The number of people aged 60 years and above is increasing in the UK. In total, this age group represents 22% of the population with estimates indicating a rise to 29% by 2050 (United Nations, 2009). One market sector that is extremely important to the health and wellbeing of older people is grocery retail (Khan, 1981). However, little previous research has addressed how older people rate the service delivered by their grocery provider, particularly in regard to satisfaction. To reconcile this gap in theoretical understanding, a sequential transformative mixed-method research design was specified using 36 qualitative interviews and quantitative questionnaires with 524 subjects. A model including both drivers and consequences of satisfaction was formulated using past research. As such, an antecedent scale for grocery store image was developed via procedures suggested in the extant literature (e.g. DeVellis, 2003). Pre-existing scales (i.e. commitment and loyalty) representing exemplary reliability and validity were borrowed and specified as consequences. The scales were modified and integrated into a ‘structural equation model’. Older people were found to place a high level of importance in aspects of merchandise, store environment, personnel and services. Price/promotions and clientele were found to be insignificant in driving satisfaction. Differences in factor mean scores and structural parameters were then analysed using ‘finite mixture structural equation modelling’ to identify segments of similar respondents (Jedidi et al, 1997). Using posterior probabilities, the emerging segments were subjected to profiling using personal and behavioural variables (Hahn et al, 2002). Market Segmentation showed three groups of similar respondents in the sample population, differing in factor mean scores and psychological operationalisation of satisfaction. Nonetheless, only several differences in personal and behavioural characteristics were found between the segments. Whilst, the results show that segmenting this group is necessary when measuring satisfaction, basing this purely on a priori descriptive variables might be erroneous given the inherent levels of unobserved heterogeneity. The model developed and tested in this study is considered the most up-to-date available in the literature.

No description available.

This thesis investigates the effects of national patterns of migration on informal support for older adults in contemporary Scotland. It argues that geography matters, and develops a multi-scale conceptual framework to analyse the relationships among population mobility, contrasting local contexts in which older people live, and care and support from the intergenerational family and the community. 130 older persons from three locales with different migration patterns are recruited to the study and a mixed-method approach is adopted, using data from the census, a questionnaire survey and a set of in-depth interviews with both older people and formal service providers. The findings demonstrate significant differences between the three study locales in terms of the geography of the intergenerational family and the extent and nature of informal support received. Daughters provide more support than sons, suggesting the continuation of traditional gender norms. Local community is important, especially in the rural locale, but friends and neighbours are not providing a substitute for adult children living at a distance. It appears that non-kin respond to need where physical health is compromised but not where the older person suffers from depression. This raises serious questions about the future of family support in an increasingly mobile society with declining fertility and growing numbers of adult daughters in full-time employment. The relationships demonstrated confirm and extend many previous findings, but the discussion concludes that there are some grounds for optimism. The intergenerational family remains important to its members who can and do overcome geographical separation at times of crisis. Further, slowly changing gender norms, combined with contemporary demographic trends, may effect changes in the pattern of intergenerational support, which will, to some extent, offset the worsening older-age dependency ratios predicted for Scotland and other European countries over the next few decades.

Objectives: The population, globally and nationally, is ageing and the numbers of those over the age of 65 is increasing. Given this increase in numbers, it is important that the physical and mental health needs of older adults are addressed by service providers. Depression is the most common form of mental ill health in this age group and effective treatments are available. The main aim of the study was to investigate the extent to which general practitioners‘ (GPs) are able to identify depression and offer appropriate treatment strategies to patients over the age of 65 presenting to non-urgent community GP clinics. Method: GPs assessed each participant, attending a general clinic appointment, for depression. Participants (n=31, mean age=75.6 years) completed, with the author, the Abbreviated Mental Test Score (AMTS), and two screening tools: the Structured Clinical Interview for DSM-IV (SCID) and the Geriatric Depression Score – short form, 15 item (GDS-15). A structured interview was conducted and patient records examined to gain demographic information for each patient. Cohen‘s Kappa was used to assess the level of agreement between the GP assessment and the objective measurements for depression. Results: Depression was identified by both the GP and the SCID in three cases. The inter-rater reliability between the SCID and the GP assessment of depression was good (Kappa = 0.61, p <0.001). The inter-rater reliability between the SCID and the GP assessment of dysthymia was poor (Kappa = -0.08, p =ns). Participant numbers prevented further analysis of how the independent variables recorded affected the diagnosis and treatment of depression by GPs. Conclusion: The findings suggest that GPs are able to identify depression but not dysthymia in their older adult patients. The difficulties in engaging GPs in research are explored. The strengths and weaknesses of the study are considered. The clinical implications of the study are discussed.

Master of Science / Department of Civil Engineering / Sunanda Dissanayake / The percentage of the U.S. population aged 65 years or older is increasing rapidly. Statistics also show this age group was 14.9 percent of the population in 2015 and is expected to be 20.7 to 21.4 percent for the years 2030–2050. Kansas has similar statewide trends with its aging population. Therefore, identifying issues, concerns, and factors associated with severity of older-driver crashes in Kansas is necessary. The Kansas Crash Analysis and Reporting System (KCARS) database maintained by Kansas Department of Transportation was used in this study to identify older-driver crash characteristics, compare older drivers with all drivers, and develop crash severity models. According to KCARS data, older drivers were involved in more than one in five fatal injuries out of all drivers in Kansas from 2010 to 2014. When compared with all drivers, older drivers were overly represented in fatal and incapacitating injuries. The percentage of older-driver fatal injuries was more than the twice that of all drivers. When compared with all drivers, older drivers were involved more often in crashes at four-way intersections, on straight and level roads, in daylight hours, and at a stop or yield signs. An in-depth crash severity analysis was carried out for the older drivers involved in crashes. Three separate binary logistic regression models were developed for single-vehicle crashes where only the older driver was present (Model A), single-vehicle crashes involving an older driver with at least one passenger (Model B), and multi-vehicle crashes involving at least one older driver (Model C). From the crash severity analysis, it was found that left turns were significant in changing the crash severity for Model A, but it was not significant in model B, meaning that older drivers may be safer with passengers. For Model B, none of the passenger attributes were significant, though it was originally developed to identify passenger attributes. Gender of the older driver was not significant in any model. For all models, variables such as safety equipment use, crash location, weather conditions, driver ejected or trapped, and light conditions distinguished crash severity. Furthermore, for Model A, variables such as day of the week, speed, accident class, and maneuver, distinguished crash severity. Moreover, accident class, surface type, and vehicle type changed crash severity in Model B. Number of vehicles, speed, collision type, maneuver, and two-lane roads were significant in Model C. A road-user survey was also conducted to identify habits, needs, and concerns of Kansas' aging road users since it was not advisable to conclude safety factors solely on crash data. The probability of occurrence was calculated by taking the weighted average of answers to a question. Then a contingency table analysis was carried out to identify relationships among variables. For older drivers, seatbelt use as a driver had the highest probability of occurrence. Driving in heavy traffic, merging into traffic, moving away from traffic, and judging gaps were dependent on age group. Findings of this research gave an understanding of older-driver crashes and associated factors. Since more than 85 percent of crash contributory causes were related to drivers, driver awareness programs, driver licensing restrictions, providing public transportation, and law enforcement can be used as countermeasures. Accordingly, results of this study can be used to enhance older-driver safety and awareness programs.

No description available.

Much of our current research about volunteering in later life has been conducted with respondents who dedicate their time and effort to volunteer in their home communities. Some, however, choose to travel to developing countries to volunteer in a number of initiatives. Little research has been done that focuses on what influences their desire and motivation to volunteer in this particular context, what meaning is derived from it, and how it impacts their perception of wellbeing and health in later years. Using an interpretative phenomenological methodology, this project attempted to discover how older Canadians experienced the phenomenon of volunteering in developing countries, asking the questions: What are the factors that lead some older people to choose to travel to volunteer in a developing country at this particular time in their lives? What were the circumstances in their lives that enabled them to be able to make this choice? What meaning did/do they derive from it? In what ways did this experience impact their perceived life satisfaction, health and well-being? The data gathering strategy involved collecting information directly from those who have participated in this phenomenon: interviews with 12 participants, ranging from age 62 to 80, were conducted. In order to understand the context of this experience, the research design also involved gathering demographic data about the participants’ life situations. Interview data gathered from the study were initially analyzed using coding techniques of the constant comparative method. The interpretative phenomenological analysis led to the discovery of core categories in the data, which were then clustered into a conceptual framework. A wealth of concept-rich data emerged to form four key properties that contribute significantly to further understanding about this phenomenon: a significant, disruptive event had occurred in their lives, at a time preceding their volunteer experience; the conviction of being led or guided into pursuing this choice; the discovery of feeling instantly welcomed into a place of belonging, where each felt instantly at home and connected in meaningful ways; and an experience of marginalization, isolation and loss of meaning upon their return home, necessitating a need to ‘re-balance’ their lives and find ways to continue to find meaning. This research study will inform the discourses about elder health and wellbeing, and volunteering in later life, particularly about the social movement of elder volunteering in developing countries. It will contribute to theories of how, and in what ways, older adults achieve meaning and purpose by positively negotiating life transitions, re-inventing themselves, learning and adopting new roles, and creating new behaviours and identities, all of which can contribute to healthy aging in later life. / Graduate

Home care of the elderly is of increasing concern not only to purchasers and providers of health care but also to the public and to those responsible for providing social care. As with any service, the aim must be to provide care that is appropriate for each individual. To achieve that, valid and reliable measures of a person's needs are required and resources are to be used as efficiently as possible. A considerable amount of work has been carried out to develop such normative-based measures for assessing the home care needs of the elderly in the form of comprehensive geriatric assessment (CGA). CGA is a commonly used technology which has been shown to be associated with improved health status and lower service use. Despite widespread use, however, the effectiveness of different CGAs has not yet been fully investigated. In the Province of Quebec, Canada, two CGAs which differ in comprehensiveness and resource requirements are being used to assess needs at entry to home care. The aim of this study is to compare the differential impact of these two CGA procedures on patient outcomes: the Systdme de mesure de l'autonomie fonctionnelle, the longer, more comprehensive and resourceintensive CGA, and the Admission au maintien d domicile which is a shorter and less resource-intensive form of CGA. In a prospective cohort study, 158 elderly patients aged 65 years or over were assessed at admission to home care using one or the other CGA and changes in health-related quality of life as well as service use were monitored and compared at the end of a 12-week follow-up. Costs related to the use of a long or a shortform CGA were also explored. These comparisons were made while controlling for patient (age, gender, living alone, quality of life at entry, depression), process (type and intensity of care received) and structural variables (budget and staff mix). Results from comparative and multivariate analyses are in favour of not rejecting the null hypothesis that both forms of CGAs are similarly associated with outcomes. Depression was the strongest predictor of changes in quality of life and high intensity of care and a low proportion of nurses on the home care teams were the strongest predictors of service use outside HC. These results lead us to discuss whether long or shortform CGAs were developed on a comparative rather than a normative definition of needs. The implications of these findings for home care policy and practice are discussed and suggestions for future research are presented.

The objective of this DNP project was to highlight the significant impact of health promotion in older adults. As of January 2011, Medicare covers an Annual Wellness Visit (AWV), which is a result of the Affordable Care Act. The AWV allows patients the benefit of receiving covered wellness and preventive care services. Through surveys this project explored what healthcare providers and patients know about the Medicare AWV and what barriers and/or challenges they have experienced with the AWV. The responses to the surveys revealed that providers have misconceptions about the Medicare AWV and some of the patients did not know that Medicare part B offers a covered annual wellness visit. There were several barriers identified by both patients and providers and these barriers will be discussed and explored in this paper.

The purpose of this research was to determine if differences exist between the young/old (55-74) and the old/old (75+) regarding external search behavior and the importance of information sources.