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.

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.

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.

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.

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.

Federally qualified health centers (FQHCs) that harness the reinforcing nature of collaborative efforts with aging services can better prepare for the future of older adult populations. The purpose of this research was to identify collaborative efforts between FQHCs and aging services and distinguish perceptions and knowledge regarding older adult populations. Executive directors, medical directors and social service directors (N=44) at 31 FQHCs across the state of Texas completed surveys measuring structural, procedural and environmental components of the health center setting. The 2007 Uniform Data System and 2000 US Census provided additional data on health centers use and services. Descriptive statistics analyzed independent variables of health center characteristics. Bivariate analysis determined significance of association between independent variables and levels of collaboration with aging services. Results found that all health centers collaborated with at least one aging service, with more informal than formal partnerships. Respondents indicated major barriers to providing services to older adults, including inadequate transportation, inadequate insurance, and limited funding. Respondents also indicated overloaded staff as a major barrier to collaborating with aging services. Aging topics for staff development and perceptions about older adults were also identified. Health center tenure (p=0.005, lambda=1.000), professional tenure (p=0.011, lambda=1.000), leadership in aging services …

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 …

This purpose of this dissertation was to examine the attitudes of retirees toward mental illness treatment. Secondary data from the Survey Research Center at the University of North Texas was utilized for this study. The focus was on the influence that gender, income, education, race/ethnicity, personal experience, fear, goodwill, and social control might have had on retirees' attitudes toward mental illness treatment. An n = 225 was selected out of the existing data to serve as the sample population. Binary logistic regression was utilized to analyze the data. Results indicated that the obtained significant findings were consistent with existing literature.

HIV/AIDS can affect individuals of any age. Efforts to educate those considered to be most at-risk, based on the age at which the most individuals are infected, are ongoing and public. Less work and mainstream education outreach, however, is being directed at an older population, who can be more likely to contract HIV, is more susceptible to the effects of HIV, and more likely to develop AIDS, than younger persons. Guided by the Health Belief Model theory, research was conducted to determine what, if any, relationship existed between age of an individual and the possibility that an HIV test will be sought. Factors of gender, education, ethnicity and marital status were included in analyses. the research indicated that as age increased, likelihood for getting an HIV test decreased. Overall, most individuals had not been tested for HIV. the implications of an aged and aging population with HIV include a need for coordinated service delivery, increased education and outreach.

The transition from hospital to home or alternate care setting is a time of vulnerability for all patients and particularly for our elders. If not handled appropriately there is a risk to our elders for readmission to the hospital environment that may decrease their overall quality of life and further compromise their health status. in addition to the individual risks associated with patient readmissions, there are societal impacts that reach far beyond our current generation of elders 65 and older. This impact may have dire implications for the future fiscal health of the next generation. a review of the current and past literature shows that there are a limited number of resources available for hospitals to use in order to comply with the new Value Based Purchasing initiatives that are being implemented by CMS regarding the reduction in readmission rates. the problem of hospital readmissions is confounded by the many processes that are available for study, from pre-hospitalization conditions and care through hospitalization, discharge, and finally to post discharge processes. While most research and literature reviews have focused on individual disease causes, there is a need to provide hospitals with a resource that outlines the available options and interventions that …

This research study examines the decreased agitation level utilizing nonpharmacological therapeutic interventions in dementia patients, age 65 and older. The study examined the following question: Will a therapeutic art program diminish agitated behaviors in persons diagnosed with dementia, aged 65 and older? In this quasi-experimental research design, the sample consisted of 19 participants in 3 groups, selected using these criteria: must be receiving services from a long term care facility, be diagnosed with dementia, display agitated behaviors, and be age 65 and older. This research measures the reduction of agitated behaviors in demented patients with the use of a therapeutic art program. The therapeutic art group pretest, midtest and posttest means were separated into Factor 1: aggressive behavior, Factor 2: physically nonaggressive behaviors, and Factor 3: verbally aggressive behavior. A multivariate analysis of covariance (ANCOVA) was conducted on the data for Factor 1, Factor 2, and Factor 3. The ANCOVA was not statistically significant for Factor 1. The ANCOVA indicated statistically significant findings when using a one tailed test for Factor 2 and Factor 3. The ANCOVA indicated statistically significant findings using a two tailed test for overall agitation. These findings inform professionals about the efficacy of therapeutic art programs …

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.

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.

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 …

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 …

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 …

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.