Matching Items (70)
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
This study examines long-distance relationships between grandparents and their adolescent grandchild through the qualitative identification and analysis of relational turning points and trajectories. A sample of 30 grandparents yielding 99 individual turning points allowed for an in-depth understanding of these relational constructs that previous research neglects to explore from the perspective of a grandparent. A constant comparative analysis of these turning points reveals 8 distinct categories of relational turning points including Spending Time Together, Family Relational Dynamics, Geographic Distance, Lack of Relational Investment, Use of Technology, Relational Investment, Lack of Free Time, and Grandchild Gaining Independence. These turning points vary in how they positively or negatively impact relational closeness between participants and their grandchildren. The use of Retrospective Interview Technique (RIT) yields 30 individual relational trajectory graphs categorized into five trajectories including Decrease in Closeness, Increase in Closeness, Multidimensional Changes in Closeness, Minimal Changes in Closeness, and Consistent Relational Closeness. Results provide theoretical contributions to aging and family literature as well as practical findings pertaining to current and future grandparents. These implications as well as suggestions for future research are discussed.
ContributorsBangerter, Lauren Reed (Author) / Waldron, Vincent (Thesis advisor) / Kassing, Jeffrey (Committee member) / Kelley, Douglas (Committee member) / Arizona State University (Publisher)
Created2012
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
Description
Researchers in the twentieth and twenty-first centuries identify the study of the intrinsic and external factors that influence human aging as senescence. A commonly held belief in the year 2015 is that at least some kinds of cells can replicate over long periods or even indefinitely, thereby meaning the cell does not undergo senescence (also known as replicative senescence) and is considered immortal. This study aims to provide information to answer the following question: While some scientists claim they can indefinitely culture a stem cell line in vitro, what are the consequences of those culturing practices? An analysis of a cluster of articles from the Embryo Project Encyclopedia provides information to suggest possible solutions to some potential problems in cell culturing, recognition of benefits for existing or historical culturing practices, and identification of gaps in scientific knowledge that warrant further research. Recent research suggests that hESCs, and immortalized cell lines in general, do not escape the effects of senescence. While there exists a constant change in the practices of cell culturing, a large portion of scientists still rely on practices established before modern senescence research: research that seems to suggest that cultured hESCs, among other immortal cell lines, are not truly immortal.
ContributorsBartlett, Zane (Author) / Maienschein, Jane (Thesis advisor) / Ellison, Karin (Committee member) / Hurlbut, James (Committee member) / Arizona State University (Publisher)
Created2015
Exploring factors influencing Chinese American older adults' intentions to plan for end-of-life care
Description
This study aimed to understand the factors that influence Chinese American older adults’ advance care planning (ACP) on end-of-life care. The Theory of Planned Behavior (TPB) and Health Belief Model (HBM) were primarily applied to explain Chinese American older adults’ intentions toward two behaviors: 1) discussion of end-of-life care plans with family members and 2) completion of an advance directive (AD). Additionally, acculturation and family cohesion were considered to examine their impacts on the TPB and HBM. A cross-sectional survey was conducted through face-to-face interviews on a sample of 298 community-dwelling Chinese-American adults aged 55 and older living in the metropolitan Phoenix area of Arizona. Based upon random assignment, 161 participants answered questions regarding discussing end-of-life care plans with family members, while 137 participants answered questions related to the completion of an AD. Hierarchical multiple regression analysis was used to focus on the influence of TPB and HBM measures on behavioral intentions toward the two behaviors. Results indicated that both the TPB and HBM had predictive power to explain the target population’s intentions. However, the predictability of TPB and HBM measures varied across the two behaviors. Acculturation moderated the relationship between attitudes and intentions to complete an AD negatively. Family cohesion moderated the relationship between perceived benefits and intentions to discuss end-of-life care plans with family members negatively. These findings would help inform future interventions for improving the target population’s ACP awareness and engagement.
ContributorsLiu, Yanqin (Author) / Roberto, Anthony J. (Thesis advisor) / Mongeau, Paul (Committee member) / Thompson, Marilyn (Committee member) / Arizona State University (Publisher)
Created2018
Description
Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. While physical activity can reduce CVD risk, most adults do not engage in adequate physical activity to maintain or improve health. Older adults are less likely to participate in physical activity and experience a greater burden of CVD compared to younger adults. Despite knowledge of motivators and barriers to physical activity, the challenge to reduce cardiovascular risk in the older adult population remains unmet. Older adults face unique and complex barriers to physical activity, including limited social contextual resources and behavioral change processes. Interventions to enhance wellness motivation have demonstrated potential in promoting health behavior change among older adults.
The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.
Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.
The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.
Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.
ContributorsBarrows, Jennifer Leigh (Author) / Fleury, Julie (Thesis advisor) / Komnenich, Pauline (Committee member) / Belyea, Michael (Committee member) / Arizona State University (Publisher)
Created2018