Medicine and Health Sciences Commons^™

Exploring The Quality Performance Of Ethno-Specific And Mainstream Not-For-Profit Long-Term Care Homes In Ontario, Lanei Amein

Electronic Thesis and Dissertation Repository

The purpose of this retrospective study was to determine how ethno-specific not-for-profit long-term care (LTC) homes in Ontario perform in comparison to mainstream not-for-profit LTC homes using nine RAI-MDS 2.0 quality indicators. Publicly available data from three sources: the Canadian Institute for Health Information "Your Health System: In Depth" database from the Continuing Care Reporting System, data on Ontario ethno-specific not-for-profit LTC homes from the Home and Community Care Support Services, and data on home and ownership records from the Ministry of Long-Term Care “Public Reporting” website, between 2017-2022, were retrieved and analyzed. Descriptive analysis suggests that for all quality …

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

Sleep And Multimorbidity In The Canadian Longitudinal Study On Aging, Shreni Patel

Electronic Thesis and Dissertation Repository

Sleep health is a latent construct comprising various sleep measures such as duration, quality, initiation, maintenance, and daytime sleepiness. This thesis compared the association of two measures of sleep health, a conventional summary score and a pooled index, with incident multimorbidity over a 3-year follow-up in 30,097 middle- to older-aged adults from the Canadian Longitudinal Study on Aging. At baseline, approximately 26% and 29% of participants with multimorbidity displayed poor sleep patterns according to additive and pooled indexing methods. Longitudinal analysis indicated that those with additive scores of 4 to 5 at baseline had a 1.54 (95% CI: 1.18, 2.03) …

Household Environments And Functional Decline Among Middle-Aged And Older Adults In China, Dandan Zhao

All Theses

This thesis investigates the associations between household social, economic, and physical environment conditions and the trajectory of self-reported functional limitations over time among middle-aged and older adults in China. Despite the increasing interest in the impact of household environments on functional decline, most existing studies are cross-sectional or concern changes in functioning observed in two waves of surveys, and they primarily focus on the influence of one condition. This thesis explores how the trajectory of functional decline is influenced jointly by multiple household factors, including living arrangement, annual living expenditure per capita, indoor air pollution resulting from solid fuels, and …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Influences On Influenza Vaccine Uptake Among Older Lebanese Adults, Doha D'Agostini

Walden Dissertations and Doctoral Studies

Influenza is a viral infection that is globally transmitted and that increases the risk for infectious diseases, hospitalization, and morbidity and mortality, especially among the older adult population. Although influenza vaccines are recommended in several countries, influenza vaccine hesitancy remains a challenge. In Lebanon, there is minimal research related to older adults’ attitudes and perceptions associated with influenza vaccination. To explore older Lebanese adults’ vaccination experiences and perceptions of the factors that affect their influenza vaccine uptake, a qualitative investigation was conducted. The theory of planned behaviors served as the theoretical framework for the study. A thematic analysis was conducted …

Influences On Influenza Vaccine Uptake Among Older Lebanese Adults, Doha D'Agostini

Walden Dissertations and Doctoral Studies

Influenza is a viral infection that is globally transmitted and that increases the risk for infectious diseases, hospitalization, and morbidity and mortality, especially among the older adult population. Although influenza vaccines are recommended in several countries, influenza vaccine hesitancy remains a challenge. In Lebanon, there is minimal research related to older adults’ attitudes and perceptions associated with influenza vaccination. To explore older Lebanese adults’ vaccination experiences and perceptions of the factors that affect their influenza vaccine uptake, a qualitative investigation was conducted. The theory of planned behaviors served as the theoretical framework for the study. A thematic analysis was conducted …

The Coping Strategies Of Older Adults With Age Related Vision Loss (Arvl) – A Narrative Account, Zakara J. Stampp

Electronic Thesis and Dissertation Repository

The goal of this study was to share the stories of older adults with age-related vision loss (ARVL) and how they have coped to maintain meaningful occupational engagement. Grounded in a constructivist paradigm, data collection and analysis were guided by the narrative inquiry methodology. The participants consisted of six older adults aged 60 or older, diagnosed with one of the following ARVL conditions: macular degeneration, diabetic retinopathy, and/or glaucoma. Participants were recruited from vision loss non-profit organizations such as the Canadian National Institute for the Blind (CNIB) and the Alliance for Equity of Blind Canadians (AEBC). One older adult was …

Ageism, Eldercare, And Healthcare: An Examination Of Growing Old In Costa Rica, Akshaya Vijayasankar

Honors Theses

The world’s aging population and the Covid-19 pandemic have revealed the high level of ageism against older adults around the globe, which has resulted in an overall decreased quality of life for elders. Societies are now faced with the challenge of creating a suitable and equitable model of care to support their aging population. Despite the recent publication of the World Health Organization's Global Report on Ageism, there is still a large gap in the literature regarding ageism. This paper addresses the issues of institutional ageism in the eldercare and healthcare sector. I argue that Costa Rica serves as a …

Exploring The Contextual Factors And Decision-Making Process Of Risky Sexual Behavior Among Homeless Adults In Louisville, Kentucky., Sarah C. Van Heiden

Electronic Theses and Dissertations

Homelessness is a complex public health issue; individuals who experience homelessness are said to engage in risky sexual behaviors at an increased rate and experience a higher prevalence of sexually transmitted infection (STI). While the sexual behaviors of homeless adolescents are commonly studied, little is known about the sexual behaviors of the growing population of older adults, or how they make decisions to engage in sex. Three aims guided this research: 1) to describe the sexual behaviors and sexual decision-making process of homeless older adults, 2) to examine how homeless older adults evaluate the outcomes associated with engaging in risky …

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Descriptive Analysis Of Fall-Related Injuries Among Older Adults In Ontario, Nicolette Lappan

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. The purpose of this study was to describe the characteristics of older adults who experienced fall-related injuries (FRIs) and the types of falls that caused them. We analyzed Ontario-wide secondary data from three databases (NACRS, DAD, RPDB) covering 2010-2014. Older adults (≥ 65 years) who visited emergency departments (ED) with FRIs were selected using ICD-10-CA codes for a fall and injury. Counts, measures of central tendency, and prevalence rates (crude, age- and sex-specific, age-standardized) were calculated. There were 304,610 (63.0% females) ED admissions (3,089 per 100,000 population) …

Fall Risk-Increasing Drugs And Gait Performance In Community-Dwelling Older Adults: Results From The Gait And Brain Study, Abdelhady Osman

Electronic Thesis and Dissertation Repository

Medication use and gait impairment are two of the most important risk factors for falls. Several drug classes have been classified as fall risk-increasing drugs (FRIDs). Gait is an important marker of overall health and independence in older adults. The overall aim of this thesis was to examine the relationship between FRIDs and gait performance in older adults through two studies. Firstly, our systematic review of twenty studies on the association between FRIDs and gait performance found that the use of drugs with sedative properties is associated with reduced gait speed. Secondly, we conducted a cross-sectional analysis of data from …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Modeling Cumulative Risk During The Covid-19 Pandemic: Psychosocial And Socioeconomic Factors For Older Minority Adults, James F. Osborne Iv

LSU Master's Theses

Continued response to the sum consequences of the COVID-19 pandemic has disparately affected the physical and mental health of older minority adults in the United States. SARS-CoV-2 created an acute epidemiological crisis of public health coinciding with a chronic pandemic of accentuated psychosocial stress. Biological and socio-economic risk of morbidity and mortality follow a demographic gradient of subjectively constructed social status that disproportionally threatens older adults and minority racial/ethnic communities. Pathways to increased socio-economic and psychosocial vulnerability are multifactorial and complex. Factors of race, socio-economic status, gender, and age, each contribute to individualized profiles of vulnerability to risk exposure.

The …

Sociodemographic And Psychosocial Factors And Wellbeing Among Adults 65 And Older In England, Dainelle Clark

Walden Dissertations and Doctoral Studies

The increased number of older adults living longer parallels with the growth of public health concerns regarding the impact of sociodemographic and psychosocial factors (e.g., loneliness and social isolation) on older adults' wellbeing. The purpose of this quantitative study was to examine the association between loneliness, social isolation, the combined model of loneliness, and social isolation on wellbeing among older adults when accounting for age, gender, ethnicity, and social support. The socioecological model (SEM) was used to evaluate the multiple levels of environmental determinants for loneliness, social isolation, and wellbeing. The target population included older adults 65 years and older …

An Evaluation Of Injurious Falls And Fall-Risk-Increasing-Drug (Frid) Prescribing Behaviors In A Nationally Representative Sample & The Pharmacist’S Role In Fall Prevention, Taylor Elliott, Susan Westneat, Shama Karanth, Erin Abner, Anna Kucharska-Newton, Daniela C. Moga

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Falls are a major public health problem affecting millions of older adults each year. Little is known about FRID prescribing behaviors after injurious falls occur.

Objective(s): The primary objective of this study was to investigate whether an injurious fall impacts the odds of being prescribed a new FRID.

Methods: We conducted a cross-sectional analysis using data from the 2016 National Ambulatory Medical Care Survey to investigate whether an injurious fall impacts the odds of being prescribed a new FRID. We included patients age >/= 65 years and classified visits based on presence of an injurious fall. The outcome of …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

Elder Isolation In Immigrant Communities, Jessica Da Silva

School of Professional Studies

This paper examined loneliness, as a measurement of perceived social isolation, in older immigrant adults. Previous research shows that older adults are more likely to experience social isolation and loneliness. Both of which have a direct correlation with their overall health (Wilson & Molton, 2010, Cacioppo et al., 2002) and mortality rates (Holt-Lunstad et al, 2015). Another international study found that immigrants in particular are at a higher risk for experiencing loneliness (Government of Canada, 2018). In this study, 35 immigrants and non-immigrants participants answered a survey which included 20 questions from the UCLA Loneliness Scale Version 3 (Russel, 1996). …

Rural-Urban Variations In Meals On Wheels Programs, Lea C. Florence

Electronic Theses and Dissertations

Older adults are living longer than ever before. By 2060, the U.S. population aged 65 or older is projected to reach 98 million. As adults age, the prevalence of chronic diseases and disabilities increases. The need for Meals on Wheels (MOW) services is growing alongside the aging population. Yet, little is known about the geographic variation of services. Little is documented about the organizational capacity of MOW organizations in terms of geography. The current policies supporting home-and community-based services, including MOW, may be insufficient to support all older adults in all types of communities. An analysis of the More Than …

Supporting Older Adults Through Aging In Place And Capable Programs, Laura Compton

OTD Capstone Projects

This experiential component or doctoral capstone project involved a partnership with Habitat for Humanity of Greater Memphis. Through this agency, projects were completed based on identified needs of the Aging in Place and CAPABLE programs. The Aging in Place (AIP) program provides critical home repairs to low-income adults aged 60 years and older. The CAPABLE program provides the same critical home repairs along with a select number of visits from a registered nurse and an occupational therapist to help the older adults age in place safely.

Risks Of Falls Among Elderly With Cognitive Impairment, Qingqing Lan

Seton Hall University Dissertations and Theses (ETDs)

Falls are the second leading cause of accidental or unintentional injury deaths worldwide among older adults. Although researchers extensively studied the risk factors of falls, there were limit studies focus on the impact of medication effects, and gait performance on the falls among cognitively impaired elderly. This study fills the gap and aims to understand: 1) the risk factors associated with occurrence of fall between older adults with cognitive impairment and the overall older adults, 2) the association between gait performance and falls 3) the association between the use of central nervous system (CNS) medications and falls, and 4) the …

Association Of Common Chronic Pain Conditions To Incident Alzheimer’S Disease And Related Dementias In Two Cohorts Of Older Medicare Beneficiaries, Sumaira Khalid

Graduate Theses, Dissertations, and Problem Reports

Objective: The purpose of this research was to study the collective and incremental association of common non-cancer chronic pain conditions (NCPC) to risk for Alzheimer’s disease and related dementias (ADRD); to explore the potential mediating influence of mood and sleep disorders; and to assess the potential synergistic effects of NCPC’s and multimorbidity on ADRD risk. This research also aimed to study the contribution of NCPC to ADRD risk in poor, rural, underserved United States populations who suffer a disproportionate burden of ADRD risk factors. To achieve these goals, this dissertation pursued three specific aims: 1) assess the association of …

Resedent Study- Reducing Sedentary Behaviour May Slow Cognitive Decline In Older Adults With Mild Cognitive Impairment: A Pilot Study, Kirsten B. Dillon

Electronic Thesis and Dissertation Repository

Physical activity (PA) has been shown to slow down dementia. Unfortunately, older adults spend most of their day in sedentary behaviours (SB). Breaking up prolonged bouts of sitting with intermittent bouts of light intensity PA may reduce glycemic variability in the brain; potentially mitigating cognitive decline. This study investigated how interrupting SB with 10 min bouts of light intensity PA 3x a day would affect mild to moderate cognitive impairment progression (primary outcome) in older adults residing in an assisted living facility. Participants (n=25) were assigned in clusters into a two arm 10-week single site pilot randomized controlled trial. Secondary …

Aging-In-Community: The Influence Of Social Capital On Accessory-Dwelling Unit Access And Utilization Among Older Americans, Travis M. Gagen

Doctoral Dissertations

Accessory-Dwelling Units (ADUs) are one form of the built-environment in which the field of public health law can intervene to improve population aging. Modifying the built-environment to incorporate ADUs allows older adults to utilize a higher level of smart home technologies (SHT) to age-in-community. Under Massachusetts law MGL c. 40A, the state gives authority to cities and towns to adopt ordinances and bylaws to regulate the use of land, buildings and structures. A mixed-methods research design was used to examine the access and utilization of ADU and SHT among older adults. Of the 351 Massachusetts town and cities, 66.5% were …

Older Adult Spouses’ Emotional Responses To Reminiscing About Their First Encounter: Associations With Mental Health, Marital Satisfaction, And Cardiovascular Reactivity, Hanzhen Lan

Public Health Theses

Objectives: While there has been growing interest in how close relationships affect older adults’ health, not much research has examined how emotional experiences in older married couples’ positive interactions relate to individual and relational well-being and physical health. The present study hypothesizes that positive emotional responses to older couples reminiscing about first encounter are associated with each spouse’s higher marital satisfaction, fewer depressive symptoms, and healthier cardiovascular reactivity (blood pressure and heart rate variability).

Method: One hundred and one couples completed a background questionnaire at home and then participated in a laboratory session in which they discussed how they first …

Unmet Support Needs Of Informal Caregivers Of Older Adults, Julie Ann Smith Hinders

Walden Dissertations and Doctoral Studies

Due to projected growth of the 65-and-older population and concerns of an impending care gap, reliance on informal caregivers is expected to increase. Improving support for informal caregivers is viewed as a national priority, yet research related to the unmet support needs of informal caregivers is limited. The purpose of this cross-sectional correlational study was to examine predictive relationships between contextual factors (caregiving relationship and type of illness) and environmental factors (rurality) and the unmet support needs (classes, service access, support groups, counseling, and respite) of informal caregivers of older adults. The theoretical framework was Bronfenbrenner's ecological systems theory. Archival …

Cognitive Impairment And The Mediterranean Diet: A Canadian Perspective, Ivan Culum

Electronic Thesis and Dissertation Repository

Global life expectancy has increased steadily over the past century and is projected to continue increasing. Life expectancy increases are co-occurring with a reduction of fertility rates in many economically developed countries, which is resulting in an aging population, meaning that the proportion of older adults within the total world population will continue to increase. This is of particular concern as there is a rise of chronic neurodegenerative diseases among older adults, such as dementia, where the number of global deaths more than doubled since the turn of the century, making dementia the fifth leading cause of death worldwide. Dementia …

The Impact Of Depressive Symptoms On Cognitive Decline And Risk For Dementia, Katheryn Conde

Doctoral Dissertations

As of 2011, the life expectancy for Latinos in the U.S. was 81.6 years, which is higher compared to non-Hispanic Blacks (75.3 years), non-Hispanic Whites (79 years), and Hispanic Black populations (74.9 years; Arias, 2011; Arias, 2015). Latinos have higher age specific prevalence of dementia, which is higher than African Americans and non-Hispanic Whites (Gurland et al.,1999). Latinos experience Alzheimers disease symptoms 6.8 years earlier, with the average onset of 67.6 years which is younger than non-Hispanic Whites (73.1 years; Clark et al., 2005). Furthermore, older Latinos tend to experience depression at a rate of 13% and 35% with the …