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OBJECTIVE: To explore the effect of pet ownership (PO) on the oral health of older adults. METHODS: NHANES data 2005-06 was analyzed (logistic/linear regression), restricted to aged 65 years and older. The outcomes of interest were the presence/absence of untreated dental caries, the presence/absence of dental restorations, and mean number of teeth. The primary independent variable was PO status within the past year. Potential confounders included demographic data (age, gender, race, marital status, poverty income ratio, education), smoking status, depression, physical activities, and mean sugar intake, taking into account NHANES complex sampling. RESULTS: Individuals aged 65-69 were more likely to own pets than those older than 70 years, with dogs being the most popular pet (62%) followed by cats (31%). After adjusting for potential confounders, there was no association between pet ownership in seniors and the outcomes of interest. Non-Hispanic blacks reported the highest tooth loss (-6.42 teeth) among the racial groups and were 40% less likely to have a dental restoration. In the unadjusted model Mexican Americans have 2.83 times the odds of untreated dental caries compared to Non-Hispanic whites, while current smokers had 7 fewer teeth than those who never smoked. CONCLUSIONS: Pet ownership was not associated with improved oral health for older adults. Despite the lack of oral health protection, pet ownership provides companionship, reduces loneliness, and increases socialization among older adults.

INTRODUCTION: Motivational Interviewing (MI) is an evidenced based counseling style to elicit health behavior change. Team-based student clinics are an ideal climate for students to learn and practice team-based care, yet little is understood as to how client-centered communication styles such as MI are implemented in a team setting. PURPOSE: The purpose of this dissertation was to conduct an exploratory study using mixed methods to better understand how an MI training translates to team-based communication with clients, the factors impacting team-based implementation of MI, and how team-based MI impacts clients’ perceived autonomy at a student-led, interprofessional, team-based wellness clinic for low-income seniors. METHODS: Fifty-five clinic sessions were audio recorded and participants completed the Health Care Climate Questionnaire to measure perceived autonomy support, 16 clinic participants were interviewed, and 15 health care students participated in four focus groups. The recordings were coded with the Motivational Interviewing Treatment Integrity code (MITI 4.2.1). Independent t-tests, and multiple regression models were used to assess differences in MITI scores, association between MITI scores and team/patient characteristics, and associations between MITI scores and perceived autonomy support. Interviews and focus groups were qualitatively analyzed to identify themes. RESULTS: A short training in MI was not associated with MI proficiency as measured by the MITI, and student teams were found to overstate their use of MI on team-report measures. Less education, older age, and a larger team size were associated with lower MITI scores. High levels of perceived autonomy support were found across all clients, but MITI scores were not associated with perceived autonomy support. Clinic participant interviews identified benefits to engaging with the student teams including opportunities to socialize, as well as support in managing their health. The students found the MI training to be beneficial but noted that team dynamics ultimately effected MI use. CONCLUSION: It is possible to implement MI in team-based settings, but sufficient training and ongoing coaching is needed to ensure translation to practice. As health care programs continue to promote team-based care, further research is needed to fully understand how teams can effectively communicate with clients, and how they can provide the autonomy supportive environment needed to elicit internal motivation to engage clients in their own health management.

Rationale: Delirium is a serious, morbid condition affecting 2.6 million older Americans annually. A major problem plaguing delirium research is difficulty in identification, given a plethora of existing tools. The lack of consensus on key features and approaches has stymied progress in delirium research. The goal of this project was to use advanced measurement methods to improve delirium’s identification. Aims and Findings: (1) Determine the 4 most commonly used and well-validated instruments for delirium identification. Through a rigorous systematic review, I identified the Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS). (2) Harmonize the 4 instruments to generate a delirium item bank (DEL-IB), a dataset containing items and estimates of their population level parameters. In a secondary analysis of 3 datasets, I equated instruments on a common metric and created crosswalks. (3) Explore applications of the harmonized item bank through several approaches. First, identifying different cut-points that will optimize: (a) balanced high accuracy (Youden’s J-Statistic), (b) screening (sensitivity), and (c) confirmation of diagnosis (specificity) in identification of delirium. Second, comparing performance characteristics of example forms developed from the DEL-IB. Impact: The knowledge gained includes harmonization of 4 instruments for identification of delirium, with crosswalks on a common metric. This will pave the way for combining studies, such as meta-analyses of new treatments, essential for developing guidelines and advancing clinical care. Additionally, the DEL-IB will facilitate creating big datasets, such as for omics studies to advance pathophysiologic understanding of delirium.

Bakgrund: Urinvägsinfektion (UVI) är den vanligaste förekommande bakteriella infektionen på äldreboenden. Idag behandlas den oftast med antibiotika men med det ständiga hotet av antibiotikaresistens krävs det andra alternativ till prevention. Tranbär är en nordamerikansk frukt som förekommer i olika former; tranbärsjuice, tranbärskapslar, tranbärspulver eller tranbärscocktails och som används som alternativ behandling. På grund av anatomiska skillnader, där kvinnans urinrör är närmre anus, är kvinnor överrepresenterade i studier om urinvägsinfektion. Syfte: Syftet var att med hjälp av studier undersöka om det går att förebygga urinvägsinfektioner, med fokus på äldre, med hjälp av tranbär och redogöra för andra effekter av dess behandling. Metod: En kvantitativ litteraturstudie med artiklar hämtade från CINAHL och PubMed, internationella databaser för forskning inom medicin och omvårdnad. Artiklarna granskades med SBU:s (statens beredning för medicinsk och social utvärdering) mall för kvalitetsgranskning.  Resultat: Resultatet av denna studie visar på att tranbär uppvisar effekt i prevention av urinvägsinfektioner i jämförelse med placebo eller annan intervention. Enstaka studier påvisar ett icke signifikant resultat trots en viss minskning i incidensen av urinvägsinfektioner. Speciellt god effekt har tranbär på Escherichia coli (E. coli bakterier) och dess vidhäftningsförmåga. Tranbär påverkar E. coli bakteriens fimbrier och försvårar därmed vidhäftningen. Till följd av tranbärsintervention rapporteras minskad användning av antibiotika.  Konklusion: Tranbärets effekt har uppvisat flera positiva resultat och är ett alternativ som är värt att överväga. Tranbär är ett billigare alternativ som kan ersätta kontinuerliga doser av antibiotika och det medför inte samma mängd biverkningar. Om det dessutom används som tillägg till antibiotikabehandling kan det minska antalet antibiotikaförskrivningar vilket på lång sikt minskar utvecklingen av antibiotikaresistens. Tranbär kan rekommenderas till äldre för att förebygga och behandla urinvägsinfektioner. / Background: Urinary tract infection (UTI) is the most common bacterial infection in nursing homes. Today it is usually treated with antibiotics but with the constant threat of antibiotic resistance other alternatives to prevention are required. Cranberries are a North American fruit that comes in various forms; cranberry juice, cranberry capsules, cranberry powder or cranberry cocktails. Due to anatomical differences, where the woman's urethra is closer to the anus, women are overrepresented in studies of urinary tract infections. Aim: The aim was to examine with the help of studies whether it is possible to prevent urinary tract infections, with focus on older care recipients, with the help of cranberries and account for other effects of its treatment. Method: A quantitative literature review with articles taken from CINAHL and PubMed, international databases for research in medicine and nursing. The articles were reviewed with SBU's (the Swedish Agency for Medical and Social Evaluation) criteria for quality review. Results: The results of this study show that cranberry demonstrates an effect in the prevention of urinary tract infections in comparison to placebo or other interventions. A few of the studies show a non-significant result despite some reduction in the incidence of urinary tract infections. Cranberry has particularly good effect on Escherichia coli (E. coli bacteria) and its adhesion. Cranberries affects the fimbriae of E. coli bacteria to make adhesion more difficult. Less use of antibiotics is reported after intake of cranberry. Conclusion: The effect of cranberry has shown several positive results and is an option worth considering. Cranberries can be seen as an unnecessary cost but could replace continuous doses of antibiotics. Cranberries are also a cheaper alternative and they do not cause the same amount of side effects as antibiotics. If it is used as a supplement to antibiotic treatment, it may not be necessary to prescribe antibiotics, which in long-term reduces the development of antibiotic resistance. Cranberry can be recommended to elderly for prevention and treatment of urinary tract infections.

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The relationship of spirituality, self-transcendence, and social support to morale in chronically ill elderly was the focus of this research study. The research was based upon a developmental framework of aging. Individuals answered questionnaires regarding their perspectives on the above variables to determine how significantly the variables related to feelings of morale. Findings revealed that self-transcendence and social support were significantly correlated with morale in this population. No significant relationship between spirituality and morale was found. Self-transcendence and social support together accounted for 45% of the variance in predicting morale in the chronically ill elderly. Findings also revealed existing relationships between spirituality and gender, education level and social support, and length of illness and social support.

Alzheimer's disease is the most common form (~60-80%) of dementia, currently affecting approximately half a million people in the UK and ~30 million people worldwide. The autosomal dominant form of AD represents a small proportion (~1-2%) of AD cases and is genetically well characterised. The vast majority of AD cases that show symptoms later in life (>65 years of age) are genetically complex. This type of AD, also known as late onset Alzheimer's disease (LOAD) disease, is still highly heritable with an estimated heritability of up to 76% (Gatz et al., 2006). Unfortunately, there is no cure for this devastating disease. Investigating genetic factors influencing the risk of LOAD is imperative for development of effective therapeutic treatments and more accurate diagnosis. A cross-platform comparison of four Genome-wide association studies (GWAS) was performed in an effort to identify novel genetic associations with LOAD (Chapter 3). A TRIM15 SNP rs929156 demonstrated significant evidence of association with LOAD with a p-value approaching genome-wide significance (p = 8.77 x 10-8) and an odds ratio that showed consistent effect on risk (OR = 1.1, p = 0.03). Within this chapter, a bio-informatic program to automate the process of GWAS meta-analysis taking into account linkage disequilibrium (LD) is also presented. Subsequently two fragments of the TRIM15 gene (including both 5’ and 3’ end flanking regions) were sequenced using the ABI SOLiDTM next generation sequencing technology. This was a pilot study using a DNA pooling strategy to determine whether this region harbours multiple rare variants which are associated with the disease (Chapter 4). Lastly, a candidate gene study combined with whole genome analysis was performed in an effort to search for genetic variants influencing human ageing using LOAD GWAS data (Chapter 5).