Medicine and Health Sciences Commons^™

Transportation Needs Of Older Adults In Suburban And Rural Areas, Dahai Han

Theses and Dissertations

The fact that the average age of the world's population is increasing, which is more pronounced in developed countries, necessitates the understanding of the challenges faced by older adults in accessing transportation services. With advancing age, individuals may experience age-related changes that can notably affect their driving capabilities, emphasizing the importance of alternative transportation alternatives. This challenge is more evident in suburban and rural settings, where transportation choices are limited, and older adults often find themselves without access to suitable transportation alternatives. Given that mobility plays an essential role in maintaining social connections, accessing healthcare services, and fulfilling daily needs, …

Establishing A Routine Process Of Medication Reconciliation In A Rural Primary Care Clinic To Address Unnecessary Polypharmacy In Patients 65 And Older, Jessica Kirkwood-Harp

Doctor of Nursing Practice Projects

Background: Medication safety by reducing the proportion of older adults who use inappropriate medications is a Healthy People 2030 goal (Office of Disease Prevention and Health Promotion, n.d.(a)). The research for this proposal supported an established medication reconciliation (MR) to reduce errors and adverse drug events (ADEs). Consistent MR is essential for patient safety and positive patient outcomes in rural outpatient primary care clinics, as these patients possess multiple comorbidities.

Purpose: This Doctor of Nursing Practice (DNP) quality improvement project (QIP) established a routine MR process within a rural primary care clinic with reduced unnecessary polypharmacy and decreased risk of …

Effects Of Meditation On Chronic Pain Management Among Older Adults, Katelyn R. Forsell

Doctor of Nursing Practice

The older adult population is expected to continue to grow. This population is more susceptible to facing chronic health conditions that often contribute to pain. Pain affects many aspects of an individual's life and can be debilitating, affecting physical and mental wellbeing. Chronic pain among older adults is often not well managed. Mindfulness meditation is a holistic healing modality that literature supports for pain mitigation (Creswell & Khoury, 2019). This scholarly project provided mindfulness meditation sessions to older adults in an independent and assisted living facility setting to help educate and guide them in reducing chronic pain. Pain reduction scores …

Patient Frailty: A Review, Lakshmi Sailaja Kodavati

Dissertations and Theses

According to Geriator (2011), frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes such as falls, incident disability, hospitalization, and mortality. An operational definition of frailty is the existence of at least three out of five observable criteria indicating compromised energetics: low grip strength; low energy; slowed walking speed; low physical activity; and unintentional weight loss (Fried, et al. 2001).

According to Dubois and Charpillet (2017), most transitions into frailty are due to unintentional weight loss which, in turn, impacts gait performance and subsequent general mobility. In this literature review, the …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Fall Risk-Increasing Drugs And Gait Performance In Community-Dwelling Older Adults: Results From The Gait And Brain Study, Abdelhady Osman

Electronic Thesis and Dissertation Repository

Medication use and gait impairment are two of the most important risk factors for falls. Several drug classes have been classified as fall risk-increasing drugs (FRIDs). Gait is an important marker of overall health and independence in older adults. The overall aim of this thesis was to examine the relationship between FRIDs and gait performance in older adults through two studies. Firstly, our systematic review of twenty studies on the association between FRIDs and gait performance found that the use of drugs with sedative properties is associated with reduced gait speed. Secondly, we conducted a cross-sectional analysis of data from …

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Older Adult Care Transition Experience Following Inpatient Rehabilitation, Patricia Versteegh

Electronic Thesis and Dissertation Repository

The internationally used 15 item Care Transition Measure (CTM-15) has been primarily used to assess the care transition experience among adults transitioning from acute care to home. Although the CTM-15’s psychometric properties have been established in this population, the ability of the CTM-15 to reliably discriminate a good from a bad care transition experience among older adults (60 or more years of age) moving from an inpatient rehabilitation setting to home is unclear. The purpose of this prospective observational cohort study was to: 1) evaluate the psychometric properties of the CTM-15 when used among older adults transitioning from an inpatient …

Reducing Polypharmacy In Older Adults At End Of Life: The Outcome On Quality Of Life, Melissa Jenson

All Graduate Theses, Dissertations, and Other Capstone Projects

Background: Older adults at the end of life are commonly prescribed multiple medications which can lead to polypharmacy. Research has shown that optimizing medications through targeted deprescribing reduces inappropriate medications, reduces adverse effects and improves select outcomes. However, the impact of deprescribing remains uncertain--specifically whether this intervention improves quality of life (QOL). Objective: Explore polypharmacy in older adults at the end of life examining outcomes of deprescribing on the QOL. Methods: A systematic literature search using Academic Search Premier, CINAHL, Medline, JSTOR and Nursing and Allied Health Database was conducted between October 2020 to November 2020. Select articles …

The Impact Of Social Isolation And Cognitive Decline In Older Adults: A Systematic Literature Review, Jody L. Doll-Wilhelm

All Graduate Theses, Dissertations, and Other Capstone Projects

Background: During the COVID-19 pandemic, deaths of Alzheimer’s Disease (AD) and dementia patients surged. Increased social isolation and decreased activity levels in older adults have been suggested as contributing factors to accelerating AD and dementia. However, assessment tools to gauge interventions and outcomes of cognitive decline are variable among the literature.

Objective: Examine the impact of social engagement versus social isolation, like that experienced with the COVID-19 pandemic, on cognitive decline/dementia in older adults (greater than 60 years of age).

Method: A systematic search for studies evaluating the relationship between social isolation and social activity in cognitive …

Understanding The Impact Of Social Distancing On Older Adults And Senior Centers To Better Adapt Towards A New Normal, Salina Jivan

Student Capstone Papers

COVID-19 brought about social distancing mandates that posed as a new barrier to meaningful social participation in the community. The purpose of this project was to understand the impact of social distancing on older adults and senior organizations to better inform the role of OT in helping seniors adapt towards a new normal within the community. A qualitative study and needs assessment were performed through phone interviews with seniors and organizations that support them from around the United States. Themes highlighted seniors desire for social contact and cautious return to the community once mandates are lifted. Both seniors and organizations …

Association Of Common Chronic Pain Conditions To Incident Alzheimer’S Disease And Related Dementias In Two Cohorts Of Older Medicare Beneficiaries, Sumaira Khalid

Graduate Theses, Dissertations, and Problem Reports

Objective: The purpose of this research was to study the collective and incremental association of common non-cancer chronic pain conditions (NCPC) to risk for Alzheimer’s disease and related dementias (ADRD); to explore the potential mediating influence of mood and sleep disorders; and to assess the potential synergistic effects of NCPC’s and multimorbidity on ADRD risk. This research also aimed to study the contribution of NCPC to ADRD risk in poor, rural, underserved United States populations who suffer a disproportionate burden of ADRD risk factors. To achieve these goals, this dissertation pursued three specific aims: 1) assess the association of …

Electrocardiographic Findings During Standard Hands Only Cpr And Hands Only Cpr Plus Pedal Cpr In Senior Rescuers, Laura Melany Yassa

Master's Theses

The standard first aid for a heart attack resulting in cardiopulmonary arrest is effective cardiopulmonary resuscitation (CPR). Chest compressions are most commonly performed on a flat surface with the rescuer kneeling next to the victim with one hand on top of the other on the sternum and elbows straight. This technique of being on the ground may be challenging for those without the mobility and strength to get up and down from the ground. In 2005, the American Heart Association (AHA) Guidelines listed “pedal”, or heel, compression as an acceptable alternative to standard chest compressions (Trenkamp & Perez, 2015). That …

Understanding The Utilization Of Community-Based Services In Late Old Age: A Participatory Approach For Connecting Through The Communication Ecology, Carrie Leach

Wayne State University Dissertations

As the pool of eligible recipients continues to grow, understanding service system utilization and barriers can help ensure very old adults can access support from their communities when needed. Mounting research demonstrates that investment in community-based services to ensure seniors remain independent translates to saved government dollars. As a contributing researcher of a multi-year county-wide older adult needs assessment in Monroe County, Michigan, data collected from 1,870 people revealed a communication disjuncture between seniors and service providers. In response, officials convened a post assessment working group that focused on communication and outreach. Along with members of the Community Advisory Group …

Resilience And Protective Factors In Older Adults, Jessica Mcclain, Katelyn Gullatt, Caroline Lee

Dissertations, Masters Theses, Capstones, and Culminating Projects

Evidence suggests resilience promotes successful aging in place and protective factors promote resilience. This study sought to investigate whether or not the combination of three protective factors, physical health, social support, and self-efficacy are all of equal importance in predicting resilience among Marin County older adults, or if some individual protective factors have a greater impact on resilience than the others. Fifty-eight participants ages 62 and higher were recruited from senior community programs and personal contacts. Four self-report questionnaires were completed by the participants in this exploratory, cross-sectional, quantitative design. SPSS was used for a descriptive and multivariate analyses to …

“Older Adults And Their Experiences With Home Care And Assisted Living”, Faith Robinson

Thinking Matters Symposium Archive

As the state of Maine and the U.S. population at large continues to age, discussion about future care and living arrangements for older adults has become an increasingly relevant issue. Older adults are often faced with a range of options for housing, including staying in their home in their community while receiving home care services, or moving to an assisted living facility.

Currently a gap in the research exists as to the attitudes, perceptions, and lived experiences of the older adults themselves around these decisions, experiences, and the meaning of “home” in our older years. This study aims to provide …

Using Instructions And Behavioral Skills Training To Teach Facebook Skills To Seniors, Alison Ann Oconnell

USF Tampa Graduate Theses and Dissertations

The senior population is growing faster than any other population group, and life expectancy is increasing. E-mail and social media enable people of all ages to stay in touch, and find information, resources, and entertainment. Positive effects are associated with computer and internet use for older adults, but not all seniors have embraced technology and some seniors feel negatively about it. Several different methods have been used to teach seniors computer skills, including mentoring, lecturing, and providing instructions, but not many procedures have been evaluated for effectiveness. In the current study, we recruited three to five seniors, taught them to …

Using An Online Learning Module In A Nursing Program To Improve Knowledge And Skills To Prevent Falls In The Community Dwelling Older Adult Population, Susan Kane Patton

Graduate Theses and Dissertations

Nationally, 28.4% of older adults fall each year. Falls and resulting injury result in decreased mobility, functional impairment, loss of independence, and increased mortality. Utilization of evidence based protocols by providers to identify older adults at risk of falling is limited and rates of participation by older adults in prevention activities is low. Because of nursing’s increasing role in caring for older adults, development of fall prevention education for nursing students would result in increased awareness of the need for fall prevention in community dwelling older adults and increased access of older adults to falls risk assessment. There is a …

Development Of A Financial Decision-Making Self-Efficacy Measure For Older Adults, Evan Gross

Wayne State University Theses

Financial decision-making is important for older adults, and many are at increased risk for elder financial exploitation due to a combination of biological, social, and psychological factors. The role of self-efficacy for financial decision-making in this population has received little attention from researchers, but evidence suggests it may be a critical aspect in motivating positive decisions and avoiding exploitation. This study developed the Financial Decision-Making Self-Efficacy Scale (FDMSES) for older adults. Participants (N = 200, mean age = 71.5) completed the Lichtenberg Financial Decision-Making Rating Scale (LFDRS) and a neuropsychological test battery. Items from the LFDRS related to financial decision-making …

The Effect Of A Multiple Modality Mind-Motor Exercise Intervention On Single And Dual-Task Gait, Balance, And Executive Function, In Community Dwelling Older Adults With A Subjective Cognitive Complaint: A Randomized Controlled Trial., John P. Bocti

Electronic Thesis and Dissertation Repository

Cognitive decline disorders are becoming increasingly prevalent, with older adults at increased risk. Combined exercise has been recently explored as an intervention to help to prevent the decline, however cognitive activation in combination with physical activity has yet to be explored. Therefore, the purpose of the study is to determine the effects of multiple modality exercise programs in combination with a mind-motor task and their effects on mobility and cognitive variables. A total of (n=89) older adults (55+ yrs), with subjective cognitive complaints participated in a multiple modality exercise class, three days a week over six months, with the intervention …

Is The Geriatric Impact Ipad Test A Valid Measurement Of Cognitive Function In Older Adults?, Heather Elise O'Dell

Graduate Theses and Dissertations

The number of older adults will rapidly increase within the next generation (Brookmeyer, Johnson, Ziegler-Graham, & Arrighi, 2007). Alzheimer’s disease risk increases with age, especially after age 60 (NIA, n.d.). Aging leads to a decrease in functional independence, and this side effect is exacerbated by cognitive decline (Johnson, Lui, & Yaffe, 2007). Executive function is a predictor of Alzheimer’s disease onset and progression (Zhang, Han, Verhaeghen, & Nilsson, 2007). The Geriatric ImPACTTM test is a potential new and more convenient testing methods than traditional methods used. The purpose of this research is to validate the Geriatric ImPACTTM test by comparing …

Antihyperglycemic Medications And Hypoglycemia In Older Adults With Diabetes, Kristin K. Clemens

Electronic Thesis and Dissertation Repository

Background: In the last decade, several new antihyperglycemic medications have been approved to treat people with diabetes. However, the hypoglycemia risk of these medications in older adults in routine clinical practice remains unclear. Further, there is limited understanding as to how these medications are being prescribed to older adults in our region.

Methods: We carried out retrospective, population-based studies of adults age 66 and older in Ontario, Canada using linked healthcare databases. We first investigated the real-world hypoglycemia risk of 2 antihyperglycemic medications – glyburide and modified-release gliclazide. In an ecological study, we then examined trends in antihyperglycemic medication prescriptions, …

Engagement In Activities And Cognitive Functioning Among Older Adults In The Health And Retirement Study, Pamela Emily May

Wayne State University Dissertations

The goal of this dissertation is to examine the effect of cognitive and social activities on cognitive performance and health conditions in a national sample of older adults from the Health and Retirement Study (HRS). This dissertation first aimed to identify longitudinal relations between activity frequency and cognitive functioning. Two hypotheses were tested, baseline activity frequency predicts change in cognitive functioning over time, and baseline cognitive performance predicts change in activity frequency over time. The dissertation’s second aim was to identify links between activity frequency and cognitive trajectories. The third aim was to identify longitudinal relations between activity frequency and …

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.

Daily Experiences Of Older Adults With Mild Cognitive Impairment, Elizabeth Hahn

USF Tampa Graduate Theses and Dissertations

Rationale and study aims: Persons with mild cognitive impairment (MCI) experience declines in everyday functioning and cognitive performance greater than what is experienced in normal aging but less than that of dementia. Daily stress and daily memory complaints associated with cognitive deficits may contribute to greater psychological distress in the day-to-day experiences of persons with MCI. However, research examining the occurrence of daily stressors, daily memory complaints and psychological distress in MCI is limited, and it is not clear how the daily processes of stress and affect in persons with MCI compare to cognitively healthy older adults. This dissertation examined …

Bereavement Outcomes Among Spousal Hospice Caregivers: The Role Of Rumination, Feelings Of Relief, And Perceived Suffering, Jessica Y. Allen

USF Tampa Graduate Theses and Dissertations

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number …

The Effects Of Pet Ownership On Physical Well-Being In Older Adults, Tami Pohnert

Theses and Dissertations

A large percentage of Americans own pets which may impact their health. This study examines pet ownership’s effect on well being in older adults looking at race/ethnicity. A sample of 6,565 older adults (>60) was selected from the Third National Health and Nutrition Survey. Pet owners comprised 28.3% of the sample. The theories of symbolic interaction and social integration were used to examine pet ownership’s effect on physical components of well-being. The descriptive results showed statistically significant differences in age, education, income, and marital status between pet owners and non-pet owners. Pet owners were younger, more educate, higher income …

Knowledge Of Pain Management In Older Adults As A Content Area For Continuing Professional Education For Licensed Nurses, Wanda Cleveland Dubuisson

Dissertations

The research of the last 30 years has revealed the inadequacy of pain management in the older adult. Although evidenced-based clinical practice guidelines exist to direct the management of pain in the older adult, health care providers are either unaware or lack the proper understanding of the guidelines. This study investigated the differences in knowledge of pain management in older adults when examining licensed acute care nurses and extended care nurses. It sampled 118 acute care nurses working in two hospitals in Mississippi and 78 extended care nurses working in six extended care facilities (ECF) in Mississippi.

Based upon the …