Participants (n=8; 50-75 years, BMI 25-40 kg/m2) completed 4-weeks of hypocaloric diet-induced weight loss (1200 or 1500 kcal/d), followed by 4-weeks of weight maintenance (hypocaloric diet + steps/d goal). Fasting blood and EF measurements were completed at baseline, and weeks 4 and 8. BMI (p=0.001), body weight (p=0.001), waist circumference (p=0.002), and percent body fat (p=0.001) decreased from baseline to week 8. Serum BDNF (p=0.359), S100B (p=0.277), and GFAP (p=0.585) did not change following weight loss. Go/No-Go (GNG) errors of commission (p=0.009) and AX-Continuous Performance Test (AX-CPT) correct response time (p=0.041) decreased following the weight loss. The change in serum GFAP was inversely correlated with GNG errors of omission (r=-0.716, p=0.046) and AX-CPT correct hits (r=-0.737, p=0.037), and positively correlated with AX-CPT correct response time (r=0.859, p=0.006). In conclusion, although weight loss does not influence serum BDNF, S100B, or GFAP levels, it may have a positive effect on inhibitory control in overweight and obese, middle-aged and older adults. Further research is needed to understand the relationship between serum BDNF, S100B, and GFAP and executive function. / Master of Science / Obesity is associated with lower brain function, particularly in executive function (EF). EF refers to advanced thought processes that help to maintain focus, practice self-control, solve problems, and easily switch between tasks. Lower EF in individuals with overweight and obesity may impact the success of weight loss and maintenance efforts. Because of this, understanding body processes that may link obesity and lower EF, as well as the ability to improve EF with weight loss, is very important. The first study aimed to determine the effect of weight loss on blood proteins responsible for brain health: brain-derived neurotrophic fact (BDNF), S100 calcium binding protein B (S100B), and glial fibrillary acidic protein (GFAP). Twenty-one blood samples from overweight and obese, middle-aged and older adults were combined from two completed weight loss studies. In these studies, blood was measured before and after 8- or 12-weeks of a weight loss (low calorie diet;1200 or 1500 Calories per day). Body Mass Index (BMI), body weight, waist circumference, and percent body fat all decreased with weight loss; however, levels of BDNF, S100B, and GFAP in the blood did not change. The second study aimed to determine the relationship between blood BDNF, S100B, and GFAP and performance on three computer-based tests of EF before and after weight loss. Eight overweight and obese, middle-aged and older adults completed 4-weeks of weight loss (low-calorie diet; 1200 or 1500 Calories per day), followed by 4-weeks of weight maintenance. BMI, body weight, waist circumference, and percent body fat all decreased following the weight loss and maintenance intervention (week 8). Blood BDNF, S100B, and GFAP levels did not change, but performance on two EF measures improved: participants made less errors of commission (doing something when not supposed to) and had faster reaction time following the intervention, indicating better self-control. Additionally, greater increases in GFAP were associated with less errors of omission (not doing something when supposed to), fewer correct responses, and slower reaction time. In conclusion, although weight loss did not affect blood BDNF, S100B, or GFAP levels, it may improve self-control in overweight and obese, middle-aged and older adults. Further research is needed to understand the relationship between weight loss, blood proteins of brain health, and EF.

The rapidly growing rate of the older adult population has created a need to better understand younger adults’ self-perceptions of aging and current trends of ageism. The purpose of this secondary data analysis research project was to determine changes, if any, in participants’ self-perception of aging after the Socially Nutritious facilitator or nutrition ambassador volunteer training, which aims to develop knowledge and skills related to aging trends, older adult nutrition, preventing ageism, and communication and educational considerations when working with older adults. Findings indicate that participants with more frequent interactions with older adults had a more positive perception of their aging at pre-test than those with less frequent interactions. However, these differences diminished at post-test. Training that includes information about healthy aging, as well as addressing ageism, may lead to a more positive self-perception of aging.

Bakgrund: Psykisk hälsa berör det emotionella, mentala och sociala välbefinnandet. Psykisk hälsa påverkar människors välmående och deras förmåga att hantera vardagliga utmaningar. I mars 2020 deklarerades Covid-19 som en pandemi, vilket kan ha bidragit till betydande förändringar i samhället i arbetet att minska spridningen av Covid-19. Denna förändring i samhället kan ha påverkat äldre psykisk hälsa. Syfte:Syftet var att undersöka hur den psykiska hälsan hos äldre personer påverkades under Covid-19 pandemin. Metod: Undersökningen genomfördes som en litteraturöversikt som inkluderade åtta kvantitativa artiklar. Databaserna Scopus och Pubmed användes vid artikelsökning och artiklarna analyserades utifrån kvalitativ innehållsanalys. Resultat: Resultat visade att äldres psykiska hälsa påverkades under covid-19 pandemin och att den påtvingade karantänen ledde till att äldre personer upplevde isolering och ensamhet samt att upplevelsen av depression, ångest och nedstämdhet ökade. Vidare visade resultatet att det förekom skillnader i hur länder i Europa hanterade smittspridningen av covid-19. Slutsats: Slutsatsen som kan dras är att de äldres psykiska hälsa försämrades under covid-19 pandemin. Äldre personer hade utvecklat depression, ångest och oro. Den andra slutsatsen som kan dras är att införandet av restriktioner och karantän upplevde äldre personer att de var ensamma och isolerade. Den tredje slutsatsen var att det behövs mer stöd och kunskap för att förebygga psykisk ohälsa hos äldre. / Introduction: Mental health pertains to emotional, mental, and social well-being. Mental health impacts individuals' well-being and their ability to cope with everyday challenges. In March 2020, COVID-19 was declared a pandemic, which may have contributed to significant changes in society as a result to reduce the spread of covid-19. Social distancing and quarantine were measures introduced to reduce the spread of covid-19. This change in society may have affected the mental health of the elderly. Aim: To investigate how mental health in older adults has been affected during the Covid-19 pandemic. Method: A literature review was conducted which included eight quantitative articles. The databases Scopus and PubMed were used to search articles and the articles were analyzed by using qualitative content analysis. Result: The results showed that older people's mental health was affected during the covid-19 pandemic and that the forced quarantine led to older people experiencing isolation and loneliness, and that the experience of depression, anxiety, and depression increased. Furthermore, there were differences in how countries in Europe handled the spread of covid-19. Conclusion: The conclusion that can be drawn is that the mental health of the elderly deteriorated during the COVID-19 pandemic. Older individuals experienced the development of depression, anxiety, and distress. The second conclusion that can be drawn is that the implementation of restrictions and quarantine led older individuals to feel lonely and isolated. The third conclusion is that there is a need for more support and knowledge to prevent mental health issues among the elderly.

This thesis discusses current insights into the applications of deep transcranial magnetic stimulation (dTMS) in older adults with treatment-resistant depression (TRD). / Objectives: To examine current evidence of clinical efficacy and applications of deep transcranial magnetic stimulation (dTMS) among older adults with treatment-resistant depression (TRD). Methods: In Study 1, we conducted a systematic review of existing literature on the clinical efficacy of dTMS across psychiatric and cognitive disorders. Studies eligible for inclusion were clinical trials which were required to have a sham/control condition to mitigate confounding variables and to strengthen our assessment of efficacy. This dissertation specifically aimed to discuss these findings in the context of older adults with depression, as a means to investigate whether available evidence supporting the clinical efficacy of dTMS for depression is generalizable to older populations. In Study 2, we analyzed recruitment data from a pilot study investigating the effects of dTMS in older adults with TRD. Specifically, we aimed to evaluate the effectiveness of various recruitment strategies by using an enrollment-cost analysis, as well as comparing enrollment rates (i.e., enrolled participants/referrals received) for each recruitment method. Moreover, we identified potential facilitators and barriers to recruitment following a verbal thematic analysis of qualitative interview data. Results: In Study 1, most substantial evidence (n = 6 studies) within the literature supports the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes in patients with bipolar disorder (BD) or major depressive disorder (MDD). Only one randomized controlled trial was conducted in older adults with TRD. This trial reported higher remission rates in the active dTMS arm compared to the sham dTMS arm following treatment with the H1-coil. In study 2, we found (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook, to be the most effective recruitment strategies. Lastly, social support from research staff (n = 15; 88.24%) and the time-intensiveness aspect of dTMS treatments (n = 6; 35.29%) were the most frequently identified facilitators and barriers to recruitment, respectively. Conclusions: While there is notable evidence supporting the clinical efficacy of the dTMS H1-coil for the treatment of depressive episodes, the majority of such evidence is based on findings from younger-to-middle aged groups. Thus, the generalizability of dTMS treatment efficacy to older adults remains less understood. Further sham-controlled studies are needed to determine the clinical efficacy of dTMS in older adults and to improve evidence-based care in the field of geriatric psychiatry. Importantly, we aimed to address this underrepresentation of older adults in clinical research by analyzing recruitment strategies and examining facilitators and barriers to recruitment. Future research is warranted to examine facilitators and barriers to recruitment in older adults with depression, particularly the importance of social support, which may offer valuable insights on how to overcome the issue of underrepresentation. / Thesis / Master of Science (MSc) / Brain stimulation therapies, such as deep transcranial magnetic stimulation (dTMS), show promising results for treatment-resistant depression (TRD). However, the applications of dTMS remain overlooked in geriatric populations with TRD, limiting the generalizability of such treatments to older adults. This dissertation aimed to examine current evidence supporting the use of dTMS in older adults with depression. In Study 1, we conducted a systematic review of available evidence on the clinical efficacy of dTMS across psychiatric and cognitive disorders. We found most evidence supporting the clinical efficacy of dTMS for the treatment of depressive episodes. However, the underrepresentation of older adults in such research was highly prevalent, with only one study being focused on older adults. In Study 2, we explored the effectiveness of diverse recruitment methods used in an ongoing dTMS trial for older adults with depression. Additionally, we identified potential facilitators and barriers to recruitment. Overall, the most effective recruitment strategies were (1) health provider outreach within the affiliated inpatient and outpatient mental health clinics and (2) Facebook advertising. Furthermore, social support from research staff and high time commitment of dTMS treatments were identified as facilitators and barriers to recruitment, respectively. These findings highlight the importance of conducting dTMS research in older adults to address the issue of underrepresentation and to improve evidence-based care in this special population.

The aging population is a global challenge, meanwhile there's a strain on Swedish healthcare. In order to make healthcare efficient, designers are responsible for developing digital services that can be used by everyone, despite disabilities. To ensure accessibility, services must comply with the European Accessibility Act by 2025, a UN directive the Swedish healthcare website 1177 does not meet. In this study, the user interface will be investigated, based on seniors 65+. Through research in graphic design and user-centered design, the group's challenges, needs and aspirations will be identified through semi-structured interviews. In order to create accessible interfaces, designers need to examine the experience based on both function and visuality. Graphic design thereby constitutes a large part of the experience as a whole and must be reflected upon. The result will contribute with insights to increase the website's accessibility and contribute to improved welfare and equality.