Background Long QT syndrome (LQTS) is characterized by a prolonged QT interval on the electrocardiogram (ECG), a risk for sudden cardiac death. A simple 'rule of thumb' method states that if a patient's heart rate is between 60-100 bpm, the QT interval should not be more than half the R-R interval. The clinical accuracy of this method has not been tested in the elderly. Objectives To determine if the 'rule of thumb' to calculate QT interval prolongation, is accurate, compared to the corrected QT interval calculated using Bazett's formula. Secondary objectives include the prevalence of long QT and risk factors for QT prolongation. Methods The QT interval was calculated using Bazett's formula, and the 'rule of thumb' method, from ECG's collected from patients over 60 years old, on their first visit to a geriatric clinical service. Only data from patients with heart rates in the range 60-100 were analyzed. Medications and electrolyte levels were recorded. Results A total of 1000 ECGs were collected. 776 ECGs were included in the study. Prevalence of prolonged QT interval was 37.8% using Bazett's formula. Compared to Bazett's formula, the 'rule of thumb' method had a sensitivity of 65.2% and a specificity of 96.9%. ECG computer analysis calculated QTc was available for 42.5% of the cases and had a sensitivity of 58.1% and specificity of 95.3% compared to Bazett's formula. Of the 23.3% of patients taking medications known to prolong the QT interval only 38.6% had a prolonged QT interval. There was a significant association between QT interval prolongation and hypokalaemia. Conclusion The 'rule of thumb' method to determine QT interval prolongation, has high specificity but low sensitivity. This bedside measure is similar in accuracy to QT determination using an ECG computer analysis calculation in this population of older persons. / MT 2019

Previous studies suggest there are numerous benefits of horticultural therapy programs. The current study explored the benefits of a horticultural therapy program with elderly populations at two facilities in Bowling Green, Kentucky. Fifteen participants attended a 2-hour session on horticulture techniques once a week for four weeks. Using a pretest to posttest study design, changes in participants’ cognition, quality of life, and loneliness were assessed. The pretest was administered verbally by the researcher before the first session and the posttest, including a series of questions about satisfaction with the program, was administered after the last session. Items on each assessment included the Mini-Mental State Exam, the Assessment of Quality of Life, and the Revised UCLA Loneliness Scale. Findings suggest that participants’ cognitive ability significantly improved after participation in the program while quality of life and loneliness perception did not significantly improve. Participants perceived the program as positive and enjoyable.

The aim of this thesis project is to investigate the current situation of elderly life in Sweden with a primary focus on the city of Stockholm, regarding the housing situation and the local environment and how these can have an impact on the life quality of this population group. Accessibility towards housing and facilities that are required for everyday living, together with socialization where the two main themes studied. Background research on the current housing and service provision for the elderly was performed in order to get an estimate of the living conditions. This estimation was afterwards verified by questionnaire research combined with semi-structured interviews with twenty elderly residents from various areas of Stockholm. Another part of the research was a literature review on publications that have been presented in the past regarding age-friendly cities, active ageing and senior living in the public space which continues with a summary of policies and guidelines, followed internationally and locally. When combining the results from the literature review on the policies with the results from the questionnaires and the interviews it became apparent that a lot of the elderly needs are satisfied in the city of Stockholm, and generally they enjoy a good quality of life, with the current system of services for housing and socialization. The results also highlighted the problematic aspects such as the lack of information about the provided services, that make the elderly not able to consider changes that might be beneficial for them. The final goal is to provide some suggestions for designing future planning policies and their potential focus areas.

本研究は，高齢者虐待の実態を的確に反映し，その実態に即した対応を促す「効果的な高齢者虐待予防モデル」の構築を目指している． / This research aims to construct "an effective elderly abuse prevention model" that accurately reflects the actual condition of elder abuse and encourages respond to its. / 博士(社会福祉学) / Doctor of Philosophy in Social Welfare / 同志社大学 / Doshisha University

Walking Assist Exoskeletons are wearable devices that can allow individuals with mobility impairments to maintain their autonomy. The growing elderly population has benefited from these devices by receiving assistance at joints where their muscle function has declined. Typically, the primary objective of these exoskeletons has been to reduce the metabolic cost of walking, allowing users to walk for extended periods of time while reducing fatigue. However, this strategy does not directly address the growing concern that seniors are at an increased risk of falling and sustaining severe injuries due to falls. Gait and balance disorders are among the most common causes of falls in the elderly. As the Canadian population ages, it is increasingly important to investigate the musculoskeletal changes contributing to frontal-plane instability, as mediolateral and posterolateral falls are correlated with higher incidences of severe injuries. Specifically, the hip abductor and hip adductor muscles are essential in maintaining balance in the frontal plane, yet little research has been conducted on the effect of hip abduction-adduction exoskeleton assistance on the stability of elderly individuals. This thesis investigates the effect of introducing an assistive torque with a specific magnitude, timing, and location (i.e. applied to one or both legs) on the margin of stability of elderly individuals using the OpenSim biomechanics software. Simulations of four elderly subjects were conducted while the subjects stood in a quiet standing position with both feet on the ground. A lateral perturbation force of magnitude 5%, 10% or 15% of bodyweight was applied to the pelvis of each subject. The simulations were designed to provide elderly subjects with contralateral (i.e. the limb on the opposite side of the body as the perturbation), ipsilateral (i.e. the limb on the same side as the perturbation), or bilateral hip abduction-adduction assistive torque from a hip exoskeleton device after a perturbation force was applied to the pelvis. The simulated actuators mounted at the hip joints were massless, applied torque in the frontal plane, and could generate torque instantaneously based on user-defined inputs. The change in margin of stability was used to measure the effectiveness of each assistive strategy and for comparison across all subjects. The results of this study suggest that, as the perturbation magnitude increases, the hip abduction-adduction assistive exoskeleton should prioritize assistance applied to the contralateral limb. Regardless of the perturbation magnitude, each assistive strategy that was simulated (i.e. contralateral, ipsilateral and bilateral assistance) was able to improve the margin of stability. The greatest mean improvement on the margin of stability compared to the unassisted condition occurred when using the contralateral assistance strategy. For the 5%, 10% and 15% bodyweight perturbations, a contralateral assistance of 0.75 N·m/kg (torque normalized by the subject's mass) resulted in an improvement in the margin of stability of 13.1 ± 0.987 mm, 13.0 ± 0.946 mm and 13.1 ± 0.816 mm, respectively. The simulations also suggested that similar improvements on the margin of stability were experienced at smaller assistive torque magnitudes when the actuators provided torque to the body quicker following a perturbation. The results of this study can be used by exoskeleton designers to guide their decisions when developing abduction-adduction assistive exoskeletons that target mediolateral stability assistance in the elderly population.

How can we design cities that can accommodate and include the increasing amount of elderly our society will experience in the coming years? What does this demographic shift mean to how our cities work, and is it possible to design our cities in a way where it becomes less of a problem?

There is a growing phenomenon in a sector of the United States population where senior citizens and disabled persons that are deemed as homebound are becoming increasingly dependent on their caregivers and as a result, they are experiencing an evolving disconnection from their occupational identity. The problem being considered is that as older adults become homebound, they begin to receive support services for assistance with self-care and home management. From this, the experience of the homebound consumer reducing engagement in necessary tasks in the home causes a decline in functional abilities which then reduces engagement in portions of the functional tasks that they may still possess the skills to participate in safely. To address this issue, research has explored how function and restorative based training for caregivers can improve quality of life, health, and function, as well as reduce health care costs. The Home Able program is a caregiver training program designed to promote occupational engagement for persons living in the community in private residences. This program has been developed as an evidence-based health promotion program designed to increase physical and mental health of persons that are homebound. The format of the program will include individual and group format training for state funded caregivers on the positive health impact of occupational engagement. Then, homebound consumers who are participants in the Home Able program will receive a series of six weekly in-home sessions focusing on identification of barriers that are impeding participation in meaningful functional activities in the home and education on compensatory strategies that can be implemented for the homebound consumer to achieve participation in meaningful occupations. A research project has also been developed to coincide with program implementation to determine how participation in the Home Able Program will impact fear of falling, depression and self-perceived quality of life. The design of the study with compare the homebound consumer’s fear of falling, depression and self-perceived quality of life using standardized measurement tools prior to program participation, and after completion of the Home Able program. The results of this research project will help substantiate the positive health impact on functional mobility, mental health and enrollment in the Home Able program to help foster buy-in from local and national stakeholders.

Mental health disorders interfere with the daily functioning of an individual’s meaningful occupations, the ability to interact with others, and decrease their ability to continue with life events (Frahm, Gammonley, Zhang, & Paek, 2010). Mental health disorders are often unreported in older adults, but the frequency is relatively high among older adults residing in long-term care settings. Further, individuals who have mental health problems are primarily located in long-term facilities (Frahm, et al. 2010). Among these diagnoses, major depressive disorder remains common within the long-term care environment. Depression could be secondary but not limited to decreased physical activity, poor social interaction, and limited participation in leisure activities. Engaging in adequate physical activities has been determined as one of the most essential factors of maintaining good health (Lipovcan, Brkljacic, Larsen, Zganec, & Franc, 2018). However, despite the widespread promotion of maintaining active lifestyles in order to live longer, many older adults live inactive lives. Research shows that activity in later life cannot be determined by only participating in exercise routines, but quality of life is measured by several domains including social, leisure, and physical (Lipovcan et al., 2018). Occupational therapists (OT) and other professionals who work with older adults should create routine programs of physical activity to increase their occupational needs and make it possible for them to maintain a meaningful life (Lok, Lok, & Canbaz, 2017). M(OT)IVATION: The Benefits of a Physical and Leisure Activity Program for Older Adults with Depression in Long-Term Care Settings is an evidence-based model program created to increase the well-being of older adults and decrease depression by engaging in exercise and leisure activities.

Introduction: Frailty is characterized by vulnerability to declining health and increased risk for adverse health outcomes. Measuring frailty would be beneficial for developing interventions and assessing healthcare resource needs. No standardized measurement tool for frailty has been established. The objective of this thesis was to evaluate the frailty of participants in the Canadian Longitudinal Study on Aging (CLSA). Methods: A Frailty Index (FI) was constructed for CLSA participants based on the cumulative deficit theory of frailty. Exploratory factor analysis was conducted to study the underlying constructs of frailty and identify key factors. A hypothesized measurement model for frailty was specified. The model was modified and tested using structural equation modelling (SEM) to improve goodness-of-fit. A new frailty measurement tool was created and the construct validity of the new tool and the Frailty Index were evaluated. Results: A FI was calculated for 20,874 CLSA participants (Mean 0.14 SD 0.07). The maximum FI value was 0.68. A model containing all hypothesized variables had good fit of the data, and all variables contributed significantly. A simplified model also showed good fit and included four domains: upper-body strength, lower-body strength, dexterity, and depressive symptoms. These results persisted in an independent dataset. A Simplified Frailty (SF) score was created based on this simplified model. The FI and SF scores showed significant agreement and associations with sociodemographic variables were as predicted. Conclusions: A FI was simple to construct in the CLSA, having good fit of the data and construct validity. These results are consistent with previous research on the cumulative deficit theory of frailty. A simplified frailty model revealed key domains of frailty and resulted in a potentially useful short screening tool. The FI is recommended as a valid and reproducible approach for measuring frailty in the CLSA and similar population datasets. / Thesis / Master of Science (MSc)

Abuse towards older people is a global public health and human rights concern and considered a hidden pandemic due to underreporting. It has been estimated that 1 in 6 people aged 60 and older have experienced abuse at some point, with World Health Organization estimating that only 4% of cases are reported. Often older adults do not recognise their situation as an abusive one or may be reluctant to disclose because the abuser is a family member, often an adult child for which the older person feels responsible for. People living with dementia and older persons with significant health concerns are especially vulnerable to elder abuse, with estimates showing that 2 in every 3 people living with dementia have experienced some form of abuse. Rigorous data on the extent of the problem globally is limited, with studies often excluding the self-report of older adults with cognitive impairment, such as dementia. Lack of disclosure may therefore be amplified in people living with dementia with limitations in insight, recall or communication skills. These realities keep elder abuse hidden, while often relying on the self-report of perpetrators to disclose abuse. Screening and identifying elder abuse, especially amongst people with cognitive impairments, are complex. Very little research is published on elder abuse in South Africa, with a complete absence of prevalence estimates, routine reporting, or monitoring and surveillance of issues relating to elder abuse. From the limited data available, elder abuse in South Africa is a serious concern. In South Africa older persons are now, more than ever, expected to manage households, rear children, and financially support their entire household with their pensions. This shift in role makes them especially vulnerable to the impact of the country's high rates of poverty, unemployment, and crime, especially within the home environment. These structural and social determinants of violence are poorly understood in the context of elder abuse. In particular, there is a serious lack of local evidence that supports the understanding, risk, and measurement of elder abuse in South Africa. This study therefore proposed to address these gaps through four sub-studies designed to describe the landscape of elder abuse in South Africa. These sub-studies had the following aims: 1. To provide a situational analysis on current service provisions for dementia and elder abuse for older adults, including people living with dementia and their families (sub-study 1). 2. To cross-culturally adapt the Elder Abuse Screening Tool (EAST) and the Caregiver Abuse Screen (CASE) in South Africa, to detect self-reported abuse and risk of abusing from older persons' and potential perpetrators' perspectives (sub-study 2). 3. To examine the nature of self-reported elder abuse using the Elder Abuse Screening Tool (EAST) to generate evidence on the prevalence, predictors, and perpetrators of abuse (substudy 3). 4. To estimate the prevalence and predictors of risk of abusing using the Caregiver Abuse Screen (CASE) amongst household informants, including carers for people living with dementia (sub-study 4). Sub-study 1: “Dementia in South Africa: a situational analysis” This study comprises of two parts. Part I presents a situational analysis that was conducted in three phases: (1) a desk review guided by a comprehensive topic guide which included the World Health Organization's (WHO) Global Dementia Observatory indicators; (2) multi-sectoral stakeholder interviews to verify the secondary sources used in the desk review, as well as identify gaps and opportunities in policy and service provisions and (3) a SWOT-analysis examining the strengths, weaknesses, opportunities and threats in current care and support provisions in South Africa. Findings highlight the gaps and opportunities with current service provisions and show how structural factors create barriers to diagnosis, support and care. These barriers to diagnosis, care and support create risk for elder abuse and neglect as families and people living with dementia are largely unsupported by formal, community-based services. Part II expands this analysis and provides a closer look at the insights gained from stakeholders interviewed and reports on the status of elder abuse support provisions in South Africa. We found that, like in the case of dementia services, support provisions for elder abuse are poor. While there is a lack of data on the nature and extent of the problem, experts agree that underreporting is a big problem, and that people living with dementia are at greater risk of elder abuse that may include extreme forms of violence. Sub-study 2: “Cross-cultural adaptation of the EAST and CASE screening tools for elder abuse in South Africa” We tested the cultural appropriateness of the EAST (Elder Abuse Screening Tool) and the CASE (Caregiver Abuse Screen) in two regions (Western Cape and Limpopo) and four languages in South Africa (English, Afrikaans, isiXhosa and Northern Sotho (Sepedi)), using a cognitive interviewing methodology. Findings show that questions in the EAST and CASE are generally well understood, but that adaptations of both tools are necessary for use within South Africa. Older persons' fear, knowledge and experience of crime also showed that strangers may deliberately use deception to build trust and abuse. Further validation is needed to determine suitable scoring and use by health and social care practitioners. Sub-study 3: “Prevalence, perpetrators, and predictors of self-reported elder abuse in South Africa: findings from a household survey” Informed by the cognitive interviews in sub-study 2, the adapted EAST was used in a household survey to screen 490 older people for self-reported elder abuse across two areas, Cape Town (Western Cape) and Dikgale (Limpopo). One in ten older adults screened positive for abuse, of which financial abuse was most common. Perpetrators of elder abuse were most often a non-family member with whom the older adult had a relationship with. Higher prevalence of self-reported abuse was strongly predicted by higher levels of the respondent's own functional impairment. This is one of the first studies that explore the relationship between dementia, functional impairment, and elder abuse at a community level in South Africa. Sub-study 4: “Risk of elder abuse in South Africa: a survey of household informants” Within the same household survey, we screened informants of the older adults using the CASE. We found that risk of elder abuse was very high, with half of participants screening positive for abusive dispositions toward an older person. Carers of people living with dementia were four times more likely to be at risk of abusing compared to carers of people free of dementia. However, our multivariate model showed that more severe psychological and behavioural symptoms and increased carer burden are the main associations with elder abuse in this population. Supporting carers to manage stress and reduce burden includes the effective management of neuropsychiatric symptoms and has potential to reduce risk for elder abuse. Overall, the findings of this study showed that elder abuse and risk of abusing is high in South Africa, with perpetrators often being a non-family member with whom the older person has a personal relationship with, or a family member. It provides an important contribution to the available evidence base on elder abuse in a low-or-middle-income country like South Africa and gave insight into understanding elder abuse in context to support targeted efforts to reduce risk of abuse and provide adequate services for older adults, including people living with dementia.