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Debt And Quality Of Life Among Older Adults After Retirement, Josephine Morrow Seegars

Walden Dissertations and Doctoral Studies

Understanding debt and the quality of life in older adults after retirement is an important area of concern. Many older adults are forced by escalating debt to reduce spending on essential needs, such as health care, nutrition, and housing, and their physical and mental health is thereby directly compromised. These essential needs represent core social determinants of health, and their erosion under financial strain can have effects on older adults' overall well-being. The purpose of this generic qualitative study was to explore the experiences and perceptions of human services practitioners who were actively assisting older adults struggling with debt in …

Home, Neighborhood, And Community Environments And Social Isolation In Later Life: Joint Associations And Their Moderation By Life-Course Socioeconomic Mobility, Jeein Law

Graduate Doctoral Dissertations

Social isolation is a major public health concern among older adults, yet less is known about how multilevel residential environments shape isolation among those aging in place. Guided by the Socio-Ecological Model, Person–Environment Fit, and a life-course perspective, this dissertation examined whether micro-level home hazards, meso-level neighborhood social cohesion and physical disorder, and macro-level census-tract structural conditions were associated with social isolation. It also examined whether life-course socioeconomic mobility moderated the associations between home and neighborhood environments and social isolation.

This dissertation used two nationally representative longitudinal studies of U.S. older adults. Aims 1 and 2 used the National Health …

The Effect Of State Policy On Individuals With Mental Illness In Nursing Homes: A Multilevel Analysis, Adrita Barooah

Graduate Doctoral Dissertations

ABSTRACT

THE EFFECT OF STATE POLICY ON INDIVIDUALS WITH MENTAL ILLNESS IN NURSING HOMES: A MULTILEVEL ANALYSIS

August 2026

Adrita Barooah, B.Sc., University of Delhi, India

M.S., University of Massachusetts Boston

Ph.D., University of Massachusetts Boston

Directed by Professor Pamela Nadash

The proportion of individuals living with a mental illness in U.S. nursing homes has grown substantially over the past few decades (Fashaw et al., 2020), raising serious concerns about care quality, resource adequacy, and costs to both nursing homes and government payers. The lack of adequate resources and knowledge has resulted in sub-par mental health care (O'Connor et al., …

From Structure To Experiences: How Facility Capacity And Staffing Shape The Adoption And Impact Of Lgbt-Affirming Policies In Long-Term Care, Andrew Alberth

Graduate Doctoral Dissertations

Long-term care (LTC) settings – including nursing homes (NHs) and assisted living facilities (ALFs) – provide necessary care for individuals with extreme health and functioning limitations. Sexual and gender minority (LGBT) older adults report challenges receiving effective, person-centered care LTC. Some LGBT older adults may hide their sexual orientation and gender identity when entering LTC settings or delay seeking needed LTC fearing discrimination from staff and other residents. Furthermore, staff in LTC settings indicate little awareness of LGBT-residents and possess inadequate LGBT-cultural competency necessary for providing person-centered care. Therefore, LGBT-residents LTC experiences remain underexplored in the broader research. Adopting LGBT-affirming …

Beyond The Checklist: Just-In-Time Education For Multi-Component Fall Risk Reduction, Kyle Knight

Master's Projects and Capstones

Objective On a Telemetry unit at a level 1 trauma center public safety net hospital in the Bay Area, a review was conducted of 45 reported falls over the past year. The analysis uncovered inconsistencies in fall-risk assessment techniques, underuse of continuous observation among high-risk patients, and an absence of standardized purposeful rounding. These data points suggest existing tools were not being applied consistently, and need reinforcement and updating.

Aim This project aimed to reduce inpatient fall rates to the national benchmark by strengthening staff's consistent use of existing fall-prevention practices and infrastructure, including multifactorial risk assessment, purposeful rounding, and …

Food For Thought: Building Confidence In Healthy Food Choices Among Seniors In A Residential Facility Through Nutrition Education, Amy Rodríguez

Master's Projects and Capstones

This quality improvement project evaluated the effectiveness of a 10-week nutrition education program designed to improve nutrition knowledge and confidence among independently living older adults residing in a low-income senior housing community. Aim By August 10, 2026, this project aimed to increase average nutrition knowledge and confidence scores related to selecting nutritious foods and preparing healthy meals by 20% among senior housing facility residents. Methods A microsystem assessment, literature review, SWOT analysis, fishbone diagram, and GANTT chart were completed to guide project development and implementation. Weekly nutrition education workshops were conducted over a 10-week period and included presentations, group discussions, …

Nourishing Confidence: Empowering Seniors To Make Healthy Food Choices, Ina Patricia Bangawan

Master's Projects and Capstones

Objective This quality improvement (QI) project evaluated the effectiveness of a 10-week nutrition education program designed to improve nutrition knowledge and confidence in making healthy nutritional choices among independent older adults living in a low-income senior housing community. Aim By August 10, 2026 the goal of this project was to increase average nutrition knowledge and confidence scores related to selecting nutritious foods and preparing healthier meals by 20% among senior housing facility residents. Methods A microsystem assessment and gap analysis, literature review, SWOT analysis, fishbone diagram, and GANTT chart were completed to guide the project development and implementation. Weekly nutrition …

Enhancing Cultural Competency Through Training In A Primary Care Clinic, Rogelio Perez Iii

Doctor of Nursing Practice Projects

Cultural competence remains essential in primary care settings serving diverse populations, yet staff at a small Southern Texas primary care clinic reported no previous formal cultural competency training in workplace orientation or school. The purpose of this Doctor of Nursing Practice quality improvement project was to evaluate whether a brief, evidence-based cultural competency intervention improved clinician cultural competency scores. Madeleine Leininger’s Culture Care Theory provided the theoretical framework, Lewin’s Change Theory guided the change process, and the Plan-Do-Study-Act cycle directed implementation and evaluation. The problem addressed was the lack of structured training to support culturally responsive communication, patient trust, and …

A Quality Improvement Initiative Utilizing Help To Reduce Delirium, Improve Patient Outcomes, And Provide Age Friendly Care For Patients 65 Years Of Age Or Older With Modifiable Delirium Risk Factors., Maggie Blake

Doctor of Nursing Practice (DNP) Manuscripts

Background: Delirium, an acute change in cognition, occurs in 21% of hospitalized patients and is linked to increased length of stay, readmissions, and increased mortality (Shen et al., 2024). In older adults, delirium prevalence increases and is linked to poor outcomes that inhibit patients' health care goals (Shen et al., 2024). Despite the well-published harms of delirium and standardized prevention measures, delirium prevention is not prioritized. Methods: HELP, originally the Hospital Elder Life Program, now preferred to be known as HELP, is a standardized delirium prevention model specifically designed to address the unique needs of hospitalized older adult patients. HELP …

Disengagement And Reconnection: Investigating The Role Of Purpose And Identity Seeking Across Career Stages In Healthcare, Charmel Renee Jeffery

Radiologic Sciences

Purpose To examine the generational purpose gap in healthcare by identifying the psychological and environmental factors underlying early-career disengagement and late-career reconnection.

Method An integrative literature review was conducted using four academic databases. An artificial intelligence (AI)-assisted thematic synthesis was applied to extract and organize findings within a standardized analytic matrix. To ensure accuracy and rigor, all AI-generated outputs were validated against the original source data.

Results Two primary themes emerged. Early-career healthcare workers commonly experienced disengagement associated with destiny beliefs, while later-career professionals demonstrated renewed purpose and resilience despite ongoing stressors.

Discussion The findings revealed a pronounced generational divide …

Improving Recognition And Communication Of Early Patient Condition Changes Through An Evidence-Based Staff Education Program, Raymond Mwanje

Walden Dissertations and Doctoral Studies

This doctoral project is a staff education project aimed at enhancing recognition and communication of early changes in patients' conditions in a long-term care rehabilitation environment. Delayed recognition of patient deterioration is a major challenge in nursing practice, as subtle changes in a patient's condition may go unnoticed, leading to delayed intervention, avoidable complications, and unnecessary hospital transfers. Poor communication among staff can also hinder the escalation of care, impacting patient safety and quality of care. There is evidence that structured communication strategies and education interventions can help enhance communication between clinicians and aid earlier detection of patient deterioration. Resolving …

A Proposal For An Evidence-Based Program For Communication Continuity, Yavonne G. Evans

Walden Dissertations and Doctoral Studies

This doctor of nursing practice (DNP) executive leadership project is a practice-focused quality improvement initiative to reduce avoidable 30-day hospital readmissions in a skilled nursing facility by implementing the INTERACT communication tools, SBAR and STOP & WATCH. The practice problem is the lack of a standardized communication process for recognizing changes in resident conditions, contributing to preventable hospitalizations. The project's purpose was to develop an evidence-based communication process that promotes early recognition and timely provider intervention. The practice-focused question asked whether implementing INTERACT communication tools would improve communication and reduce avoidable acute care transfers. A focused literature search was conducted. …

Responsivity Education Reflection Packet For Multigenerational Caregivers, Natalie Holsky

Honors Projects

Caregivers play an essential role in supporting their child’s language development. Through everyday routines, caregivers have countless opportunities to foster strong language skills. Extensive research has examined the influence of caregiver input on language development. Comparatively little research has explored how historical trends in parenting advice across generations may shape caregivers’ use of language facilitation practices. The purpose of my honors project was to examine how generational parenting trends could inform the development of a clinic-to-home language facilitation resource. This resource was designed to help caregivers incorporate language facilitation strategies into everyday routines to increase language-rich interactions at home. A …

Experiential Learning In Child Life Education, Amanda L. Lockett

All Dissertations

Child life specialists support children and families during healthcare experiences and other stressful life events, making it important for child life students to develop both knowledge and practical skills before entering the profession. This study explored how current child life students and recent graduate experienced hands-on learning activities in their child life education. Through interviews, a survey, and follow-up reflection, participants described how activities like role play, case studies, realistic scenarios, activity play plans, and teaching plans influenced their learning and professional development. Participants shared these experiences helped them learn to apply what they learned in the classroom into real …

Establishing And Validating Foundational Competencies In The Application Of Behavioral Gerontology Through Expert Consensus, Alexandra Doran

Dissertations

Behavioral gerontology continues to evolve and grow as an application of behavior analysis, but there remains a critical need to define competencies necessary for behavior analysts to provide ethical, effective care within their scope of competence. This study sought to establish and validate foundational competencies for Board Certified Behavior Analyst s® (BCBA s® ) working in this area. A mixed-methods design using three experiments was used. In Experiment 1, a review of discipline-specific competency frameworks and a job mapping process yielded a preliminary set of behavior-analytic competencies for behavioral gerontology. This produced a preliminary framework consisting of 142 competencies. Experiment …

Exploring Caregiving Choice In The Adult Cancer Population, Jennifer L. Huggins

MUSC Theses and Dissertations

ABSTRACT Purpose Although extensive research examines family caregivers (FCs) across populations, less attention has been paid to how lack of choice in assuming the role affects quality of life (QOL) among FCs of adults with cancer. Understanding choice could guide interventions protecting this invaluable, often invisible workforce. Aims (1) Synthesize what is known about perceived choice among informal caregivers of adults with serious illness; (2) assess relationships between caregiving choice and caregiver QOL, burden, sleep, depression, stress, and social determinants of health; (3) describe experiences of FCs of adults with cancer providing care with no, little, or some choice. Design …

Enhancing Well-Being: Implementing Weekly Social Interventions For Older Adults In Independent Living, Rosa Huang

Dissertations

Loneliness and social isolation significantly impact the physical and mental well-being of older adults. This quality improvement project implemented an eight-week social intervention designed to reduce loneliness and enhance well-being through weekly sessions incorporating mindfulness exercises, gratitude journaling, and structured socialization activities. The intervention was delivered by nursing students to a sample of residents in a Midwestern independent living community. While most standardized measures of loneliness and mood did not show statistically significant changes, the project resulted in a statistically significant increase in social network engagement as measured by the Lubben Social Network Scale-6 (LSNS-6). The findings suggest that group-based …

Managing Elderly Patients With Dementia Using Evidence-Based Non-Pharmacological Interventions In The Ed Setting, Rita Anue Cho

Walden Dissertations and Doctoral Studies

Persons with dementia frequent emergency departments (EDs), but ED staff lack understanding of cognitive impairment and evidence-base management of these symptoms, which sometimes results to unsafe encounters, aggression, agitation and assault with or without injuries. As a result, staff may resort to physical or chemical restraints to maintain safety for patients, staff, and the milieu. It is essential for staff in the ED to understand the disease process, recognize behavioral triggers, and apply evidence-based non-pharmacological interventions. The purpose of this project was to provide education to ED staff to enhance their understanding of cognitive disorders and dementia in the elderly …

Impact Of Baseline Cognition On Dual-Task Performance: Tracking Verbal Accuracy And Fluency In Adults At Risk For Alzheimer’S Disease, Rebecca Nicole Frederichs

Graduate Theses and Dissertations

Alzheimer’s Disease (AD) is increasing in prevalence as life expectancy continues to rise, highlighting the need for sensitive measures to detect early cognitive changes. This study examined the effects of baseline cognitive status on dual-task performance over time, in terms of dual-task cost, verbal fluency, and verbal accuracy in older adults at risk for AD. This study utilized a quantitative secondary analysis of the longitudinal dataset, the Digital, Cognitive, Multi-Domain Alzheimer Risk Velocity (DC-MARVel) study (Gray et al., 2022). Participants were categorized into low, medium, or high cognitive tertiles based on baseline Repeatable Battery for the Assessment of Neuropsychological Status …

Reducing Emergency Department Boarding Using Pull-Based Throughput Intervention: Quality Improvement Project, Eunice Dundu

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Emergency department (ED) boarding increases overcrowding and delays care. A 200-bed acute care hospital in the southeastern United States has a median time from inpatient bed readiness to ED departure that exceeds its hospital benchmarks, resulting in prolonged boarding and delays. Hospital data showed a median bed-ready-to-departure time of 76 minutes, exceeding the target of less than 45 minutes. Workflow analysis identified delays in transport activation, communication, and accountability as major contributors to inefficiency.

Aim of the Project: ED throughput quality improvement project aimed to reduce the median time from when an inpatient bed is marked ready to …

Improving Medication Reconciliation Compliance In Home Health Admissions, Paula A. Petrie-Rivas

All Doctor of Nursing Practice (DNP) Scholarly Projects

Background: Clinician compliance with medication reconciliation at a home health agency was below regulatory expectations, with agency performance significantly lower than state and national averages. Workflow inefficiencies, inconsistent clinician practices, and limited training contributed to noncompliance, increasing the risk of medication discrepancies, preventable rehospitalizations, and Medicare reimbursement penalties.

Aim: This quality improvement project implemented a standardized medication reconciliation workflow using the Agency for Healthcare Research and Quality’s MATCH toolkit to improve clinician compliance during admission to home health.

Evidence: Literature supports structured medication reconciliation as an effective strategy to improve safety during transitions of care. The MATCH toolkit provides a …

Bridging Gaps In Spanish-Speaking Individuals In Rural Areas About Parkinson’S Disease, Fabiola Barajas Velasco

Occupational Therapy Student Capstones

Provide education and bring awareness of Parkinson’s disease in rural areas through educational trainings and community outreach, specifically those close in contact with farmworkers or farmworkers themselves.

Kickin' It Old School: Connecting The Ages, Elyssia Lambert

Occupational Therapy Student Capstones

Problem Statement

Lack of social participation is associated with negative impacts on QoL in individuals with dementia

Lack of awareness and knowledge of OT as a career option

Medical Social Workers’ Knowledge Of Alzheimer’S Disease Screening And Treatment In Primary Care Settings, Amy Davis Cook

Walden Dissertations and Doctoral Studies

No abstract provided.

Older Recent Widows’ Physical Activity Before And After Spouses’ Deaths A Qualitative Investigation Of The Impact Of Duration And Intensity Of Care Work And Social Support, Mary Theresa Pagan

Dissertations - ALL

Abstract This study investigates and expands understanding of how care work, widowhood, social support, and physical activity intersect in the lives of older recent widows. The study addresses three primary research questions examining the duration and intensity of care work, pre- and post-death social support, and factors that influenced widows’ physical activity before and after the death of their spouses. Thirty semi-structured, face-to-face interviews conducted with heterosexual widows aged 60 and older residing in Upstate New York who were widowed within 6–24 months prior to interview. Interviews explored care work experiences, social support, widowhood transitions, and both structured and non-structured …

Implementation Of Standardized Mental Health Screening And Referral Protocols For Depression In Patients Aged 65 And Older In Primary Care Settings, Elizabeth Nyambura Irungu

Walden Dissertations and Doctoral Studies

No abstract provided.

A Qualitative Study Of Gratitude Practice Among Won Buddhist Older Adults And Implications For Gerontological Social Work, Sungsim Lee

Dissertations

Although gratitude has been widely studied in social science, existing scholarship has largely relied on Western worldviews and quantitative research frameworks, limiting understanding of lived gratitude experiences within diverse spiritual and cultural contexts, including Eastern spiritual traditions. In Won Buddhism, originating in South Korea, gratitude holds a central place in spiritual life and is understood as an essential practice. This qualitative study explores the views of Won Buddhist older adult practitioners regarding their experiences, benefits, and challenges of engaging in spiritually grounded gratitude practice. Semi-structured interviews were conducted with 23 practitioners aged 65 and older from English-speaking Won Buddhist communities. …

Risk Management Strategies To Reduce Pressure Injuries In Skilled Nursing Homes In Florida, Teresa Latoya Desir

Walden Dissertations and Doctoral Studies

No abstract provided.

Clinical Practice Guideline Emergency Department Discharge Acuity Scale To Improve Care Transitions, Charlisa Hedrick

Walden Dissertations and Doctoral Studies

No abstract provided.

Educating Staff On The Use Of The Phq-9 Screening Tool For Depression, Clarice Malla

Walden Dissertations and Doctoral Studies

No abstract provided.