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 …

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.

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 …