Medicine and Health Sciences Commons^™

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

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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

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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) …

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

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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 …

Lived Experience Of Having Difficult Conversations Among Care Partners Of Individuals With Parkinson's: An Occupational Science Perspective, Helen A. Reid

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Difficult conversations, which can be challenging co-occupations, play an important role in the lives of care partners of individuals living with Parkinson’s disease. In our first study for this integrated-article thesis, we used a critical interpretive synthesis to explore how informal caregiving had been conceptualized in occupation-focused research. We found that an occupational perspective illuminated otherwise overlooked aspects of caregiving. In our second study, we used an occupational science lens to explore how seven care partners of individuals with PD experienced having difficult conversations within the caring role. We conducted two rounds of in-depth semi-structured interviews and used an American …

Exploring The Perspectives Of Older Adults And Health Care Providers On Patient Participation In Transitional Care From Hospital To Cardiac Rehabilitation During The Covid-19 Pandemic, Cecilia Flores Sandoval

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Older adults who transition from hospital to cardiac rehabilitation settings often are vulnerable and at risk of experiencing adverse health care outcomes. Given the complexities of transitional care, it is crucial to engage older adults in the clinical decision-making process and to promote their active participation in their medical care. Older adults have unique ways of understanding their participation in the transitional care process. Gaining an in-depth understanding of their specific needs during this process can help inform clinical practice and interventions aiming to improve care for older adults living with cardiovascular disease. Focused ethnography methodology was used to explore …

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

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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

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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 …

Older Adult Care Transition Experience Following Inpatient Rehabilitation, Patricia Versteegh

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The internationally used 15 item Care Transition Measure (CTM-15) has been primarily used to assess the care transition experience among adults transitioning from acute care to home. Although the CTM-15’s psychometric properties have been established in this population, the ability of the CTM-15 to reliably discriminate a good from a bad care transition experience among older adults (60 or more years of age) moving from an inpatient rehabilitation setting to home is unclear. The purpose of this prospective observational cohort study was to: 1) evaluate the psychometric properties of the CTM-15 when used among older adults transitioning from an inpatient …

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

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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 …

Exploring The Effects Of The Cycling Without Age Program On Older Adults Living In Long-Term Care, Victoria Cotnam

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The Cycling Without Age program, offered in long-term care homes around the world, allows residents to experience the feeling of a bike ride in the trishaw as a volunteer pedals the electrical bike. The purpose of this pragmatic observational study was to measure the effects of an existing program in a Canadian long-term care home on residents’ happiness, quality of life, pain and functional status (using Resident-Assessment Instrument Minimum Data Set 2.0). A convenience sample of 39 residents participated in two groups, a biking group (n=23) and a strolls group (n=16) over the period of 12 weeks. Findings show that …

Exploring Co-Occupation Between University Students And Older Adults Living Together In A Retirement Home, Rachel J. Gorjup

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Intergenerational housing programs in which young and older adults live together have been implemented worldwide, yet research exploring these programs is sparse. An important component of intergenerational living seems to be the activities that young and older adults engage in together. Taking a lens of co-occupation, that is everyday occupations performed together by two or more people, this thesis explored how university students and older adults, living together in a retirement home, enacted co-occupations and the factors that shaped these co-occupations. A focused ethnography, involving interviews and observations, was used to gain insight into the co-occupational experiences of the students …

Health-Seeking Behaviour Related To Selected Dimensions Of Wellness In Community-Dwelling Older Adults, Navjot Gill

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Older people generally prefer to ‘stay-put' in their own homes. Informed by the Seven Dimensions of Wellness, a component of the International Council on Active Ageing (ICAA) Model, measures of physical function (i.e. physical), fall risk (i.e. environmental), and psychosocial factors (i.e. emotional, spiritual and social) related to wellbeing were selected. It is assumed that they intersect to influence the health-seeking behaviour of older adults ageing-at-home. The primary objective of this cross-sectional design study was to investigate the relationship among dimensions of well-being, including physical function, fall risk, psychosocial factors, and awareness of community support services, with health-seeking behaviour in …

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

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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 …

Differences In Quadriceps Muscle Layer Thickness (Qmlt) And Contributing Risk Factors To Muscle Mass In Community-Dwelling And Institutionalized Older Adults, Nesrine Cheikh

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Sarcopenia, a major concern in the older adult population, is defined as age-related loss of muscle mass and strength. Quadriceps muscle layer thickness (QMLT) measured using ultrasonography (US) is a newly-validated tool to measure muscle mass, which can be used to identify sarcopenic individuals. Our objective was to determine the association of factors such as handgrip strength (HGS), protein intake, nutritional status (via Subjective Global Assessment-SGA) and fat mass (FM) percentage with QMLT size (measured by US) in community-dwelling and institutionalized older adults. Additionally, we aimed to understand how perceived food intake of protein-rich foods could have an impact actual …

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

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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 …

Assessing The Risk Of Falling In Adults One-Year After Total Hip Arthroplasty, William Janes

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The purpose of this study was to examine falls prevalence, falls risk factors and knowledge of falls in individuals who have undergone a total hip arthroplasty. There were 135 patients examined at their one-year follow-up appointment for total hip arthroplasty. Our primary outcome, falls prevalence and falls circumstances, found a falls prevalence of 21.5% with identical circumstances to that of average community-dwelling older adults. Female sex, number of prescription medications and multiple joint replacements were found to be significantly associated with the occurrence of falls in the previous year. The Falls Risk for Older People in a Community Setting Questionnaire …

The Lived Experiences Of Home Care Nurses Providing Palliative Care Information To Community-Dwelling Older Adults With A Terminal Illness, Katharine Fuchigami

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For the past decade, expanding palliative care information has been one strategy for improving palliative care in Canada, yet there remain many concerns regarding the lack of information available to clients and their families. Nurses play a key role in providing information to community-dwelling clients and families. To date, however, limited research has investigated nurses’ experiences of providing palliative care information in a community context. The purpose of this phenomenological study was to better understand the lived experiences of 10 home care nurses providing palliative care information to community-dwelling older adults with a terminal illness. Thematic analysis revealed eight key …

Is Allocation Of Attention Impaired In Fallers Compared To Non-Fallers? An Event-Related Potential Study, Phil Parrot-Migas

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Approximately 30% of older adults experience one or more falls annually. The ability to properly allocate attention may be a risk factor falls. Our study examined whether older adults (aged 58-79) with a history of falls, allocated attention differently to auditory distractor stimuli compared to those without a history of falls, and whether such differences subsequently altered cognitive processing of visual target stimuli. We examined allocation of attention using event-related potentials (ERPs) as participants responded to visual targets while ignoring task-irrelevant auditory distractors. A posterior to anterior shift in electrical brain activity was exaggerated in the faller group compared to …

Asset-Based Community Capacity Building: A Process For Expanding A Retirement Home Physical Activity Program, Charlotte W. Crombeen

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The population is aging rapidly and physical inactivity and sedentary behaviour are on the rise, a trend noticed at a northern Ontario retirement home looking to improve the choices for, and attendance at, physical activities provided for residents. A community capacity building (CCB) approach using an asset-based, partnership methodology was utilized to create internal and external asset maps. These maps were used to inform potential partnerships within the community. Partnerships were recommended with a university, college, and two high schools, whose staff and students could help to implement new physical activities. Walking and gardening clubs were presented as examples that …

Dual-Task Gait Assessment In Lower Extremity Amputees, Courtney A. Frengopoulos

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The purpose of these studies was to develop a reliable dual-task functional mobility protocol and investigate changes in dual-task performance over time in lower extremity amputees. Relative and absolute test-retest reliability of the protocol were evaluated across the population in a study consisting of three groups, with 20 participants per group. A pilot study of 16 participants investigated change in dual-task performance between discharge from rehabilitation and follow-up for both cognitively normal and cognitively impaired individuals. Gait was assessed by the developed protocol as well as an electronic walkway (GaitRITE®). All three groups in Study 1 had excellent relative test-retest …

The Phenomenology Of Masters Alpine Ski Racers: Experiencing Ski Racing In Old Age, Carly Litchfield

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This thesis is a study of the lived experience of ten older adult alpine ski racers in their continued participation in ski racing. The aim of this study was to gain an understanding of the experiences of these older adults as they continued to compete in ski racing. Masters skiers between the ages of 69 and 82 participated in individual interviews lasting between 30 and 60 minutes. Data analysis was completed using van Manen’s phenomenological methods and the visual technique of mind mapping. The major theme that emerged was the importance of being a ski racer to participants’ identities. The …

Testing The Interpersonal Theory Of Suicide In Community - Residing Older Adults, Dorian Murariu

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Suicide rates among older adults are high in Canada and around the world. Evidence-informed and theory-driven research on late life suicide may help to devise effective interventions to reduce suicide rates among older adults. In this thesis, I tested the Interpersonal Theory of Suicide (IPTS: Joiner, 2005; Van Orden et al, 2010) using data collected from a community-based sample of older adults recruited for a larger study designed to assess risk and resiliency factors for late life suicide (Dr. Marnin Heisel, PI). According to the IPTS, (Hypothesis 1) the interpersonal constructs of perceived burdensomeness (PB) and thwarted belongingness (TB) can …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

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Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

Examining The Roles Of Life Satisfaction, Meaning In Life, And Daily Hassles In Predicting Suicide Ideation Among Community-Residing Older Adults, Orsolya Gyorgy

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Research is needed testing models that potentially promote psychological well-being and reduce suicide risk in later life (Heisel, 2006). In the present study, we tested Shmotkin (2005) and Shrira’s (2011) theory proposing that subjective well-being and meaning in life serve unique as well as interrelated roles in promoting psychological functioning in the face of adversity. We specifically investigated whether life satisfaction and meaning in life are more strongly inter-correlated in the presence of daily hassles, and tested the premise that when either life satisfaction or meaning in life is low, the other variable is more strongly associated with suicide ideation, …

Exploring The Fall-Risk Experience Of Masters Athletes Actively Competing In Sport, Dylan Brennan

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The risk of falling increases in adults over the age of 65. Exercise can prevent falls. The motivation to partake in physical activity might be dependent on an older adult’s experience with the risk of falling. Since the majority of older adults are sedentary, experiences of masters athletes can provide valuable insights. The purpose of this phenomenological study was to explore the fall-risk experience of masters athletes actively competing in sport. Masters athletes over the age of 55 (n=22) described their experiences in semi-structured interviews. Data was analyzed through an interpretive-constructive paradigm using inductive content analysis. There were five dominant …

Antihyperglycemic Medications And Hypoglycemia In Older Adults With Diabetes, Kristin K. Clemens

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Background: In the last decade, several new antihyperglycemic medications have been approved to treat people with diabetes. However, the hypoglycemia risk of these medications in older adults in routine clinical practice remains unclear. Further, there is limited understanding as to how these medications are being prescribed to older adults in our region.

Methods: We carried out retrospective, population-based studies of adults age 66 and older in Ontario, Canada using linked healthcare databases. We first investigated the real-world hypoglycemia risk of 2 antihyperglycemic medications – glyburide and modified-release gliclazide. In an ecological study, we then examined trends in antihyperglycemic medication prescriptions, …

Careful, Not Fearful: A Mixed Methods Study To Investigate Fall-Risk Appraisal And Fear Of Falling In Community-Dwelling Older Adults, P. Karen Simmavong

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This study investigated older adult’s accuracy in fall-risk judgement and ascertained whether fall-risk appraisal was situation specific or general in nature. Convenience and snowball sampling were used to recruit 30 community-dwelling older adults aged 65 years and older. An embedded correlational mixed methods was utilized to investigate relative and absolute fall-risk judgement, balance confidence, and hazard identification. Using Pearson Product Moment correlations, multiple regressions, and qualitative analysis, the findings suggest older adults are not always accurate in appraising fall-risk. Judgements were specific and not general in nature, as only 9.30% of variance in risk appraisals and 12.96% of variance in …

Dietary Sodium And Hypertension Status: A Quantitative Study Exploring Older Adults’ Food Purchasing And Consumption Behaviour, Asma Aktar

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Objectives: The purpose of the study was to investigate the relation between hypertension (HTN) status and the amount of sodium purchased and consumed by community dwelling older adults. The secondary objective was to compare their accordance with the DASH dietary pattern according to hypertension status.

Method: A dietary survey of 30 community dwelling older adults was conducted. The amount of daily sodium purchased and consumed, DASH score and DASH accordance were compared between the hypertensive and normotensive older adults using grocery receipts and 24-hour dietary recall. Participants’ knowledge, concern and behaviour regarding dietary sodium were also assessed using a researcher …

Investigating Meaning In Life, Perceived Social Support, And Suicide Ideation Among Community-Residing Older Adults, Joyce L. Cheng

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Older adults have high rates of suicide, necessitating enhanced models of suicide risk in later life. Previous cross-sectional findings suggest that suicide ideation is positively associated with psychological risk factors and negatively associated with resilience factors, including recognition of meaning in life (MIL) and perceptions of social support (PSS). We designed the current longitudinal study to replicate and extend these findings and to test a multidimensional model of suicide ideation (SI), which incorporates consideration of risk and resilience factors, among a sample of 173 community-residing older adults. Using Structural Equation Modeling, both MIL and PSS, which were measured at the …

Investigating Personality Vulnerability To Suicide Ideation In Community-Residing Older Adults, James Andrew Mcclure

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This study assessed associations between suicide ideation and personality characteristics in a sample of community-residing adults 65 years of age and older. Measures of personality, suicide ideation, and depression were administered at two time points 6-12 months apart. Multiple linear regression analyses were employed to investigate cross-sectional and longitudinal associations between personality characteristics and suicide ideation. A total of 106 older adults (mean age=74.2 years, SD=5.8, including 78 women) completed both phases of the study. The majority of participants included in this study were relatively emotionally and psychologically healthy. Within this sample of older adults, more severe suicide ideations was …