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.

No / Visual impairment is an important risk factor for falls. However, relatively little is known about how visual impairment affects stair or step negotiation. The aim of the present study was to determine the effects of blurred vision on the mechanics of landing during stepping down by the elderly. Twelve elderly subjects (72.3±4.7 year) stepped down from three levels (7.2 cm, 14.4 cm and 21.6 cm). Step execution time, ankle and knee joint angular displacements at the instance of ground contact, and vertical landing stiffness and the amount of bodyweight supported by the contralateral (support) limb during the initial contact period were recorded. Measurements were repeated with vision blurred by light scattering lenses. With blurred vision, step execution time increased (P<0.05), knee flexion and ankle plantar-flexion increased (P<0.05), vertical stiffness decreased (P<0.01), and the amount of bodyweight being supported by the contralateral leg increased (P<0.05). These findings suggest that under conditions of blurred vision, subjects were more cautious and attempted to ‘feel’ their way to the floor rather than ‘drop’ on to it. This may have been an adaptation to increase the kinaesthetic information from the lower limb to make up for the unreliable or incomplete visual information. Correcting common visual problems such as uncorrected refractive errors and cataract may be an important intervention strategy in improving how the elderly negotiate stairs.

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)