This secondary research study uses data from two convenience samples of homeless persons in Central Arkansas collected during 2004 and 2011 Point in Time Counts. The prevalence of predictors of homelessness are compared across years, and also compared by age (<50 and > 50) controlling for year of survey. The number of older adults increased significantly between 2004 and 2011 surveys, and reporting serious mental illness and veteran status significantly decreased from 2004 to 2011. Age differences were noted in 2004 with older adults more likely to report serious mental illness in comparison to younger adults. Older adults were also more likely to report veteran status in comparison to younger adults during both the 2004 and 2011 surveys. The predictors of homelessness -- including serious health problems, substance abuse, race, age, and developmental disabilities-- remained fairly consistent from 2004 to 2011 and across "age groups". In addition to Point in Time data, qualitative surveys and interviews of providers were performed for their observations of the older homeless population. Providers indicated their belief that the older homeless population is increasing. Providers suggested possible challenges and reasons for the increase among older adults who are homeless. In central Arkansas, service providers feel the current economy, programs, and agencies that provide homeless services and funding sources are adequate at this time as evidenced by no increase in numbers. Due to new funding, improvement has occurred with the veteran population through VA programs. Even though this research did not find any change in gender, the providers feel that for future homeless, trends in gender (women in poverty), as well as older adults becoming homeless for the first time, should be watched in addition to other predictive factors such as the economy, increase in substance abuse, and physical and mental health concerns.

A pre-test, post-test, randomized control study (n=78) was conducted to test whether participation in Stay on Your Feet (SOYF), a falls prevention program for community-dwelling older adults, improved participants’ falls-related self-efficacy and balance. The Activities Balance Confidence (ABC) Scale (Powell & Myers, 1995) was used to measure falls-related self-efficacy and the Timed Up and Go (TUG) test (Podsiadlo & Richardson, 1991) was used to measure balance. Participants in both the intervention and control groups scored at the higher end of the ABC Scale (range 0-100) at baseline (mean 76.78 ± 18.91 and 82.46 ± 18.27 respectively) and at follow-up (mean 75.01 ± 19.51 and 84.10 ± 12.49 respectively), suggesting participants in this study were already fairly confident in their ability to manage daily activities without losing their balance. TUG times at baseline and follow-up testing were low suggesting participants had good balance. The SOYF program did not meet its intended objectives of improving falls-related self-efficacy and balance for participants who received the program. Recommendations for changes to future SOYF programming include targeting older adults with a history of falls or identified falls risk factors. The SOYF program was not effective for this study group; however, it may work for older adults at higher-risk for falls. / Thesis (Master, Nursing) -- Queen's University, 2007-09-27 19:47:26.195

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To date very few studies have examined the difference in driving patterns between winter and non-winter driving and those that have, have primarily used self-report. The purpose of this study was to determine if there were changes in trip distance between winter/non-winter and inclement/non-inclement driving in older adults using a sub-set of Candrive participants. Candrive is a longitudinal study examining the everyday driving patterns and habits of older drivers. Participants were recruited from seven different sites in Canada (Ottawa, Toronto, Montreal, Hamilton, Thunder Bay, Winnipeg, and Victoria). In total 279 participants (of which 248 were kept for analyses of City Only Trips) were included for analysis, almost 50% were female, with an average age at enrolment of 77.5 ± 5.2 years. A total of 377,464 trips were taken on 866 different days. It was found that there was a 7% decrease in trip distance during winter when controlling for day and site when examining all trips taken by older drivers. In addition, there was a 1% decrease in trip distance during winter and a 5% increase in trip distance during rain when compared to no precipitation when controlling for precipitation type (or winter respectively), day, and site, when only looking at trips in the city. There was a minimal (albeit significant) change in trip distance associated with both winter and inclement weather conditions, suggesting that older drivers may not be adjusting their driving patterns during these conditions as much as was previously thought based on the self-report literature.

Background: Frailty has an impact on outcomes in the acute care and in the community setting but there is minimal research that examines frailty in the geriatric rehabilitation setting. Purpose: The purpose of this thesis was to answer the question “What is the association between frailty status and rehabilitation outcomes among older adults?” Methods: A systematic review using the Cochrane Handbook’s guidelines and adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was completed. Four databases were searched as well as grey literature. Screening, extraction, and quality assessments were completed by two reviewers. Data synthesis was completed through vote counting. Results: Twelve studies met the inclusion criteria from which data were extracted. There is a negative association between frailty and discharge functional status, functional change, discharge to home, and a positive association between frailty and length of stay. Conclusion: Further research is needed on this topic to replicate these findings through meta-analyses. Frailty needs to be addressed in the geriatric rehabilitation setting to improve the functional status of frail patients and reduce extended stays in rehabilitation and decrease discharges to a new place of residence.

HIV/AIDS can affect individuals of any age. Efforts to educate those considered to be most at-risk, based on the age at which the most individuals are infected, are ongoing and public. Less work and mainstream education outreach, however, is being directed at an older population, who can be more likely to contract HIV, is more susceptible to the effects of HIV, and more likely to develop AIDS, than younger persons. Guided by the Health Belief Model theory, research was conducted to determine what, if any, relationship existed between age of an individual and the possibility that an HIV test will be sought. Factors of gender, education, ethnicity and marital status were included in analyses. the research indicated that as age increased, likelihood for getting an HIV test decreased. Overall, most individuals had not been tested for HIV. the implications of an aged and aging population with HIV include a need for coordinated service delivery, increased education and outreach.

As medical researchers test the feasibility of deprescribing programs to reduce medication burden associated with polypharmacy, limited scholarly consideration has been given to the perspectives of the older adults largely targeted by these programs. This dissertation makes central the voices of older adults experiencing polypharmacy and/or deprescribing. Presented as a collection of three articles, this work explores the perspectives of older adults on their use of medication in the context of both polypharmacy and deprescribing. Data were collected using in-depth semi-structured qualitative interviews with older adults concurrently using 5+ prescription medications. The first article draws on Habermas’ writing on the contribution of communicative action in negotiating trust within complex social relationships. This analysis highlights the social nature of medication work and challenges to communicative action within personal and professional health systems. The second article applies embodiment theory to understand the way older adults’ construct unique forms of expertise regarding their health, resulting from a lifetime of experiences living as and in their bodies. The last article uses social constructionist theories on systems of classification to show the way dichotomies in medical classifications are often paradoxical. This article offers insight into the work older adults do to optimize their use of medicines in the context of these paradoxes. This study, in its entirety, indicates a need for collective efforts to identify and address the problems of polypharmacy while facilitating appropriate polypharmacy for older adults with complex multiple co-morbidities. Doing so encourages a reframing of polypharmacy as a complex phenomenon about which clinical judgments are made through an ongoing collaboration with the patient and family. / Thesis / Doctor of Philosophy (PhD)

Falls are a leading cause of injury and death in older adults. Numerous exercise interventions have been explored for fall prevention with their effectiveness being inconsistent. An alternative intervention based on motor learning concepts has potential to help prevent falls. Two separate studies are reported in this thesis. The purpose of the first study was to investigate if older adults exhibit short-term performance adaptation and long-term motor learning with repeated exposures to a simulated trip. While in a safety harness, participants stood on a treadmill that was quickly accelerated to simulate a trip. Improvements in trip recovery performance due to repeated exposures of a simulated trip included arresting the forward rotation of the trunk more quickly, reacting to the perturbation more quickly, and decreasing agonist/antagonist co-contraction. Overall, the results provide evidence for both short-term performance adaptation and motor learning. The purpose of the second study was to investigate if skills obtained from repeated exposure to a simulated trip transfer to recovery from an actual trip. Participants were randomly assigned to either an experimental or control group performing one trip before and after an intervention. The intervention for the experimental group consisted of trip recovery training on a treadmill while the intervention for the control group was walking on a treadmill. Overall, the results suggested beneficial effects of trip recovery training on actual trip recovery. These beneficial effects included decreasing maximum trunk angle, decreasing the time to reach maximum trunk angle, and raising minimum hip height during the initial recovery step. / Master of Science

As dementia progresses older adults may lose the ability to communicate their pain experiences to healthcare providers, relying on the ability of the provider to infer their pain (Kelley, Siegler, & Reid, 2008; Pesonen et al., 2009). In the long-term care setting, the licensed nurse and certified nurse aide provide direct patient care to these residents and may be more likely to identify nonverbal behaviors that may indicate pain (Nygaard & Jarland, 2006; Pautex, Herrmann, Michon, Giannakopoulos, & Gold, 2007). The Conceptual Model for Assessing Pain in Nonverbal Persons with Dementia highlights provider, patient, and method-related factors that can hinder the process of inferring pain in nonverbal persons with dementia. The purpose of this dissertation is to explore the impact of these potential barriers on pain assessment/screening. Each chapter of this dissertation explores provider, patient, or method-related factors that impair the judgment of pain in others, either through an integrative review of the literature or by secondary analysis of a data set that was originally collected for the psychometric evaluation of the Non-communicative Patient's Pain Assessment Instrument. Statistical analysis was completed using SPSS version 21.0. Results indicate that nurse-related factors are well supported in the literature as barriers to pain assessment and can impair the nurses' pain assessment decisions. Ethnic differences in the expression of the nonverbal pain behavior "pain words," signify the role of patient-related factors on the pain assessment process. Lastly, examination of method-related factors support the benefits of training staff to use nonverbal pain assessment tools, with those staff members who were trained having greater accuracy in pain assessment when compared to untrained raters. In closing, this dissertation has implications for nursing science, education, policy, and practice and serves as a valuable contribution to the current literature.