Older adults in residential care are at an increased risk of a number of mental health disorders when com- pared to community samples. Research indicates that 40.5% of residents in high level care and 25.4% of resi- dents in low level care experience depression . Older adults are also at risk of experiencing loneliness, with approximately 10% of older adults in care reporting frequent loneliness . Harper  has found that the aged care environment does not promote well-being or the formation of meaningful friendships even though residents are often with other people. Loneliness in older adults is strongly associated with higher levels of depression, even after controlling for variables such as gender, age, ethnicity, education, income, marital status, social support, and perceived stress [6, 7]. Older adults in residential care are at an increased risk of a number of mental health disorders even though residents are in an environment that has been designed to provide social support, alleviate boredom, and decrease loneli- ness along with providing medical support. Knight and Mellor  have proposed that a combination of unful- filling social activities and constant interactions with unfamiliar people can lead to the development of poor mental health in aged care residents.
The health education comparison intervention consisted of weekly, 90-min health information workshops con- ducted in group format. The intervention was held at a university medical center, with access to public transpor- tation and reimbursed parking. The sessions consisted of a 60-min lecture followed by 30 min of discussion. The lecture titles were: Introduction/ Exploring Communica- tion, The Science of Successful Aging, Acupuncture 101: How it Works & What it is Good for, Quality of Life/ Quality of Well Being, Fighting Cancer With Your Fork, Forgiveness via Shakespeare’s: A Winter’s Tale, Better Eyesight in Minutes a Day, Brain Fitness, The Importance of Organic Foods/ Organic Gardening, How Dementia Can Be Modified. Lectures were provided by credentialed experts (physicians/psychologists, etc.) and other clinicians. Instructors were asked to minimize discussions of yoga or meditation. Similar comparison interventions have been used in other large behavioral clinical trials [12, 13].
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This qualitative approach was selected because it can produce a data set rich enough to explain how older adults shop for food, what factors influence older adults shopping behaviors, and what aspects of food shopping behavior could be changed. When grounded theory methods are used, comparisons are made between data and concepts using the collected data to construct and test a theory that is grounded in the data rather than comparing the data against prior expectations and previous theoretical formulations (Achterberg, 1988). A grounded theory of old adults food purchasing behaviors, therefore, should provide new information about the kinds of education and program developments that may be needed to improve nutritional status of older adults as they age in place and lead to decreased risk of chronic diseases. We approached this study with three general questions. How do older adults shop for food? What factors influence older adults’ food shopping behavior? What aspects of older adults’ food shopping behavior could be changed to improve their health?
Of the 420 questionnaires completed, six were identified as outliers, and they were eliminated from analysis to increase the empirical advantage such as evaluation rigor and reducing deductive errors, and ultimately, 414 questionnaires were analyzed. The mean age of the older adults was 68.76 years (SD = 6.24). According to the data obtained, the majority of the older adults were women with primary to high school education, married, housewives, with no history of smoking or alcohol and coffee use, no history of anxiolytic and hypnotic medications, and no history of physical or mental diseases, able to perform daily tasks, with no history of falls and resulting injuries, no osteoporosis, with access to medical services and social supports in emergency, able to walk without walking aids, with moderate income, and homeowners, covered by health insurance, and had insomnia or sleep disturbance [Table 1].
standard practice. The finding that no participants had received support from mental health nurses in the com- munity indicates that the largest section of the mental health workforce did not contribute to the treatment and support so urgently needed by this sample of older adults with depression. Notwithstanding significant challenges regarding expanding scope of practice, fund- ing, and recruitment (Day 2017; Dreizler et al. 2014; Heslop et al. 2016; Wilberforce et al. 2017), the poten- tial exists for mental health nurses to play a greater role in the treatment and support of older adults living in the community with depression. It is important that older adults and their families understand the role of mental health nurses in this regard, so that they may actively seek their support, as needed. Thus, considera- tion should be given to promoting the availability and increasing the accessibility of mental health nurses to provide education and support. This is especially important, given that population ageing will require that healthcare systems meet the needs of a growing number of older adults with depression.
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Traditional medical education methods may include short visits to the nursing home with quick exits. Medical student training and experiences in nursing homes are often viewed as negative, which mirrors the views ex- pressed by the general public . However, it is important to note that as stated by White (2008), “long-term care services represent a growing aspect of our medical system that receives little attention in medical education” . The truth is, in the United States, nursing homes are often referred to as “institutions,” which conjures up a depressing image and receives negative attention. Learning by Living has been designed with these aforemen- tioned views in mind and is based on three significant premises to augment medical education within nursing homes: 1) older adults residing in nursing homes are human beings deserving of good care, respect, and “com- munity” connection; 2) medical students can attain medical care skills including empathy and advanced rela- tionship building skills with older adults from living the life of an older adult nursing home resident for an ex- tended period of time; and 3) older adults and their care partners have perceptions and considerations that are relevant to the health care process. Additionally, living in a nursing home enables medical students to build knowledge, skills, and attitudes about patient care by constructively adapting to this environment through expe- riences and reflection . In doing so, students become well equipped to form patient-centered care models based on the care they received and preferred. Each stage of this immersion research contributed to the medical students’ learning about empathy; an often lost art in medical education.
One of the most recent studies, pertaining to older adults and Web usage, was conducted by Roger Morrell and Christopher Mayhorn (2000). Results of their survey indicated a strong age, as well as demographic, difference between older adults that use the Web and those that do not. The study also indicated that middle-aged and older Web users were similar in the time spent on the Web, use patterns, how taught to use the Web, perceived problems on the Web and their perceived efficacy in the ability to use the Web. Their study also revealed that the primary reason, and therefore a predictor, for not using the Web was the lack of access to a computer with a strong second place held by lack of knowledge regarding the Web. Although, in their study, all groups indicated interest in learning more about the Web, the
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One of the limitations of this study was that the older adults who participated were a self selecting population. They were recruited from local computer education classes, and showed a great deal of interest in learning more about computers. Another limitation was that only relatively high-ability older adults participated in this study. This study was a best-case scenario. The average older adult will likely make more errors, and have greater difficulty. Follow-on studies should look at special needs populations within the older demographic, and at potential users with less enthusiastic interest in technology.
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The findings of this study should be interpreted in the light of some methodological considerations. The inter- views gave a better understanding of the barriers that older adults perceive concerning dietetic treatment. The fact, however, that most interviewed older adults just started receiving dietetic treatment may have resulted in a homogenous group of respondents, and conclusions may not apply to all older adults receiving dietetic treat- ment for undernutrition. It would have been interesting to also have interviewed older adults who successfully adhered to dietetic counselling and were no longer at risk of undernutrition to learn how they overcame certain bar- riers. Considering that undernutrition among older adults usually is caused by multiple factors, collecting additional background information could have been interesting, such as education level, socio-economic status, and psycho- social factors. Such factors could have partly explained our findings, so not collecting these can be considered a limitation of this study. Furthermore, we contacted dieti- tians who treated many older adults and therefore this was a very undernutrition-conscious group of dietitians. This was, however, a deliberate choice because we wanted to learn from the experiences of dietitians who actually treat these older adults. To our knowledge, this is the first study that both interviewed dietitians and older adults who were being treated for undernutrition, which in our
The trend internationally and within New Zealand is of an increasing aging population, with numbers of those with dementia projected to increase rapidly. One way to address this issue is to consider the practical and clinical benefits of running memory intervention groups for older adults with memory difficulties/impairment. The current study intended to address some of the limitations found in memory intervention literature by (a) using a social control group as a control comparison, which has not been done before, and (b) separating out components of memory training interventions (i.e., memory strategies and lifestyle education). Therefore, the aim was to determine the extent to which receiving Memory intervention separately from a Lifestyle Education intervention would affect memory functioning in older adults with
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for interpersonal relationships"(Fenalti; Schwartzd, 2003, p. 133). Salvador et al. (2009) bring up issues related to the environment and the leisure for older adults. This work analyzed several aspects related to the practice of physical and leisure activities by men and women. Their analysis includes the following: perception of safety, presence of nearby sports courts or gyms, residing near bank branches, churches or health clinics (10 minutes on foot) and invitation of friends to practice physical activities. Taking into account these factors, the same authors have identified that the perception of safety may be the main element that could increase chances of an older adult become more active. In this sense the authors add that these factors "are associated with the practice of physical activities in the leisure and should be considered in the planning of programs that promote physical activities for the older adult population” (Salvador et al., 2009, p. 979). An analysis of the sedentary lifestyle in older adult leisure programs was done by Zaitune et al. (2007). Carried out in the city of Campinas, this work demonstrated a high level of sedentarism, mostly, among older adults that present at least one of the following aspects: low socioeconomic level or low education, smokers, female and with some type of mental disorder. The discussion brought up the important relationship between sedentarism and lifestyle. They noticed that the practice of physical activities in leisure time is a result of an active lifestyle; such practices can be offered by the public services. They ended the discussion pointing out that public policies on quality-of-life should focus on lower socioeconomic levels in order to reduce inequalities related to information, acquisition of habits for maintaining quality of life and health care (Zaitune et al., 2007).
Despite considerable research into racial/ethnic disparities in cognitive functioning among older adults and the role of education in explaining these disparities, less scholarship has examined if the likelihood for CIND and dementia among older Hispanics varies by nativity status (i.e., US-born vs. foreign-born) compared to Whites. Prior research documents the risk for cognitive impairment, rates of cognitive decline, and proportion of years after age 65 lived with cognitive impairment vary by nativity status among older Hispanics (Downer et al. 2017; Garcia et al. 2017b; Garcia et al. forthcoming; Hill, Angel, and Balistreri 2012; Hill et al. 2012). However, these analyses only included US-born and foreign-born Hispanics of Mexican origin residing in the Southwest United States, which prevented racial/ethnic and nativity comparisons in cognitive status with older White and Black adults.
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In this paper we have sought to explore the sources that older Australian men and women use, or would like to use, in seeking educational opportunities on sex in later life. Our findings illustrate that while participants used a diverse range of sources, they most commonly relied on the Internet as a site of information. This reflects emerging work highlighting the use of the Internet for sexuality education, discussion and support across both young and old age groups (Adams et al 2003; Berdychevsky & Nimrod 2015, 2016; Daneback et al 2012). As use of the Internet increases amongst older adults, it is likely that this will be a key site of education, and a space in which specific resources for older adults should be made available. However, it is important to note that not all older adults use the Internet (ACMA 2015). It is therefore necessary for sexuality education targeted towards older individuals to also be available across a range of settings and modes of delivery. This could include, for example, information provided in healthcare settings, discussion in popular media (such as television shows, radio, or newspapers) (Attwood et al 2015), or through advertisements in public spaces. As the experiences of some of our participants show, while the Internet is a vast source of information, it does not replace the expertise of healthcare professionals. In line with existing research (e.g., Graf & Patrick 2015), participants overwhelmingly indicated that they used (or would prefer to use) passive sources of information in learning about sex. In contrast to existing research (Graf & Patrick 2015), participants did not identify friends as a key source of sexuality education. The reasons for this difference are unclear, though it may be that both Australian socio-cultural norms and cohort-level effects (e.g., growing up in a time where sex was not openly discussed) are at play.
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In the context of this literature, the PICO (Patient, Intervention, Comparison, Outcome) question that will be addressed focuses on community dwelling older adults (P), receiving nutritional education to empower healthy nutritional and dietary decision making (I), in an effort to combat malnutrition and chronic disease, due to an absence of nutritional education available to this demographic (C), and improve health outcomes, decrease associated healthcare costs, and improve literacy in the community dwelling older adult population, so they can make dietary modifications and decrease risk associated with chronic, non-communicable disease (O). This nutrition education initiative aims to improve health, wellness, and increase nutritional education and health literacy among community dwelling older adults in an effort to combat the personal and financial impact of non-communicable diseases, and improve health outcomes among the population. There is strong evidence to support this initiative as evidenced in a recent
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Physical activity in older adults is extremely important in the maintenance of independence, improvement in the quality of life experienced and the prevention and protection from many NCDs including CVD, cancer and diabetes (Blair et al. 1996, Hu et al. 1999, Knowler et al. 2002, Manson et al. 2002, Slattery & Potter 2002, Thompson et al. 2003, Chao et al. 2004, Ratnasinghe et al. 2010). In addition, physical activity has been recognised to reduce the risk of osteoporosis, obesity, falls and depression in older adults (Vuori 2001a, Vuori 2001b, Wing & Hill 2001, Brosse et al. 2002, Ross et al. 2004, Mann et al. 2007, Mertz et al. 2010). The benefits of physical activity extend way beyond these health benefits in society, by also increasing social interaction and community engagement and it is associated with other positive health behaviours including healthy eating and non-smoking (Fahey et al. 2004, WHO 2006). According to the WHO (2006, p.2) “promoting physical activity should be seen as a necessity, not a luxury”. Surveys to date have suggested that there is still room for improvements in guideline achievement and that understanding the factors associated with physical activity in older adults can more effectively guide policies and practices to increase physical activity participation which ultimately reduce the burden of NCDs including CVD, the most common cause of death (Perk et al. 2012, Murtagh et al. 2014). Factors associated with physical activity will be further discussed in depth in section 2.5.
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Generalized anxiety disorder (GAD) is the most common anxiety disorder in older adults with reported prevalence rates of between 2.4% and 6.3%. 1, 2 The numbers affected by GAD may actually exceed these figures, given that subthreshold GAD is associated with significant disability. 3 GAD is a chronic and disabling condition regardless of age, and in older adults it is associated with increased disability, cognitive impairment, reduced quality of life, and increased service use. 4-8 High rates of comorbidity occur, with depression comorbidity rates of up to 60% reported. 9 Numerous differences have been found in the functional connectivity of emotion-focused brain networks amongst older adults with GAD, illustrating abnormalities in both worry generation and worry reappraisal. 10 Cognitive behavioral therapy (CBT) uses this neuroanatomical evidence to justify targeting
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This study is important because it showed that some aspects of letter fluency performance may not be as affected by normal cognitive aging as category fluency. Not only did older participants perform as well as younger adults on this task in terms of the total number of correct words produced, their performance was also unaffected by time of day influences and was stable within session and across sessions. Therefore, in clinical practice, psychologists can be more confident that a lower than expected performance on number of correct words produced on letter fluency is due to an abnormal change rather than an effect of normal cognitive aging. In fact, Troyer et al. (1997) showed that older adults performed well as younger adults on letter fluency, and produced larger clusters.
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Kim and Pai’s study (2010) offers a unique perspective on the relationship between volunteering and depression, as the sample used in this research demonstrated increasing rates of depression amongst older participants over the years of the study. This is unusual, given that rates of depression have been shown to decline with age (Byers, Yaffe, Covinsky, Friedman & Bruce, 2010). Kim and Pai (2010) found that the rate of the increase in depressive symptoms was slower on average for volunteers compared to non-volunteers, and the more hours of voluntary work that the person engaged in, the slower the rate of increase in depressive symptoms. These results may suggest that volunteering may not only be protective against the onset of depressive symptoms, but it may also help to alleviate depressive symptoms (Kim & Pai, 2010).
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not aware of studies that have considered dosage, dura- tion and follow-up visits in defining adequacy of anti- depressant therapy in older adults. In a previous study, Robinson et al. reported in a mixed-age group sample that 19% had received antidepressant therapy according to the number of follow-up visits and length of therapy during the acute and continuation phases . Others, using fewer criteria in adults, have also reported similar results in the proportion of respondents receiving ade- quate antidepressant prescription [2, 36]. Consistent with previous findings [20, 37] no association was observed between overall adequate antidepressant therapy and individual and healthcare system characteristics studied.
Results in the present study show a difference between the two groups of older adults; older adults who reported a higher degree of self-determination also reported significantly higher experienced QoL than the adults who reported lower degree of self-determination. Our results are not surprising as previous research in other areas has also found a positive relation between self-determination and QoL [2, 3]. However, as far as we know, this is the first study that focuses on this topic within HCS. Further studies into the relationship be- tween self-determination, dependence and health-related QoL would be valuable, for example developing and test- ing models of care to strengthen the self-determination of older people in all aspects of HCS and to evaluate the impact of this on health-related QoL. Today, people are expected to live 15 to 20 years longer than previously in developed countries. Living longer might increase the length of time spent living with functional dependence, thus increasing the need for care models that also main- tain self-determination and independence in respect to functional aspects are needed .