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.

To meet the growing demand for community-based adult services (CBAS) adult day health care (ADHC) programs, it is important these programs make the necessary modifications in their systems of care to embrace a person-centered care (PCC) model. This study was designed to create an assessment to determine a community-based CBAS/ADHC program's readiness to meet the new federal standards as determined by the program's current operational evidence and by center participants', their families' as well as staff's perspectives. This was measured by self-report of access to the community, choice of setting, individual rights, autonomy and independence, choice of services and supports, center accessibility as well as their needs and preferences in the practice. Results will assist similar CBAS/ADHCs in identifying the necessary modifications within their own program to continue as a certified licensed entity and remain a viable agency.

Mobility safety, especially fall prevention, plays a significant role in successful aging for older adults. Fall preventive programs aim to reduce risks for mortality from fall-related injuries among older adults. However, the covariation between personal perceptions of falls and factors and confidence of self-management in falls (CSMoF) is still under-studied despite its importance to fall prevention. Using the International Classification of Functioning, Disability, and Health (ICF) model, this dissertation aimed to investigate the relative contribution of CSMoF in relation to fall risk self-perceptions while controlling for demographics and self-reported health and functioning. Participants were 691 older adults recruited from Area Agency on Aging at Arlington, Texas. They completed measures of physical functioning, CSMoF, fall risk perceptions and fear of falls. Regression analyses indicated that fear of falls was the most predictive factor of CSMoF among older persons. Physical function measures of age, chronic illnesses of metabolism, sensory impairment, and health status were also significant predictors of the CSMoF. The interaction of perception of falls and fall experience attenuated CSMoF, with physical functioning limitations. Fear of falls served as a mediator through which demographic predictors influence CSMoF. The joint effects of perception of falls and fear of falls likely explain CSMoF …

Mental health is an intrinsic capability that constitute an essential component of healthy aging. Mental health is constituted by positive constructs such as happiness and negative constructs (mental disorders) such as depression. As people grow older, they become more prone to developing mental disorders which are linked to poorer quality of life, increased disability, increased utilization and cost of health services, and higher rates of suicide. This dissertation involved three studies that focused on factors that predict change in mental disorders and happiness of older Americans over a period of five years. Two waves of publicly available national representative data from the National Social Life Health and Aging Project (NSHAP) collected in 2010 and 2015 were used. A total of 2210 older adults within the ages 62-90 years were used in the analyses. Mental health measures were CES-Depression scale, HADS anxiety scale, and self-rated happiness. Essay 1 aimed to identify the important aspects of older adults' interaction with their neighborhood that predict the presence of mental disorder and happiness. Essay 2 evaluated the psychosocial factors that predict change in mental disorder and happiness of older adults, whereas essay 3 investigated the multifactorial determinants of change in mental disorder and happiness …

In the context of health care delivery for senior citizens, this research utilizes three studies that examine the development and implementation of health policy and the factors that can directly or indirectly impact the effective delivery of health services to senior citizens. It utilizes three essays employing mixed methods (qualitative and quantitative) methods including semi structured interviews, multiple regression and partial least squares structural equation modelling to examine the extent to which the implementation of health services delivered attributes of primary and integrated care to seniors. The two essays identified methods, approaches and strategies of integrated care relevant to the development of policy that can be successfully implemented when the contextual issues that older people consider to be important in maintaining their functional capabilities and their motivation to improve health as perceived by them are addressed. Consequent upon the results from these studies, the third essay examines the methodological issues on integrated geriatric care implementation when guidelines for effective policy development identified were not followed. By highlighting the relationship between effective policy and patient satisfaction, these three essays' recommended approach enhances the theory of health design that confirms that theoretical models of primary care must incorporate the system, process and …

This dissertation contributes to research on social isolation in older adults aged 65 years and above through three essays that expand our understanding of the social determinants of health and identify the social and interpersonal factors that contribute to elderly wellbeing. This dissertation examines the significant factors contributing to the problem of social isolation, and how the availability of interest-based, low-cost engagement resources in the community can alleviate social isolation and foster healthy aging. Essay 1 is a systematic literature review with implications for future research that explores how technological skills and training based on user intention and availability of resources can alleviate social isolation. Essay 2 is a qualitative study that evaluates the effectiveness of a unique community-based senior exercise program in fostering social integration and in reducing social isolation. Essay 3 is a quantitative study that examines the magnitude and direction of the correlated relationships among the determinants of social inclusion and the impact of social and interpersonal processes on senior wellbeing. These three essays provide insight into the social isolation phenomenon that negatively impacts senior wellbeing and recommends solutions derived from a data driven examination of the problem that is especially applicable to economically disadvantaged senior communities. …

Members of Greek Life organizations consume more alcohol and participate in risky drinking behaviors at higher rate than their non-Greek counterparts due to deep rooted social norms within this population. Undergraduate sorority women at college and universities are often overlooked in research regarding trends in alcohol use in Greek Life organizations. However, women between the ages of 18 and 24 are more vulnerable to the consequences of heavy alcohol use compared to men, including liver disease, sexual assault, poor academic outcomes and post-collegiate alcohol use disorders (AUDs). Although higher education institutions are tasked with educating their students about safe alcohol use and protecting students from harm, these interventions are often inadequate in decreasing alcohol related consequences. Among students, sorority women consistently consume higher amounts of alcohol and exhibit higher rates of risky drinking behavior. This thesis aims to examine the unique alcohol-related consequences and risk factors sorority women face. Implications are discussed to guide college administrators, counselors and other supports that are likely to encounter issues associated with alcohol use within this population.

Individuals diagnosed with autism spectrum disorder often experience difficulty during speech-in-noise (SIN) processing tasks. However, it remains unclear how behavioral and cortical mechanisms of auditory processing explain variability in SIN performance in adults with ASD and their neurotypical counterparts. The proposed research explored variability in SIN as it relates to behavioral, perceptual, and objective measures of auditory processing. Results showed significant differences between groups in SIN thresholds. In addition, neurotypicals outperformed the ASD group on measures of sustained auditory attention characterized by reduced impulsivity, increased inhibition, and increased selective auditory attention. Individuals with ASD showed decreased acceptance of noise as compared to neurotypical peers. Overall, results highlighted auditory processing deficits in individuals with ASD that contribute to SIN performance.

Data from this dissertation was obtained from the Texas Behavioral Risk Factor Surveillance System (BRFSS). The Texas BRFSS questionnaire used a cross-sectional retrospective research design while asking questions about individuals' exposure to adverse childhood experiences (ACEs) and included 11 questions. The sample included 9096 individuals over the age of 18 who had exposure to at least one ACE. An ACE score was calculated for all participants and were divided into two groups (less than 4 ACEs and more than 4 ACEs) to compare whether differences in ACE score would impact participating in routine health screening or not. Additionally, whether different kinds of ACEs would impact health screening was also examined. Logistic regression was used to assess whether different kinds of ACEs impact participation in routine health screening. This study found that individuals with a history of childhood adversities including experiencing childhood emotional abuse, living in a dysfunctional household impeded them from participating in routine health screenings. It is recommended that both primary care physicians and mental health providers to use motivational interviewing while interacting with patients with ACE histories. It is also suggested that using trauma-informed care (TIC) in primary care can help patients talk about their abuse histories and …

There remains a dearth of literature that explains with no ambiguity, the complex relationships that exist between adverse childhood experiences (ACEs) and resilience, as well as school engagement and school in individuals with a co-occurring diagnosis of autism spectrum disorder (ASD) and attention deficit hyperactive disorder (ADHD). This study seeks to fill this missing gap in the literature. These research questions were answered using a retrospective cross-sectional study design of national secondary data from the National Survey of Children's Health (NSCH). The findings revealed that the more ACEs an individual had, the less they were likely to engage and succeed in school. A similar finding was obtained for resilience as individuals with more ACEs showed less resilience. However, counterintuitively to the hypothesis of the project, having both ASD and ADHD does not necessarily make these outcomes worse compared to having a singular diagnosis of either ASD or ADHD. The significance of this study is that it informs rehabilitation counselors as well as educators on the need for early identification of individuals with ASD and ADHD with a background of ACEs and commence interventions early enough to ensure they are more resilient and obtain improved success in school-related activities as well …

Postlingually deafened cochlear implant (CI) adults have large variability in speech perception abilities. While CIs are one of the most successful neural prosthetic devices, they are not able to adequately provide fine structure cues which results in a degraded signal for the listener to interpret. While behavioral measures remain the gold standard for determining speech perception abilities, an objective measure is needed for patients who are unable to provide reliable behavioral responses. Behavioral, cognitive, and neural measures were collected in this study to identify potential neural biomarkers that correlate with speech perception performance. Behavioral experiments evaluated participants' abilities to identify, discriminate, and recognize words as well as sentences in quiet and in noise. Cognitive measures were assessed to determine the roles of attention, impulse control, memory, and cognitive flexibility on speech recognition. Auditory event-related potentials (ERP) were obtained with a double oddball paradigm to produce the mismatch negativity (MMN) response, which has been shown to have associations with phonetic categorical perception at the group level. The results indicated that executive function is highly predictive of speech performance and that the MMN is associated with categorical perception at the individual level. These findings are clinically relevant to determining appropriate follow-up care …

Some people experience cumulative advantages or disadvantages at birth and during their lifespan that determine future life course outcomes. Health disparities and systemic inequity can define a negative trajectory for some minority and underserved communities. Without intervention, such inequity can spiral and eventually affect more and more areas of an older person's life, much like cumulative disadvantages. This research proposes that older adults can improve their situation through targeted support factors that systematically improve lifespan areas. Eventually, more adults can experience the cumulative advantage effect as life progresses. The dissertation consists of a systematic literature review to evaluate literature that isolates degree-level education as a predictor of successful retirement transition planning. This foundational information is used as a basis for identifying constructs in two follow-on studies of the longitudinal National Health and Aging Trends Study (NHATS) Wave 9 public dataset. We explore factors supporting readiness for retirement and retirement transition in later life using data of older adults aged 65+. Multiple regression, exploratory factor analysis, and partial least squares structural equation modeling (PLS-SEM) are used to gain a multi-angle view. The results showed that degree-level education influences higher salaries, improved healthcare access, and financial literacy. In addition, old age has …

This study will extend the current body of knowledge about how accessible and affordable information communication technologies (ICT; smartphones, tablets, and computers) can foster social interaction and reduce social isolation and loneliness in older adults aged 55 plus. The first study is a systematic literature review of existing studies on ICT and the willingness of older adults to use technology. The second study is quantitative research that investigates the trust and reasoning of older adults using ICT, like smartphones, tablets, and computers that foster social interaction and the level of technological ownership. The second study is conducted using research data through surveys conducted by Pew Research Center on behalf of Princeton University. Finally, the third study explores the level of ownership of technology and methods to reduce social isolation using ICT. The effectiveness of smartphones, tablets, and computers that foster social interaction were reviewed to create a sense of community to reduce social isolation.

Loss is an inevitable part of life. The actual process of grieving is unique and can be hard to quantify. Grief interventions can address the relationship quality and attachment status between the griever and the deceased and how memories are interpreted and carried into the present and future. This three-essay dissertation explores variations of loss and the factors that contribute to a resilient recovery.

Knee osteoarthritis affects approximately 25 million adults. In severe cases, total knee arthroplasty (TKA) is the most common solution. TKA is effective at addressing pain and reducing continued degeneration of articular cartilage. However, effective physical therapy (PT) following TKA is vital for a full functional recovery. Despite the importance of PT, half of patients never achieve a full functional recovery. Decreases in proprioceptive feedback, severe atrophy, and pain inhibition all likely contribute to the variability in effectiveness. Surface electromyography-based biofeedback (sEMGBF) may allow clinicians to address some of these barriers by supplementing proprioceptive feedback and targeting small muscle contractions before eventually increasing the contraction requirement. Using a between group design, we compare the effectiveness of sEMGBF (7) to neuromuscular stimulation (NMES) (6), and a control group (6) in recovery following TKA. Effectiveness was evaluated across 4 metrics (quadriceps strength, range of motion, functional improvement, and quality of life) in a pre-test/post-test fashion. At the statistical level this study suggest that sEMGBF leads to greater improvements in quadriceps strength relative to the NMES and control group. Additionally, visual analysis suggests that sEMGBF may also lead to greater improvements in range of motion, and functional improvement relative to the NMES and control …

Tinnitus, or the perception of sound in the absence of external acoustic stimuli, is a common condition that impacts approximately 10-15% of the United States population, with similar prevalence rates reported in other countries. Current diagnosis of tinnitus relies on case history and audiometric testing, which depend on responses provided by the patient. To date, there is no objective test that can be used for tinnitus diagnosis, despite the high prevalence and significant financial impacts of this condition. Cortical auditory evoked potentials have shown promise in their ability to assess not only the integrity of the auditory system, but also higher level preattentional and cognitive processing. For this study, the pitch-matched tinnitus frequency was used to evoke an auditory late response. Double oddball paradigms with the tinnitus frequency as the deviant stimuli were also used to evoke a mismatch negativity and P300 to determine where along the auditory pathway biomarkers of tinnitus may exist. The results of this study suggest that when the tinnitus frequency is incorporated into paradigms designed to produce cortical auditory evoked potentials, differences exist between participants with tinnitus and matched controls without tinnitus. Individuals with tinnitus exhibit smaller MMN amplitudes and area under the curve and …

Due to an increasingly aging population and long-term care available, the number of older adults seeking long-term care facilities is growing. Resident satisfaction indicators have become essential measurements of service quality. However, few studies have investigated the evidence on prevalent resident satisfaction indicators and associated factors. In order to understand what are the types of resident satisfaction measurements utilized in long-term care facilities in the United States and how these types of care services influence resident satisfaction, the researcher conducted the first study, which consists of a systematic scoping review by summarizing the evidence on the types of resident satisfaction indicators utilized in long-term care settings in the United States. The second study completed a further systematic review to summarize how nursing assistants impact resident satisfaction in long-term care settings.The third study aims to translate and validate a Chinese version of the resident satisfaction assessment based on the Ohio Long-term Care Resident Satisfaction Survey (OLCRSS). The fourth study will apply hierarchical regression to predict older adults' satisfaction with individual factors and care services factors in long-term care settings. The dissertation provided a holistic solution to measure resident satisfaction in long-term care settings, assist health providers in meeting the resident`s needs …

This study aimed to understand subjective cognitive decline (SCD) and functional difficulties in older age cohorts with depressive symptoms, using one scoping review and two empirical studies. We implemented the six steps of Arksey and O'Malley's procedure for the scoping review. We used the population, concept, and context (PCC) inclusion and exclusion criteria in the literature search across MEDLINE via Ebscohost, PubMed, and PsycINFO for articles published on ADL/IADL indicators of SCD in older adults with depressive symptoms and that published in English language journals from January 2011 to November 2021. The two empirical studies used the 2019 wave of the Behavioral Risk Factor Surveillance Survey dataset of older adults aged 65 and ≥ 80 from the Centers for Disease Control and Prevention. We used multiple regression and the bias-corrected percentile bootstrap with 5000 samples using standard path-analytic approaches for the moderated mediation for the two empirical studies. Findings supported that instrumental activities of daily living (IADLs) presented more difficulties for older adults with SCD than the basic activities of daily living (B-ADLs), given that IADLs require more cognitive capabilities than B-ADLs. Environmental factors like healthcare access and subjective functional difficulties predicted SCD by mentally unhealthy day (MUD) mediation and …

The objectives of the present dissertation were: (1) determine the relationships between time use in physical vs social leisure activities (PLA - SLA), and cognitive vs emotional leisure activities (CLA - ELA) by older adults age cohort (60-69, 70-79 and 80-plus yrs.); (2) ascertain the role of sex in moderating the relationship between time use in PLA-SLA and CLA-ELA by older adults age cohort; and (3) assess how employment status mediates the relationship between time use in PLA-SLA and CLA-ELA by older adults age cohort with moderation by sex. Secondary data was obtained from the 2019 American Time Use Survey database. Applying a cross-sectional design, data were analyzed using a linear regression model in SPSS version 27 and PROCESS Macro with Hayes Model 1 and 59. We identified the extent of the conditional indirect moderation effect of sex and the indirect employment status mediation effect moderated by sex in the relationship between PLA-SLA and CLA-ELA by older adult age cohorts. An index of moderated mediation was used to test the significance of each effect. The 80-plus yrs. cohort SLA time use was greater than in PLA across cohorts. Sex moderation showed a stronger effect in men by substantially decreasing their …

In the US, rural Native American communities (RNACs) experience excess morbidity in mental health disorders and mortality from opioid use disorder (OUD). This study used mixed methods to evaluate and analyze the primary data from 76 healthcare providers (HPs) from 24 states across the US (physicians = 7%), to identify HP knowledge and training regarding available prevention, treatment, and recovery (PTR) programs in treating OUD, assessment and management skills, and networking and collaboration capacity among the RNACs they serve. The HP completed the Opioid Survey for Health Care Providers online. A majority of HPs reported a need for knowledge and training regarding OUD treatments (92%). Less than half of the HPs provide intensive outpatient treatment; 40% contracted out for medication assisted treatment/medications for opioid use disorder (MAT/MOUD) services. Recovery support was low at 33% for adults and 38% for youth. HPs reported use of Narcan to be effective in reversing overdose (87%). Qualitative responses supported survey findings and described barriers, including lack of resources, inadequate staffing, insufficient funding, lack of training and OUD knowledge, stigma, and lack of tribal involvement and support. The study findings indicate HPs' need for information and training about OUD and networking and collaboration of healthcare …

This dissertation investigates videoconference technology adoption by aging-in-place organizations to facilitate the social engagement of older adults. It comprises three studies that examine the initiation and coordination of technology adoption by aging-in-place organizations and addresses the factors associated with successful adoption of relational videoconference technology by older adults. The first study is a systematic literature review exploring the role of aging-in-place organizations in social engagement of older adults through videoconference technology. The second study is a survey of adult relatives and friends of older adults regarding videoconference technology adoption by older adults during the COVID-19 pandemic and their experience with facilitating resources. It applies technology adoption theory and a structural equation model to characterize the role of aging-in-place organizations. The third study is a pilot test of a new online platform called Circular that is designed to support social engagement of older adults. Through these studies, this research extends the existing body of knowledge regarding modes to facilitate adoption of relational technology by older adults and to empower senior centers and other aging-in-place organizations as they seek to socially engage the aging members of their communities.