The aging experience of men and women in rural America is different than that of their urban counterparts. In this study, I identified key disparities in access to health care, mortality, and utilization of health care that result from geographic location. Foundational theories are discussed to illustrate that disparities can originate from historical societal behaviors. Secondary data and literary reviews create a combined qualitative and quantitative approach to explore the rural/urban divide, concluding that the potential for increased disparities as the aging population grows is very real and rural residents remain vulnerable to a poor(er) aging experience. Recommendations for policy and practice, as well as additional research, are made to address the conclusion.

Understanding underlying mechanisms and pathways that lead to chronic homelessness would help develop intervention strategies that could help prevent subsequent episodes of homelessness. Quantitative data for this cross-sectional study was gathered by interviewing individuals who were homeless in the State of Arkansas, using a structured survey between 2007 and 2011. Qualitative data was gathered using semi-structured interviews between 2016 and 2018. Chi-square statistics and a multivariate logistic regression model was used to analyze the quantitative data, while phenomenological methods were used to analyze the qualitative data. Nearly half of the study participants identified themselves as being chronically homeless. Chronically homeless adults in this region were significantly more likely to be older men with no family ties, more likely to be victims of domestic violence, have higher rates of physical health problems, and have alcohol and substance abuse problems. Results from the multivariate nominal regression revealed that individuals who reported themselves as chronically homeless were more likely to be in the 50 years or older age group. In addition, study findings highlighted a dynamic interplay between three biopsychosocial risk factors for homelessness. Fostering development of inclusive sustainable communities, intergenerational relationships, and shared housing practices could help ease such social inequities and …

I examined the factors that led to the rise and fall of psychiatric hospitals and its impact on two select groups of individuals: adults and older adults with severe mental illness. To explore the reasons behind these fluctuations, the State of Texas was used as a case study. Additionally, the fluctuations occurred for different reasons in public vs. for-profit investor-owned psychiatric hospitals. Using an investor-owned psychiatric hospital organization as a case study, I investigated the differences in factors that influenced the growth and/or demise in public vs. investor-owned psychiatric hospitals. Evolution and devolution of psychiatric hospitals was assessed during select time periods: 1700 to1930, 1940 to1970, 1980 to 2000, and 2000 to present. Time period selections were relevant to the important drivers of the span of time that influenced the psychiatric hospitals. Historical review and trend analysis was used to identify the total number of psychiatric hospitals and/or total number of psychiatric hospital beds and psychiatric hospitals by type. Analysis showed there was a cyclical pattern of evolution and devolution of psychiatric hospitals and each cycle altered the form, function, and role of the psychiatric hospital along with altering the location of care for adults and older adults with severe …