Cerebrovascular burden (CVB) is a significant factor among the aging population. Age-related cognitive decline is an important social and economic issue, and understanding the mechanisms has clinical implications, both in selecting potential therapies and in choosing specific modifiers for their evaluation. In summary, past work suggests that high CVB is one source of variance in neurovascular functioning among older adults. High CVB and associated brain-changes have been identified as causes of age-related changes and it may be that high CVB is a correlate of age-related changes in sleep quality. The primary hypothesis to be tested is that cerebrovascular burden measured using an index variable reflecting blood pressure, resting heart rate, and blood oxygen saturation, will predict subjective sleep quality in a sample of adults over age 70. Sleep quality was measured using the Pittsburgh Sleep Quality Index. A sample of 8 dementia-free, community dwelling participants over the age of 70 completed the study. Though individual cerebrovascular risk factors (blood pressure, resting heart rate) had moderate but non-significant correlations with sleep quality, only the CVB index variable significantly related (1-tailed) to sleep quality. Findings support the hypothesized relationship. Future research should seek to replicate these findings with a larger sample, and to identify mechanisms by which this relationship may function.

In comparison with the national U.S. population, African American aged adults are less likely to reside in assisted living facilities (ALFs). At present, little qualitative data exist concerning how African American aged adults perceive living at home as opposed to living in an ALF. Using a phenomenological approach, this study explored how African American aged adults who live at home feel about residing in ALFs. The research questions focused on aged adults' perceptions, beliefs, and attitudes about ALFs and the conditions that may prevent African American aged adults from living in ALFs. A conceptual framework based on the Purnell Model of Cultural Competence was used to interpret study results regarding the cultural beliefs of African American aged adults. Data was collected through in-depth interviews with a purposive sample of nine African American adults aged 70 years and older who live at home and have not resided in an ALF. The data was managed through the NVivo 12 Plus program software, which assisted in providing inductive content analysis. The findings in the study revealed that the majority of the participants did not have knowledge about ALFs services however, the participant's attitudes to consider residing in ALFs were positive. There were some trust issues with the participants, indicative of a cultural heritage of beliefs and perceptions, as the participants stipulated they would reside in an ALF with support of family to monitor their care. The research study may contribute to a positive social change for African American aged adults by supporting an increased in knowledge and understanding of ALFs and increase the likelihood of African American aged adults residing in an ALF.

Avec le vieillissement de la population, il est à prévoir que les chiropraticiens traiteront plus souvent des patients vieillissants. Les comorbidités et les changements musculosquelettiques observés lors du vieillissement nécessitent que les chiropraticiens modifient les soins de thérapie manuelle qu’ils prodiguent afin de ne pas occasionner d’effets indésirables chez ces patients. Quoique des recommandations aient été proposée par Hawk et al. (2017), la façon dont les chiropraticiens traitent les patients vieillissants et la façon dont ils appliquent ces recommandations sont inconnues. L’objectif de cette recherche était donc d’identifier et de comprendre les croyances et les perceptions relatives aux pratiques et comportements qui sous-tendent la façon dont les chiropraticiens adaptent leurs soins, plus particulièrement l’exécution des thérapies manuelles, chez un adulte vieillissant. Cette étude qualitative s’est intéressée aux pratiques et aux croyances relatives aux stratégies d’adaptations utilisées par les chiropraticiens à l’aide de questionnaires et d’une entrevue semi-dirigée d’une heure. Des chiropraticiens avec plus de 5 ans d’expérience clinique ont été recrutés. Les données démographiques des participants ont été analysées de manière descriptive. Une analyse thématique incorporant les thèmes abordés par Hawk et al. (2017) et des thèmes émergents a été effectuée à partir des questionnaires, des entrevues et des notes de l’interviewer. Neuf chiropraticiens ont été inclus dans cette étude. Quatre thèmes ont été identifiés, soit la définition d’un patient vieillissant, les raisons des modifications des soins de thérapie manuelle, 6 les stratégies d’adaptation des soins de thérapie manuelle et les objectifs ultimes poursuivis. La définition d’un patient vieillissant est beaucoup plus complexe, car elle incorpore d’autres facteurs que seulement l’âge et varie d’un participant à l’autre. Les chiropraticiens ne modifient donc pas leurs soins seulement en fonction de l’âge, mais plutôt en fonction de l’état de santé de leurs patients vieillissants. Ce qu’ils considèrent être une contre-indication à certaines interventions varie. Les stratégies d’adaptation qu’ils utilisent sont des techniques qu’ils considèrent comme étant de force plus faible que la manipulation articulaire. Les techniques utilisées varient cependant d’un participant à l’autre. Ils considèrent qu’en faisant cela, ils limitent le risque de survenue d’effet secondaire et d’être impliqués dans des recours légaux, tout en assurant la sécurité des soins. Cette étude démontre l’importance de considérer d’autres facteurs que l’âge lorsqu’il est question d’étudier les patients vieillissants. Quoique certaines pratiques et croyances communes ont été identifiées, il semble exister plusieurs différences entre les participants quant aux raisons qui sous-tendent les modifications des soins et les techniques de thérapie manuelles utilisées. Il apparaît essentiel d'investiguer la provenance de ces pratiques et croyances ainsi que l'adéquation entre celles-ci et les pratiques réelles des chiropraticiens. / As the population ages, it is to be expected that chiropractors will be treating aging patients more frequently. The comorbidities and musculoskeletal changes seen with aging require chiropractors to modify the manual therapy care they provide minimize the risk of adverse effects in these patients. Although recommendations have been proposed by Hawk et al. (2017), how chiropractors treat aging patients and how they apply these recommendations is unknown. The aim of this research was therefore to identify and understand the beliefs, practices and behaviours that underpin how chiropractors adapt their care, specifically the performance of manual therapies, in an aging adult. This qualitative study investigated the practices and beliefs related to adaptive strategies used by chiropractors, using questionnaires and a semi-structured interview. Chiropractors with more than 5 years of clinical experience were recruited. Participant demographic information was analyzed descriptively. A thematic analysis method incorporating themes addressed by Hawk et al. (2017) and newly emerged themes was performed based on questionnaires, interviews and interviewer notes. Nine chiropractors were included in this study. Four themes were identified: definition of an aging patient, reasons for changes in manual therapy care, strategies for adapting manual therapy care and ultimate goals pursued. The definition of an aging patient is much more complex than just age and varies from one participant to another. Chiropractors therefore do not modify their care solely according to age, but rather according to their patients' state of health. What 8 they consider to be a contraindication to certain interventions varies. The coping strategies they use are techniques they consider to be of lower strength than joint manipulation. The techniques used also vary from participants to participant. They consider that by doing so, they limit the risk of side effects and of becoming involved in legal proceedings, while ensuring safe care. This study demonstrates the importance to considerate other factors rather than just age when caring for older adults. Although some common practices and beliefs were described, there appeared to be many differences between participants as to the reasons behind the changes in care and the manual therapy techniques used. It seems essential to investigate the origins of these practices and beliefs as well as the link between these with the real practices of chiropractors.