Objectives: This study aimed to investigate the risks and impacts associated with fractures, osteoporosis, frailty, physical function, and dementia in older adults in community and LTC setting. The study aims to identify important factors influencing these health issues and identify strategies for improving management and outcomes. Methods: The research integrates data from three primary sources: Project 1 (ICES Data Repository): Healthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures and osteoporosis management among adults aged 66 and older from April 1, 2014, to March 31, 2018. Osteoporosis management was assessed through pharmacotherapy records. Sex-specific and age-standardized rates were compared based on pre-fracture residency and discharge location (e.g., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS). Project 2 (Canadian Longitudinal Study on Aging - CLSA): Participants aged 45 to 85 years who completed both the baseline and three-year follow-up assessments were included. Outcomes examined include frailty (Fried Frailty Phenotype), and physical function limitations. MSK conditions were self-reported diagnosis by a health care professional and included rheumatoid arthritis (RA), osteoarthritis (OA), low-back pain, osteoporosis, and related fractures. Project 3: The review employed Arksey and O'Malley's framework, guided by Joanna Briggs Institute methodology and PRISMA-ScR guidelines. A comprehensive search strategy was implemented across MEDLINE, EMBASE, CINAHL, and grey literature. Independent reviewers used Covidence software for study selection and data extraction. A narrative synthesis was conducted to summarize findings, identify patterns, and highlight gaps in the literature. Findings: We found increasing hip fracture rates and low osteoporosis treatment in LTC settings, highlighting to the need for improved screening and management of osteoporosis treatment in LTC. In community, hip fracture rates decreased. We found that older adults with musculoskeletal (MSK) conditions at baseline were more likely to experience frailty at the three-year follow-up compared to those without MSK conditions. However, this association was not significant in the unadjusted analysis. Individuals with cognitive decline experience worse outcomes following hip fractures, underscoring the need for integrated care addressing both physical and cognitive health. Conclusion: Hip fractures, frailty, physical function decline, and cognitive decline are prevalent and interrelated issues among older adults aged 65 and older. These findings underscore the need for improved screening and integrated care strategies to enhance management and prevention of these complex health challenges. / Thesis / Doctor of Philosophy (PhD) / Aging is associated with increased risks of osteoporosis, fractures, frailty, physical function decline, and dementia, particularly for older adults in long-term care (LTC). This study explores these health challenges by analyzing data from three key sources: ICES, the Canadian Longitudinal Study on Aging (CLSA), and a scoping review of patient-important outcomes following a hip fracture in older adults with cognitive impairment or dementia. First, we found increasing hip fracture rates in LTC and among older adults living in community at time of fracture and transferred to LTC post fracture. Osteoporosis treatment was low among high fracture risk LTC residents. Second, we found that older adults with baseline musculoskeletal (MSK) conditions (osteoporosis, fractures, osteoarthritis (OA), rheumatoid arthritis, and back pain) were more likely to become frail and have physical function limitation over three years compared to those without MSK conditions. However, after adjusting for covariates, these associations were no longer significant. Among the individual MSK conditions, we found older adults with only OA and osteoporosis-related fractures to be significantly associated with physical functional limitations. Lastly, we found that following a hip fracture, older adults with cognitive impairment or dementia have poorer functional outcomes, reduced quality of life, higher hospitalization and mortality rates, and are significantly more likely to be institutionalized compared to older adults without cognitive impairment or dementia, highlighting the need for integrated care that addresses both physical and cognitive health

Research surrounding older adults, social support, and emotional well-being are richly researched topics. However, literature is devoid of qualitative studies and research focusing specifically on community centers and older adultsâ social networks, which are integral for understanding the growing needs of older adults in todayâ s society. Guided by the theoretical frameworks of phenomenology, activity theory, and ecological theory, four in-in-depth interviews were conducted and then coded for themes. The central themes highlighted family connection, connection with others, resiliency, helping others, type of activity, restoring self, community connection, exploration, convenience, and life stages. Suggestions for future research and possible impacts for clinical practice are discussed. / Master of Science

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The aging Canadian population is becoming increasingly ethno-culturally diverse primarily due to immigration. This, together with research indicating increased likelihood of long-term residential care (LTRC) use at older ages and challenges in providing these services, prompt important questions about whether LTRC services are prepared to provide culturally responsive and competent care to immigrant and ethno-cultural minority older adults (EMOA). This ethnographic study, informed by a critical theoretical perspective, explored these questions from the perspectives of South Asian older adults (SAOAs) and their family caregivers (FCGs). In-depth interviews with 18 SAOAs in LTRC, assisted living and those at home, their FCGs, and seven key informants from LTRC and the South Asian (SA) community (n=43) were undertaken. These interviews, in addition to 220 hours of participant observation in two LTRC facilities, provided information regarding the needs, preferences, experiences and situation of SAOAs in LTRC as well as how SA families make decisions regarding the use of such services. A select review of provincial policy, residential care regulation, health authority and facility documents, exposed taken-for-granted assumptions in how care and services are provided and the sociopolitical context of LTRC provision. Study findings suggest that LTRC services are challenged to meet the needs of immigrant and EMOA and reflect unequal and inequitable care, illuminated by the differential impact of macro-policies and resource-constrained LTRC environments on SAOAs and their families and on the ability of existing LTRC services to provide person-centred care. This inequity in service provision has implications for immigrant and EMOA and their family members in light of findings that the decision to move to LTRC is essentially a (non) decision influenced by a range of social structural factors that interact to necessitate the move to LTRC. Study findings revealed the salience of socio-economic status and economic resources in particular, in the (non) decision for LTRC placement. The findings from this study along with demographic shifts in the aging Canadian population call for LTRC service providers and policy makers to actively prepare for increasing ethno-culturally diverse resident populations and point to the need for equity informed approaches to the care of older adults. / Graduate / 2022-03-31

Malgré des études prolifiques sur le bien-être et la détresse psychologique, peu d'études ont testé la relation entre ces domaines de la santé mentale. De plus, il y a peu de modèles de la santé mentale qui ont été validés auprès des personnes âgées. II est essentiel de comprendre la notion de santé mentale des personnes agées étant donné le nombre important que represents cette population. Obiectifs : L'objectif de cette étude était de tester un modèle de mesure de la santé mentale chez les Canadiennes et Canadiens agés. Une validation de construit a été realisée pour les échelles de mesures du bien-être et la détresse psychologique et l'hypothèse d'indépendance des deux dimensions a été examinée. Le modèle a été testé selon le sexe et l'âge. Méthodoloqie : Les données proviennent de L'Enquête sur la santé dans les collectivités canadiennes - Cycle 1.2 - Santé mentale et Bien-être de Statistique Canada (2002). Cette étude épidemiologique transversale a été realisée auprès de 37 000 canadiens vivant dans la communauté dont 8 000 personnes de 65 ans et plus. Les échelles de mesures incluent l'Echelle de mesure des manifestations de bien-être psychologique de Masse et al. et le K10, une mesure de détresse psychologique developpée par Kessler et al. Les modèles d'équations structurales ont été testés à l'aide de la version 8.71 de LISREL. Résultats : Le modèle 2-facteur était valide pour les hommes et les femmes ages de 55 - 74 et 75 et plus. Ses résultats sont en accord avec la littérature. L'échele du bien être besoin plus d'études de validation. Des échantillons plus grands des personnes âgées ont nécessaires pour valider l'étude étant donne les méthodes utilités.

The older lesbian, gay, and bisexual (LGB) population is often underrepresented in the current body of research and the needs of this population are not well understood. Most research with this population has focused on wealthy, gay men, creating a deficit in regard to our understanding of the lesbian and bisexual individuals in the population. The present study was designed to add to the body of research on same-sex attracted older adults, by assessing well-being and acceptance of sexual orientation within the population. This study filled gaps in our current understanding of this population and provided new data for the Gay Identity Questionnaire (GIQ) as well as normative data for this population on several measures of well-being. Additionally, it created an image of how older same-sex attracted adults view themselves and the needs that they perceive within their population. Same-sex attracted adults, age 50 and older, were recruited through an anonymous online survey (N = 327; Age M: 59 years old, SD = 6.96). Sexual identity development was assessed with the GIQ (Brady & Busse, 1994; Halpin & Allen, 2004), and psychological well-being was assessed via the Depression-Happiness Scale (Joseph & Lewis, 1993), Satisfaction with Life Scale (Pavot & Diener, 1993), UCLA Loneliness Scale (Russell, 1996), Rosenberg's Self Esteem Scale (Rosenberg, 1989), Interpersonal Support Evaluation List. Regression analysis showed that age was overall a significant predictor of all of the outcome measures, with higher age predicting better well-being scores. The GIQ was not a significant predictor in the final model. The implications of these results in regard to the usefulness of the GIQ as a research and clinical assessment tool are discussed, as well as suggestions for future research with this population. A descriptive analysis of results and participants comments is also provided, with an emphasis on different areas of need within the older LGB population.

This thesis portfolio examines attitudes to ageing in older adults, and explores the impact that attitudes to ageing have on mental health status and quality of life. Attitudes to ageing are becoming more widely measured in older adults, particularly with the ageing population but also due the recent development of the Attitudes to Ageing Questionnaire. There is growing evidence to suggest a relationship between attitudes to ageing and mental health status in older adults. However, no study has explored the association between attitudes to ageing and quality of life in older adults, incorporating the Attitudes to Ageing Questionnaire and the World Health Organisation Quality of Life measures. Firstly a systematic search of studies exploring the relationship between attitudes to ageing and mental health in older adults (≥55 years) was undertaken. All potentially relevant studies were screened against inclusion and exclusion criteria. Variables related to attitudes to ageing, ageism, age stereotypes, depression and anxiety were considered in this review. Twelve papers met inclusion criteria for the systematic review. The setting, culture and measures incorporated varied across the studies. A negative attitude to ageing was associated with poorer mental health status in older adults across all 12 studies. The second part of this portfolio was an international cross-sectional analysis of attitudes to ageing and quality of life in older adults (≥57 years). Correlation and regression analyses explored the relationship between attitudes to ageing and QOL and investigated the impact of socio-demographic variables, depression and attitudes to ageing on two quality of life measures. The two constructs were positively related; a more positive attitude to ageing was associated with a better quality of life. Further, positive attitudes to ageing was a significant predictor of a better QOL. The sample was then divided into two age groups (57-79 years and 80+ years) and attitudes to ageing and quality of life ratings were compared. Results revealed more negative ratings in attitudes to ageing and quality of life in the over 80 year old age group. Correlation and regression analyses were then explored across both age groups. More positive attitudes to ageing was a significant predictor of better quality of life across both age groups. Overall, the two studies in this thesis portfolio highlight the need to better recognise and target older adults’ negative attitudes to ageing. Appropriate psychological interventions could be provided to challenge negative attitudes and promote attitude change in an attempt to improve mental health difficulties and quality of life in older adults. Continued use of the Attitudes to Ageing Questionnaire and quality of life psychometric measures in clinical practice and research is encouraged.

Aims The overall aim of this thesis was to extend current knowledge about the prevalence of malnutrition, to identify possible risk factors for development of malnutrition, and to describe the consequences of malnutrition in relation to all-cause and cause-specific mortality among older adults admitted to hospital. Methods The prevalence of malnutrition was estimated in a cohort of 1771 older adults (≥65 years) who were admitted to a Swedish hospital during 2008–2009 (15 months) and screened for malnutrition using the Mini Nutritional Assessment (MNA) instrument. Possible risk factors for malnutrition were recorded during the hospital stay (Study I). Dietary intake 10 years earlier (in 1997) was collected for 725 of these older adults (Study II). All-cause (Study III) and cause-specific (Study IV) mortality were followed up after medians of 3.5 and 5.1 years, respectively, for 1767 of the participants. Results The prevalence of malnutrition was 9.4% while 55.1% were at risk of malnutrition. Risk factors for malnutrition was an overnight fast >11 hours, <4 eating episodes a day, and not cooking independently. In middle-aged and older adults with a body mass index <25 kg/m2 in 1997, the risk of malnutrition increased for each additional percentage point of energy from total, saturated and monounsaturated fat at follow-up after 10 years. Malnourished older adults had almost four times higher risk of death during follow-up, while those at risk of malnutrition had a 56% higher risk, compared to well-nourished. Furthermore, well-nourished older adults had consistently lower risk of death, regardless of the cause of death. Conclusions Only 35.5% of older adults admitted to hospital were well-nourished. The identified risk factors could be used in interventions aimed at preventing malnutrition. Normal-weight and underweight middle-aged and older adults should consider limiting the intake of total fat and/or improve the quality of the fat in the diet in order to decrease the risk of becoming malnourished later in life. Malnutrition and risk of malnutrition were associated with increased overall and cause-specific mortality. These relationships emphasize the need for nutritional screening to identify individuals who may require nutritional support in order to avoid preterm death.

The aim of the thesis was to investigate factors influencing ICT use by older-adults. A selection of psycho-social, socio-demographic and health determinants were investigated with Internet use. Data were collected through questionnaires (Studies I-III) and interviews (Study IV). Univariate and multivariate analyses were conducted, investigating Internet use as a dichotomous variable, with the aforementioned factors. The results indicated that psycho-social determinants did not affect older-adults’ Internet use (Study I). Scoring higher on the personality traits openness and extraversion did not affect whether the older adults started to use the Internet (Study II). However, well-being increased for some frail older-adults when using the tablet computer and connected to the Internet (Study IV). Some socio-demographic determinants affected Internet use. Being younger in age was a strong contributing factor in all four studies whether the older-adult would use the Internet. Higher education influenced Internet use (Study I & III), correlated with living in a rural or urban setting (Study III); yet education was not influencing whether they would start to use the Internet. Living alone was correlated with Internet use, especially if the older-adult lived in an urban setting (Study III). Functional disability and household economy did not affect Internet use. Finally, the health determinants on Internet use were quite strong. Normal cognitive functioning influenced whether older-adults would start to use the Internet (Study II). The older-adult living in an urban environment, would use the Internet if they had normal cognitive functioning (Study III). It was noted also from Study IV that the learning to use the Tablet PC and Skype took longer for older people and more repetition was needed. Being frail was a strong factor whether the older-adult would use the Internet. They would not want to learn or try to use the technology if they were too ill (Study IV). The findings show only a small increase (7.7%) in Internet use by older-adults over time. The indicators of non-use are: higher in age, lower educated, living alone or rurally, lower cognition and frailty. There are two different profiles of rural and urban Internet users. These determinants along with an understanding of the use of technology, and a good support system, are a few pillars in ICT adoption by older-adults. As ICT continues to develop as a means to provide better health care, it will be important to take into account the abovementioned indicators. In certain cases Internet use is not a given, which continues to exclude older-adults. Part of healthy aging is social participation; therefore being connected and included in the digital society is important. Alternative and not only one design solutions should be explored in health care and by organisations, so as to cater to the heterogeneity of the aging population.