Assessing and improving everyday functioning in older adults

Docherty, Sarah (2022) Assessing and improving everyday functioning in older adults. Doctoral thesis, Northumbria University.

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Abstract

The ageing population has led to a range of societal issues, and research needs to identify ways to promote healthy ageing and independent living for longer. One such area of interest in this area is diet and supplementation, which has focused on improving aspects of psychological and psychical health in older adults. However, there have been clear methodological limitations within this research, including stringent inclusion criteria and no measure of dietary intake. Furthermore, nutraceutical research has focused on very specific outcome measures which do not have clear real-world applicability. This programme of work aimed to address these limitations, and further knowledge in the area by taking novel approaches to assess and improve everyday functioning in older adults.

The first experimental study reported in Chapter 2 aimed to explore older adults’ own views of their perceived levels of everyday functioning and in which areas they would like to see improvements. It was identified through thematic analysis that older adults reported difficulties with a range of activities (such as recreational hobbies and household tasks) which stemmed from underlying health and mobility issues. Furthermore, the themes found within this study were used as a guide to design outcome measures for the subsequent intervention (Chapter 3), with the aim to undertake a participant-led approach to study design.

Chapter 3 reports an experimental, randomised, placebo-controlled, double blind parallel groups study, investigating the effects of a multivitamin supplement on everyday functioning in older adults. This trial was designed to improve on issues with previous trials, and to incorporate areas highlighted as important to older adults in Chapter 2. Results showed that 12-week multivitamin supplement improved feelings of friendliness in females and reduce measures of prolonged stress reactivity and emotional loneliness in males. Furthermore, a range of interactions were found between habitual dietary intake and multivitamin supplementation, indicating that supplementation may be more effective in those with lower nutritional intake.

Chapter 4 explored how habitual dietary intake before supplementation effected everyday function outcomes. The aim of this was to both add to the vast literature in this area and to fully understand interaction found within Chapter 3. Surprisingly results of this study showed that those below the mean intake of various vitamins and minerals (in this sample) performed more favourably on everyday function outcomes. Suggesting that there may be an inverted U shape curve in relation to vitamin and mineral intake and favourable outcomes in everyday functioning, which warrants further exploration.

Finally, Chapter 5 reports a naturalistic repeated measures design, exploring the effects of COVID-19 lockdown on everyday function in older adults. It was shown that the government lockdown in response to the COVID 19 pandemic had largely negative implications for wellbeing, mood, perceived stress and memory in older adults, but there were improvements in general health, physical activity and social interaction. There are clear applications going forward for ways to minimise harmful side effects of stressful situations in older adults.

Overall, this programme of work has clear and important implications. As well as implications already mentioned in this abstract, it highlights that multivitamin supplementation in older adults may have the potential to elicit positive effects on everyday functioning. With these effects being even more pronounced in those who have worse diet, suggesting supplementation should be recommended in older adults who do not consume adequate levels of vitamins and minerals.

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