The focus of this research study is glycemic control in the presence of multiple morbidities and polypharmacy in homebound individuals with Type 2 diabetes aged 65 years and older. The research method is a quantitative retrospective cohort study of discharged patients of a nonprofit community-based home health agency from January 1, 2010, to December 31, 2011, using OASIS data. Glycemic control is assessed using the hA1C laboratory test following the recommendation of the American Diabetes Association. The study documents a moderate significant association between glycemic control, polypharmacy and comorbid conditions, indicating that homebound individuals with Type 2 diabetes aged 65 years and older are less likely to have optimal glycemic control in the presence of multiple morbidities and polypharmacy. There continues to be a need for scientific research in this population cohort; and the dose-response association between antidiabetic therapy interventions designed to lower blood glucose levels in the presence of chronic disease and polypharmacy.

The purpose of this study was to examine perceptions of Texas Adult Protective Services (APS) case managers (CM) in regard to their relationships with the law enforcement community and area courts. The sample consisted of 138 Texas APS CMs. The survey measured respondents' perceived strengths and weaknesses of their relationships with both the law enforcement community and with area courts. Items also included respondents' interest in receiving additional training and their perceptions of level of job-readiness of newly hired APS CMs. Data were analyzed quantitatively using SAS. Findings of the survey revealed high ratings of perceived teamwork on the part of the CM are associated with high relationship ratings with both area courts and law enforcement. Findings also revealed that high ratings of perceived autonomy on the part of the CM are associated with lower relationship ratings with law enforcement personnel but not with area courts.

Although institutional care has started to be outmoded in the developed countries with development of different models of care, it still has a considerable place in the developing countries such as Turkey. This is because, changes in the demographic structure, extended family, and urban development of Turkey has brought about several aging problems leading older adults to end up in institutions. Loneliness was one of the significant reasons given in the Social Inquiry Survey of Applicants of Darulaceze Old-Age Institution and the basis for a micro level analysis in this study. Therefore, the main objective of the study was to determine the predictors of loneliness, including age, the state of living alone, functional independence, education, and gender. Analysis of the results indicated that these predictors have significant effects on the loneliness predominantly defined by social factors rather than medical factors. In addition, the meso and macro level analyses were employed to control the micro level analysis and see a general picture of institutional care. Thus, an academic example of diagnosing the main reasons behind the institutional care was presented to understand the context of aging in Turkey.

This secondary research study uses data from two convenience samples of homeless persons in Central Arkansas collected during 2004 and 2011 Point in Time Counts. The prevalence of predictors of homelessness are compared across years, and also compared by age (<50 and > 50) controlling for year of survey. The number of older adults increased significantly between 2004 and 2011 surveys, and reporting serious mental illness and veteran status significantly decreased from 2004 to 2011. Age differences were noted in 2004 with older adults more likely to report serious mental illness in comparison to younger adults. Older adults were also more likely to report veteran status in comparison to younger adults during both the 2004 and 2011 surveys. The predictors of homelessness -- including serious health problems, substance abuse, race, age, and developmental disabilities-- remained fairly consistent from 2004 to 2011 and across "age groups". In addition to Point in Time data, qualitative surveys and interviews of providers were performed for their observations of the older homeless population. Providers indicated their belief that the older homeless population is increasing. Providers suggested possible challenges and reasons for the increase among older adults who are homeless. In central Arkansas, service providers feel …

The purpose of this study was to identify factors that predict quality of life (QOL) for aging adults and to examine and compare Baby Boomers', Older Adults' and Younger Adults' responses to the 2010 National Health Interview Survey/QOL Functioning and Disability. Significant findings included several significant values based on the multivariate regression to estimate a model to predict QOL. In particular, being male, four ethnicities other than white, being older than Boomer, age in 10 years, the Functional Difficulty Index, the Functional Limitation Index scores, chronic heart disease, asthma, and arthritis all had significant p values. Adults with chronic heart disease, asthma, or arthritis scored lower on the QOL index, but cancer, stroke, or diabetes were not associated with the QOL index. Two hypotheses had strong support. Lower scores on both the Functional Difficulty Index and the Functional Limitation Index yielded lower QOL scores. Further research recommendations include establishing reliability and validity of the QOL index; running additional regressions for demographics (ethnicity, marital status, etc.) to predict possible combinations of variables predicting QOL or barriers to QOL; and investigating the viability of incorporating the QOL index into an electronic medical record (EMR) dashboard parameter to serve as a screening mechanism …

The purpose of this exploratory study was to examine resident, family member and staff perceptions of electronic monitoring and their effect on resident rights. The sample consisted of 53 nursing home residents, 104 staff and 25 family members, in the Dallas Fort Worth metroplex, from a nursing facility in which residents utilize video cameras in their rooms (Nursing Facility 1), two nursing facilities that have video cameras in their common rooms areas (Nursing Facility 2 and 3) and a nursing facility that does not utilize video cameras (Nursing Facility 4). The interview questions and self-administered surveys were in regard to the participant's perceptions of electronic monitoring, perceived risks and benefits of video cameras, awareness of resident rights and consciousness of potential risks to resident rights. Data were analyzed using a mixed methods approach using both ATLAS t.i and SAS. Study findings revealed that residents, family members and staff are aware of the potential benefits of electronic monitoring in nursing facilities. While respondents are hesitant to have electronic monitoring in resident rooms, they are interested in utilizing electronic monitoring in common areas. While residents and staff believe that electronic monitoring compromises resident rights, family members believe resident rights are protected. Different …

This dissertation examined the impact of Medicare Plan D on medication compliance in Medicare beneficiaries at University of Texas Health Center at Tyler, TX. Data were collected before and after the implementation of Plan D. The impacts of various types of benefits, such as private insurance, employer insurance and pharmacy assistance programs were evaluated in terms of impact on drug compliance. Medication compliance was found to increase in those respondents without Plan D. Plan D was found to be a predictor of those who spent less on basics in order to buy medications. Although compliance increased in general, these increases could not be attributed to the acquisition of a Plan D policy.

The purpose of this study is two-fold: (1) to examine the correlation between frequency of sexual activity and general happiness among older Americans and (2) to examine the correlation between frequency of sexual activity and marital happiness among older married Americans. This study employed quantitative data drawn from the 2004-2008 General Social Surveys. Two samples were used. The first sample included all respondents 65 years of age and older with valid responses for the dependent, independent, and control variables. The second sample was a subset of the first and included only the married respondents. Both bivariate cross-tabulations and binary logistic regression analyses were conducted. As expected, the data support a positive association between sexual activity and general happiness in both the total elder sample and the married elder sample (p < 0.05). Also, as expected, the data support a positive association between frequency of sexual activity and marital happiness in the married elder sample (p < 0.05). Even with the introduction of control variables, frequency of sexual activity was found to be a significant predictor of both general and marital happiness (p < 0.05). This study suggests that sexual activity does indeed contribute the happiness and well-being of older Americans.

The purpose of this dissertation was to understand how genetics, socioeconomic status (SES), and lifestyle factors influence the development of age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy in an adult population in Dallas County. Two hundred fifty-three older adults participated in this study as the sample. Crosstabulation and binary logistic regression were utilized to analyze the data. Results indicated a disparity among participants' test scores, visual health status, and perceptions of their visual impairment and highlighted the fact that many seniors are not educated about age-related retinal disorders. Furthermore, variables reaching statistical significance were consistent with the literature included race/ethnicity, age, having a family history of both AMD and diabetes, frequency of eye exams, and level of education. The results not consistent with the literature as affecting visual health included health insurance, access to health care, body weight, and smoking status. Recommendations for future study included applied research focusing on determining risk factors, raising awareness, educating, and providing early detection of these diseases among low to middle income Caucasian, African American, and Hispanic older adults.

The United States of America is a country composed of various ethnicities. This country is considered to be a multi-cultural society. There are various cultural traditions values, norms and superstitious practices within each ethnic group. Attitudes toward end of life care are complex and vary differently across each ethnic group. This study explored factors that explained African Americans' disproportionate use of hospice. Access to hospice care was address, experience with hospice was explored, and recommendations were provided. This study conducted non-experimental research. The design of this exploratory study was quantitative in nature. A survey approach was utilized to collect data that was statistically analyzed. The important concept was African American disproportionate use of hospice. The variable willingness to use was employed to try to explain African Americans' disproportionate use of hospice. The independent variables African Americans who mistrust formal healthcare providers and knowledge about hospice services were operationalized using multiple indicators. The independent variable experience with hospice services did not use a scale. The research findings supported all three study hypotheses. This research results recommend that an important focus of the future be to counsel persons on the availability of hospice as an option for end-of-life care. Well-structured programs of …

This study examined if domestic violence shelters in Texas are responding to the needs of older female victims of intimate partner violence. Data for this study was collected through online questionnaire surveys of 45% of Texas domestic violence shelters. Findings of this study indicated that less than 10% of Texas shelters are providing specialized programming for older victims of IPV. In Texas, the demographic growth of older adults has remained comparable to increased national trends. The state of Texas will face several policy implications and social issues related to an older population that is rapidly growing. This includes, the importance of addressing certain members of an aging population who continue to fall victim to domestic violence. Furthermore, an unchanged resource of safety for victims of IPV is domestic violence shelters. Therefore, this study challenges current domestic violence shelter policies to address this issue of a rapidly growing segment of the Texas population. This study found less than 10% of shelters in Texas, who participated in this study, were providing specialized programming and outreach for older victims. Important practical implications for domestic violence shelter programming in Texas is provided.

The effects of teamwork in a long-term care setting were explored, and four key elements of teamwork in the long-term care facility were discovered. These elements--clarity of purpose, clear communication, well-defined decision-making procedures, and participative leadership--are presented in detail. The literature reviewed as well as observations from personal participation in a case study show that employing the teamwork concept in a nursing home environment significantly enhances the quality of life for the residents of such facilities.

The long-term care administrator profession is one that is both new and evolving. The unique historical perspective of this health profession is brief in the number of years it encompasses and crucial in understanding the current issues facing the profession. Administrator experiences provide a point of reference regarding the profession's structural problems. Ethical considerations play a dynamic role in administrators' daily jobs as well as their continued licensure. The significance of the profession's ongoing problems at the state and national level causes the need for alternatives to the current system. A combination of these alternatives must be embraced to assist in the recruitment and retention of long-term care administrators.

Tuberculosis in the nursing home is an ever-growing problem for the health care community. The incidence of tuberculosis in the United States has risen alarmingly since 1982, and high-population environments such as nursing homes are among the places where it is most prevalent. The first part of this document is an introduction to the current concerns faced by nursing home infection control personnel. It includes information about the history, symptoms, and epidemiology of the disease, as well as other topics. The second part is a policy and procedure manual that contains a basic guide to methodical testing for tuberculosis, steps for dealing with active cases of the disease, and suggestions for education of nursing home health care workers.

Although humor is a generally accepted part of everyday life for humans, its existence, importance, and positive influence on older persons are often underestimated. The purposes of this study are to determine whether humor is a normal experience for nursing home residents, enhancing their activities of daily living, and whether it plays a role in contributing to their psychological well-being. The study includes a discussion of research on humor, particularly as it relates to the elderly and the aging process; analysis and comparisons based on interviews with residents on the subject of humor and review of their psychological state as evaluated by the MDS 2.0 nursing facility assessment; individual case studies, and anecdotes illustrating the beneficial contributions humor brings to the lives of nursing home residents.

Assisted living, the fastest growing segment of the senior housing industry, allows individuals to remain as independent as they prefer and still receive necessary services. However, assisted living residences exist primarily to serve those seniors who can pay for the services from their own savings/income. We are facing a critical need for housing options for both the current senior generation and the soon-to-be-retired baby boomers. How will access to assisted living be opened to all types of payors? How will states fund the growth of assisted living? The purpose of this paper is to discuss opportunities for expansion that will make assisted living an affordable option for the low- and moderate-income elderly.

The primary purpose of this study was to examine the correlation between depression and the personal characteristics of Asians who are 50 years or older. The secondary objective was to determine whether Asians 50 years or older living in the United States are more likely to be depressed than other ethnicities. The information for this study was secured from the National Health Interview Survey, spanning the years 2001 to 2010. In this study, I utilized the SAS-Callable SUDAAN statistical system. Multivariate regression was used to predict and determine significant correlations. The results indicated that Asians 50 and older living in the U.S. and who experience functional limitations, poor vision, hypertension, poor health, not married, and unemployed in previous year were in general more prone to depression. Furthermore, the study indicated that Asian elderly living the U.S. showed lower rates of depression than all non- Asian ethnicities. However when controlled for personal characteristics only Whites and Hispanics had higher depression incidences than Asian elderly. Recommendations for future studies include: conducting more micro and macro studies of Asian elders, such as in-depth case studies for each ethnicity, longitudinal studies of various Asian subgroups, and studies of Asian elderly with hypertension who have …

This study examined how Korean co-ethnic churches serve as connections between Korean seniors and the agencies that offer social and health care services. The study developed from a pilot outreach program funded by the North Central Texas Council of Governments’ Area Agency on Aging (NCTAAA) to inform Korean seniors about Medicare-related programs between February and May of 2011. The results of the pilot program suggested that the Korean-American church can be an effective place for program outreach. The dissertation project, working in partnership with the NCTAAA and 2-1-1 services, further explored the use of Korean churches as a vehicle to connect Korean seniors to Extra Help (EH) and Medicare Saving Programs (MSP) and 2-1-1 services, a toll-free number for information about non-emergency health and social services. Fifty-three pastors were contacted to participate in a telephone survey and a face-to-face, in-depth semi-structured interview. Thirty telephone surveys and 11 face-to-face interviews were conducted. Five of the 30 pastors agreed to host program outreach presentations for the EH, MSP, and 2-1-1 services in their churches. Host churches tended to be more likely highly structured, regularly scheduled programs (e.g., Senior College) for seniors already in place. A total of 405 Korean seniors participated in …

A combination of aging and poverty is becoming dominant in African society today, at a time when African countries are expected to be recovering from poverty, and are projected to house the economic growth of the next century. The emergence of aging in African context and the aging of the world population will expose the weakness of the current mechanisms used for older people around the world. As economies grow around the world, the distribution gap between the affluent and the poor widens, and the constant struggles for wealth, power, and social status, amidst scarce resources, continue to be sustained. To remain in charge of economic resources, the powerful few devise means to disenfranchise the weak, and witchcraft accusation is one of such tools used in Northern Ghana today. A new wave of witchcraft accusation has caught the attention of many in Northern Ghana. These victims with certain socioeconomic characteristics appear helpless and without defense against such accusations. As a result, they suffer untold hardships and are often compelled to leave their homes and to reside in camps reserved for witches. This study was undertaken to identify those sociodemographic characteristics, which are commonly shared by witchcraft accusation victims. These sociodemographic …

This study was a qualitative examination of social, economic, political, and cultural dilemmas that face Peruvian survivors of the Communist Shining Path Revolution, an internal armed conflict that cut a swath of terror and destruction during the years 1980-2000, with a reported loss of 69,000 residents either killed or considered “disappeared.” The conflict affected primarily poor, uneducated Andean campesinos and townspeople in the highland areas of the Ayacucho District. In this study, I looked closely at the responsibilities of both government and NGOs in the facilitation of readjustment during and after times of instability. In addition, specific challenges the elderly, women and campesinos face in a post-conflict world are analyzed and possible social policies are discerned that might be developed to better implement the transition to a new form of community. Ideas that emerged from this research may assist policy shapers in other less developed countries involved in similar conflicts by examining how Peru dealt with its own issues. Methodology included participant observation and interviews with long-term Ayacuchan residents who stayed-in-place during war time, along with migrants who went to live in shantytowns in more urban areas. The government-mandated Truth and Reconciliation Commission report serves as a framework as it …

The issue of rising number of disasters, the overwhelming increase in number of older adults, and historically flawed evacuations presents real challenges. Disasters can strike anywhere, any time, and have devastating consequences. Since 1900, the number of Americans 65 and older has increased 12 times (from 3.1 million to 36.3 million). During the next two decades, the number of American baby boomers, now aged 45-64, who turn 65, will increase by 40%. As evidenced by recent disasters, the imperfections and vulnerabilities of flawed evacuations for older adults are still present. This study examined the level of willingness to evacuate among older adults in the event of a disaster. Despite the extensive literature on disasters and evacuation, some significant questions regarding evacuation and older adults have not been addressed. This study addressed the following concerns: (1) What is the willingness among older adults to evacuate when asked to do so by emergency management officials? (2) Does the call to evacuate being mandatory versus voluntary influence the willingness of seniors to evacuate? (3) Do preconditions (Gender, Marital Status, Age, Ethnic Origin, and Education Levels) influence the willingness to evacuate among older adults? The sample population consisted of 765 voluntary participants aged 60 …

The researcher had two objectives: first, explore how social involvement changes by age among Greek elderly, and second, examine the relationship between social involvement and depression by age among study participants, controlled for education, marital status, and gender. The researcher used data from the 2004 Survey of Health, Aging, and Retirement in Europe (SHARE) database subjecting a sample of 2,898 elderly aged 50 or older to analysis in terms of the study questions. Approximately 43% of the participants (n = 1,244) were males and 57% were females (n = 1,654). Study results showed Greek elderly participated more in religious activities and less in non-religious activities with increasing age. The study results showed the level of education did not have an effect on the level of religious or non-religious participation. Marital status could influence Greeks’ tendency to participate in religious activities, however, it did not have an effect on non-religious participation. Women are more likely to participate in religious activities than the men. The gender of the participants did not have an effect on non-religious participation. Older Greek elderly were more likely to be depressed than the younger elderly. Participation in religious activities was not shown to relate to decreasing the …

Dabner, Carol P. Legal Compliance in Guardianship Cases. An Exploratory Study: Investigating Denton County Probate Court Visitors' Program Success with Legal Compliance in Guardianship Cases. Doctor of Philosophy (Applied Gerontology), December 2016, 140 pp., 18 tables, references, 20 titles. Aim: To evaluate the effectiveness of the legal compliance of the Denton County Probate Court Visitor's program in the year 2013. Rationale: Guardianship case management success is based on the presence of legal compliance of both guardians and the Court. When a guardian is legally compliant, a ward is receiving the statutorily minimum standards of care. Legal compliance equates (evidence of) the Ward receiving legally sufficient care. Research has not been vast; it has been consistent as to necessity of guardianship training, monitoring, and narrow focus of research. Evidence based research will assist in defining and developing appropriate court monitoring programs, which can add to the quality of care for elderly and disabled adults. Methods: 1,300 guardianship cases in the probate court. Of these cases, 910 had annual reports of the person filed, which 304 were reviewed using the Legal Compliance Audit. Eight (8) factors of compliance were reviewed with three (3) being Court actions and five (5) being guardian actions. …

The focus of this research study was to gain needed information on the older adult population in the United States who have diabetes. The research method was quantitative retrospective study of American diabetes obtained from the National Health Interview Survey database from 2001 through 2010. The study results confirmed more than one-third of the U.S. diabetics are aged 65 and older. More than 75% of the older diabetic population report clinical limitations or comorbidities. Based on surrogate markers of education, it appears the older diabetic cohort did receive more preventative care visits than did the older nondiabetic population; however, the difference was not robust. I found a slight negative trend between age and emergency room visits in the older diabetic population; in addition, there was a negative association between age and smoking in this population. There continues to be a need for scientific research in this population. Greater numbers need education and more clinical trials specific to the older diabetic should be encouraged.