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There is a growing demand for sustainable interventions to promote health and well-being in later life. One way to support older adults is to intervene during the retirement transition when individuals experience increased free time and a heightened need to develop new lifestyles (Moffatt & Heaven, 2017). However, to understand how retirement transition can serve as a 'gateway' for health interventions, exploring the mechanisms behind psychological adjustment to retirement is needed. t is posited that one approach to understanding retirement adjustment is to apply self-determination theory (SDT; Deci & Ryan, 1985, 2000). According to SDT, changes in well-being are predicted by satisfaction or frustration of basic needs for autonomy, competence, and relatedness. This PhD aimed to examine if SDT showed utility in understanding the complex process of retirement adjustment and to develop an intervention for supporting health and well-being in retirement. Four empirical studies used a combination of qualitative and quantitative methods to address the research aims. The first longitudinal study tracked changes in well-being and other psychological factors including need satisfaction/frustration over retirement transition. A vignette study examined the effects of personality on the perception and behaviour responses to need supportive and thwarting events in retirement. A qualitative study further explored the role of individual and contextual contributors to retirement adjustment. The final study followed the Intervention Mapping approach (IM; Bartholomew et al., 2006) to design a retirement lifestyle planning initiative. Results suggest that SDT can be used to understand retirement adjustment by 1) evidencing the link between need satisfaction and well-being in the target group; 2) suggesting an SDT-informed mechanism behind the effects of personality on retirement experiences; 3) explaining the role of psychological contributors (identity, social interaction, independence) and contextual factors in retirement adjustment through need satisfaction/frustration. The findings informed the development of a new 'Backcasting' intervention.

Objective: This thesis reports on the design, development and implementation of a feasibility study to investigate if a tailored exergame could be implemented to improve postural control outcomes for community-dwelling older adult fallers living in the North East of England, UK. Design: This feasibility study was carried out in several phases according to the Medical Research Council (MRC) framework guidance for complex interventions. Phase 1 consisted of two systematic reviews to identify characteristics to aid in the design, development and implementation of the intervention and subsequent pilot study and also to identify potential outcome measures. This also included a qualitative study of participants' perspectives using focus groups. Phase 2 consisted of a non-randomised controlled study where participants, recruited from 2 sites, Northumbria University and Gateshead Older Peoples Association (GOPA), were allocated to either one of two intervention groups (exergaming or traditional balance training) or a no exercise control group. The intervention lasted for 6 weeks and outcomes were assessed prior to the start of the intervention and following the final training session. Follow up interviews were conducted with participants and analysed using deductive thematic analysis. Findings: After reviewing the existing evidence, the literature indicated that exergaming interventions were as beneficial as traditional balance interventions, although the evidence for each outcome was of low quality, assessed using the GRADE approach. No intervention had implemented an outcome measure that assessed reactive postural control, verticality or the cognitive influences on postural control, such as the Mini-Balance Evaluation Systems Test (Mini-BESTest) and not all components of postural control were trained. Thematically analysed data from 3 focus groups totalling 13 participants, deduced four main themes: 1) attitudes toward technology, 2) consideration of balance and movement, 3) ease of use, and 4) social influence and exergaming. Adults of all ages perceived exergames to be enjoyable, yet, there were perceived barriers in using commercial exergames for older adults and individuals with balance impairments. The nonrandomised pilot intervention took place in Newcastle and Gateshead, UK. Thirty-five participants (10 exergaming, 10 traditional balance training and 10 controls) were included in the study. All four of the progression criteria were met in that 69% of eligible participants were screened and allocated to the intervention with a retention rate of 95.7% for all assessments. Adherence was 100% successful and only 1 adverse event occurred (3%) and did not occur during any of the training or assessment visits. Analysis of interview data from 10 participants (5 exergaming, 5 traditional balance training) following the pilot intervention revealed that older adult fallers accept the use of a tailored exergame (Mira™) as a method to train postural control. Conclusions: A tailored exergaming intervention was successfully implemented and received well by participants, although amendments to the protocol and barriers to future participation for older adult fallers should be considered prior to implementing a future definitive trial.

Rehabilitation potential is the potential of an individual to benefit from interventions which aim to optimise and restore function after a period of ill-health or new onset of disability. Health professionals are frequently required to evaluate this potential to determine who may be most likely to benefit from the provision of ongoing rehabilitation services. This doctoral study explored decision-making related to the assessment of rehabilitation potential of older people in hospital and the recommendation of rehabilitation pathways. To explore this in real-time, and in the shared patient and professional context in which decision-making occurred, principles of ethnographic and case-study research were utilised. The case study site was one acute medical ward within a local acute hospital in the North East of England. Three phases of fieldwork were undertaken, including a 2-week orientation and mapping phase, an 8 week period centred on the practice of occupational therapists and physiotherapists in relation to five patient cases, and finally a phase which involved five in-depth interviews with individual health professionals. Data was generated through observation, interviews and the review of clinical records. The whole data-set was analysed using thematic analysis. Key findings highlight that rehabilitation in this context was understood as a process to facilitate physical improvements and associated with an organisational aim for optimum safety rather than optimum function. And, although idealised as a phase of care, rehabilitation was often linked to a specific place, with the evaluation of rehabilitation potential subsequently linked with a hospital transfer. Furthermore, rehabilitation potential was ambiguous and poorly explained to patients and families. Health professionals recognised that their evaluation of rehabilitation potential was linked to high-stakes decisions about access to, or withholding services, and therefore the ethical dimensions of this decision had far-reaching influence. The involvement of the older person in judgements about rehabilitation potential and pathways was minimal, and there were many critical challenges to older people receiving fair and just access to services. The research findings conclude that there are significant tensions between the context of acute hospital care and the philosophy and ideals of rehabilitation. Furthermore, findings can assist professionals to recognise and reconcile tensions in practice and to move towards reframing rehabilitation to place the individual needs of older people at the centre of service delivery.

Adult safeguarding guidance in the UK highlights the importance of fully engaging adults at risk in all areas of safeguarding (at both a strategic and an individual level). However, research has suggested that the level of involvement is low, both regionally (in the North East of England), and nationally. This thesis presents an exploration of the involvement of older people at both a strategic level (within local decision making on policy and practice guidance), and an individual level (within individual safeguarding investigations), with the aim of contributing to greater knowledge and understanding of this area, and developing indicators for best practice. The research applied a qualitative approach, informed by critical realism, with data collected in two local authorities in the North East of England. Data collection methods included interviews and observations, as well as the compiling of related policy documents. Participants included key stakeholders in adult safeguarding; social workers, members of the Safeguarding Adults Boards, family members, and advocates were all interviewed as part of the research. The data was analysed using thematic analysis. Through this in-depth exploration a theoretical model of the involvement of older people in adult safeguarding was developed. The emerging model provides a deeper understanding of involvement in adult safeguarding by highlighting key factors which both help and hinder involvement. The model reveals the complex interplay between multiple factors impacting on the involvement of older people in adult safeguarding which include, for example, the individual circumstances of the older person and the environment within which adult safeguarding work occurs. The importance of establishing a clear role and remit for involvement in this area is also demonstrated with reference to established models, and the manner in which involvement is constructed within adult safeguarding policy and by key stakeholders. The outputs from this project include contribution to the current discussion in the areas of service user involvement, adult safeguarding, and social work policy, practice and research.