Gerontology Theses

ABSTRACT Many older African American adults have inadequate health literacy and are more likely to have chronic illnesses needing medication therapy. African Americans continue to experience significant health disparities in the incidences of cardiovascular disease and diabetes. It was postulated that ethnic disparities in medication compliance are related to a dynamic interplay between low health literacy and health locus of control. Thirty older African Americans taking at least one prescription medication were interviewed. Although the vast majority was well-educated, only 53% displayed adequate health literacy. Most of the participants believed they controlled their health, and over half were noncompliant with their medications. Poor health literacy and health locus of control appeared to influence medication compliance in older African Americans.

Fall prevention is a serious issue in the health and aging fields, and much attention and research is now being focused on examining why older adults fall and ways to prevent them from falling. Although it has been well-documented that older adults benefit from programs designed to decrease falling by promoting exercise participation, balance training, and fall education; little research has focused on specifically examining how older minority women view preventive exercise programs. This qualitative study explores the experiences of older minority women participating in a fall prevention program. The specific aims of the study are to: 1) gain an understanding of older minority women’s experiences and perceptions about falling and fall prevention; 2) establish what factors influence older minority women to participate in fall prevention programs; and 3) explore participants’ perceived outcomes of program participation. Post-test interviews with 21 participants were analyzed using the method of grounded theory to identify common themes and outcomes associated with participation in a fall prevention program. Findings from this study provide an in-depth look into the factors motivating older minority women to participate in exercise and explore their beliefs regarding falling and fall prevention.

This study examined the influence of personal and workplace factors on direct care workers¡¯ retention in Assisted Living Facilities (ALFs). The sample includes 11 ALFs in urban areas in Atlanta, Georgia and 13 participants from the sample facilities. The findings show that personal and workplace factors interact with each other to influence retention in the long-term care field and retention in a particular facility. The findings of this study may have implications for facility policy and practice to retain workers.

Food security amongst community-dwelling older adults attending senior centers is not often examined. It is an integral determinant of health because of its impact on multiple health conditions. This study examined the relationship between food security, activities of daily living, and demographic variables of older adults attending senior centers in Georgia served by nutrition provider Open Hand Atlanta (OHA). One hundred sixty-five senior center attendees were recruited from ten senior centers in Fulton County Georgia. Food security was measured by the USDA 6-item module. Bivariate associations were tested between food security and ADLs and iADLs (instrumental ADLs) measured by a 15-item list. Results showed that food security differed based on race/ethnicity X² (n=165) = 8.94 (df=2), p = .011 and type of insurance X² (n=100) = 5.95, (df=1) p = 0.015). Public/Govt insurance holders experience a higher proportion of food insecurity compared to those under private insurance (p=.015).

Human-animal interaction (HAI) is a potentially valuable form of meaningful engagement among assisted living (AL) residents yet has received very little research attention, especially among those with dementia. This research addresses the gap in knowledge by 1) examining opportunities for human-animal interaction among AL residents, including those living with dementia and 2) Understand the experiences with and significance of human-animal interaction by identify influential factors that play a role in meaningful engagement. To address these aims, I analyzed qualitative data from the Grounded Theory (GT) study, “Meaningful Engagement and Quality of Life in Persons Living with Dementia in Assisted Living.” Using a modified form of GT, I analyzed data from 6 diverse AL communities studied for one year each through participant observation and in-depth interviews. I found HAI opportunities were presented through the AL community, family and friends, and depended on resident’s interest in animals. Findings show that HAI opportunities provided connection through social, physical, cognitive, and emotional engagement. Findings have implications for practice and research by highlighting the significance of meaningful engagement through connections to the animal, care partner, and environment.

My thesis focuses on understanding the ways in which single-frame editorial cartoon images depicting older adults and sex are used online. Cartoons draw upon social stereotypes and reflect societal attitudes toward aging. The importance of sexuality across the lifespan is evident; however, people often direct ageist stigma at sexual activity in older adulthood. My study explores the use of single-frame editorial cartoons to further social, political, and capitalistic agendas. The location of these editorial cartoons on the internet indicates how the sexuality of older adults is used as a digital marketing strategy. I used the Google Lens search engine to conduct reverse image lookups (RIL) of cartoons to see where they are being published online. I recorded data on 32 single-cel cartoons about “old people and sex” that were previously collected for paper “‘Shout Dirty to Me’: A Discourse Analysis of Single-Cel Cartoons about Menopause, Erectile Dysfunction, and Old People and Sex” (Simonds and Pope, in progress). This thesis is guided by the theory of ageism, the encoding/decoding model of communication, and feminist intersectional theory. I explore these frameworks and how ageist messages are interpreted in a social context. Editorial cartoons, if wielded responsibility, could in fact help challenge stigmas that oppress older populations I used this data to explore the social and commercial implications of cartoon use on the sexuality of older adults. I hope this research will help provide a better understanding of the extent of ageist content online. Editorial Cartoons, Single-frame Cartoons, Sex and Older adults, Reverse Image Search, Visual Ageism, Humor, Disability, Age-Related Anxiety, Self-help, Capitalism

Social isolation is a prevalent issue among nursing home residents, which can lead to various chronic diseases, such as depression, dementia, and chronic pain. Social integration refers to the active engagement in social ties, institutional connections, and participation in community-based social, cultural, and religious activities. Organizational culture is a critical factor in providing person-centered care and fostering communication, teamwork, and quality improvement processes. The study examines organizational culture specifically in terms of person-centered care practices and social integration, social isolation, and loneliness among residents. The study adopted a descriptive study design to understand the context of organizational culture and social integration among nursing home residents. The was guided by the following research questions: how do staff perceive that they influence the social integration of residents, what person-centered practices are currently in place to support reducing social isolation and loneliness and how does the transition to private rooms in the nursing homes setting impact residents perception on social isolation and integration. The study aims to identify areas of organizational culture and person-centered practices that could be improved and, in that context, better understand the social health of residents. The study includes targeted recommendations for promising practices that will support the entire community of workers, families, and residents.

The significant role of case managers in improving the health status of clients and in achieving cost-containment has been increasingly recognized. However, very few studies have touched on the emerging group of case managers who work exclusively with frail older adults. The purpose of this study was to determine the level of overall job satisfaction and some of its determinants among case managers of the Visiting Nurse Health System, Atlanta, Georgia, working primarily with older adults in two community-based programs. The objectives were to learn: (1) the level of overall job satisfaction among these case managers; (2) how these case managers perceive their role; and (3) what factors facilitate their work, what factors present barriers to their job performance, and what policy or procedural changes they feel would improve their performance. An established job satisfaction scale was employed to assess job satisfaction among the case managers. The overall job satisfaction scores ranged from 109 to 198 (out of a maximum possible score of 216), with a mean of 158.2, which is considerably higher than the theoretical mid-point of the scale (126). Nine subscales of job satisfaction, ordered by the satisfaction level from highest to lowest were, Coworkers, Supervision, Nature of Work, Communication, Contingent Rewards, Fringe Benefits, Operating Conditions, Pay, and Promotion. Case managers in the Older Group (aged 45 and older) showed higher overall satisfaction compared to those in the Younger Group (younger than 45). Furthermore, satisfaction levels with Fringe Benefits and Operating Conditions were significantly higher in the Older Group than in the Younger Group. No significant difference was found in job satisfaction between case managers in the two programs (CCSP and CBSP). Case managers with longer experience (at least 4 years) showed a higher satisfaction level with Pay compared to those with shorter experience (less than 4 years) in their current program. No significant difference in job satisfaction was found between social worker and nurse case managers, except that nurse case managers were significantly more satisfied with Fringe Benefits than social worker case managers. Qualitative analysis of the interview found that case managers tended to describe their role in terms that were either related to program objectives or activities. They viewed their role more as providing or ensuring services to their clients than as cost-containment. At the same time, initial assessment appeared to be the most important component of their role compared to other activities, such as evaluation or contact with service providers. Nature of the work, management, and coworkers are the three major sources of facilitating factors reported. On the other hand, the majority of deterring factors, related to operating procedures, pay, promotion, supervision, funding, and management, fell in the category of organizational factors. Deterring factors related to individual factors were related to communication and coworker relationship. Long-term study is needed to learn the job satisfaction among case managers working primarily with older adults and to determine what contributes to or undermines their job satisfaction. Policy changes might be needed at the organizational level to enhance job satisfaction among case managers.

Post-stroke depression (PSD) affects at least one out of every three stroke survivors worldwide and presents with a variety of symptoms. The likelihood of its development relates to individual biological, psychological, and social circumstances, yet incidences are rarely addressed in the literature. Moreover, the presence of aphasia in some cases makes identifying PSD challenging. The purpose of this study was to investigate the incidence of PSD in adults with aphasia compared the incidence of PSD in adults without aphasia in an acute care setting, and to identify risk factors for PSD in adults with aphasia. Results indicated that adults with aphasia are 7.408 times more likely to exhibit PSD than adults without aphasia. Logistic regression controlling for the presence of aphasia showed a significant relationship between aphasia severity and PSD. Adults with aphasia were 2.06 times more likely to experience PSD with every 1-point increase in aphasia severity.

Direct care workers (DCWs) face persistent challenges with low pay, few benefits, heavy workloads, and limited access to paid leave. COVID-19 have increased the precarity of the long-term care system and has left many direct care workers more vulnerable. With layered risks of systemic racism, COVID-related risks, and political turmoil on top of socio-economic challenges, direct care workers, older adults, and those with disabilities experience high risks to health and well-being. Using the socio-ecological framework, the aim of this exploratory study was two-fold; (1) examine DCWs understanding of trauma and how it affects their ability to provide care, and (2) understand the strategies and supports DCWs and organizations use to cope with trauma. Using semi-structured interviews with 25 certified nursing assistants, the findings demonstrate the impact of COVID-19, work stress, and systemic inefficiencies that negatively impact care work and examined strategies to support resilience-building and ultimately empowerment practices.

An overlooked and little-understood potential site for meaningful engagement among assisted living residents with dementia is the salon. This thesis addresses this knowledge gap by 1) examining salon experiences in relation to resident appearance, self-identity, and engagement opportunities; 2) identifying processes and factors related to salon experiences; and 3) viewing salon experiences and their meaning through the lens of embodied selfhood. Qualitative interview and fieldnote data from the study, “Meaningful Engagement and Quality of Life in Persons Living with Dementia in Assisted Living” were analyzed, guided by grounded theory method and informed by the sensitizing concepts of embodiment, self-narrative, and social identity. Several processes were identified comprising the salon experience that, collectively, provided engagement in a form of embodied selfhood meaningful to residents with dementia, and as such, helped residents maintain their personhood and sense of self. Findings point to the importance of care partner facilitation of resident salon experiences.

This thesis focuses on direct care workers’ (DCW) interpretations of and responses to the behaviors and expressions of assisted living (AL) residents with dementia. Data are drawn from a five-year grounded theory study of AL residents’ care arrangements that involved interviewing, participant observation, and resident record review. This study analyzes data from a sub-sample of 29 residents living with dementia and their care network members from 7 diverse AL settings studied over 2 years. The aims are to: examine DCWs’ reactions to resident behaviors; and understand how and under what circumstances DCWs seek assistance from external network members. DCWs responses included being patient and working directly with residents to reaching out to others, especially in instances of perceived aggressive. Resident- and DCW-factors influenced staff perceptions and responses and were highly variable. Findings underscore the importance of enhanced dementia care training for DCWs and the value of family participation in care.

Aging Black adults remain disproportionately diagnosed with physical and mental health conditions. Behavioral interventions promoting healthy behaviors, such as dance therapy, can be used to manage many physical and mental health conditions successfully. Little is known about the willingness to participate in dance specifically for health benefits among this population. Using an exploratory research design, this study examined Black older adults’ preferences and perceptions about dancing in general and specifically for physical and mental health benefits. Thirty-six participants completed a semi-structured questionnaire that assessed demographics, health status, beliefs, attitudes, intentions, and dance therapy intervention structure and delivery preferences. Findings indicate Black older adults express interest in engaging in dance for health benefits. Beliefs, attitudes, and intentions were positively correlated with dancing for health benefits. Therefore, designing dance therapy interventions for health benefits may be a feasible way to increase physical activity and prevent adverse health outcomes among Black older adults.

ABSTRACT

Increasing numbers of people are living with dementia in every part of the globe. Curative options are unavailable through traditional medical model; alternative therapeutic approaches are required urgently. Using a grounded theory methodology, this study seeks to build an understanding of the barriers and facilitators to person-centered care (PCC) approaches and the integration of complementary and alternative approaches for people living with dementia (PLWD) and residing in nursing homes throughout the state of Georgia. This study will generate implications for implementing PCC and culture change, its barriers, facilitators and how PCC can improve the daily lives of persons living with dementia in an institutional setting. This study will describe different engagement activities and alternative therapies which promote relaxation and improve quality of life of those individuals. This knowledge of the landscape of activities will help us identify and improve strategies for supporting PLWD at a deeper, more meaningful level.

Perimenopause is a significant, transitional event in the life span of women. To date, most empirical research has focused on the experiences of middle-class Caucasian women, while the experiences of low-income black women have largely gone understudied. This qualitative study is one of few studies published in the past 20 years that investigates the perimenopausal experiences of low-income black women. I used an intersectionality framework to explore the lived experiences of eight low-income black women recruited from a large, urban city in the southeastern U.S. The main research question guiding the study was: How do low-income black women perceive and manage the menopause transition? Secondarily, the study investigated how this sample of participants interpreted and made meaning of their perimenopausal experiences in the larger context of aging. Digital audio recordings of face-to-face interviews were transcribed verbatim and analyzed using N-Vivo 12. Based on an interpretative phenomenological approach, an iterative coding strategy produced five dominant themes: a lack of knowledge about menopause; a need for more information and resources from doctors; managing vasomotor symptoms, sleeplessness, and mood lability; an acceptance that menopause is a natural part of life; and positive views toward aging. Research findings have implications for healthcare and mental health practitioners tasked with addressing the health-related quality-of-life concerns of midlife minority women. Gerontologists studying reproductive aging issues in racially diverse populations will also glean important insights from this qualitative study (e.g., black women’s menopausal experiences are often embedded in a larger context of chronic health issues and health disparities).

Framed by Anderson’s Behavioral Model of Health Services and institutional racism, this study examines the relationship between age and perceptions of access to health care resources within local communities. Multi-variate models will be used to assess perceived access to quality health care among older adults in rural Georgia examining the relative impact of age, race, income, barriers accessing local doctors/providers, issues related to distance/transportation on residents’ perceptions and the role of community support. State-level analysis detailing rural residents’ perceptions of access-to-care is expansive but lacks inclusion of individuals’ perception of access as they progress to old age. Findings indicate that age, race and income are important predictors of perceived transportation barriers to health care access and perceived access to local doctors/providers. Policy recommendations include expanding community/private/government partnerships, encouraging public communication of access concerns, and state-level commitment to support the development of health care resources in underserved rural communities

Social support is a key factor influencing older adults’ health and well-being. Disclosing one’s lesbian, gay, or bisexual identity at any age has great potential for altering, if not destroying, existing relationships with family, friends, and others. With long-established social roles and personal relationships, the potential risks may be accentuated for those who come out in mid- or later-life. Yet, researchers have paid scant attention to this phenomenon. This exploratory qualitative study examines the impact of coming out “late” on older adults’ social networks. In-depth interviews were conducted with a sample of fourteen older adults who disclosed their non-heterosexual identity at or after age 39. Interviews inquired about participants’ past and present social networks and the coming out process, particularly the influence of coming out “off time.” Findings show coming out is a dynamic, continuous, and non-linear process that simultaneously characterizes and is characterized by social network gains and losses.

As the U.S. population ages, there is a significant increase in functional impairment, chronic conditions and other age related health concerns. In later life, functional limitations and poor quality of health often lead to the utilization of skilled nursing care in institutional settings. However, older adults often report the desire to age in place even when experiencing health challenges. Therefore, identifying ways to promote aging in place at home as a long-term care option could enhance quality of life. The objective of the study is to examine the impact of home modification and other home and community-based services on the ability of Black older adults to age in place in comparison to Whites. The study utilizes administrative data from the Georgia Money Follows the Person program. The results indicate that race, the use of financial support and the utilization of many services were significant in attaining success in the MFP program.

Despite health benefits of physical activity (PA) and risks of physical inactivity, many older adults do not accumulate sufficient levels of PA to achieve associated health benefits. Lack of PA enjoyment may be a barrier to PA participation. This pilot study posited that by combining endurance-enhancing laughter yoga exercises with a moderate-intensity strength, balance, and flexibility PA program, LaughActive would increase health and self-efficacy for PA among older adults residing in 4 assisted living facilities (ALFs). The 12-week wait list control study used pre- and 6-week post-intervention comparisons among and between groups (n=27) who participated in twice-weekly LaughActive classes. Significant improvements (p < .05 - .10) were observed in mental health (SF-36v2^®), aerobic endurance (SFT), and self-efficacy (OEE). Further well-designed research is needed to demonstrate the effectiveness of laughter-enhanced PA programs in achieving health and self-efficacy for PA outcomes among older adult populations.

This paper presents the results of a focus group study exploring older individuals' perceptions of older drivers. The study extends the stereotype research of Joanisse, Gagnon, and Voloaca (2012b), further investigating the terms used to describe older drivers. Also explored were the ways older adults perceive age versus health in their considerations of driving. Three focus groups (N=24) were conducted with former and current drivers, 64 years and older, living in Asheville, North Carolina. Participants showed positivity in their descriptions of older drivers as "slow" and "cautious" and believed they adapted their driving behavior as aging demanded. Participants showed heterogeneity in their acceptance of the health issues that threatened their continued driving ability. The importance of context in understanding stereotypes of older adults is illustrated. Results are discussed in terms of ingroup/outgroup theory in line with the proposed model.