Research in the late 1990s and early 2000s projected that the number of people aged 50 and older who needed treatment for illicit drug use and abuse of prescribed medications to increase from approximately 1.7 million in 2001 to approximately 4.4 million in 2020. The purpose of this study was to examine how gender, marital status, employment status, and primary referral source predicted treatment outcomes with this older population. Of interest was how these predictions could better prepare treatment providers to treat individuals born between 1946 and 1964 who are addicted to substances. This quantitative study used an archival database, the Treatment Episode Dataset-Discharges (TEDS-D) from the Substance Abuse and Mental Health Services Administration. A discriminant function analysis revealed significance in the predictor variables with treatment outcomes. The second research question asked whether the criminal justice system/legal system alone, as the primary referral source, could predict treatment outcomes. A chi-square test revealed the primary referral source had a significant impact on treatment outcomes. These findings have implications for positive social change by empowering practitioners working with the older adult generation in substance abuse treatment to recognize the changing roles of retirement. These findings may, in turn, help those adults cope with physical health problems and loss of mobility, foster social supports within the community, and address the mental health problems among this population.

Adequate medication management is a focus of effective care that is often overlooked in caring for adults with comorbid psychiatric and physical conditions, especially in patients who are treated by multiple care providers and have a variety of health issues at the same time. The purpose of this project was to develop evidence-based policies and practice guidelines to reduce polypharmacy in elderly patients in a rural outpatient psychiatric clinic. Bandura's self-efficacy theory was used to inform the project for its value in assessing motivation, capacity for self-regulation, and perceptions of individual ability. An interdisciplinary team of stakeholders explored best practices for electronic health records (EHR) in a rural mental health facility, created policy and practice guidelines, and developed implementation and evaluation plans to guide the initiative as it moves forward. The team included physicians, psychiatrists, psychologists, nurse practitioners, nursing support staff, social workers, and substance abuse counselors. The team explored approaches for implementing EHR-based medication management based on research in the current literature and goals/objectives of each department. Team members identified major issues and proposed guideline changes based on evidence in their own fields. The team then collaborated to develop policies and practice guidelines in a series of meetings designed to build consensus for supporting a unified set of products to be accepted by all departments. The resulting policies and practice guidelines are accompanied by plans for implementation and evaluation that provide the institution with a comprehensive solution to polypharmacy in elderly patients. This project may improve overall quality of care by reducing medication and preventing health complications related to polypharmacy.

Older women constitute a growing segment of Puerto Ricans and the U.S. population. A limited number of studies have examined the activity level in response to alcohol use in late life. Generally, older women present risks and benefits from alcohol use. Alcohol misuse may decrease health and in some cases, psychiatric symptoms may develop. However, some benefits are found in moderate alcohol consumption including improved physical function compared with nondrinkers (Blow & Barry, 2002). Since activity level may depend on factors such as health, functioning, emotional well-being, and perception of alcohol effects, these factors were then assessed in response to alcohol use in order to identify the degree of greater or lesser activity among elderly Puerto Rican females. This study examined the activity level in response to alcohol use in a sample of elderly Puerto Rican females (N = 419) and investigated factors that influence the practice of alcohol consumption. The independent variable was daily and weekly consumption of alcohol. Five dependent variables were examined, which included self-rating of physical health and emotional well-being, self-perception of activity level, function, and perception of alcohol effects. After conducting MANOVA analyses, no significant association between activity level and alcohol use was found. In addition, regarding the negative and positive effects of alcohol, the researcher found that elderly females who drank heavily reported having alcohol-related problems compared to those who drank moderately who described their drinking behavior as positive. The MANOVA and ANOVA analyses determined a significant relationship between higher self-perception of functionality and moderate alcohol use, but the relationship between moderate alcohol use and physical health and emotional well-being was not significant. Considering the increase of alcohol use in the older adult population, principally in the baby boomer generation, these findings are important not only to rehabilitation counseling professionals, but to many individuals in the helping professions, including educators and researchers. Rehabilitation counseling professionals should focus on initiatives to decrease and prevent alcohol misuse in the older adult population. Information revealed from this study will also contribute to knowledge of the cultural characteristics and psychosocial aspects of older Puerto Rican females regarding their alcohol use to promote better outcomes, as well as support literature in the area.

OBJECTIVE: To establish baseline data of dental utilization and determine the predictors of receipt of dental procedures by Medicaid-enrolled senior adults who reside in Iowa nursing facilities. METHODS: This was a longitudinal retrospective analysis of Iowa Medicaid claims data for SFY 2007-2014 of senior adults who were 68 years or older upon entry to a nursing facility and continuously enrolled (eligible 58 out of 60 months) in Medicaid for three years prior to and at least two years after admission. RESULTS: Controlling for the subject and nursing facility level variables, the strongest predictor of dental utilization after entry was the receipt of a dental procedure before entry (p< 0.001). Subjects residing in a facility located in an urban area (p< 0.002) or in two regions of Iowa (p=0.035, p=0.019, respectively) also had increased odds of receiving a dental procedure. CONCLUSION: Our results show that approximately 50% of the subjects never received a dental procedure in the 5-year study period. The strongest predictor of receipt of dental procedures in the 2 years after entry was the receipt of dental procedures in the 3 years before entry. It is important for Medicaid-enrolled senior adults to establish a dental home while community-dwelling.

An intrinsic religious orientation has been linked to improved cardiovascular health. Individuals may be protected by their beliefs against anger/hostility, which have been linked to increased cardiovascular reactivity and disease. Health locus of control differentiates between internals, who take responsibility for health, and externals, who attribute responsibility to chance or powerful others. Internal health locus of control has been linked to healthy behaviors, but its relationship to religious orientation is unclear. Intrinsically held religious beliefs and internally held expectancies for health may, through the mechanism of reactivity, reduce risk for cardiovascular disease. This study explored relationships among health locus of control, religious orientation, and cardiovascular reactivity to an interpersonal stressor in an older adult population. Intrinsic religiousness and internal health locus of control emerged as highly related potential buffers against anger/hostility and cardiovascular reactivity.

Three-day dietary records were analyzed for nutrient content and 24 hour urine samples were analyzed for calcium, phosphorous, total nitrogen, and free alpha-amino nitrogen for 210 elderly people. Dietaries and urine samples were collected twice, October and March at five month intervals, for each subject. Increases were found in both dietary intake and urinary components October to March. Based on a criteria of high dietary protein, low dietary calcium, high urinary nitrogen and low calcium, 23 subjects were selected as osteoporotic and and 25 were selected as non-osteoporotic. This method of prediction was not supported by radiological evaluations. Bone density and percent cortical area of the second metacarpal and the trabecular pattern of the femoral head were evaluated for each subject. A negative correlation of trabecular pattern with age indicated a general loss of bone with age. Decreased percent cortical area was the most consistent bone phenomena associated with osteoporosis. No significant difference was found between sexes in any of the radiological analysis. The osteoporotic condition is more closely associated with a loss of bone quantity than decreased bone quality. As yet, osteoporosis is not associated with specific nutrient(s) consumption or urinary excretion(s).

No description available.

Hearing loss and cognitive impairment are significant health problems, threatening the independent function of older adults. While there appears to be a strong relationship between the two conditions, the mechanisms underlying this association are complex and are not fully elucidated. The purpose of this secondary analysis was to explore the relationship between hearing ability and cognitive performance in older adults. In addition, this study attempted to examine the role of depressive symptoms in the relationship between hearing loss and cognitive performance. Comprehensive measures of peripheral hearing, central auditory processing and cognitive performance were utilized to examine these relationships in a sample (N = 30) of adults aged 60 years and older. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms. Correlational analyses revealed a statistically significant relationship between central auditory processing and executive function. Statistically significant relationships were also observed between speed of processing and peripheral hearing as well as central auditory processing. No significant relationships were noted between depressive symptoms, hearing acuity and cognitive performance. While the correlation coefficients (r) for several of the hearing and cognitive performance measures were not statistically significant, medium effect sizes were detected, suggesting a moderate association may exist between these variables.

Numerous Thai older people fall each year. Although it has been shown that only 3.1% of fallers sustained fractures (Nevitt, Cumming, Kidd, & Black, 1989), injuries in older people are often more serious. For example, hospital charges for older adult fall injuries are about US $2,000 per person higher than for young fallers (Ellis & Trent, 2001). Moreover, falling can lead to social isolation, physical restraint, disability and institutionalisation (Donald & Bulpitt, 1999; Tideiksaar, 1994). Therefore falling in old age results in a considerable burden on, not only the individual concerned, but also the whole society. Internationally, a successful falls prevention program usually employs a multidimensional approaches (Alexander & Edelberg, 2002; Mosley, Galindo- Ciocon, Peak, & West, 1998). However, limited information about fall prevention has been reported in Thailand. A survey indicated that Thai elderly fall outside their homes which is different from the findings in Western countries (Jitapunkul et al., 1998). This suggests that adoption of fall prevention strategies from Western countries might not be successful in Thailand. Prior to this study, details of fall circumstances in terms of location, time, associated activity, hazards and type of falls in Thai older people were not available. Moreover, there was no information about fear of falling and activity restriction. These are important fall consequences that impact on quality of life and themselves are risk factors for falls. The purpose of this study was to determine the prevalence of fear of falling, and to describe activity restriction in fallers and non-fallers, and the circumstances associated with falls in Thailand. No fear of falling measurement tools for Thai older people were available prior to the study. / Therefore the Survey of Activities and Fear of Falling in the elderly (SAFE) has been modified for use with Thai elderly people. The SAFE was translated to Thai by a certified translator, checked for cultural relevance and back-translated by a second translator; reliability testing then took place in Thailand. Face validity and cultural appropriateness were tested with a sample of convenience of 10 bilingual Thai elderly people living in Perth, Australia. After translation into Thai, 4 items showed less than 80% agreement and required adjustment to capture the equivalent meaning of the original version. The ‘take a show/wash yourself with a basin of water’ was added because the participants reported that taking a tub bath is not common or traditional in Thailand. However, the item ‘take a tub bath’ was retained until the examination in the main study confirmed that less than 1% of Thai older persons had taken a tub bath and inclusion of the item confounded actual fear of falling results. Interrater reliability was tested; nine 4th year occupational therapy students and 15 older persons living in the Chiang Mai community were recruited. The intraclass correlation coefficient of fear of falling of activities done, activities not done and activity restriction scores were .9845, .9236 and .9718 respectively (p < 0.001). Four raters and 50 older community dwellers participated in the intrarater and test-retest reliability tests. The results showed that intrarater reliability of all raters exceed 0.8 in every scores (p < .001). / The test-retest also demonstrated good reliability: .9960, .9376 and .9849 (p < 0.0001) for fear of falling of activities done, activities not done and activity restriction scores respectively. Five hundreds and forty six Thai older adults were then recruited by multistage random sampling. Fall history, fall circumstances, fear of falling and activity restriction data were obtained by structured interview and using the Thai version of the SAFE. The results demonstrated that prevalence of falls, fear of falling and activity restriction in Thai older people were 21%, 48% and 18%, respectively. Comparison between fallers and non-faller showed that fallers were more likely to be older (p < .001), female [χ2(1, N = 546) = 6.133; p = .013], not married [χ2 (4,N=546)=61.102;~= .001], living alone[χ2 (l,N=546)=4.313;p= ,041, rated their health as poorer [χ2 (4, N = 546) = 13.232; p < .001], had fear of falling [χ2 (1, N = 546) = 6.265; p = .015] and activity restriction [χ2 (1, N = 546) = 5.488; p = ,0271]. Older persons with a fear of falling tended to be older (p = .005), lower educated (p < .001), female [χ2 (1, N = 546) = 29.602; p = .001], rated their health as poorer [χ2 (4, N = 546) = 69.70; p < .001], had fallen [? (1, N = 546) = 6.265; p = ,0151 and had activity restriction [χ2 (l, N = 546) = 23.267; p < .001]. Older adults who curtailed their activities tended to be married [χ2 (1, N = 546) = 6.188; p = ,0131, rated their health as poorer [χ24, N = 546) = 14.302; p = ,0061, have a fall history [χ2 (1, N = 546) = 5.488; p = ,0271 and have a fear of falling [χ2(1, N = 546) = 23.267; p < .001]. / Using Chi-square test, the results showed that there were significant associations between falls and fear of falling χ2(l,N=546)=6.265;p=.015], falls and activity restriction [χ2 (l,N= 546) = 5.488; p = ,0271] and fear of falling and activity restriction [χ2 (1, N = 546) = 23.267; p < .001]. Fall circumstances of 114 falls demonstrated that most falls took place outdoors (65%), were associated with work (40%), involved environmental hazards (76%), occurred during the daytime (90%). Moreover most falls were falls on the same level from slipping, tripping or stumbling (61%). Logistic regression analysis indicated that risk factors for fear of falling in Thai older people were age (odds ratio = 1.025), unmarried-female (odds ratio = 5.979), married female (odds ratio = 1.903), poor self perceived health (odds ratio = 3.383) and more than 2 falls experience (odds ratio = 7.202). The protective factors were unmarried marital status for men (odds ratio = 0.344) and level of education (odds ratio = 0.933 2 or less falls and = 0.5625 if more than 2 falls in 12 months). The logistic model also provided a logistic equation for individual prediction of probability of fear of falling. To calculate the probability of having fear of falling, 6 parameters are required: age, gender, marital status, level of education, self-perceived health and number of falls in the past 12 months. The equation predicts with 70% accuracy and can be used for screening fear of falling in Thai elderly people. In conclusion, this study has modified a measurement tool (the SAFE Thai version) and developed a screening tool (logistic equation) for fear of falling. Both of them appear to be appropriate to further examine FOF in Thai elderly. The survey results showed a considerably number of Thai elderly people have fall experiences, fear of falling and activity restriction. / The predisposing factors for each problem have been identified. The association between 3 problems implicated that fear of falling and activity restriction interventions are necessary for fall prevention. The fall circumstances data show that conditions of falls in Thai elderly people were similar and dissimilar to those in Western countries. The preventive efforts to reduce falls should consider these distinctive fall circumstances.

The health care requirements of older people admitted to acute hospitals and their need for nursing care have been identified in current literature as problematic. Hospital organisations which are medically oriented and more focused on implementing programs directed by economics, efficiency and effectiveness may be unsupportive of nursing practices based on a professional value system. There is a need, therefore, to examine how health care structures that tend to promote cost containment and a technical imperative, impact on the professional capability of nurses to provide the standard of care required by acutely ill older hospitalised patients. The collected data, analysed thematically, indicates that the nurses were knowledgeable and potentially competent in providing the standard of technical and functional care required by older adults in hospital. However, although nurses articulated that they wanted to provide the quality of care needed by acutely ill older patients, they nevertheless admitted they were optionalising this care because of constraints in the health care system.While the nurses’ constructions revealed they believed technical tasks took up most of their time during shifts, it is evident during the observations that this was not the case. Through the use of Giddens’s (1984) Structuration Theory, a very different picture began to unfold about the incongruence about was said, and what was actually done. The significance of this study is that the incongruence found between the nurses’ knowledge and their actions has been revealed. / Doctor of Philosophy (PhD)