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Efficacy Of Pharmacologic Treatment For Orthostatic Hypotension In The Elderly Population, Abigail Moeller May 2021

Efficacy Of Pharmacologic Treatment For Orthostatic Hypotension In The Elderly Population, Abigail Moeller

Physician Assistant Scholarly Project Papers

The purpose of this literature review is to determine the efficacy and safety of pharmacologic treatments for orthostatic hypotension (OH), with an emphasis on researching the elderly population. In this review, three electronic search databases were utilized including PubMed, Google Scholar, and Dynamed from the years 1997 to 2019. Several keywords were used during the search. Criteria for chosen articles included that the article must be peer-reviewed, the studied population must have a median age of at least 50 years-old, at least 20 subjects must be involved, and the study must be published after the year 1995. The specific pharmacologic …


Cholinergic Antagonist Use And The Risk Of Developing Dementia In Persons Aged 65 Years And Olders, Heidi N. Artz Schmaltz Jan 2021

Cholinergic Antagonist Use And The Risk Of Developing Dementia In Persons Aged 65 Years And Olders, Heidi N. Artz Schmaltz

Physician Assistant Scholarly Project Posters

Anticholinergic medications cause a therapeutic or negative effect in the human body by blocking neuronal cholinergic receptors, thereby inhibiting the binding of acetylcholine in the central nervous system and the peripheral nervous system. These medications have short-term side effects including dry mouth, constipation, visual impairments, or delirium; however, research regarding the long-term side effects is limited. The purpose of this systemic literature review is to determine the correlation between prolonged exposure to anticholinergic medications and the development of dementia. The literature databases PubMed, Cochrane Review, Science Direct (Elsevier), and DynaMed were utilized in this review. Journal articles published within the …


Temporal Trends In 6-Minute Walking Distance For Older Japanese Adults Between 1998 And 2017, Grant R. Tomkinson, Tetsuhiro Kidokoro, Trevor Dufner, Shingo Noi, John S. Fitzgerald, Holly M. Brown-Borg Jun 2020

Temporal Trends In 6-Minute Walking Distance For Older Japanese Adults Between 1998 And 2017, Grant R. Tomkinson, Tetsuhiro Kidokoro, Trevor Dufner, Shingo Noi, John S. Fitzgerald, Holly M. Brown-Borg

Education, Health & Behavior Studies Faculty Publications

Background

The 6-minute walking distance (6MWD) is an excellent measure of both functional endurance and health. The primary aim of this study was to estimate temporal trends in 6MWD for older Japanese adults between 1998 and 2017; the secondary aim was to estimate concurrent trends in body size (i.e., height and mass) and self-reported participation in exercise/sport.

Methods

Adults aged 65–79 years were included. Annual nationally representative 6MWD data (n = 103,505) for the entire period were obtained from the Japanese Ministry of Education, Culture, Sports, Science and Technology. Temporal trends in means (and relative frequencies) were estimated at …


A Group Protocol For Promoting Wellness In Rural Community-Dwelling Older Adults, Emily Bachmeier, Laurel Busch Jan 2019

A Group Protocol For Promoting Wellness In Rural Community-Dwelling Older Adults, Emily Bachmeier, Laurel Busch

Occupational Therapy Capstones

Purpose: In the United States, there are currently 46 million citizens aged 65 and older. This number is projected to more than double by the year 2060 (Mather, 2016). As the elderly population continues to grow, the need for evidence-based, client centered prevention programs for community-dwelling older adults becomes more crucial to promote independence and preserve well-being in the community. Older adults living in rural areas are at an even higher risk of losing independence secondary to decline in activity tolerance, which further elevates their need for targeted interventions (Park, Kim, & Lee, 2015). Creating a preventative program to maintain …


Physical Therapy Treatment For A Patient With A Hip Fracture And Cognitive Impairments: A Case Report, Tracie Boehmlehner Jan 2019

Physical Therapy Treatment For A Patient With A Hip Fracture And Cognitive Impairments: A Case Report, Tracie Boehmlehner

Physical Therapy Scholarly Projects

Background and Purpose: As the population shifts to include higher numbers of people in the elderly population, diseases and pathologies associated with geriatric populations will also increase. Two of these conditions are cognitive impairment and hip fractures. Hip fractures can be costly and life altering injuries. Treating patients with both of these conditions can pose a unique challenge to healthcare workers.

Case Description: The patient in this case study is a 78 year-old female who suffered a hip fracture secondary to a fall with a hip herniarthroplasty completed. She had many co-morbidities that are typical of an aging person such …


A Website Designed To Equip Occupational Therapists With Information And Strategies For Holistically Addressing Sexual Activity With The Geriatric Population, Amber Fernandez, Ashleigh Mora Jan 2019

A Website Designed To Equip Occupational Therapists With Information And Strategies For Holistically Addressing Sexual Activity With The Geriatric Population, Amber Fernandez, Ashleigh Mora

Occupational Therapy Capstones

As individuals age, they are likely to experience occupational deprivation. Occupational deprivation occurs in many forms. Many older adults experience occupational deprivation relating to the activity of daily living, sexual activity. Older adults experience many age-related changes, which impacts their ability to engage in sexual activity. Health care professionals have a responsibility to ensure older adults are able to engage in safe sexual practices. Yet, healthcare professionals, including occupational therapists, are not addressing this need with their clients in a routine manner. A literature review was conducted in order to gain a comprehensive understanding of all the barriers older adults …


Occupational Therapy Practitioners' Knowledge And Perception Of The Value Of Environmental Adaptations For Nursing Home Residents With Neurocognitive Disorders, Hannah Fiser Jan 2019

Occupational Therapy Practitioners' Knowledge And Perception Of The Value Of Environmental Adaptations For Nursing Home Residents With Neurocognitive Disorders, Hannah Fiser

Occupational Therapy Capstones

The purpose of this independent study was to evaluate occupational therapy practitioners’ perceptions of the efficacy of certain environment-based intervention types when utilized with nursing home residents who present with neurocognitive disorders. A non-experimental research design in an online survey format was utilized. An invitation to take the online survey was submitted to 56 occupational therapy (OT) practitioners working in skilled nursing facilities. The online survey was comprised of questions addressing awareness/use and perception of efficacy of environment-based intervention methods. Seventeen responses were received. The majority of respondents reported awareness and use of the 20 environment-based intervention methods. Overall, respondents …


Wellness Programming For Men In Long-Term Care, Katie Hautman, Ashley Heinze Jan 2019

Wellness Programming For Men In Long-Term Care, Katie Hautman, Ashley Heinze

Occupational Therapy Capstones

Introduction: The purpose of this project was to develop a wellness guide for staff to implement in long-term care (LTC), to increase participation of meaningful activities and well-being for male residents of all abilities, both physically and psychosocially.

Methodology: A literature review was conducted to understand the need for activities of male residents in LTC. Sources included: online databases, textbooks, and government websites. The Canadian Model of Occupational Performance and Engagement (CMOPE) was selected to direct the development of the program guide. The CMOP-E promotes engagement in occupations and enablement of occupational performance, both of which are important for male …


Using Leisure As A Therapeutic Activity To Enhance Health, Well-Being, And Quality Of Life Among Long Term Care Residents, Olivia Mayasich, Alexis Tyce Jan 2019

Using Leisure As A Therapeutic Activity To Enhance Health, Well-Being, And Quality Of Life Among Long Term Care Residents, Olivia Mayasich, Alexis Tyce

Occupational Therapy Capstones

Purpose The purpose of this scholarly project is to address health, well-being, and quality of life with the use of leisure activities as modalities with residents in long term care (LTC) facilities.

Methodology The results of a thorough literature review supported the need for a program to address leisure participation in residents in LTC facilities. An abundance of literature supporting participation in leisure to enhance health, well-being, and quality of life emerged from the literature review, revealing an obvious gap between literature and practice. The information gathered in the literature review helped guide the development of a program manual to …


Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz Jan 2019

Standard And Cognitive Four Square Step Test (Fsst), Renee Hoffman, Hannah Bucholz

Physical Therapy Scholarly Projects

Background/Purpose: The Four Square Step Test (FSST) measures dynamic standing balance and agility and was developed to identify older adults at risk for falls. It has a cognitive component for remembering the stepping sequence but has never been tested with an additional cognitive task. The purpose of this study was to collect normative data for the FSST and Cognitive FSST in community dwelling adults for various age groups.

Materials/Methods: Eighty-seven community-dwelling adults (55 females, 32 males) between the age 21 and 86 (48.22 years) were included in the study. Participants completed a fall risk checklist and a cognitive screen prior …


Effects Of Pole Walking On Older Adults Following Six Weeks Of Training, Samantha Forsch, Raevyn Haugland Jan 2019

Effects Of Pole Walking On Older Adults Following Six Weeks Of Training, Samantha Forsch, Raevyn Haugland

Physical Therapy Scholarly Projects

Introduction: Age-related changes in adults over 60 include reduced mobility and function as well as an increase in frailty. Conventional walking has been shown to be an effective physical activity to maintain mobility and improve function and overall health and fitness. Specifically, walking speed has been identified as a crucial predicting factor for fall risk and decreased functional mobility. For this reason, clinicians considered the element of walking speed as the sixth vital sign. Pole walking has gained popularity over the years and may provide additional benefits, when compared to conventional walking, such as improved stride and step length, faster …


Vacationing Older Adults, Breanna Taralson, Brittany Winter Jan 2018

Vacationing Older Adults, Breanna Taralson, Brittany Winter

Occupational Therapy Capstones

Introduction: This scholarly project was conducted to explore the aspects of vacationing in older adults and how age-related changes seen within this population can impact decisions while traveling. The purpose of this project was to create a resource guide for older adults to help navigate the vacationing process.

Methodology: A literature review was conducted using various sources including: online databases, books on travel and vacationing, personal communication via informal interview, and through major travel corporation websites. Information from these sources was then compiled to create a resource guide for older adults.

Results: Information found within the literature …


Conservative Treatment Of A 58 Year-Old Male Referred To Physical Therapy With A Knee Sprain And Knee Osteoarthritis, Chase Pruitt Jan 2018

Conservative Treatment Of A 58 Year-Old Male Referred To Physical Therapy With A Knee Sprain And Knee Osteoarthritis, Chase Pruitt

Physical Therapy Scholarly Projects

Background and Purpose: Knee osteoarthritis (OA) is a common condition in people over 50. Although there may be an association between acute knee injuries and knee OA later in life, the occurrence of acute knee injuries in patients with existing OA is less clear. The purpose of this case study is to evaluate the effectiveness of an impairment based therapy program in an individual with an acute knee injury and knee OA.

Case Description: This case follows a 57 year old male referred to physical therapy with an acute knee sprain and tri-compartmental knee OA. Treatment lasted 7 sessions …


Generationactive: Creating Healthier Communities Two Generations At A Time, Jerrica Thiel, Mallory Manecke Jan 2018

Generationactive: Creating Healthier Communities Two Generations At A Time, Jerrica Thiel, Mallory Manecke

Occupational Therapy Capstones

Obesity has become an epidemic across all ages, as the prevalence of obesity has nearly tripled over the last 40 years (World Health Organization, 2017-a). Obesity can have a detrimental impact on the health and future of Americans, as many diseases are correlated with obesity. Diabetes, which often occurs secondary to obesity and is the 7th leading cause of death in America, is similarly on the rise (CDC, 2012). To combat these issues, there is a great need for a health promotion initiative that provides individuals of all ages an opportunity to learn about health and wellness, to take steps …


Wise And Well: A Pilot Study On The Effects Of Providing A Wellness Group Protocol To Enhance Occupational Fit Among Rural Community Dwelling Elderly Women, Brianna Berendt, Carly Hills Jan 2017

Wise And Well: A Pilot Study On The Effects Of Providing A Wellness Group Protocol To Enhance Occupational Fit Among Rural Community Dwelling Elderly Women, Brianna Berendt, Carly Hills

Occupational Therapy Capstones

Problem: There is a need for rural services for community-dwelling women due to a lack of resources, transportation, and social opportunities (Bacsu et a!., 2016; Averill, 201 2). Likewise, Shimada et a!. (2014) emphasized the impact and causes of social isolation on elderly individuals and how important it is for elderly individuals to establish a support system when facing challenges throughout later life. A third problem was described by Choi et a!. (2013) in that elderly individuals may experience a loss of independence and functional decline can result from being physically inactive. This indicates that there are increased health risks …


Lived Experience Of Individuals Who Had A Disruption In Ability To Drive, Shelby Hoskinson, Graydon Larsen Jan 2017

Lived Experience Of Individuals Who Had A Disruption In Ability To Drive, Shelby Hoskinson, Graydon Larsen

Occupational Therapy Capstones

Purpose: Driving is both a highly valued occupation within the United States and an occupation that is frequently addressed by occupational therapists. According to the CDC (2017) there are more than 40 million older drivers ages 65 years or older within the United States. There is extensive research pertaining to the value of the occupation of driving as well as evaluation and treatment approaches for the occupation of driving following an injury or illness. While driving is sometimes the best option after an injury or illness, there are situations when returning to driving is not realistic or safe for the …


Educating Caregivers In Assisted Living Facilities (Alfs) Who Care For People With Dementia, Rodney Palmer, Ashley Palmer Jan 2017

Educating Caregivers In Assisted Living Facilities (Alfs) Who Care For People With Dementia, Rodney Palmer, Ashley Palmer

Occupational Therapy Capstones

It is estimated that approximately 40-71% of residents living within assisted living facilities (ALFs) have a form of dementia or other cognitive impairment (Harris- Kojetin et al., 2016; Zimmerman, Sloana, & Reed, 2014). There is also evidence that suggests that caregivers working within ALFs have inadequate knowledge on how to care for a resident diagnosed with dementia (Hughes, Bagley, Reilly, Burns, & Challis, 2008; McKenzie, Teri, Pike, LaFazia, & Van Leynseele, 2012; Sharpp, Kayser-Jones, & Young, 2012; Zimmerman et al., 2014). The authors of this scholarly project created an instructional manual that can be used to train caregivers within ALFs …


The Effectiveness Of "Stepping On" In Reducing Fall Risk In The Elderly Using The 30-Second Chair Stand Test, Brianna Albrecht Jan 2017

The Effectiveness Of "Stepping On" In Reducing Fall Risk In The Elderly Using The 30-Second Chair Stand Test, Brianna Albrecht

Physical Therapy Scholarly Projects

Background: One-third of all adults over the age of 65 years of age falls each year. Falls cost patients financially, physically, and emotionally. Balance and strength deficits contribute to increasing an individual's fall risk. Studies have shown the efficiency of community-based exercise and education programs on reducing the risk of falling.

Objective: The purpose of this study was to determine whether participants in Stepping On experienced an improvement in balance and confidence following completion of the program. The study also evaluated the correlation between self-perceived risk of falling on the CDC Fall Risk Survey and their actual risk …


Evaluation Of Program Satisfaction, Quality Of Life, Strength, And Fall Risk Of Community-Dwelling Older Adults Participating In A Community Exercise Program: Part 2, Marissa Adolphson, Roy Nelson, Jenna Wyffels Jan 2017

Evaluation Of Program Satisfaction, Quality Of Life, Strength, And Fall Risk Of Community-Dwelling Older Adults Participating In A Community Exercise Program: Part 2, Marissa Adolphson, Roy Nelson, Jenna Wyffels

Physical Therapy Scholarly Projects

Background and Purpose: Bone Builders is an exercise program that incorporates both lower and upper extremities and is specifically designed for the older adult population. It was originally created for those that wanted to reduce their risk of osteoporosis, but currently there is no evidence that demonstrates these effects. However, exercises that are completed in the class are those that target causes of fall risk such as strengthening of hip abductors and balance activities. Participants have also reported that benefits of the class include improved balance, increased energy and mobility, and social support. Our study consisted of testing the …


Perceptions Of Wellness Among Community Dwelling Older Adults, Sara Johnson, April Schmiesing Jan 2017

Perceptions Of Wellness Among Community Dwelling Older Adults, Sara Johnson, April Schmiesing

Occupational Therapy Capstones

Most older adults prefer to age in place where they are more likely to experience greater health benefits and cost savings as opposed to living in skilled care facilities. Literature supports the role of occupational therapy in community-based wellness programming that helps older adults age in place; however, there is a need to conduct needs assessments to inform wellness program topics and activities. This study explores health and wellness needs of older adults living in a low-income, senior housing complex in order to inform current health and wellness programming provided at this site.

Researchers used a non-experimental, cross-sectional survey study …


Total Knee Arthroplasty Rehabilitation: Case Report, Allen Kennedy Jan 2017

Total Knee Arthroplasty Rehabilitation: Case Report, Allen Kennedy

Physical Therapy Scholarly Projects

Background and Purpose: Osteoarthritis (OA) of the knee is a common problem in the world population and total knee replacement has become the gold standard for repair when the OA becomes severe enough. Total knee replacement, however, is not the complete answer to knee OA. Without rehabilitation these patients may struggle to be fully functional. The purpose of this case study was to describe the rehabilitation of a geriatric patient who underwent TKA and benefited from the use of hydrotherapy in his recovery.

Case Description: This report will look at the rehabilitation of one 73-year-old male patient and interventions …


Effectiveness Of The Timed Up And Go (Tug) Test In Assessing Fall Risk In Community-Dwelling Elders Participating In The Stepping On Program, Megan Shanahan Jan 2017

Effectiveness Of The Timed Up And Go (Tug) Test In Assessing Fall Risk In Community-Dwelling Elders Participating In The Stepping On Program, Megan Shanahan

Physical Therapy Scholarly Projects

Background: The Timed Up and Go (TUG) is intended to predict fall risk through assessment of balance, functional mobility, and gait in community-dwelling adults age 65 and older. The Stepping On program aims toward fall prevention through education, exercise, and shared experiences among participants. Previous evidence has displayed positive, significant results for Stepping On and the TUG, indicating use of the assessment to track participants' progress in the program.

Objective: The purpose of this study was: 1) to determine if the Stepping On program decreases fall risk in community-dwelling elderly individuals as measured by the TUG test, 2) …


Evaluation Of Fall Risk, Functional Mobility, And Quality Of Life Changes Of Community-Dwelling Older Adults With Parkinson's Disease Participating In A Community Exercise Program: Part Ii, Lauren Trudel, Courtney Mcdonald, Brittany Bleichner Jan 2017

Evaluation Of Fall Risk, Functional Mobility, And Quality Of Life Changes Of Community-Dwelling Older Adults With Parkinson's Disease Participating In A Community Exercise Program: Part Ii, Lauren Trudel, Courtney Mcdonald, Brittany Bleichner

Physical Therapy Scholarly Projects

Purpose/Hypothesis: As a person ages, the risk of a fall increases. Parkinson Disease (PD) is most commonly seen in the elderly population, which presents with symptoms such as bradykinesia, decreased balance, tremors, postural instability, and muscle weakness. These symptoms are associated with an increase in falls; therefore, a person with PD is more susceptible to falls than the average elderly individual. Exercise has been shown to combat those symptoms affecting people with PD. This study is an extension of a previous study, which examined the effect of a community based exercise program, for people with PD, on quality of …


A Health Care Provider Training Guide To Enhance Cultural Competency In Long-Term Care, Julia Mcbrien, Ashley Prososki Jan 2017

A Health Care Provider Training Guide To Enhance Cultural Competency In Long-Term Care, Julia Mcbrien, Ashley Prososki

Occupational Therapy Capstones

The population of adults over the age of 65 in the United States is steadily increasing and becoming more diverse. Older adults are the greatest consumer of health care services, and they have unique health care needs. One notable health care need pertains to cultural beliefs and wants. When health care providers address the diverse needs of older adults, health outcomes improve for the client and communication across the interprofessional team improves. Therefore, the students of this scholarly project created a series of three, 50-minute long training sessions focused on training health care providers how to be culturally competent in …


Addressing Sleep Deficiencies In Older Adult Residents Of Long-Term Care Facilities: Presenting A Flowchart For An Interdisciplinary Approach, Peter Owens, Tavin Deru Jan 2017

Addressing Sleep Deficiencies In Older Adult Residents Of Long-Term Care Facilities: Presenting A Flowchart For An Interdisciplinary Approach, Peter Owens, Tavin Deru

Occupational Therapy Capstones

There is a growing population of older adults, or those people over 65 years old in long term care (LTC) facilities who report sleep deficiencies at a heightened rate, leading to decrease function, cognition, and social participation while increasing mortality, morbidity and the risk of falling (Booth & McMilliam, 2009; Cipolli, Mazzetti, & Plazzi, 2013; Crowley, 2011; Dzierewski et al., 2014; Helbig et al., 2013; Kuck, Pantke, & Flick, 2015). Occupational therapists (OTs) offer non-pharmacological sleep interventions in the long-term care facilities but are not present at many relevant sleeping times. This scholarly project is a flow chart aid to …


The Role Of Occupational Therapy In Primary Care With Older Adults, Kate Gearman, Tessa Richards Jan 2016

The Role Of Occupational Therapy In Primary Care With Older Adults, Kate Gearman, Tessa Richards

Occupational Therapy Capstones

The older adult population in the United States (U.S.) is projected to increase over the next 30 years (United States Census Bureau, 2014). With that, nearly two-thirds of older adults in the U.S. are diagnosed with at least one chronic health condition (Center for Disease Control and Prevention [CDC], 2016b). These findings highlight a need for more specialized services for this population. Primary care is one sector of healthcare service delivery operating within the U.S. healthcare system. Presently, occupational therapy services are limited in primary care settings as defined in this scholarly project. Occupational therapy services have demonstrated efficacy in …


Physical Therapy Rehabilitation Following Arthroscopic Rotator Cuff Repair, Brittany E. Wirth Jan 2016

Physical Therapy Rehabilitation Following Arthroscopic Rotator Cuff Repair, Brittany E. Wirth

Physical Therapy Scholarly Projects

Background and Purpose: According to the American Academy of Orthopaedic Surgeons, previous studies have found the prevalence of rotator cuff tears may exceed 50% in individuals older than age 65. Since this age group is the fastest growing of the U.S. population, rotator cuff pathology is sure to become a more significant problem in the future. With this information, it is important to continue research on rotator cuff rehabilitation following arthroscopic surgery.

Case Description: This case report describes the physical therapy interventions and functional outcomes of a 58-year-old patient who underwent arthroscopic surgery to repair a partial tear …


Evaluation Of Fall Risk, Functional Mobility And Quality Of Life Changes Of Community-Dwelling Older Adults With Parkinson's Disease Participating In A Community Exercise Program, Gabrielle Dahl, Elizabeth Hermanson, Laura Nelson, Kayla Selinger Jan 2016

Evaluation Of Fall Risk, Functional Mobility And Quality Of Life Changes Of Community-Dwelling Older Adults With Parkinson's Disease Participating In A Community Exercise Program, Gabrielle Dahl, Elizabeth Hermanson, Laura Nelson, Kayla Selinger

Physical Therapy Scholarly Projects

Purpose/Hypothesis: Falls are evident in the older population and are a common and disabling feature of Parkinson Disease (PO). The benefits of activity are well known to decrease balance deficits and increase overall quality of life in the older adult population. In addition highly challenging exercises have been suggested to increase neuroplasticity in individuals with PD. The effect of challenging exercises on clinical outcomes in a structured Physical Therapy setting is documented in literature; however, the effect of a community based program is not well documented. Our pilot study examined the effect of a community exercise program on improving …


Stepping On: Gait Velocity And Fall Risk Assessment, Brittney Herbst Jan 2016

Stepping On: Gait Velocity And Fall Risk Assessment, Brittney Herbst

Physical Therapy Scholarly Projects

Purpose: To identify fall risk and determine if the Stepping On program is effective at reducing the risk of falls in participants by increasing gait speed to greater than or equal to 1 m/s. Step and stride length were also compared to age related norms to determine if they correlated to fall risk. Gait speed of less than I m/s has been shown to increase the risk for falls in elderly.

Methods: Fourteen female participants over the age of 65 (mean age of 87) were recruited from a local Stepping On class conducted at an assisted living facility …


Transitioning To Retirement: Useful Topics For A Wellness Program With Retired Older Adults, Katie Spitzmueller, Amy Feller Jan 2015

Transitioning To Retirement: Useful Topics For A Wellness Program With Retired Older Adults, Katie Spitzmueller, Amy Feller

Occupational Therapy Capstones

Retirement has evolved from traditional stereotypes to an individualized plan. Transitioning into retirement can be a stressful time and it is generally accepted that pre-retirement attitudes impact post-retirement success (Marshall, Clarke & Ballantyne, 2001). A wellness program can make the transition into retirement less difficult by incorporating different dimensions of wellness: social, intellectual, occupational, physical, emotional, and spiritual (Strout & Howard, 2012). Currently there is very little research indicating the effectiveness of a wellness program that addresses these dimensions. The purpose of this phenomenological study was to gain insight into useful topics for a wellness program based on perspectives of …