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 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 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 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 …

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.

Loneliness is a significant problem for older adults and can lead to negative health and social outcomes. Having a companion pet is beginning to be recognized as a way loneliness can be reduced for older persons. The purpose of this descriptive study was to determine the effect of pets on the level of loneliness in persons 60 years old or older who live alone and independently in a large metropolitan community in the North Central Texas area. Using a non-random snowball sample of older individuals (N = 252), who met the study criteria, each subject was administered the researcher-developed demographic data survey instrument containing the following variables: (a) pets - having a pet/wanting a pet, (b) age, (c) gender, (d) marital status, (e) living alone, (f) losses within the last six months, (g) interactions with family members, (h) interactions with others outside of the family, (i) highest educational level achieved, (j) employment or volunteer involvement in the community, (k) religious participation, and (l) self perceived health status. The UCLA Loneliness Scale Version 3 was used to obtain the loneliness scores. Prediction of loneliness and relationship with the independent variables was tested using frequency, correlation, analysis of variance (ANOVA), and multivariate …

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 …

This research portrays a paradigm for the assessment of aging services to support populations aging in place. The dissertation was designed to establish a model to identify and evaluate senior ready communities. Area specific social programs and services are identified. In order to meet the growing needs of aging populations, the dynamic representation of existing services and the need for services that could be developed in certain communities require reevaluation in current planning, restructuring, and/or community development.

This study assessed falls efficacy and confidence-related changes among participants attending the a Matters of Balance/Volunteer Lay Leader (AMOB/VLL) falls prevention program for older adults, based on their residential location. Data were examined from 431 older Texans enrolled in AMOB/VLL during a two-year period, and assessed at baseline and post-intervention. Results indicate that participants significantly increased falls efficacy, reduced activity interference due to their health, and decreased the number of days limited from usual activity. Regression models show that participants, despite entering the program with lower reported health status, reported greater rates of positive change for falls efficacy and health interference compared with their baseline pre-intervention counterparts. Overall program attendance and attendance at major sessions showed the greatest influence. Findings contribute to the understanding of cognitive restructuring and strengthening variations with falls prevention program outcomes.

Promoting physical activity in older adults is an important part of healthy aging. With an increasing older foreign-born population in the United States, there is limited information on physical activity participation in this group and even less for those experiencing difficulties in physical functioning and chronic illnesses. The primary objective of the study was to determine how physical factors, psychological issues, chronic illnesses, pain symptoms, perceived health status, and number of years living in the U.S. influence physical activity participation in older foreign-born respondents. The secondary objective was to identify the difference of predictors of physical activity participation between older foreign-born and older native-born respondents. The study is based on data collected from the National Health Interview Survey (NHIS) conducted from 2002 to 2009 for adults aged 50 or older. Ordinal logistic regression analysis was used to predict and explain the physical activity participation in older foreign-born respondents. Factors associated with more physical activity participation included a higher level of education, more time living in the U.S., more positively perceived health status, and having at least one chronic illnesses, or pain symptoms. Having more difficulties in physical functioning caused older foreign-born respondents to participate less in physical activity. This study …

Access to healthcare is needed and wanted by people of all ages and especially by those of the older population. The number of people in the 65 years of age and older population is rapidly growing with their needs expected to have a significant impact on the existing healthcare system and healthcare providers. The impact will be critical given the severe shortage of healthcare providers, especially of nurses and the rate of services being more often provided in non-hospital settings. The objectives of the study were to discover the plans of graduating nursing students as they choose their first place of employment, if they have future plans to pursue a nursing advance practice degree, and if they are very happy with their decision to become a nurse. Data for the study were obtained from a questionnaire presented to senior graduating nursing students. The findings were: (a) Most students prefer a hospital setting. (b) Younger students are three times as likely to seek out the hospital, and 1/3 of the students seek out the hospital setting because they were encouraged to become a nurse. (c) About 70% of the students want to work with their friends while 1/3 will seek the …

The purpose of this exploratory study was to operationalize the responses from a sample of the community dwelling older population from Denton County, Texas on disaster preparedness education given by Denton County Health Department (DCHD) personnel. The goals and objectives were drawn from the Texas Public Health and Medical Emergency Management 5-Year Strategic Plan 2012-2016. It was hypothesized that after the disaster preparedness education was received, then comprehension, retention, and application of the information would increase and the goals set forth by the DCHD would be reached. Thirteen sites were used to educate the 224 participants between August 2011 and April 2012. The data were received using a pre-test survey before the training, a post-test immediately after the training, and a follow-up survey call approximately 30 days later. Using Cronbach's alpha, logistic regression and regression analysis through SAS, the data revealed that all DCHD goals were met by this training method and outcome which include the sample population increasing comprehension, retention, and action on the information learned.

The nursing home industry has been saturated for decades with culture change initiatives in an effort to improve resident quality of care. The direct care worker (DCW) is considered a critical position to achieving nursing facility quality improvements. Understanding what leads to job satisfaction for DCWs could result in improved resident care. The relationship DCWs have with their direct supervisor or upper-level manager can impact employee satisfaction. The purpose of this research is to identify factors that are associated with DCWs satisfaction with supervisor and management support. Data was obtained from 307 DCWs who were employed at 11 North Texas nursing homes. It was expected that factors affecting satisfaction with direct supervision and upper-level management would differ. In fact, the study found that the antecedents for employee satisfaction with supervisor support were participative decision-making/empowerment, age, information exchange and feedback. Furthermore, participative decision-making/empowerment, perceived competence, staffing, information exchange and feedback were found to affect direct care workers' satisfaction with manager support. In conclusion, this research provides a starting point towards a more holistic view of employee satisfaction with supervisor support by considering the preceding factors and its subsequent effects.

The intent of this qualitative, grounded theory study was to understand why the Nigerian (Igbo) adult immigrants in the United States provide long distance international caregiving to their elderly parents left behind in Nigeria, the challenges they encounter, and their views on long-term service care. This study was grounded in semi-structured interviews of 20 Igbo adult immigrants residing in the Dallas/Fort Worth Metropolis. Analysis of the literature demonstrates a lack of existent topic on long distance international caregiving to elderly parents left behind in Nigeria. Findings show that reasons for Igbo adult children immigrants providing care to their elderly parents left behind stem from filial obligation, immigrant’s position in the family, perceived vulnerability of parents, and lack of government support. Also because of cultural expectations, the participants felt obligated to reciprocate to the care their elderly parents gave to them when they were growing up. While providing long distance international care, the participants encountered some challenges like adjusting to their new country, distance, financial constraints, being available for family procreation, issues with means of communication, and legal papers and parental adjustment to life in the U.S. This study also revealed that the participants would support the Nigerian government and private …