As baby boomers age, the population of the United States moves toward a higher proportion of elderly than ever before. These seniors retire earlier, have more discretionary income, active lifestyles and education. They also have a growing interest in fitness--challenging future outdoor recreation planning. Providers of public outdoor recreation, including the U.S.D.A. Forest Service, are under pressure to accommodate all population groups--including seniors. An emerging problem for recreation planners is how to address the special needs generated by this important demographic shift. To explore this issue, the author studied the retirement community Green Valley, Arizona's influence on the Forest Service's Madera Canyon Recreation Area. The study identified Madera Canyon as a model for successful recreation planning by enlisting volunteers, encouraging user participation, providing trails with different experiences, benches, wildlife viewing, and educational opportunities in natural areas, to meet senior's needs. The author provides planning guidelines.

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<p> One in three American older adults fall every year, making falls the leading cause of nonfatal injury treated in the emergency department (Centers for Disease Control and Prevention [CDC], 2013). Fall-related injuries cost the United States healthcare system nearly $30 billion a year and result in 27,000 deaths per year (Burns, Stevens, &amp; Lee, 2016). The risk of falls increases with age, occurring more often in women than man. Age-related muscle weakness and functional decline contribute to fall risk. Age-related changes in neuroendocrine hormone production and shifts in circadian rhythms promote sleep disorders, affecting nearly two-thirds of older adults. Poor sleep quality over time leads to drowsiness and impaired attention span and judgment. The purpose of this secondary analysis of a previously collected data set was to describe the relationships among frailty, subjective sleep quality, and falls in community-dwelling older adults. This secondary analysis also sought to determine the extent to which frailty and subjective sleep quality predict risk of future falls among community-dwelling older adults. Correlational analyses were performed to determine the nature and significance of the relationship between sleep quality and falls, frailty and falls, and sleep quality and frailty. A multiple regression analysis was performed to determine if sleep quality and frailty combined could predict falls. Frailty was found to account for a small variance in fall risk. However, sleep quality was not significantly related to falls nor was sleep quality predictive of falls. Risk for falls should be assessed at every clinical encounter and efforts to promote restful sleep should be addressed at least annually to reduce the risks of falls, functional decline, and sleep disorders among older adults in the community.</p>

Background. Considerable research has demonstrated the link between early life adversity (ELA) and the development of significant health problems in adulthood (Felitti et al., 1998; Gilbert et al., 2015). Regarding the specific biological pathways through which ELAs influence the development of physical health conditions, there is a growing literature examining the effects of ELA on allostatic load. Allostatic load represents the biological toll of stress on the body and may act as a biological pathway through which ELAs influence later health. Importantly, identification of modifiable factors that increase resiliency to the negative effects of ELAs on allostatic systems may lead to the development of prevention and intervention protocols. Finally, the interplay among these variables (e.g., ELAs, allostatic load, resiliency, health functioning) may change with age – thus, it is informative to examine these factors across age groups. Specifically, the current study examined a biopsychosocial model of the effects of ELA on adult health in which we conducted an empirical exploration of the effects of resiliency factors on the relationship between ELAs, allostatic load, and health. Methods. The current study used longitudinal data from three waves of the Midlife Development in the United States (MIDUS) study to examine the following hypotheses. 1) ELAs would lead to higher allostatic load, which would, in-turn, be associated with higher rates of health conditions over time. 2) Resiliency factors would each moderate the relationship between ELAs and allostatic load, reducing the negative effects of ELAs on allostatic load. 3) Lastly, we explored the extent to which these proposed pathways in the full model differed as a function of age. Results. ELA predicted onset of new health conditions among middle-aged adults. Allostatic load partially mediated the relationship between ELA and later health conditions. None of the resiliency factors moderated the relationship between ELA and allostatic load, although ELA was associated with three of the resiliency factors, and all four resiliency factors were related to fewer health conditions at MIDUS III. Finally, there were no differences based on age in the full mediation model. Conclusions. ELA was strongly associated with lower levels of resiliency resources and later health outcomes, even decades following the occurrence of ELA. Allostatic load partially mediated the relationship between ELA and later health, though the effect was weaker than expected. Our findings suggest that ELA and resiliency resources may have more specialized influences on allostatic systems and system biomarkers, which should be examined in future research. Clinical implications of the study point to the continued use of a cumulative indicator for ELA assessment. Finally, the development of interventions to promote certain resiliency resources may be useful in clinical settings to reduce the impact of ELA on later health. / A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2017. / June 8, 2017. / aging, allostatic load, Early life adversity, Health, resilience / Includes bibliographical references. / Natalie Sachs-Ericsson, Professor Directing Dissertation; Miles Taylor, University Representative; Colleen Ganley, Committee Member; Neil Charness, Committee Member; Jesse Cougle, Committee Member.

Studies examining the link between older adults’ labor force participation and health frequently report that later life employment is health enhancing. However, few studies consider how these benefits could vary by socioeconomic status (SES). In this dissertation I seek to address this oversight using data from the Health and Retirement Study (HRS). By exploring the relationship between older adults’ employment, SES, and health in three key areas (i.e., depressive symptoms, total recall, and physical impairment), I provide a more in-depth account of the health implications of later life employment. To accomplish this goal, I conduct three sets of analyses. In the first set of analyses I assess cross-sectional associations between employment status and health. My findings indicate that both part-time employment and full-time employment are significantly linked to fewer depressive symptoms, better recall, and fewer functional limitations. Contrary to my expectations, I find no evidence that full-time employment is especially beneficial compared with part-time employment. In the second set of analyses, I use longitudinal data to evaluate associations between employment stability and change and health. The longitudinal results are generally consistent with cross-sectional findings and indicate a positive relationship between older adults’ employment and health. In the third set of analyses, I examine whether the relationship between older adults’ labor force involvement and health varies by SES using cross-sectional and longitudinal data. A review of the interaction terms from the cross-sectional analyses suggests that SES does not significantly condition such a relationship. However, longitudinal findings do offer some evidence that higher educational attainment and wealth may weaken the association between employment change and cognitive and physical health. / A Dissertation submitted to the Department of Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. / Summer Semester 2018. / July 12, 2018. / Cognitive Health, Employment, Physical Health, Psychological Health, Retirement, SES / Includes bibliographical references. / Anne E. Barrett, Professor Directing Dissertation; Patricia Born, University Representative; Miles Taylor, Committee Member; Dawn Carr, Committee Member.

This dissertation was motivated by the growth in the number of elderly with dementia in the United States and worldwide, and the consequent need to assist caregivers who face the chronic stress and consequent negative outcomes of caring for dementia patients for increasingly longer periods of time. While behavioral and psychological symptoms of dementia (BPSD) are routinely cited as important predictors of negative caregiving outcomes, they consist of a wide variety of patient behaviors (e.g., depression, physical aggression and paranoid delusions). This dissertation aimed to further elucidate the BPSD-caregiver relationship by determining if and why individual components of BPSD impacted caregiver depression, how these relationships change over time, and how the timing of behaviors across the disease course affect the caregiver. First, via a systematic literature review we found that despite the significant amount of research conducted examining BPSD and caregiving, the literature focused on the aggregate effect of symptoms rather than on the effect of individual symptoms. Existing studies categorized BPSD based on how they clinically manifest in the patient, rather than from the perspective of how they may differentially impact the caregiver. Second, we tested the differential impact of four symptom clusters derived based on their likely impact on the caregiver (accusatory/aggressive symptoms, non-threatening psychotic symptoms, depressive symptoms, and difficult behaviors) on caregiver depression. All clusters exerted similar effect sizes on caregiver depression, with patient depressive symptoms exerting the strongest and most consistently stable relationship with caregiver depression. The patient depression-caregiver depression relationship was mediated by both perceived burden to caregivers and impact of symptoms on the patient. Finally, we did not find evidence that the presence of individual BPSD early in the disease course impacted subsequent caregiver depressive symptoms. When examining change patterns over time, we found that most caregivers had stable trajectories of depressive symptoms, with a smaller subset showing more evidence for wear-and-tear over time. Given that there may be a differential effect of individual symptoms on caregivers, research in this field should continue to study the effects of individual BPSD symptoms rather than the cumulative effects of a range of behaviors and should also consider how symptoms may negatively impact caregivers by evoking empathy in addition to increasing burden for the patient. Future work should continue to utilize a longitudinal perspective on caregiving to better characterize the relationship between individual BPSD and caregiver outcomes and to understand varied outcome trajectories. The continued focus on understanding how, why and when BPSD are most detrimental to caregivers can help target and improve patient treatment and caregiver intervention efforts.

<p> Aspects of heart-failure day-to-day health monitoring include adherence to medication, diet, and physical activity recommendations, and identifying changes in dyspnea, fatigue, or lower-limb edema. Participation in a telehealth program can guide day-to-day health monitoring toward healthy behaviors and symptom recognition. The purpose of this study was to characterize telehealth data, nurse responses to telehealth alerts, and healthcare utilization by participants. A retrospective review was conducted of the initial 90 days of 187 older veterans with heart failure participating in one Care Coordination Home Telehealth program from September 2007&ndash;September 2013. Data were collected from telehealth records and electronic medical records. Descriptive statistics were used to identify differences in call compliance, telehealth alerts, and nurse responses to alerts. Rates of heart-failure-related healthcare utilization were analyzed using logistic regression. Participants were predominantly male and non-Hispanic White, with the comorbidity of hypertension and an average age of 73.9 years. Telehealth call compliance was 75.8%. There was a sharp decline in daily compliance the 1st week of program participation, with a significant nonlinear effect. The mean proportion of submissions measuring within alert range was 23.3% (<i>SD</i> = 24.6) for weight and 1.3% (<i>SD</i> = 3.3) for dyspnea. The mean proportion of timely nurse response to alert range data was 15.1% (<i>SD</i> = 17.7) for weight and 48.5% (<i>SD</i> = 43.0) for dyspnea. Among the sample, 17.6% required an emergency department visit and 18.2% required inpatient hospital care. Hospital length of stay was likely to increase among participants with chronic renal disease (incidence rate ratio [IRR] = 1.78, <i>p</i> &lt; 0.001), advancing age (IRR = 1.01, <i>p</i> &lt; 0.001), presence of telehealth alerts (IRR = 1.006, <i>p</i> &lt; 0.035), and presence of nurse responses to alerts (IRR = 1.013, <i>p</i> &lt; 0.001). The initial rapid drop in daily compliance by older adults highlights the need for equipment training and follow-up support throughout the 1st week of participation. Telehealth alerts and nurse responses to alerts were statistically significant predictors for heart-failure-related hospital length of stay. Future healthcare utilization risk models and clinical trials of telehealth systems should include measures related to telehealth alert-range data and nursing responses to changes in patient status identified by telehealth alerts. </p><p>

In developed countries, most healthy retirees still have fears about growing old; however, there is little empirical data on the relationship between this fear and quality of life. This cross-sectional, correlational, survey study tested whether a summated measure of fears of growing old (fear) based on Laslett’s theory of retirement (the third age) significantly predicted life satisfaction and retirement satisfaction after adjusting for significant activity theory covariates. 190 Canadian volunteer retirees at 3 community retirement centers completed surveys. A pilot study established the reliability and valdity of the scales, including an instrument Fears about Growing Old derived from Laslett’s exemplifications, used to assess the independent variable. In a regresion analysis, fear (R2 change = .06) was found to be a statistically signficant predictor of life satisfaction when controlling for 5 covariates (activity level, circumstance on the last job, non job-related interests, post-retirement work, and social support); overall R2 = .26. In the model with retirement satisfaction as the outcome, fear significantly explained variance in the outcome (R2 change = .04) while controlling for 2 significant covariates (activity level and social support); overall R2 = .14. A separate analysis did not support a work by gender interaction on satisfaction. The highest rated fears were loss of indpendence and loss of mobility, and men rated loss of partner very high while women rated disease very high. Implications for positive social change include preparing employers, counselors, workers at senior centers, and spouses to discuss these fears with prospective and recent retirees to help them cope more effectively which can lead to improved quality of life.

Thesis (Ph. D.)--University of Oklahoma, 1992. / Includes bibliographical references.

<p> Unpaid family caregivers of people with dementia are faced with a variety of physical, emotional and social stressors. A systematic review of the literature was compiled to summarize existing evidence regarding subjective burden, expressed emotion and psychological distress related to this category of caregiving and to build a multinational representation of these individuals that will facilitate in identifying areas of supportive intervention. A synthesis of 44 data sets that included 5,249 participants from 20 countries indicated that the majority of caregivers are experiencing depression and high levels of distress related to their caregiving role, and that a small number of caregivers are relying on coping strategies that may add to their distress. Results suggest an ongoing need for medical and psychology practitioners to be aware of appropriate supportive and mental health interventions to improve the quality of life for people with dementia and their family caregivers.</p>