Little is known about the molecular biology of late onset Alzheimer’s disease (LOAD), the most common dementia in the elderly. Genetic loci associated with LOAD have been identified through genome-wide association studies (GWAS). However, the functional variants responsible for the observed GWAS association at each of the loci remain unknown. The aim of this project was to identify and assess potential functional rare variants at three associated loci, CD2AP, EPHA1 and CD33. Target enriched, pooled sequencing of 96 post-mortem confirmed LOAD patient samples was used to identify 1273 variants within the three GWAS loci. Variants were prioritised using a combination of in silico functional annotation and putative disease association. Disease association was assessed through comparison to an independent, imputed LOAD GWAS dataset (2067 cases, 7376 controls). 18 coding and untranslated region variants and 9 noncoding variants were prioritised for further investigation. Potential splicing variants in CD2AP (6:47544253A > G) and EPHA1 (rs6967117) were assessed using minigene assays, although neither were found to influence splicing products in vivo. Five untranslated variants from the three genes and a frameshift variant in CD33 (rs201074739) were assessed for potential cis-regulatory consequences using allelic expression imbalance in brain tissues and B-lymphoblast cell lines. Only the frameshift variant displayed significant allelic expression imbalance and was found to be targeted for nonsense-mediated decay. None of the prioritised variants investigated were both functional and significantly associated with LOAD. However, pooled next generation sequencing using target enrichment successfully identified potential functional rare variants in CD2AP, EPHA1 and CD33. Rare variants do have a role to play in late onset Alzheimer’s disease. With the development of additional functional databases and improvements imputing rare variants from GWAS datasets, the combined prioritisation strategy used in this thesis will be useful for similar studies investigating causal GWAS variants.

Vitamin D and calcium are essential for the health of the elderly population. Due to the changes that occur in the body during aging, it is necessary to monitor the intake of these micronutrients and, if necessary, to supplement or substitute them appropriately. This thesis focuses on prevention of vitamin D and calcium deficiency in old age. The theoretical part explains the function of vitamin D and calcium in the human body, their metabolism, sources and problems of deficiency or excess. There is information about diseases related to the deficiency, especially osteoporosis and sarcopenia. The practical part has two sections. The first analyses the data from the SPRINTT trial. Data related to vitamin D, calcium, their supplementation and sarcopenia, as a disease associated with vitamin D deficiency, were used. The second section analyzes the data from a questionnaire survey in nursing homes, which obtained information about the health of seniors, the frequency of consumption of selected foods and vitamin D and calcium supplementation. Using data from the SPRINTT, it was found that 55 % of men and 40 % of women had the values of sarcopenia. 11 % of the participants had vitamin D deficiency. The data from the questionnaire found that only 51 % of respondents over the age of 70 supplemented with...

In Sweden, the elderly population above the ages of 65 who can no longer cater for themselves can seek assistance from the social services in their municipalities. A case officer popularly known as biståndshandläggare in Sweden is usually assigned by the municipality to assist in planning, assessing and making decisions on the kind of services which best fits the elderly clients seeking assistance. This study investigated the experiences of geriatric case officers working with grieving elderly clients who are either in hospitals or in their private homes. A qualitative methodology was employed and, interviews were conducted with four geriatric case officers working within elderly care departments in social services around Mid-Sweden. The results were analysed using thematic analysis. The findings revealed that these geriatric case officers had insufficient knowledge on how to work with grief and loss. The results also showed that geriatric case officers had both positive and negative experiences when working with grieving elderly clients. To work in elderly care services, a social work degree or related education is a requirement.

Seniors are a growing segment of the population of the United States. By 2030 they will make up nearly 20% of the general population. Senior citizens face many health challenges as they age. Injury due to falling is a major concern for many in this age group. Research shows that approximately one third of seniors will fall each year. Injuries that result from falls have been identified as the number one cause of accidental death in this age group each year. While falls have been studied by researchers for a number of years, and some progress has been made in finding ways to improve balance in seniors, the high incidence of falls continues to plague this demographic. Many of the current treatments to improve balance are too expensive, not accessible, or not motivating for seniors. This research project explored the effect of using a readily available video-game system to address these barriers. The Wii Fit gaming system was used with participants three times each week for 30 minutes and the resulting changes were documented. The Berg Balance Scale and Timed Up and Go test, both frequently used by professionals to assess balance in seniors, were used to document balance change. Every participant showed improvement. The Activities-specific Balance Confidence scale, which is used to measure a person's fear of falling, was also used to assess the participant's confidence in their balance as well as the level of fear associated with falling. The results of this test were positive but not to the extent of the balance tests. Finally, each participant was interviewed to assess how easy to use the participants felt the Wii Fit was as well as the motivational qualities of the Wii Fit as a balance tool. Answers given by the participants in the interview were generally positive. These results indicate that the Wii Fit gaming system may be beneficial for improving balance in seniors.

Abstract: Determine the level of concordance between the Mini-Mental State Examination (MMSE), Short Portable Mental State Examination (SPMSQ), and Montreal Cognitive Assessment (MoCA) screening test for cognitive impairment in older adults. A cross-sectional study based on an original cohort study. 1683 patients over 60 years-old were included between 2010 and 2015. Demographic information was collected and the MMSE, MoCA, and SPMSQ scores were obtained. Categorical variables were presented as frequencies and percentages, while numerical ones as median and interquartile range. The agreement was measured and adjusted by the number of years of education by Cohen’s Kappa index (k) with a 95% confidence interval (CI). The agreement was considered as good if k > 0.80. MMSE classified 43.32% of the patients as having cognitive impairment, MoCA 43.14%, and SPMSQ 24.84%. MMSE and MoCA showed an agreement (k) of 0.99 with a 95% CI of 0.99–1.00; MoCA and SPMSQ showed a k of 0.43 (95% CI: 0.38–0.46). Finally, MMSE and SPMSQ showed a k of 0.42 (95% CI: 0.37–0.46). The results did not change when performing the analysis by education subgroups. There was a strong concordance between MoCA and MMSE tests. Nevertheless, the SPMSQ was discordant with the other tests. / Revisión por pares

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<p>The project explores decision making in the context of end-of-life (EOL) care choices among adults with few social and economic resources. Although most American adults believe that planning for EOL is important, only about 30% report making formal EOL plans such as Advance Directives, wills, trusts, or any other formal documentation. Using qualitative methodology, 25, participants who were all living at the same long term care facility, were interviewed during two different waves of data collection. The transcribed interviews were analyzed using thematic analysis and guided by Normative Rhetorical Theory framework. Remarkable conclusions were that without social and economic resources, participants reported they did not make choices about EOL and care, but rather their decisions were made by default.</p>

During the COVID-19 pandemic, the Veterans living in the Kerrville VA community living center were required to shelter in place, isolate, and quarantine, much like the rest of the world during the Spring of 2020. Although the Veterans were potentially safe, they were experiencing increased loneliness and feelings of isolation; in turn, their quality of life suffered. In the Ibrahim & Dahlan (2015) article, the authors underscore the importance of engagement in occupations to improve quality of life, as occupational engagement facilitates life’s purpose. Healing Heroes Virtually aims to improve quality of life, provide opportunities for occupational engagement, learning a new skill to bridge the digital divide gap among the older adult population living in long-term care facilities. The Diffusion of Innovation Theory (DOI) will direct this program improvement project within long-term care facilities. This theory introduces innovation to potential adopters (Veterans & staff at the Kerrville VA) and disseminates it into social systems. Timing is also essential when utilizing the DOI theory to move the program. The authors (Abbott-Gaffney et al., 2022) found that “organizations can remove barriers by providing multiple learning opportunities and support to reinforce the learner’s confidence, therefore increasing the likelihood of continued use of telehealth as a service delivery model.” Adult Learning Theory will also be utilized considering the various learning styles adult learners receive/learn information. It is essential for the Veteran to feel comfortable and confident in the newfound skill. The program should run for ten weeks, two times a week, to educate and introduce the iPad, Zoom application, and program to the Veterans. Between weeks four and seven, the goal will be troubleshooting and increasing independence with technology use. During weeks eight through ten, programs such as an exercise session, current events hour, or a virtual Bible study will occur. The Veterans will be given surveys, and staff will evaluate the program’s success for future use. The goal is to create a library of various activities/sessions available to Veterans. Healing Heroes was made with the idea that if the world shuts down again, these Heroes will have the opportunity for occupational engagement and not have to endure occupational deprivation and alienation.

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