The aim of this littrature review has been to describe how you can satisfy the need of nourishment for older people who suffer from dementia. Data has been retrieved by searches in Academic Search Elite, Sience Direct, Blackwell, PubMed and in the Journal Vård i Norden. The studies show that most of the people with dementia have a hard time to satisfy the nourishment. The results show that through different preventive measurement you can improve the nourishment for these people, to set the table, play calm music and to have a table companion. By taking the food oneself created a good meal environment and the individually need was provided for. A good oral status improved the nutritional status. Patients who got nourishment addition put on weight or retained their weight. Nursing staff wished and needed more education in nutrition for older people with dementia.

It is well established that there are many intrinsic and extrinsic risk factors associated with falls in older adults. Less well-known is what risk factors predict falls in more vulnerable populations, such as those with neurological conditions living in long-term care homes or receiving home care services. Furthermore, evidence comparing those with neurological conditions to those without is lacking in the literature. The primary purpose of this thesis was to determine risk factors for falls in long-term care residents and home care clients with no recent history of falls to determine if risk factors differed between individuals with dementia or Parkinson’s disease and those without any neurological conditions. Secondary data analysis was performed on a database of standardized health assessments completed for long-stay home care clients and long-term care residents in Ontario. Within each major diagnostic group, observations were stratified based on ambulatory status (ambulatory vs. non-ambulatory). Bivariate analyses followed by generalized estimating equations were used to determine statistically significant predictors of falls in each group within each care setting. The results of multivariable analyses showed that there is not a distinct set of risk factors associated with falls in home care clients and long-term care residents with dementia or Parkinson’s disease that is systematically different from risk factors associated with falls in clients and residents not diagnosed with any of the neurological conditions in this study. These results suggest that a common set of risk factors may effectively predict falls in all clients and residents with no recent falls history, regardless of certain neurological diagnoses.

With the growing number of older adults in the general population, there is also a concomitant rise in the number of older adults who require mental health services, making the measurement of psychological conditions in later life a priority. However, due to a lack of measures created for older adults, researchers and clinicians must often rely on measures created for younger populations. Three studies were designed to add to the field of evidence-based assessment and determine which anxiety measures possess strong evidence when used with older adults to warrant their use with this specific population. In the first study, I systematically reviewed the literature to identify the anxiety measures most commonly used with older adults. I reviewed each measure to examine its psychometric properties (e.g., internal consistency, test-retest reliability, inter-rater reliability, concurrent and discriminant validity) and the availability of age-appropriate norms in order to evaluate whether the instruments are appropriate for use with older adults. In the second study, I conducted a reliability generalization meta-analysis to estimate the mean reliability of each commonly used anxiety measure identified in the first study. Finally, in the third study, I examined whether the anxiety measures commonly used with an older population can be consistently and accurately categorized as evidence-based. The literature review and the reliability generalization study both revealed that most of the most commonly used measures lacked sufficient evidence to warrant their use with older adults. However, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults. This suggests that based on their overall level of reliability and previous psychometric evidence, both researchers and clinicians assessing anxiety in a geriatric population should consider these measures as likely to be the best currently available.

Osteoarthritis is a disease that causes decreases in hand function in the elderly adult and can lead to full disability of the hand. There is no clear cause of osteoarthritis of the hand, although injury and overuse can contribute to development of the disease. Traditional treatments include splinting, paraffin therapy, medications and, in severe cases, joint replacement. Nontraditional therapies include mobility training, therapeutic touch, acupuncture and exercise. The purpose of this study was to explore the non-traditional treatment of hand-strengthening exercise as a way to improve hand function. Specifically, this study evaluated the effects of an eightweek hand exercise program utilizing Hand Exercisers and FlexBars on hand grip strength and dexterity in 13 elderly women aged 70-85 (M=80.4, SD= +/- 4.25) who showed signs and symptoms of hand osteoarthritis, which are pain, stiffness and swelling.. Participants were evaluated before and after the exercise intervention for grip strength, pinch strength, range of motion of the trapeziometacarpal, metacarpophalangeal, interphalangeal and wrist joints, and were timed on a hand dexterity test that involved putting on and buttoning a shirt with ten 3/8th inch buttons. A repeated measures ANOVA was the mode of data analysis. Hand strength significantly improved (p<0.05), as both grip (19%) and pinch (26%) strength showed improvements. In range of motion testing, palmar flexion (12%), interphalangeal flexion (46%), metacarpophalangeal flexion (39%) and wrist extension (11%) showed significant improvements while palmar abduction (12%) and wrist flexion (8%) did not. Hand dexterity also improved as evidenced by a 24% decrease in the amount of time to button a shirt. Pain, stiffness and disability, as measured by the AUSCAN, also decreased significantly, with a 17.3% decrease in means. The results indicate that hand exercise programs can be used to increase hand function while decreasing the signs and symptoms in patients with hand osteoarthritis. / Thesis (M.Ed.)--Wichita State University, College of Education, Dept. of Kinesiology and Sport Studies. / "July 2006." / Includes bibliographic references (leaves 33-37).

Objective: The purpose of this investigation was to examine the effect of implementation intentions on physical activity in older adults with stronger and weaker executive control resources (ECRs). Methods: One hundred and ten community dwelling older adults (Mage=74.42) were randomly assigned to receive either a physical activity implementation intention intervention, a control intervention, or no-treatment. Three ECR facets (inhibition, task-switching, working memory), baseline behaviour and baseline intentions were assessed during the initial laboratory session. During 4 weekly follow-up telephone interviews, participants reported physical activity behaviour for the previous week, and refreshed implementation intentions for each upcoming week. Results: A main effect of treatment condition on 1-month self-reported physical activity was observed, with those in the experimental group reporting significantly higher physical activity than those in the control or no-treatment conditions. In addition, a significant 2-way (intention strength by treatment condition) interaction emerged, with the experimental group showing higher intention-behaviour correspondence than the control and no-treatment groups. A marginal 2-way interaction of intention and behavioural inhibition was also detected; those with stronger behavioural inhibition had higher intention-behaviour correspondence relative to those with weaker behavioural inhibition across all three treatment conditions. Conclusions: Implementation intentions are effective in facilitating physical activity in healthy older adults. The findings also indicate that behavioural inhibition may be important for the moderation of intention-behaviour relationships in the context of physical activity, regardless of goal setting strategy.

INTRODUCTION: The fastest growing segment of the U.S. population is among individuals aged 50 and older. However, advanced age is not protective against HIV. AIM: The purpose of this study is to examine individual characteristics (gender, age, education) as well as environmental and behavioral factors (doctor visits and IDU) that may be linked with HIV status among older heterosexual African American adults. The factors associated with HIV status that were examined include education level, IDU within the last six months, non-injected drugs that were used within the last six months and the length of time since the last doctor visit. METHODS: The original study used participant-driven sampling to identify seeds in high risk zip codes within the City of Atlanta to complete questionnaire and provide biospecimens. This study focuses on the interviews and test results of participants ages 50 and older. Associations of demographic characteristics, behavioral risk factors and HIV status were analyzed using Pearson chi-square, univariatae, and multivariate tests. RESULTS: African Americans who have injected drugs within the last six months are more likely to be HIV positive than those that have not injected drugs in the last six months. DISCUSSION: Results of this study reveal that there are unique patterns of risk taking behavior among older adults. These findings can provide potential intervention opportunities that may prevent HIV transmission among this vulnerable, increasing segment of the population.

Introduction: Bandura’s self-efficacy theory postulates that confidence is a stronger determinant of behaviour than one’s actual skills or abilities. The Day and Night time Driving Comfort Scales (D-DCS and N-DCS) are new tools to measure perceived confidence in older drivers. Developed inductively with older drivers, the DCSs have good structural properties and preliminary psychometric support, including test-retest reliability. Purpose: This thesis builds on previous work by further examining the construct validity of the DCSs via (1) temporal associations (Study 1) and (2) cross-sectional relationships (Study 2). Study 1 prospectively examined the relationship between DCS scores and self-reported driving behaviour. Study 2, meanwhile, examined cross-sectional associations between DCS scores and selected sample characteristics, self-reported driving behaviour and driving problems, perceived abilities and seven objectively measured driving-related abilities (visual acuity, contrast sensitivity, disability glare, brake reaction time, lower body mobility, executive skills and visual attention). Methods: For Study 1, a convenience sample of 82 older drivers (aged 63 to 93) were assessed at baseline and follow-up (five to 17 months later). Study tools comprised the DCSs, multi-item ratings of driving frequency, avoidance and perceived abilities and a background questionnaire. Telephone interviews were conducted with a subgroup of 45 drivers to examine reasons for changes in driving comfort. For Study 2, cross-sectional relationships with the DCSs were examined using baseline data from 65 drivers (aged 63 to 93). A subgroup of 42 participants completed objective assessments of driving-related abilities assessed via ETDRS charts, Pelli-Robson charts, Brightness Acuity Tester, brake reaction time apparatus, the Rapid Paced Walk, the Trail Making Tests (Parts A and B) and the UFOV subtest 2. Results: Prospectively, lower baseline N-DCS scores (p<.001) and decreased N-DCS scores (p<.001) were significant predictors of lower self-reported situational driving frequency (R2 = 34%) and greater situational avoidance (R2 = 51%) at follow-up. While DCS scores did not change appreciably for those who continued driving, N-DCS scores were significantly lower at follow-up for seven individuals who stopped driving (p<.05). Cross-sectionally, lower DCS scores were significantly associated with lower self-reported situational driving frequency, higher situational avoidance and lower ratings of perceived abilities (p<.001). Poorer left eye acuity scores were significantly associated with lower D-DCS (p<.05) and N-DCS (p<.05), while slower performance on Part A of the Trail Making Test was significantly related to lower D-DCS scores (p<.05). Participants with a discrepancy between their perceived and actual abilities had significantly higher D-DCS, situational driving frequency and lower situational avoidance (p<.05). Conclusions: Findings are consistent with Bandura’s self-efficacy theory and Rudman’s model of driving self-regulation and, thus, provide further support for the construct validity of the DCSs. Further studies are needed with larger, more diverse samples, including those with diagnosed impairments, to establish benchmarks for driving comfort in healthy drivers and various clinical populations (such as those with stroke, Parkinson’s or visual conditions). Prospective studies should also involve longer follow-up periods, examination of actual driving behaviour and barriers to self-restriction, and attempt to pinpoint whether there is a critical level of discomfort at which voluntary cessation is likely to occur.

The hazard perception test developed by Sagberg and Bjornskau (2006) measuring reaction times in relation to different hazardous situations in traffic, has been used in the present study to analyze older drivers’ visual behaviour when passing/responding to the test. The overall objective of this study has been to investigate the relation between hazard perception in traffic and visual behaviour among older drivers in comparison with a younger age group. The purpose of the study was to provide knowledge on what traffic situations that are more difficult for older drivers to interpret or perceive as hazardous. The elderly were expected to have more problems in situations that included objects classified as context hazards. Context hazards consist of objects that are slowly moving on the side of the road, which poses a situation where the driver should be prepared for the potential behaviour of that object. The study was composed of two groups of drivers, one group of middle-aged drivers, 35-55 years old, and one group of older drivers, 65 years old and above, who performed the hazard perception test wearing an eye tracker. Hazard interpretation level within age group and situation was investigated, and eye movement data analyzed in terms of fixation duration time. Overall results showed that the older participants had more problems in interpreting situations classified as context hazards as risky, especially context hazards consisting of pedestrians or cyclists. The differences were nevertheless significant. In addition, when investigating total fixation time on the hazard objects, the differences between age groups were shown to be significant for one of the situations consisting of pedestrians, classified as context/hidden hazard. No significant differences between age groups were found in either of the other situations. The conclusions are that the elderly tentatively should be exposed to context hazards composed by pedestrians or cyclist in future training schemes. Since there were no significant differences between age groups, more research is, however, needed in the area. Also, since the class of context/hidden hazards, which showed significant differences in fixation time between age groups, was composed by only one situation, resembling situations should be investigated in order to verify these differences.

Health seeking behaviour is important in older people with hypertension and overweight, in terms of managing health factors that are related to their health and illness. However, health seeking behaviour of Thai older people is not well documented. This qualitative study aimed to describe health seeking behaviour of overweight hypertensive older people. Seven older women and three men participated in this study through purposive sampling. Qualitative data were gathered via in-depth interviews and were analyzed using content analysis. The results of this study illustrated that older people started to seek health care after understanding the need to seek health care due to the severity of their symptoms. The older people began illness management by using their knowledge to take care of themselves. If management was ineffective, they would seek health care from professional health care providers and traditional healers. Additionally, family members play important roles in the health seeking behaviour of older people. In particular, Thai older people with hypertension and overweight demonstrate various health seeking behaviours that are useful to health care providers in providing appropriate care to these older people, aiming to promote better health of the older people.

Introduction: Bandura’s self-efficacy theory postulates that confidence is a stronger determinant of behaviour than one’s actual skills or abilities. The Day and Night time Driving Comfort Scales (D-DCS and N-DCS) are new tools to measure perceived confidence in older drivers. Developed inductively with older drivers, the DCSs have good structural properties and preliminary psychometric support, including test-retest reliability. Purpose: This thesis builds on previous work by further examining the construct validity of the DCSs via (1) temporal associations (Study 1) and (2) cross-sectional relationships (Study 2). Study 1 prospectively examined the relationship between DCS scores and self-reported driving behaviour. Study 2, meanwhile, examined cross-sectional associations between DCS scores and selected sample characteristics, self-reported driving behaviour and driving problems, perceived abilities and seven objectively measured driving-related abilities (visual acuity, contrast sensitivity, disability glare, brake reaction time, lower body mobility, executive skills and visual attention). Methods: For Study 1, a convenience sample of 82 older drivers (aged 63 to 93) were assessed at baseline and follow-up (five to 17 months later). Study tools comprised the DCSs, multi-item ratings of driving frequency, avoidance and perceived abilities and a background questionnaire. Telephone interviews were conducted with a subgroup of 45 drivers to examine reasons for changes in driving comfort. For Study 2, cross-sectional relationships with the DCSs were examined using baseline data from 65 drivers (aged 63 to 93). A subgroup of 42 participants completed objective assessments of driving-related abilities assessed via ETDRS charts, Pelli-Robson charts, Brightness Acuity Tester, brake reaction time apparatus, the Rapid Paced Walk, the Trail Making Tests (Parts A and B) and the UFOV subtest 2. Results: Prospectively, lower baseline N-DCS scores (p<.001) and decreased N-DCS scores (p<.001) were significant predictors of lower self-reported situational driving frequency (R2 = 34%) and greater situational avoidance (R2 = 51%) at follow-up. While DCS scores did not change appreciably for those who continued driving, N-DCS scores were significantly lower at follow-up for seven individuals who stopped driving (p<.05). Cross-sectionally, lower DCS scores were significantly associated with lower self-reported situational driving frequency, higher situational avoidance and lower ratings of perceived abilities (p<.001). Poorer left eye acuity scores were significantly associated with lower D-DCS (p<.05) and N-DCS (p<.05), while slower performance on Part A of the Trail Making Test was significantly related to lower D-DCS scores (p<.05). Participants with a discrepancy between their perceived and actual abilities had significantly higher D-DCS, situational driving frequency and lower situational avoidance (p<.05). Conclusions: Findings are consistent with Bandura’s self-efficacy theory and Rudman’s model of driving self-regulation and, thus, provide further support for the construct validity of the DCSs. Further studies are needed with larger, more diverse samples, including those with diagnosed impairments, to establish benchmarks for driving comfort in healthy drivers and various clinical populations (such as those with stroke, Parkinson’s or visual conditions). Prospective studies should also involve longer follow-up periods, examination of actual driving behaviour and barriers to self-restriction, and attempt to pinpoint whether there is a critical level of discomfort at which voluntary cessation is likely to occur.