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Choices Related To Maximizing Quality Of Life At End Of Life, Theresa Lynn

Dissertations

Humans, including those residing in the United States, can live in denial of their own mortality. Because of this, futile care is sometimes provided, often at great monetary expense and for little or no return in terms of quality or length of life. At least two opportunities exist for making choices regarding care at the end of life in the U.S.: completing advance directives and choosing hospice care. This dissertation consists of three studies related to this topic. The first is a quantitative study about advance directives and attitude toward death. The advance directive completion rate among adults in the …

Connecticut's Elderly Population: An In-Depth Analysis Of Current And Future Trends In Elder Care, With A Focus On Dementia And Cognitive Decline, Emily J. Snodgrass

Honors Scholar Theses

The aging population in Connecticut currently represents ~15% of the state’s population but is anticipated to rapidly increase over the next 20 years. My thesis is an examination of the types of interventions and programs currently available for elderly persons with memory impairment and cognitive decline, as well as the challenges associated with caring for a larger elderly population. Data collected from interviews with CT healthcare and research professionals representative of the diverse specialties of aging together with an analysis of current research literature are used to demonstrate the importance of continued research and expansion of appropriate and accessible services …

Assessment Of The Preoperative Assessment: A Case Study, Steven James Birchenough

Nurse Anesthesia MSNA Student Capstones

The geriatric population defined as individuals 65 years of age or older is expected to increase to 20% of the total population by the year 2020. This population currently makes up one-third of the surgical population and is projected to double by 2020. The perioperative risks for this population are also increased and pose significant increases in morbidity and mortality. The need for a detailed preoperative assessment is crucial in any surgical patient. It is increasingly imperative for the geriatric surgical patient as assessment is vital for the surgical team to make decisions regarding the projected necessity, plan and desired …

Targeting Tumor-Initiating Cells: Eliminating Anabolic Cancer Stem Cells With Inhibitors Of Protein Synthesis Or By Mimicking Caloric Restriction., Rebecca Lamb, Hannah Harrison, Duncan L Smith, Paul A Townsend, Thomas Jackson, Bela Ozsvari, Ubaldo E. Martinez-Outshoorn, Md, Richard Pestell, Anthony Howell, Michael P. Lisanti, Federica Sotgia

Kimmel Cancer Center Faculty Papers

We have used an unbiased proteomic profiling strategy to identify new potential therapeutic targets in tumor-initiating cells (TICs), a.k.a., cancer stem cells (CSCs). Towards this end, the proteomes of mammospheres from two breast cancer cell lines were directly compared to attached monolayer cells. This allowed us to identify proteins that were highly over-expressed in CSCs and/or progenitor cells. We focused on ribosomal proteins and protein folding chaperones, since they were markedly over-expressed in mammospheres. Overall, we identified >80 molecules specifically associated with protein synthesis that were commonly upregulated in mammospheres. Most of these proteins were also transcriptionally upregulated in human …

Hospice Home Immersion Project: Advancing Medical Education, Marilyn R. Gugliucci, Himanshu Malhotra, Andrea Gaul

Geriatric Medicine Faculty Publications

The University of New England College of Osteopathic Medicine (UNECOM) Hospice Immersion project was piloted in 2014 in southern Maine. It was designed and implemented as an experiential medical education learning model whereby medical students were “admitted” into the local Hospice Home to live there for 48 hours. Until this project, palliative and end of life care education at US Medical Schools and specifically UNECOM were accomplished through traditional medical education methods. The Hospice Immersion project utilizes qualitative ethnographic and autobiographic research designs, whereby a unique environment or “culture” (Hospice Home) is observed and life experiences of the medical student …

Framework For Classifying Compliance And Medical Immediacy Among Low-Acuity Presentations At An Urban Trauma Center, Joshua G. Behr, Rafael Diaz, Barry Knapp, Cynthia Kratzke

VMASC Publications

Background: This research offers two exploratory frameworks for medical regimen compliance and medical immediacy. The first classifies compliance awareness, compliance mitigation, and financial limitation for those patients that exhibit nonadherence with a medical regimen. The second classifies medical immediacy and characterizes avoidable utilization.

Methods: Representative sampling of adult patients presenting at an emergency department (62,000/ppy) triaged as low acuity; emergency department physician assessment of noncompliance with medical regimen for those patients with a complaint related to a chronic condition; and emergency department physician assessment of medical immediacy and avoidable utilization.

Results: Physicians report 48.3% (95% confidence interval (CI) 43.5% to …

The Association Of Cognitive Endophenotypes And Risky Single Nucleotide Polymorphisms Of Alzheimer's Disease Within The Alzheimer's Disease Neuroimaging Initiative (Adni) Database, Kyle Joseph Jennette

USF Tampa Graduate Theses and Dissertations

Objective: The purpose of this study was to assess the influence of three single nucleotide polymorphisms (SNP) previously associated with Alzheimer's disease on specific domains of cognition, when controlling for Apolipoprotein E gene (APOE), in a sample of individuals with Alzheimer's disease. Methods: The data were drawn from the Alzheimer's Disease Neuroimaging Initiative database, a comprehensive, longitudinal database of controls, persons with mild cognitive impairment, and persons with mild Alzheimer's disease. Each subject has a full neuropsychological assessment, neuroimaging, genetic sequencing, and physical evaluation. For the purposes of this study, individuals were selected based on the presence of the three …

Search Strategies Used By Older Adults In A Virtual Reality Place Learning Task, Rebecca L. Davis, Catherine Weisbeck

Peer Reviewed Articles

Purpose of the study: Older adults often have problems finding their way in novel environments such as senior living residences and hospitals. The purpose of this study was to examine the types of self-reported search strategies and cues that older adults use to find their way in a virtual maze

Design and Methods: Healthy, independently living older adults (n = 129) aged 55–96 were tested in a virtual maze task over a period of 3 days in which they had to repeatedly find their way to a specified goal. They were interviewed about their strategies on days 1 and 3. …

Physical Therapy Faculty, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Letter From The Chief Of The Division Of Physical Therapy, Unm Department Of Orthopaedic Surgery

UNM Orthopaedic Research Journal

No abstract provided.

Medical Education Digest, Vol. 17 No. 1 (January-February 2015), Nova Southeastern University

Medical Education Digest

No abstract provided.

Sleep Disorders And Cardiac Consequences, Robert D. Vorona

Case Studies from Age in Action

Educational Objectives:

1. Review the clear relationship between obstructive sleep apnea and hypertension.

2. Discuss the cardiac consequences of sleep apnea, including coronary heart disease, heart failure, and different dysrhythmias.

3. Understand that sleep disorders beyond obstructive sleep apnea, such as insufficient sleep itself, may have an impact on the cardiovascular system.

4. Appreciate the potential benefits of identifying and treating sleep disorders for our health.

Bringing Comfort To People With Advanced Dementia, Ann Wyatt

Case Studies from Age in Action

Educational Objectives

1. Explain the purpose of looking at palliative care through a dementia lens.

2. Define dementia-capable palliative care.

3. Identify and provide examples of specific care practices that can bring comfort to people with advanced dementia.

4. Describe the process that staff use in identifying what brings comfort to individual residents.

Comorbid Profile Rather Than Age Determines Hip Fracture Mortality In A Nonagenarian Population, A. Graver, S. Merwin, L. Collins, N. Kohn, A. Goldman

Journal Articles

BACKGROUND: In light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment. QUESTIONS/PURPOSES: This study sought to investigate if patients over 90 years had different preoperative laboratory, clinical, and injury characteristics than younger patients with the same injury. We compared our cohort with previously published data. We wished to identify if there were pre-injury risk factors associated with 30-day mortality, which could be modified to enhance postoperative outcomes. METHODS: This is a retrospective review of 198 operatively managed hip fractures in …

We Happy Few: Accomplishments In Calendar 2014, Edward F. Ansello

Director's Editorials from Age in Action

The Virginia Center on Aging recognizes strides its staff has made in confronting elder abuse and domestic violence in later life; building and improving lifelong learning opportunities across the Commonwealth for mid-life and older adults; delivering interprofessional geriatrics training for health care providers and measuring the impacts of this training upon the patients they care for; training clinical students to partner across professions to improve geriatrics care; developing and delivering education and training programs to audiences in state, regional, and national conferences and webinars on topics ranging from gerontological education to aging with lifelong disabilities, community health to interdisciplinary teamwork; …

The Experiences Of Black American Older Adults Managing Pain: A Nursing Ethnography, Sheria Grice Robinson

Wayne State University Dissertations

Introduction: Pain can negatively affect quality of life for Black elders. They are less likely to report pain concerns and have voiced pain needs adequately met. To better understand the pain management experiences and concerns of Black elders, an ethnographic study was completed within an urban, low-income, elder housing facility. Methods: 106 participants completed a questionnaire comprised of a demographic tool, the PROMIS Global Health Scale (PROMIS), the Brief Pain Inventory (BPI), and the Psychological Stress Measure (PSM-9). Additionally, participant observation, informal interviews, and 20 formal recorded interviews with individuals identified as having pain were completed. Qualitative and frequency analysis …

Behavioral Implications Of A Cognitive Training Program For Individuals With Moderate Cognitive Impariment, Joseph L.D. Kennedy

All Graduate Theses, Dissertations, and Other Capstone Projects

The purpose of this study was to evaluate the effectiveness of a cognitive training program on behavioral outcomes for individuals with moderate cognitive impairment. A total of twenty participants were randomized into either a waitlist control or an experimental group. Collateral individuals familiar with each participant completed a series of measures of behavioral and emotional functioning at both pre- and post-intervention. Results demonstrated little effectiveness for the cognitive training program in stabilizing or improving behavioral functioning. Limitations and future directions are then provided to enhance future research in this area.

Physical, Cognitive, Social And Mental Health In Near-Centenarians And Centenarians Living In New York City: Findings From The Fordham Centenarian Study, Daniela S. Jopp, Min-Kyung S. Park, Jonathan Lehrfeld, Michelle E. Paggi

Publications and Research

Background: Despite their strong increase, the population of the very old, including near-centenarians and centenarians, represent an unstudied and underserved population. Available studies mostly concentrate on predictors of exceptional longevity, but rarely extend their focus to other areas of functioning. Also, little is known about what contributes to experiencing a quality life in very old age. The present population-based study aims at providing a comprehensive picture of key domain of functioning, including physical, cognitive, social and mental function in very old individuals and to determine predictors of mental health indicators.

Methods: A total of 119 individuals aged 95 to 107 …

Impact Of Caregiving Role In The Quality Of Life Of Family Caregivers For Persons With Alzheimer's Disease, Supriya Sarkar

All Graduate Theses, Dissertations, and Other Capstone Projects

This study investigated quality of life of family caregivers of persons with Alzheimer's disease (AD). Caregiving is a strenuous and challenging job. Family caregivers experience poor quality of life after they take the role of caregiving which might be related to depression. Purpose of this study was to find if caregiving duration and depression has any role in affecting family caregivers' emotional, physical, and general health.

Data for this study were collected through electronic and mailed survey methods. The questionnaires completed by subjects: Medical Outcomes Study Short Form 36 (MOS-36) and Center for Epidemiologic Studies Depression Scale (CES-D). Descriptive statistics …

African American Grandparents Residing In A Nursing Facility: Perceptions Of Influence With Their Grandchildren, Family, And Community, Monica Bester

Wayne State University Theses

African American older adults have historically been identified as vital members of the African American family and community (Hill, 1972; Cox, 2002; Waites, 2008). Unfortunately, research has shown an increasing number of older African Americans are being admitted into nursing facilities (Paul, 2004; Feng et al., 2011). Between the years of 1998-2008, it was projected African Americans living in nursing homes increased by 10.8% (Feng et al., 2011).

This study explores the intergenerational relationships of older African American adults with their grandchildren, family, and community through the lens of Intergenerational Family Systems Theory. By viewing this qualitative study through the …

Diabetes Phenotypes In Transgenic Pancreatic Cancer Mouse Models, Toya Albury-Warren

Electronic Theses and Dissertations

Protein Kinase B/AKT, a serine/threonine kinase with three isoforms (AKT1-3), is downstream of phosphatidylinositol 3-kinase (PI3K), and signals through the phosphorylation and subsequent activation or inhibition of downstream substrates, such as mammalian target of rapamycin complex 1 (mTORC1) or glycogen synthase kinase 3 beta (GSK-3?), respectively. The AKT1 isoform is predominantly recognized for regulation of cell survival, growth, and proliferation, due to its constitutive activation in pancreatic cancers (e.g., islet cell carcinoma and pancreatic adenocarcinoma). The progression of pancreatic ductal adenocarcinoma (PDAC), the most lethal common cancer, is initiated by activation mutations of the KRas oncogene. This leads to additional …

Osteoporosis In Older Saudi Women: A Perspective Study, Zahra Saeed Alfaraj

Graduate Research Papers

The purpose of this research is to first discuss and discover reasons behind this increasing outburst of osteoporosis cases in older Saudi women and then to develop certain prevention strategies based on Social Cognitive Theory and this research and its reasoning, in an attempt to check the rapid increase of this disease in menopausal Saudi women. All of these targets can be achieved by an in-depth study of osteoporosis, and then applying this knowledge toward prevention of the disease.

Attention Test Performance And Normal Aging: The Effect On Executive Function, Rachel Carmen

Honors Program Theses

In this pilot study, twenty-nine participants completed the following three executive function tests: the Behavioral Assessment of the Dysexecutive System, the Functional Assessment of Verbal Reasoning and Executive Strategies, and Auditory Process Training. Participants, aged blank to blank, were divided into two age groups: young adults, which was comprised of 16 participants, and older adults, which was comprised of 13 participants. Performance means of the two groups were established and compared. There were no predictive qualities to the younger adults’ scores, and there were only in two FAVRES subtests for the older adults: accuracy and reasoning. Further research is needed …

A Therapeutic Approach For Senile Dementias: Neuroangiogenesis, Charles T. Ambrose

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Alzheimer's disease (AD) and related senile dementias (SDs) represent a growing medical and economic crisis in this country. Apart from cautioning persons about risk factors, no practical, effective therapy is currently available. Much of the recent research in AD has been based on the amyloid cascade theory. Another approach assumes a vascular basis for SDs. This paper presents evidence from a score of studies that cerebral capillary density (CCD) declines during old age in animals and people as well as in AD. Neuroangiogenic (NAG) factors initiate and maintain capillaries in the brain. Thus a waning level of these factors and …

Hood's Theory Of Aging, Drew Michael Hood

All Graduate Theses, Dissertations, and Other Capstone Projects

This thesis proposes that the theory of gerotranscendence can be improved by emphasizing life course events that influence the gerotranscendence process. Further, this paper proposes that teaching gerotranscendence to long-term care staff and residents with Hood's theory of aging and with a departmental framework will yield better results in staff following gerotranscendence best practices and thus result in increased resident development towards gerotranscendence.

Primary Care Providers’ Knowledge And Experience With Pediatric Acute Watery Diarrhea And Hemolytic Uremic Syndrome, Krista Marie Cassel

DNP Projects

The purpose of this capstone is to investigate the potential for hemolytic uremic syndrome (HUS) risk reduction in children through the evaluation of current evidence as well as pediatric primary care providers' knowledge and experience with children at risk for HUS. The goals of this capstone are to 1) evaluate the current literature to determine best practice for prevention of HUS, 2) assess primary care provider knowledge of HUS and experience with children with acute watery, and 3) develop a guideline for the initial management and referral of these children at risk for HUS.

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Psychobiobehavioral Model For Preterm Birth In Pregnant Women In Low- And Middle-Income Countries, Shahirose S. Premji, Ilona S. Yim, Aliyah Dosani (Mawji), Zeenatkhanu Kanji, Salima Sulaiman, Wangira Musana, Pauline Samia, Kiran Shaikh, Nicole Letourneau

School of Nursing & Midwifery, East Africa

Preterm birth (PTB) is a final common outcome resulting from many interrelated etiological pathways; of particular interest is antenatal psychosocial distress (i.e., stress, anxiety, and depression). In LMI countries, both exposure to severe life stressors and rate of PTB are on average greater when compared with high-income countries. In LMI countries women are exposed to some of the most extreme psychosocial stress worldwide (e.g., absolute poverty, limited social resources). High prevalence of antenatal stress and depression have been observed in some studies from LMI countries. We propose a psychosocial, biological, and behavioral model for investigating the complex multisystem interactions in …

Trailmaking Test Performance Contributes To Subjective Judgment Of Visual Efficiency In Older Adults, Annalisa Setti, James Loughman, George Savva, Rose Anne Kenny

Articles

Introduction.

The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially novel determinant factors.

Materials &Methods. Community dwelling adults (aged 50+) recruited to Wave 1 of The Irish Longitudinal Study on Ageing, excluding those registered blind, participated in this study (N = 5,021). Self-reports of vision were analysed in relation to visual acuity and contrast sensitivity, ocular pathology, visual (Choice Response Time task; TrailMaking Test) and global cognition. Contextual factors such as having visited …

Sleep, Depressive Symptoms And Cognition In Older Adults And Caregivers Of Persons With Dementia, Glenna Shemida Brewster

USF Tampa Graduate Theses and Dissertations

Caregivers of persons with dementia, who are often older adults, report sleep disturbance, high rates of depressive symptoms and may be at risk for impaired cognition. This dissertation examined sleep, depressive symptoms, and cognition in older adults and caregivers of persons with dementia. The aims of the review of literature were to understand, in community dwelling adults 60 years and older, the relationships among sleep parameters (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and general sleep complaints), and the domains of cognition (Executive Function, Attention, Episodic Memory, Working Memory, Processing Speed), and global cognition. Based …