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- Genre: Doctoral Dissertation
Description
ABSTRACT Caregiving studies generally do not focus on the post-caregiving phase of care, or African Americans post-caregivers (AAPCGs). This mixed-methods study guided by the Transitions Theory, explored the experiences of 40 AAPCGs residing in Los Angeles, California and Phoenix, Arizona, whose loved ones died within the last 10 years. Data collection tools included individual interviews, demographic questionnaire, CES-D, Brief Cope, and Social Support. Findings present the specific aims of the study. Aim 1 dealt with the types, patterns and properties of post-caregiving transitions (PCT). Many AAPCGs experienced multiple, simultaneous transitions that continued to impact their lives many years after caregiving ends. Aim 2 dealt with factors that facilitate or inhibit healthy PCT. Facilitators include: Being satisfied with care provided; fulfilling death-bed promises; living out the legacy of the deceased; deep spiritual beliefs in God and support of family, friends and church. Inhibitors include: Experiencing a deep sense of loss, confusion, depression, loneliness, and guilt; physical challenges such as fatigue and exhaustion, breathing problems, dizziness, fainting, cognitive difficulties, pain, headaches, hypertension and insomnia; family conflicts, job or home loss that linger long after PCT. Aim 3 involves process indicators including: connectedness with family, friends, co-workers, church and God; returning to work or school. Coping strategies that helped AAPCGs include: productive ventures, family mementoes, reminiscing, new baby, or visiting cemetery. Appropriate coping led to outcome indicators of mastery such as new environment; making decisions; taking actions; readying oneself for another caregiving role; preparing for one's own life and death; or caring for self. Fluid integrative identities include: Sense of balance, peacefulness and joy, fulfillment, compassion; remembering without pain; or new identity. Implications for practice, policy, education and research include: Care providers and policy makers must ensure that AA caregivers receive adequate EOL and hospice information and support for adequate preparation of loved one's death. Geriatric educators must design and implement curricular programming that includes the post-caregiving phase as a very important phase of caregiving. Researchers should design culturally-congruent assessment tools or improve the checklist developed in this study to appropriately measure PCT; and also develop culturally-relevant interventions to facilitate healthy PCT.
ContributorsUme, Ebere Peace (Author) / Evans, Bronwynne C. (Thesis advisor) / Coon, David W. (Thesis advisor) / Keller, Colleen S (Committee member) / Arizona State University (Publisher)
Created2013
Description
Cognitive function declines with normal age and disease states, such as Alzheimer's disease (AD). Loss of ovarian hormones at menopause has been shown to exacerbate age-related memory decline and may be related to the increased risk of AD in women versus men. Some studies show that hormone therapy (HT) can have beneficial effects on cognition in normal aging and AD, but increasing evidence suggests that the most commonly used HT formulation is not ideal. Work in this dissertation used the surgically menopausal rat to evaluate the cognitive effects and mechanisms of progestogens proscribed to women. I also translated these questions to the clinic, evaluating whether history of HT use impacts hippocampal and entorhinal cortex volumes assessed via imaging, and cognition, in menopausal women. Further, this dissertation investigates how sex impacts responsiveness to dietary interventions in a mouse model of AD. Results indicate that the most commonly used progestogen component of HT, medroxyprogesterone acetate (MPA), impairs cognition in the middle-aged and aged surgically menopausal rat. Further, MPA is the sole hormone component of the contraceptive Depo Provera, and my research indicates that MPA administered to young-adult rats leads to long lasting cognitive impairments, evident at middle age. Natural progesterone has been gaining increasing popularity as an alternate option to MPA for HT; however, my findings suggest that progesterone also impairs cognition in the middle-aged and aged surgically menopausal rat, and that the mechanism may be through increased GABAergic activation. This dissertation identified two less commonly used progestogens, norethindrone acetate and levonorgestrel, as potential HTs that could improve cognition in the surgically menopausal rat. Parameters guiding divergent effects on cognition were discovered. In women, prior HT use was associated with larger hippocampal and entorhinal cortex volumes, as well as a modest verbal memory enhancement. Finally, in a model of AD, sex impacts responsiveness to a dietary cognitive intervention, with benefits seen in male, but not female, transgenic mice. These findings have clinical implications, especially since women are at higher risk for AD diagnosis. Together, it is my hope that this information adds to the overarching goal of optimizing cognitive aging in women.
ContributorsBraden, Brittany Blair (Author) / Bimonte-Nelson, Heather A. (Thesis advisor) / Neisewander, Janet L (Committee member) / Conrad, Cheryl D. (Committee member) / Baxter, Leslie C (Committee member) / Arizona State University (Publisher)
Created2012
Description
Generativity was first described by Erikson (1963) as an adult's concern for and commitment to promoting the welfare and development of future generations. Generativity is juxtaposed by stagnation in Erikson's stage of midlife (35-65 years old). The developmental hurdle faced at this point in the developmental cycle is whether a person will produce something of real value, both in the present and impacting future generations. Generative adults seek to give something back to society, generally behaving in a way to make the world a better place for others with no personal gain attached. The goal of the current study was to assess differences in levels of generativity at the final stage of adult life, and the potential functions that generativity can serve individuals. Results suggest that lowly generative individuals in older adult life tend to experience doubts about the impact they have had on the world and the lack of legacy they are leaving behind. Themes of highly generative participants included having felt they lived a purposeful and meaningful life, along with feeling fortunate and lucky in their lives. Also highly generative participants seemed to feel confident in the legacy they will leave behind after death. Results are discussed in light of the theories and findings of Erikson and McAdams.
ContributorsHauser, David (Author) / Kinnier, Richard T. (Thesis advisor) / Homer, Judith (Committee member) / Arciniega, Guillermo M. (Committee member) / Arizona State University (Publisher)
Created2013
Description
This dissertation explored how immigrants cope with and thrive in old age by utilizing social networks, and the hindrances which may prevent this. Through ethnographic fieldwork and in-depth interviews at two senior centers in Phoenix, Arizona with a high concentration of an ethnic minority group - Asian and Latino, I describe what makes the Asian dominant center more resource abundant than its Latino counterpart given prevalent tight public funding. Both centers have a large number of seniors disenfranchised from mainstream institutions who bond together via similar experiences resulting from shared countries/regions of origin, language, and migration experience. The Asian center, however, is more successful in generating and circulating resources through "bonding" and "bridging" older immigrants who, therefore benefit more from their center affiliation than the Latinos at their center.
The abundance of resources at the Asian center flowing to the social networks of seniors are attributed to three factors: work and volunteer engagement and history, the organization of the center, and individual activities. At both centers seniors bond with each other due to shared ethnicity, language, and migration experience and share information and companionship in the language in which they feel most comfortable. What differentiated the two centers were the presence of several people well connected to individuals, groups, and institutions beyond the affiliated center. The presence of these "bridges" were critical when the centers were faced with budgetary constraints and Arizona was experiencing the effect of ongoing immigration policies. These "bridges" tend to come from shared ethnicity, and better social positions due to cumulative factors which include but are not limited to higher education, professional occupation, and work and volunteer history. I have also presented cases of individuals who, although have developed expertise from past work experiences and individual activities, have limited contribution to the resource flow because of the differences in ethnicity. The study also explored a gendered life course and its impact on the social network for older Asian and Latino immigrants.
The abundance of resources at the Asian center flowing to the social networks of seniors are attributed to three factors: work and volunteer engagement and history, the organization of the center, and individual activities. At both centers seniors bond with each other due to shared ethnicity, language, and migration experience and share information and companionship in the language in which they feel most comfortable. What differentiated the two centers were the presence of several people well connected to individuals, groups, and institutions beyond the affiliated center. The presence of these "bridges" were critical when the centers were faced with budgetary constraints and Arizona was experiencing the effect of ongoing immigration policies. These "bridges" tend to come from shared ethnicity, and better social positions due to cumulative factors which include but are not limited to higher education, professional occupation, and work and volunteer history. I have also presented cases of individuals who, although have developed expertise from past work experiences and individual activities, have limited contribution to the resource flow because of the differences in ethnicity. The study also explored a gendered life course and its impact on the social network for older Asian and Latino immigrants.
ContributorsFukui, Haruna Miyagawa (Author) / Menjivar, Cecilia (Thesis advisor) / Glick, Jennifer E. (Committee member) / McHugh, Kevin (Committee member) / Arizona State University (Publisher)
Created2014
Description
A core principle in multiple national quality improvement strategies is the engagement of chronically ill patients in the creation and execution of their treatment plans. Numerous initiatives are underway to use health information technology (HIT) to support patient engagement however the use of HIT and other factors such as health literacy may be significant barriers to engagement for older adults. This qualitative descriptive study sought to explore the ways that older adults with multi-morbidities engaged with their plan of care. Forty participants were recruited through multiple case sampling from two ambulatory cardiology practices. Participants were English-speaking, without a dementia-related diagnosis, and between the ages of 65 and 86. The older adults in this study performed many behaviors to engage in the plan of care, including acting in ways to support health, managing health-related information, attending routine visits with their doctors, and participating in treatment planning. A subset of patients engaged in active decision-making because of the point they were at in their chronic disease. At that cross roads, they expressed uncertainly over which road to travel. Two factors influenced the engagement of older adults: a relationship with the provider that met the patient's needs, and the distribution of a Meaningful Use clinical summary at the conclusion of the provider visit. Participants described the ways in which the clinical summary helped and hindered their understanding of the care plan.
Insights gained as a result of this study include an understanding of the discrepancies between what the healthcare system expects of patients and their actual behavior when it comes to the creation of a care plan and the ways in which they take care of their health. Further research should examine the ability of various factors to enhance patient engagement. For example, it may be useful to focus on ways to improve the clinical summary to enhance engagement with the care plan and meet standards for a health literate document. Recommendations for the improvement of the clinical summary are provided. Finally, this study explored potential reasons for the infrequent use of online health information by older adults including the trusting relationship they enjoyed with their cardiologist.
Insights gained as a result of this study include an understanding of the discrepancies between what the healthcare system expects of patients and their actual behavior when it comes to the creation of a care plan and the ways in which they take care of their health. Further research should examine the ability of various factors to enhance patient engagement. For example, it may be useful to focus on ways to improve the clinical summary to enhance engagement with the care plan and meet standards for a health literate document. Recommendations for the improvement of the clinical summary are provided. Finally, this study explored potential reasons for the infrequent use of online health information by older adults including the trusting relationship they enjoyed with their cardiologist.
ContributorsJiggins Colorafi, Karen (Author) / Lamb, Gerri (Thesis advisor) / Marek, Karen (Committee member) / Greenes, Robert (Committee member) / Evans, Bronwynne (Committee member) / Arizona State University (Publisher)
Created2015
Description
The population of older adults and the percentage of people living in urban areas are both increasing in the U.S. Finding ways to enhance city-dwelling, older adults' social integration, cognitive vitality, and connectedness to nature were conceptualized as critical pathways to maximizing their subjective well-being (SWB) and overall health. Past research has found that gardening is associated with increased social contact and reduced risk of dementia, and that higher levels of social support, cognitive functioning, mindfulness, and connectedness to nature are positively related to various aspects of SWB. The present study was a pilot study to examine the feasibility of conducting a randomized, controlled trial of community gardening and to provide an initial assessment of a new intervention--"Mindful Community Gardening," or mindfulness training in the context of gardening. In addition, this study examined whether community gardening, with or without mindfulness training, enhanced SWB among older adults and increased social support, attention and mindfulness, and connectedness to nature. Fifty community-dwelling adults between the ages of 55 and 79 were randomly assigned to one of three groups: Traditional Community Gardening (TCG), Mindful Community Gardening (MCG), or Wait-List Control. The TCG and MCG arms each consisted of two groups of 7 to 10 participants meeting weekly for nine weeks. TCG involved typical gardening activities undertaken collaboratively. MCG involved the same, but with the addition of guided development of non-judgmental, present-focused awareness. There was a statistically significant increase in different aspects of mindfulness for the TCG and the MCG arms. The interventions did not measurably impact social support, attention, or connectedness to nature in this small, high functioning, pilot sample. Qualitative analysis of interview data from 12 participants in the TCG and MCG groups revealed that both groups helped some participants to better cope with adversity. It was concluded that it is feasible to conduct randomized, controlled trials of community gardening with urban older adults, and considerations for implementing such interventions are delineated.
ContributorsOkvat, Heather Audrey (Author) / Zautra, Alex J. (Thesis advisor) / Davis, Mary C. (Committee member) / Knopf, Richard C. (Committee member) / Okun, Morris A. (Committee member) / Arizona State University (Publisher)
Created2011
Description
Identifying modifiable causes of chronic disease is essential to prepare for the needs of an aging population. Cognitive decline is a precursor to the development of Alzheimer's and other dementing diseases, representing some of the most prevalent and least understood sources of morbidity and mortality associated with aging. To contribute to the literature on cognitive aging, this work focuses on the role of vascular and physical health in the development of cognitive trajectories while accounting for the socioeconomic context where health disparities are developed. The Assets and Health Dynamics among the Oldest-Old study provided a nationally-representative sample of non-institutionalized adults age 65 and over in 1998, with biennial follow-up continuing until 2008. Latent growth models with adjustment for non-random missing data were used to assess vascular, physical, and social predictors of cognitive change. A core aim of this project was examining socioeconomic and racial/ethnic variation in vascular predictors of cognitive trajectories. Results indicated that diabetes and heart problems were directly related to an increased rate of memory decline in whites, where these risk factors were only associated with baseline word-recall for blacks when conditioned on gender and household assets. These results support the vascular hypotheses of cognitive aging and attest to the significance of socioeconomic and racial/ethnic variation in vascular influences on cognitive health. The second substantive portion of this dissertation used parallel process latent growth models to examine the co-development of cognitive and functional health. Initial word-recall scores were consistently associated with later functional limitations, but baseline functional limitations were not consistently associated with later word-recall scores. Gender and household income moderated this relationship, and indicators of lifecourse SES were better equipped to explain variation in initial cognitive and functional status than change in these measures over time. Overall, this work suggests that research examining associations between cognitive decline, chronic disease, and disability must account for the social context where individuals and their health develop. Also, these findings advocate that reducing socioeconomic and racial/ethnic disparities in cognitive health among the aging requires interventions early in the lifecourse, as disparities in cognitive trajectories were solidified prior to late old age.
ContributorsBishop, Nicholas Joseph (Author) / Kronenfeld, Jennie J. (Thesis advisor) / Haas, Steven A. (Committee member) / Eggum, Natalie D. (Committee member) / Arizona State University (Publisher)
Created2011
Description
ABSTRACT The massive number of baby boomers approaching retirement age has been termed the `gray tsunami.' As America's gray tsunami approaches, healthcare workers and social workers will become overwhelmed with requests for services and supports (St. Luke's Health Initiative, 2001; Bekemeier, 2009). This impact can be ameliorated by assisting aging individuals in maintaining or in some cases regaining independence. Individuals who live in assisted living facilities (AFLs) come from diverse backgrounds. Many of these individuals have lived in paternalistic environments such as prisons and mental health institutions. As a consequence of these disempowering conditions, residents of ALFs may experience increased depression, decreased self-esteem, and decreased locus of control (R. Hess, personal communication, September 30, 2010). These disabling conditions can severely limit residents' choice-making opportunities and control over their own lives. If programs can be created to provide empowering experiences and to teach self-advocacy skills, I hypothesize that residents will report an improved quality of life and display fewer depressive symptoms, increased self-esteem, and increased locus of control. Helping these individuals to maintain or regain independence will not only reduce the workload for care workers, it will enhance the lives of residents. The only hypothesis that was supported by the study was an improvement in residents' quality of life, and that hypothesis was only partially supported. Two of the five domains in the Residents' Quality of life questionnaire indicated an increase in quality of life. ii The Activities subscale of the Ferrans & Powers Quality also indicated that there was an increase in quality of life.
ContributorsHedgpeth, Jay (Author) / Napoli, Maria (Thesis advisor) / Gerdes, Karen (Committee member) / Bonifas, Robin (Committee member) / Arizona State University (Publisher)
Created2012
Description
Cognitive function is multidimensional and complex, and research indicates that it is impacted by age, lifetime experience, and ovarian hormone milieu. One particular domain of cognitive function that is susceptible to age-related decrements is spatial memory. Cognitive practice can affect spatial memory when aged in both males and females, and in females alone ovarian hormones have been found to alter spatial memory via modulating brain microstructure and function in many of the same brain areas affected by aging. The research in this dissertation has implications that promote an understanding of the effects of cognitive practice on aging memory, why males and females respond differently to cognitive practice, and the parameters and mechanisms underlying estrogen's effects on memory. This body of work suggests that cognitive practice can enhance memory when aged and that estrogen is a probable candidate facilitating the observed differences in the effects of cognitive practice depending on sex. This enhancement in cognitive practice effects via estrogen is supported by data demonstrating that estrogen enhances spatial memory and hippocampal synaptic plasticity. The estrogen-facilitated memory enhancements and alterations in hippocampal synaptic plasticity are at least partially facilitated via enhancements in cholinergic signaling from the basal forebrain. Finally, age, dose, and type of estrogen utilized are important factors to consider when evaluating estrogen's effects on memory and its underlying mechanisms, since age alters the responsiveness to estrogen treatment and the dose of estrogen needed, and small alterations in the molecular structure of estrogen can have a profound impact on estrogen's efficacy on memory. Collectively, this dissertation elucidates many parameters that dictate the outcome, and even the direction, of the effects that cognitive practice and estrogens have on cognition during aging. Indeed, many parameters including the ones described here are important considerations when designing future putative behavioral interventions, behavioral therapies, and hormone therapies. Ideally, the parameters described here will be used to help design the next generation of interventions, therapies, and nootropic agents that will allow individuals to maintain their cognitive capacity when aged, above and beyond what is currently possible, thus enacting lasting improvement in women's health and public health in general.
ContributorsTalboom, Joshua S (Author) / Bimonte-Nelson, Heather A. (Thesis advisor) / Conrad, Cheryl D. (Committee member) / Neisewander, Janet L (Committee member) / West, Stephen G. (Committee member) / Arizona State University (Publisher)
Created2011
Description
Ascribed elements of one's self-identity such as sex, race, and the place of birth are deeply related to one's national identity among Japanese immigrant women. Spouses, offspring, friends, networks in the U.S., or even information about their local area also represent the nation they feel they belong to. The feelings of belonging and comfort are the basis for their achieved sphere of identification with the U.S. This study found that few elderly immigrants would identify only with the host county. Likewise, very few elderly immigrants would identify only with the homeland. Therefore, most of them identify with both countries (transnational), or they identify with neither country (liminal) to an extent. Developing transnational or liminal identity is a result of how Japanese elderly immigrant women have been experiencing mundane events in the host country and how they think the power relations of the sending and receiving countries have changed over the years. Japanese elderly immigrant women with transnational identity expressed their confidence and little anxiety for their aging. Their confidence comes from strong connection with the local community in the host country or/and homeland. Contrarily, those with liminal identity indicated stronger anxiety toward their aging. Their anxiety comes from disassociation from the local community in the U.S. and Japan. With regard to the decisiveness of future plan such as where to live and how to cope with aging, indecisiveness seems to create more options for elderly Japanese immigrant women with the transnational identity, while it exacerbates the anxiety among those who have liminal identity.
ContributorsKawakami, Atsuko (Author) / Tsuda, Takeyuki (Thesis advisor) / John, Johnson (Committee member) / Menjivar, Cecilia (Committee member) / Arizona State University (Publisher)
Created2012