This Thesis follows the portfolio format and a brief overview is given here. Chapter one is a systematic review of the literature on the relationship between emotion regulation, anxiety and depression in older adults. Chapter two is a research journal which explores the relationship between fear of falling and emotion regulation in community dwelling older adults. The systematic review is written up for publication in the Journal of Affective Disorders. The research article is written up for publication in Aging and Mental Health. Their respective style guidelines were followed. Purpose The aim of the thesis was to explore the relationship between emotion regulation and psychological distress in older adults. The aim of the systematic review was to explore the relationship between self-reported emotion regulation, anxiety and depression in older adults. The empirical study aimed to look at the relationship between fear of falling, a common type of psychological distress in older adults, and emotion regulation. It also aimed to look at the relationship between fear of falling related avoidance behaviour and emotion regulation. Methods The literature was systematically searched for research which has explored the relationship between emotion regulation, anxiety and depression in older adults. The papers which met the inclusion criteria were rated according to predetermined quality criteria. An overview of the results and implications were discussed. The empirical research used a cross-sectional design to examine the research hypothesis. Older adults completed self-report measures of emotion regulation, fear of falling, fear-related avoidance behaviour, anxiety and depression. Correlational analysis explored the relationship between the study variables. A linear regression model examined the unique contribution of emotion regulation to fear of falling after controlling for age, falls history, anxiety and depression. Results 12 studies met the inclusion criteria for the systematic review. The most prevalent relationship explored was that between rumination and depression with consistent evidence that higher levels of rumination were related to higher levels of depressive symptoms. Common methodological limitations were the lack of valid and reliable emotion regulation measures for older adults, non-random sampling, and failure to control for important confounding factors. Within the empirical research, a significant relationship between emotion regulation and fear of falling was found. There was also a significant relationship between emotion regulation and fear of falling avoidance behaviour. After controlling for age, number of falls, depression and anxiety, emotion regulation was no longer significantly associated with fear of falling. Depression was the only modifiable variable that retained a significant association to fear of falling.

Falling is a significant risk for older adults in Canada. Suffering a fall can result in injury and reduced quality of life which may include loss of autonomy. Additionally, injuries and rehabilitation from falls are a significant resource burden on the healthcare system. With the increasing proportion of older adults in Canada, there will be an increase in incidence of falls. Early identification of fall-risk is an essential step for the prevention of falls, and will provide the opportunity for fall-prevention interventions for at-risk older adults. This research is comprised of four projects that investigate and enhance current methods of fall risk detection which has potential to improve the quality of life of older adults. The first study was a scoping review that identified tools for self-assessment of fall-risk. Seven distinct fall-risk self-assessments were identified; of which most were survey based. The most effective self-assessment tools were those that included physical assessments, with interactive technology-based assessments showing exceptional promise in preliminary studies. While self-assessment is an important first-line defense for fall-risk identification and monitoring, more sensitive measures that require administration by trained professionals are likely required for accurate prediction of fall risk. The second project concurrently investigated a battery of clinical, physiological, and biomechanical assessments, to determine which measures, alone or in combination, best retrospectively classified fall risk. Ten clinical balance and mobility tests, comprising 40 unique measures, 5 physiological assessments, and 45 gait measures were included. From this extensive battery, only 5 measures were required to classify fallers with 92% sensitivity and consisted only of gait measures. A practical clinical fall risk detection tool must be both time efficient and accurate. Thus it is essential to determine the minimum amount of reliable data that is required to maintain accuracy. To this end, based on the value of walking gait assessment for fall risk detection, it is essential to determine the minimum number of strides required to accurately classify fallers. To determine the number of strides required to identify fallers, subsets of a large sample of gait data measured with a GAITRite™ pressure sensing walkway were created and compared for internal consistency and variance between the reduced and complete data sets. For measures of mean values for dual-task and difference scores of walking gait it was determined that a minimum of 10 strides are required, while for measures of variability between 30-50 strides, are required. It is encouraged to acquire as much gait data as possible, however, reasonable limits may be set to reduce the strain on older adults. This will allow for studies to include additional measures, such as clinical tests which prolong the experiment duration, to produce a clinically viable tool. Emerging technologies allow research to remain at the cutting edge and provide opportunities to expand into new markets. The use of Microsoft Kinect V2 for measurement of walking gait will allow for long term monitoring of fall status in the homes of older adults. To this end, we developed a walking stride detection algorithm that can be utilized for measurement of gait. The proven measurement accuracy of the Microsoft Kinect depth sensing capability coupled with an accurate and reliable stride detection algorithm provides the opportunity for affordable and portable gait analysis. This algorithm can be utilized with any 3D depth sensing technology, and future investigations will assess the accuracy across devices and clinical populations. / Graduate / 2019-09-14

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.

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The Falling Creek Reservoir (FCR) in Roanoke is monitored for water quality and other key measurements to distribute clean and safe water to the community. Forecasting these measurements is critical for management of the FCR. However, current techniques are limited by inherent Gaussian linearity assumptions. Since the dynamics of the ecosystem may be non-linear, we propose neural network-based schemes for forecasting. We create the LatentGAN architecture by extending the recurrent neural network-based ProbCast and autoencoder forecasting architectures to produce multiple forecasts for a single time series. Suites of forecasts allow for calculation of confidence intervals for long-term prediction. This work analyzes and compares LatentGAN's accuracy for two case studies with state-of-the-art neural network forecasting methods. LatentGAN performs similarly with these methods and exhibits promising recursive results. / Master of Science / The Falling Creek Reservoir (FCR) is monitored for water quality and other key measurements to ensure distribution of clean and safe water to the community. Forecasting these measurements is critical for management of the FCR and can serve as indicators of significant ecological events that can greatly reduce water quality. Current predictive techniques are limited due to inherent linear assumptions. Thus, this work introduces LatentGAN, a data-driven, generative, predictive neural network. For a particular sequence of data, LatentGAN is able to generate a suite of possible predictions at the next time step. This work compares LatentGAN's predictive capabilities with existing neural network predictive models. LatentGAN performs similarly with these methods and exhibits promising recursive results.

No / PURPOSE: The risk of falling increases dramatically with age, and visual impairment is known to be an important risk factor. Therefore, it is highly pertinent to assess the effects of age and vision on the performance of everyday tasks linked to falling, such as stepping from one level to another. METHODS: Nine young (age, 26 +/- 4 years) and ten elderly (age, 72 +/- 5 years) subjects performed a stepping-up task of three different heights. Their stepping strategies with blurred and optimally corrected vision were compared. Center of mass (CM), center of pressure (CP) dynamics (in the mediolateral and anteroposterior directions), and foot clearance parameters were determined, and statistical regression modeling was applied. RESULTS: Elderly subjects spent 20% more time (P = 0.03) than young subjects during double support and they had reduced anteroposterior CM-CP divergence (P < 0.001) during double support and slower anteroposterior (P < 0.001) and mediolateral (P = 0.002) CM velocities during initiation of movement and single limb support. Blur caused similar adaptations, such as increased toe clearance, across both age groups, though mediolateral (ML) CM-CP divergence in elderly subjects was significantly more reduced than in young subjects (P < 0.001). CONCLUSIONS: Findings indicate, in general, that older subjects used a more cautious and controlled stepping strategy. However, the lack of significant age differences in toe clearance suggests this strategy was mainly aimed at reducing ML instability rather than increasing margins of safety regarding toe clearance.

The effectiveness of the A Matter of Balance (MOB) program, a multifactorial falls prevention intervention, is uncertain. Although targeting multiple risk factors of falling at the same time seems reasonable and desirable, in that falls are often caused by several risk factors, results from previous studies investigating the effects of multifactorial falls prevention interventions are inconsistent. In addition, research shows that single factor interventions (e.g., exercise) can produce the same effects. The cost-effectiveness of multifactorial falls prevention interventions has varied across studies (e.g., Jenkyn, Hoch, & Speechley, 2012; Tinetti, Baker, et al., 1994). Despite the fact that the American Geriatrics Society and British Geriatrics Society (2001) have incorporated multifactorial falls prevention interventions into geriatric practice guidelines, more studies are needed to better understand the effects of the MOB program on falls and risk factors for falling among older adults. The MOB program aims to reduce fear of falling by increasing self-efficacy and perceived control (Tennstedt et al., 1998). This program provides exercises to enhance older adults' physical capacities, lessons to teach seniors fall-related risk factors, and methods to enhance self-efficacy. Previous studies mainly focused on the effects of the MOB program on fear of falling and falls efficacy. However, falls, fear of falling, and physical frailty (e.g., poor balance) are all correlated. Little is known about the effects of the MOB program on falls and related physical risk factors. Meanwhile, fear of falling and falls efficacy are two constructs often used to delineate psychological consequences of falling, but there has been confusion about these two constructs. As a result, researchers have been using measures developed for falls efficacy to assess fear of falling in error. Previous study also shows that both fear of falling and falls efficacy need to be examined after intervention with separate appropriate measures(e.g., Valentine, Simpson, Worsfold, & Fisher, 2011). Nevertheless, in the research of the MOB program, studies often examined either fear of falling or falls efficacy, but not both (e.g., Tennstedt et al., 1998; Zijlstra et al., 2009). Therefore, whether the MOB program could improve both fear of falling and falls efficacy is uncertain. This dissertation includes three studies to examine the effects of the MOB program. The first study explores whether the program could effectively prevent falls and improve physical risk factors (i.e., mobility, walking speed, and postural control) among older adults. The second study examines the psychometric properties of a modified fear of falling measure and the effects of the program on fear of falling and falls-efficacy. The third study investigates whether the effects of the MOB program on falls, mobility, walking speed, and postural control can be maintained across five months. Three studies using a comparison group design were conducted to examine each objective. Data were collected at baseline (Time 1), the conclusion of the program (Time 2), and at a 3-month follow-up (Time 3). Overall, the studies in this dissertation show that older adults can improve their mobility, walking speed, postural control, fear of falling, and falls efficacy by participating in the MOB program but the program did not affect the total number of falls. The results also showed that older adults who received the MOB program reached their highest performance on mobility and walking speed immediately at the end of the program. However, their performance on postural control continued to improve and was the best at the 3-month follow-up.

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Many adults are afraid of falling. While aging can affect one'€™s physical and cognitive abilities related to fear of falling (FOF), research has revealed that FOF increases risk of falls and adversely affects independence levels among older adults. The purpose of this study was to explore older adults'€™ perceptions of FOF and risk of falling. Guided by the health belief model, the research questions focused on older adults'€™ perceptions of FOF, contributing factors of FOF, and how FOF may affect independence levels. How older adults perceive FOF, and how FOF may affect an individual older adult'€™s fall risk and independence levels are not well known. Following face-to-face interviews with adults age 60 and older, Colaizzi'€™s data analysis strategy demonstrated thematic older adult reports of constant anxiety, loss of confidence, and activities of daily living (ADLs) avoidance as perceptions of FOF; traumatic health incidence, loss of health, and decreased quality of life as contributing factors in FOF; and depending on others, loss of muscle strength, and loss of balance as to how FOF affected older adult independence levels. Recommendations for future research include exploring the influence of gender, race, education level, and socioeconomic status on FOF in older adults. This study may enhance social change through greater FOF awareness and added context among caregivers.