Background. Although Detrusor Hyperactivity (DH) with Impaired Contractility (IC) is a common urodynamic finding in elderly subjects, its pathogenesis remains unknown. Human detrusor biopsy studies indicate that subjects with DHIC exhibit ultrastructural evidence of both the dysfunction and degeneration patterns present in isolated DH and IC, respectively. Based on the known cellular effects of estrogen, we proposed a hypothesis that declines in ovarian hormone production could contribute to the pathogenesis of DHIC in elderly women. / Methods. In this thesis project, mature 3--14 month old female F-344 rats were studied 4 months after bilateral ovariectomy (OVx) or sham surgery. Detrusor structure was evaluated at this time point using light and electron microscopy, while classical muscle strip studies were used to measure the impact of OVx on detrusor muscle contractility. In an effort to identify estrogen-regulated proteins in the mammalian detrusor, known candidate proteins were screened using Western blotting, while identification of novel proteins was undertaken through proteomics, with two-dimensional gel protein resolution followed by microsequencing. (Abstract shortened by UMI.)

<p> The aging population coupled with the complexity of the older adult patient has presented a significant challenge for the healthcare industry. The literature has shown that the elderly are the major consumers of healthcare expenditures in the United States. Caring for this population in the realm of healthcare reform will require new strategies to improve the health status of the older adult patient. The objective of this study was to complete a comprehensive literature review of geriatric care models and create a business plan applying the Nurses Improving Care for Healthsystem Elders (NICHE) program. </p><p> NICHE is a national nurse-driven geriatric program that provides the necessary resources and tools to assist healthcare organizations in enacting system-level changes, which will impact the care of the older adult patient. </p>

<p> The focus of this quasi-experimental pre-post study with mixed methods was to assess the effect of an experiential learning activity on freshmen and sophomore nursing students' cognitive and affective knowledge of sensory changes that occur in older adults as part of the aging process. Based on Kolb's Experiential Learning Theory, the students took part in an interactive learning experience using low fidelity simulation which included a Sensory Kit, a Power Point^&copy; Presentation and Unfair Hearing Test&copy;. Participants were guided through reflective observation, abstract conceptualization, active experimentation and concrete experience during the study. An overall increase in cognitive knowledge was found to have occurred in all subgroups which included those who have either worked or lived with older adults or have had previous training in a geriatric sensitivity training program as well as those who have not in the aforementioned categories. The total sample (N=72) had a pre-test Mean&plusmn;SD of 58.06&plusmn;12.29 and post-test Mean&plusmn;SD of 80.97&plusmn;9.06 with a <i>p</i> &lt; 0.0001. Affective knowledge was analyzed using the coding method in which the written data was organized into four themes: Student Experience; Anticipated Feelings of Older Adults as Experienced by the Students; Changes in Participants' Feelings towards Older Adults after the Experience and Influence on Participants for Future Practice with Older Adults. The subjects reported an overall sense of empathy along with anticipated feelings of frustration and anger, gaining a greater sense of respect and admiration for older adults as well as special safety concerns to address in their plans of care.</p>

<p> An exploratory study was conducted to examine the effectiveness of a group gratitude intervention with 29 permanent residents at a long term care/ skilled nursing facility in improving elder mood, behavior, and well- being over a 3 week time period. The sample included individuals diagnosed with dementia, other cognitive impairment, major depressive disorder, insomnia, and generalized anxiety disorder. The gratitude intervention consisted of asking elders to share what they are thankful for at the dinner table each day. Measures included the Elder Well Being Scale and The Dinner Rating Scale. On both measures, higher scores indicated better functioning. To test the hypothesis that post treatment elder well-being will be significantly higher than pretreatment elder well-being ratings, a one-way ANOVA was conducted. Post-hoc tests revealed a statistically significant increase in Elder Well Being Scale scores. An ANOVA of comparing Dinner Ratings demonstrated a nonsignificant increase over the 3 week experiment. Implications are discussed.</p>

<p> This content analysis of existing literature explored older adults' perceptions and use of technology in healthcare. Thirty studies within the last 10 years were analyzed for content. Results of the content analysis revealed that many older adults used the Internet as a health resource and/or to search for health-related information. Some predictors of computer and/or Internet use for health-related information were younger age, more years of education, and more diagnosed diseases and conditions. Barriers of computer and/or Internet use included lack of interest, functional limits, cost, complexity, and security and privacy concerns. Privacy was also an identified as a potential barrier of smart home technology use. Perceived need for technology was important in older adults' willingness to use smart home technology. Implications for social work practice were discussed.</p>

Introduction: To date, there has been little research on driving or transportation use in retirement living seniors or the associations with quality of life, including staying active, socially engaged and connected with the outside community. This thesis is part of a larger project being conducted by a team of researchers at the University of Waterloo to examine these issues in collaboration with the Schlegel-UW Research Institute for Aging, the Schlegel Villages and Luther Village on the Park. Purpose: The primary objectives of this thesis were to: 1) examine the actual driving practices and other modes of travel in relation to functional abilities and other characteristics; 2) examine associations between driving and other modes of travel with community engagement; 3) examine fall status and compare fallers and non-fallers; and 4) compare current drivers to a sample of former drivers with respect to falls, balance confidence, depression, activity levels in and out of Village (engagement) and travel patterns. Methods: A convenience sample of 55 drivers (mean age 81.9 ± 6.2, 49% male) from five retirement villages located in Southern Ontario were assessed between February and October, 2013. Participants completed questionnaires (background and driving history, activities inside and outside the village), scales (depression, well-being, self-reported driving restrictions, perceived driving abilities, balance and driving confidence) and assessments of cognition and executive function, lower body mobility and contrast sensitivity. In addition, participant vehicles were equipped with two electronic data logging devices (vehicle diagnostics and GPS) for two weeks, while they concurrently kept trip logs (for driving trips) and travel diaries (for non-driving trips). Falls were assessed through both self-report and incident reports from the villages. Similar data (from scales, questionnaires, travel diaries, falls) previously collected on a sample of 20 former drivers from these retirement villages was merged into the database to permit statistical comparisons between current and former drivers. Primary Results: Overall, the sample reported driving less after moving to the villages. Compared to prior studies with community seniors, older drivers living in the retirement villages had more restricted driving practices. Residents who were considering driving cessation were not only restricting their driving, but had diminished functional abilities, were more likely to fall, had worse balance and driving confidence, and were less engaged with the community. Compared to current drivers, former drivers were more likely to have fallen in the past year, had lower balance confidence, and were less active outside the village, although they were equally socially engaged. Level of independent living (townhomes versus apartments or suites, versus assisted living rooms) emerged as a significant predictor of community engagement. When level of independent living was controlled for, greater community engagement was associated with younger age, being able to walk 1/4 mile and better balance confidence scores. Driving status approached significance with higher community engagement scores associated with being a current (versus former) driver. Conclusions: The results indicate that although residents of retirement villages may not drive as much as community living seniors, continuing to drive enables them to stay more connected to the broader community. Although few had considered driving cessation prior to relocation, about half the sample were now considering this transition. Retirement living may make the transition to driving cessation easier, particularly for those who take advantage of village shuttle buses and retain the ability to walk to shops and services in the area. Alternate modes of transportation are critical as older adults retire from driving to ensure continued mobility and independence, as well as to maintain productive community and social engagement.

This study examines the lived reality of women caregivers of older adults. Using a microethnographic approach and videographic data collection in the homes of five caregiver - care receiver dyads, the research provides a new account of family caregiving. Grounded in a conceptual framework of embodiment, as articulated by social theorists Pierre Bourdieu and Erving Goffman, the data illustrates that seemingly banal gestures and expressions expose the intimate, often hidden, reality of caregiving. The findings reveal a gendered caregiver habitus characterized by emotional labour, performance, body management, health divestment, and vacillating boundaries between the caregiver and care receiver. The project validates the everyday experiences of women caregivers, proposes recommendations for improved clinical practice, and bridges scholarship on caregiving and the sociology of the body. / Cette étude examine la réalité vécue par les proches aidantes de personnes âgées, à partir d'une approche microethnographique et des données vidéographiques filmées au domicile de cinq dyades proches aidantes – aidé. La recherche fournit un nouveau calvas de prestation de soins familiaux. Ancré dans un cadre conceptuel d'« embodiment », tel que défini par les sociologues Pierre Bourdieu et Erving Goffman, les données recueillies démontrent que les gestes et expressions, de prime abord banals, révèlent une intimité, souvent cachée, des soins prodigués. Les résultats dévoilent un habitus influencé par le genre des aidants qui se caractérise en fonction du travail émotionnel, de la performance, de la gestion du corps, d'un désengagement en matière de santé personnelle, et des frontières poreuses dans la relation entre la proche aidante et l'aidé. Le projet valide les expériences quotidiennes vécues par des proches aidantes, recommande des pistes pour améliorer la pratique clinique et dresse des ponts académiques entre l'étude des soins familiaux et celle de la sociologie du corps.

<p> The purpose of this study was to identify, through meta-analytical techniques, evidence-based recommendations for the type, frequency, and duration of exercise to slow the progression of dementia. Inclusion criteria were that the research had to be published between January 2000 and January 2012 and include both pre- and post-Mini Mental State Examination (MMSE) scores. After conducting extensive computer-aided and manual searches, eight studies were chosen for analysis. Of those eight studies, one study in particular indicated the optimal type, frequency, and duration of exercise to slow the progression of dementia, which was walking four times per week for thirty minutes per session. Future research should include the impact of other forms of exercise on the progression of dementia and the role of physicians in the prescription of exercise to slow the progression of dementia.</p>

<p> A move toward care of residents in nursing homes where they are respected and heard is finally emerging. Common strategies used in nursing homes to improve quality of care for residents are integration of person-centered care and assessing care using satisfaction surveys. Although approaches of integrating person-centered care and satisfaction surveys have been valuable in improving nursing home quality, strategies of care that include things that matter from residents' perspectives while living in nursing homes need investigation. The purpose of this qualitative descriptive study was to describe things that residents age 65 and older state matter to them while living in the long-term care sections of nursing homes. A qualitative mode of inquiry using purposeful sampling led to a natural unfolding of data that revealed things that mattered to residents. Content analysis was used to reduce the data in a manner that kept the data close to the context yet moved the data toward new ideas about including things that mattered to residents in nursing care. The findings revealed residents' positive and negative experiences and addressed the question: How can nurses manage residents' positive and negative aspects of care in nursing homes? This study substantiated the importance of developing nursing care strategies derived from residents' descriptions of care. Finding ways to promote nurses' investment in attitudes about a person-centered care philosophy is essential for successful person-centered care implementation. Enhancing nurses' knowledge, skills, and attitudes with an investment in person-centeredness will be more likely to put nurses in a position to role-model care that is person-centered from residents' perspectives.</p>

<p> The purpose of this qualitative study was to explore, from the perspectives of clinicians, the therapeutic techniques they have found to be effective in helping older adults recover from elder abuse. The researcher developed the interview guide. A total of 12 clinicians, who had experience working with survivors of elder abuse in a therapeutic setting, were interviewed. </p><p> The results indicated that clinicians saw similar symptoms, including depression, anxiety, trauma, and fear. Methods for addressing those symptoms included cognitive-based therapy, active listening, life reviews, and making referrals. Therapeutic involvement with the family was low, but when used included education and active listening. Lastly, there was a high demand from clinicians for prevention efforts and education regarding elder abuse. </p><p> More research is needed on effective interventions for helping older adults recover from elder abuse.</p>