Gerontology Commons^™

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 …

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., …

Frailty, Home Accessibility, And Falls In Later Life, Bonnie Albright

Graduate Doctoral Dissertations

As more people remain in their homes as they age, the risk of living at home with frailty and reduced function increases, which may also increase the risk for falls in the home. The scientific literature shows that frail people are more likely to experience falls, which leads to many negative outcomes, such as hospitalization, placement in a skilled nursing facility, and even death. The preference to age-in-place (AIP) is more likely to be met if older people live in accessible housing. Accessible homes may mitigate the risk for falls and promote AIP, especially among frail older people.

While there …

The Gendered Role Of Friendships For Advanced Care Planning And Health In Later Life, Zee Kee Emily Lim

Graduate Doctoral Dissertations

Friendship is becoming more pertinent to older adults because they are increasingly living with fewer family ties in later life due to changing social and demographic trends (Fiori et al., 2020; Verdery et al., 2019). However, friendships are not as extensively studied as compared to family relationships (Blieszner et al., 2019). Thus, additional research is needed to better understand the influence of friendships on health and health behaviors in later life.

This dissertation includes three studies that focus on the association between friendship and loneliness, advanced care planning, and cognitive function, examining the role of gender in these three studies, …

The Provision Of Healthcare For Older Adults In A Massachusetts Jail/House Of Correction: Perspectives From Providers, Laura Driscoll

Graduate Doctoral Dissertations

THE PROVISION OF HEALTHCARE FOR OLDER ADULTS IN A MASSACHUSETTS JAIL/HOUSE OF CORRECTION: PERSPECTIVES FROM PROVIDERS November 2024 Laura C. Driscoll, B.S., Boston University M.S.P.T., Boston University DPT, MGH Institute of Health Professions M.S., University of Massachusetts Boston Ph.D., University of Massachusetts Boston Directed by Professor Jan Mutchler The aging population in U.S. jails is growing rapidly presenting significant challenges for healthcare provision within carceral settings. Older adults in these facilities often experience complex health conditions, including chronic diseases and age-related impairments, that require specialized care. Despite this, limited research has explored the experiences of healthcare providers tasked with caring …

Perspectives Of Hispanic/Latina Women Ages 60 And Over On The Impact Of Single Motherhood And Their Long-Term Financial Well-Being, Tess Juno Anselm

Graduate Doctoral Dissertations

Unmarried women over the age of 60 continue to experience disproportionate rates of adult poverty in the United States, while families headed by single mothers experience the highest poverty rates. This study explores the long-term impact of single motherhood on financial wellness through the perspective of Hispanic/Latina women ages 60 and over who have experienced single motherhood in Massachusetts. A transdisciplinary study, it utilizes intersectionality as a theoretical framework, employs feminist standpoint informed inquiry methods to document lived experiences through in-depth interviews, and engages diffraction as a mode of praxis as it intra-acts with narratives and explores the systems and …

Acculturation And Health Services Utilization Among Older Asian Americans: The Roles Of Social Support And Psychological Distress, Mei Chen

Graduate Doctoral Dissertations

There are relatively few studies about health services utilization among older Asian Americans. Historically, Asian Americans have been treated as one homogenous race group, and the underlying heterogeneity among specific ethnic groups was underappreciated and neglected. This dissertation investigates the relationship between acculturation and health services utilization among older Asian Americans and several specific Asian ethnic subgroups, including Chinese, Japanese, Korean, Filipino, and Vietnamese Americans. In addition, South Asian Americans and members of other Asian groups were also examined.

This study employed two samples of older Asian Americans based on the specific healthcare resources evaluated. The first sample employed five …

The Role Of Physical Activity And Gender As Moderators For The Relationship Between Insomnia And Depression, Claire E. Wickersham

Graduate Doctoral Dissertations

Objective: The aim of this study was to examine the association between insomnia and depressive symptoms among middle-aged and older adults and to investigate whether gender or physical activity moderates this relationship. Method: This study used nationally representative data from the 2016 and 2018 waves of the Health and Retirement Study (HRS) and binomial logistic regression was used to estimate models. Regression models for risk of depressive symptoms (2018) were based on a longitudinal model with time-lagged indicators of insomnia, levels of physical activity, and covariates (2016). Results: Analyses showed that participants who reported having insomnia in 2016 were more …

The Influence Of Medicare Insurance Type – Traditional Fee-For-Service V. Medicare Advantage – On Rehospitalizations For Patients With Heart Failure In Skilled Nursing Facilities, Andrea Elizabeth Lane Daddato

Graduate Doctoral Dissertations

Heart failure (HF) is a leading cause of rehospitalizations for Medicare beneficiaries from skilled nursing facilities (SNFs). This research sought to determine if HF patients’ insurance type (Medicare Fee-for-Service (FFS) vs. Medicare Advantage (MA)) influences their risk for readmission within 30 days of hospital discharge to a SNF. This research is particularly timely in light of new penalties under the Protecting Access to Medicare Act SNF Value-Based Purchasing (SNF-VBP) program directed at SNFs for 30-day rehospitalizations. Previous literature finds FFS beneficiaries with HF in SNF at greater risk for rehospitalization compared to MA members. This research contributes to the literature …

The Role Of The Environmental Context In Advance Care Planning Among Older Adults, Brittany E. Gaines

Graduate Doctoral Dissertations

Research has focused on various individual characteristics associated with advance care planning (ACP), but little is known about how the environment context is associated with ACP. This study examined the role of environmental characteristics in ACP by addressing three key aims: 1) examine the independent effects of environmental factors on ACP, 2) assess the moderating effects of environmental factors on the associations between ACP and individual household income and educational attainment, and 3) conduct a longitudinal examination of ACP and environmental characteristics. I combined individual ACP information from the 2004 and 2011 waves of the Wisconsin Longitudinal Study with county …

To Adopt Or Not To Adopt: Factors Impacting States’ Pursuit And Implementation Of Aca’S Home And Community-Based Programs, Lisa Kalimon Beauregard

Graduate Doctoral Dissertations

The Patient Protection and Affordable Care Act (ACA) sought to improve the United States’ long-term services and supports (LTSS) system by expanding home and community-based services (HCBS). The ACA contained several optional Medicaid HCBS opportunities for states, including the Balancing Incentive Program, the 1915(k) Community First Choice personal care benefit, and the revised 1915(i) state plan benefit. This research examined these HCBS provisions to explain what factors determine whether states participate in the ACA’s new HCBS programs and, after adoption, what factors facilitate or impede implementation of these programs. To answer these questions, this study used a mixed methods research …

Developing Age-Friendly Communities: Evidence From Multiple Case Studies, Patricia A. Oh

Graduate Doctoral Dissertations

Population aging brings opportunities and challenges for local community and economic development. One policy solution that has been adopted by 325+ jurisdictions in the United States is joining the AARP Network of Age-Friendly States and Communities or the WHO Global Network of Age-Friendly States and Communities. Although the age-friendly movement is gaining momentum in the US, few studies have looked at what influences municipal decision-making about joining a network or making age-friendly changes. The purpose of this multiple case study was to explore what influences municipal decision-making about joining a formal age-friendly network and how communities mobilize the resources at …

Intergenerational Financial Exchange And Cognitive Well-Being Among Older Adults In China, Ping Xu

Graduate Doctoral Dissertations

Although cognitive loss is part of normal aging, it has unfavorable consequences for older individuals, their family, as well as society. The prevalence of mild cognition impairment is expected to go up in China. How to maintain normal cognition for a longer period of time and to delay impair process is an emerging concern for older Chinese adults. Unlike Western countries, China lacks of formal support system. Intergenerational support between older parents and adult children is a predominant resource when they are in need. This study examines how intergenerational financial exchanges between older parents and their adult children is related …

Understanding The Role Of Driver, Vehicle, Environment, And Policy Factors In Crash Injury Severity Among Older Adults In The United States, Chae Man Lee

Graduate Doctoral Dissertations

Driving is related to quality of life and health outcomes. Older drivers involved in car crashes have a higher risk of experiencing a severe injury or fatality. Understanding factors related to injury severity may identify points of intervention to promote road safety. The purpose of this study is to investigate how individual characteristics, vehicle elements, environmental elements, and driving licensing policy are associated with level of injury severity from no injury to fatal injury resulting from car crashes. Furthermore, this dissertation research utilizes the Geographic Information System (GIS) process to visualize the location of crashes and to identify the hot …

Multiple Roles In Later Life: Role Enhancement And Conflict And Their Effects On Psychological Well-Being, Emma D. Quach

Graduate Doctoral Dissertations

Holding both work and family roles can be a central experience for men and women, young or old. Yet, to date, the bulk of knowledge on holding roles in both domains is specific to young adults, a critical gap as conditions warrant longer work life. This inquiry thus focused on older working men and women (over 50 years of age) with at least one family role (spouse, parent of adult children, caregiver to an aging parent, or grandparent). With survey data from the Health and Retirement Study in 2010 and 2012, latent profile analysis, path analyses, and regressions were conducted …

Living Alone And Subsequent Living Arrangement Transitions Among Older Americans, Yao-Chi Shih

Graduate Doctoral Dissertations

Past research often considers living alone as a risk factor for older persons. In fact, adverse health outcomes are associated with living arrangement transitions, suggesting a need to consider the dynamic process of living arrangements. Using eight waves of the Health and Retirement Study (1998-2012), this study examines three research questions: (1) Do older Americans’ living arrangements exhibit a pattern of sequence? (2) What are implications of living arrangements at particular older ages on life expectancy? (3) What factors predict transitions out of a living alone arrangement?

The first analysis displays and classifies ordered patterns of living arrangements over time. …

Marital History And Retirement Security: An Empirical Analysis Of The Work, Family, And Gender Relationship, Lauren A. Martin Palmer

Graduate Doctoral Dissertations

This dissertation investigates the relationship between marital history and individuals’ retirement resources, namely Social Security, employer-sponsored pensions, and non-housing wealth. Prior research provides a foundation for understanding marriage’s positive relationship to retirement security, and suggests that marriage is financially beneficial and can even lessen some external factors that would otherwise damage a family’s financial situation. Yet changing demographics, with fewer people in first marriages and rising numbers of individuals experiencing divorce and choosing to remain unmarried, suggest our understanding of this relationship for today’s retirees may be limited. The purpose of this research is to identify which aspects of complex …

Gender, Race, And Ethnic Differences In The Effects Of Education On Depression In Later Life: The Mediating Roles Of Mastery And Stress, Cathy Mae Wong

Graduate Doctoral Dissertations

The central objective of this study was to examine gender, race, and ethnic differences in the effects of education on late-life depression. This study differentiated education from other measures of SES due to the psychosocial resources developed through schooling. Education provides intrinsic resources, such as perceived mastery, that are beyond monetary value. Higher levels of education is hypothesized to increase perceived mastery throughout the life course and result in lower levels of stress, influencing psychological well-being in later life. The Stress Process Paradigm was the conceptual framework used for this study. The Stress Process Paradigm includes elements of Ross and …

Patterns Of Dissaving Among U.S. Elders, Deborah Gray

Graduate Doctoral Dissertations

This paper examined patterns of decumulation and the role that health events and marital disruption play in forming those patterns. Study data were drawn from six biennial waves of the HRS (1998 - 2008), and merged RAND HRS data files for the period 1998 - 2008. The a priori expectation was that there will be variation in drawdown strategies households employ.

Findings suggest that patterns of dissaving are heterogeneous. The five most prevalent patterns were discussed. Households predominantly transitioned between oversaving and overspending. Households are expected to have a goal of on target spending therefore the observed cycle's dissaving will …

The Social Environment, Apoe-E4, And Dementia: The Social Environment As A Moderating Factor Among Individuals Genetically Predisposed To Develop Dementia, Judith L. Poey

Graduate Doctoral Dissertations

Many studies have shown a relationship between the APOE-e4 allele and dementia, as well as a relationship between the social environment and dementia. However, relatively little investigation into the potential moderating effect of the social environment on the relationship between the APOE-e4 allele and cognitive well-being has been reported. Further, studies that did examine these relationships typically have employed clinical populations, along with regional and non-U.S. samples. This study contributed to the research literature, in part, by using the first U.S. nationally representative sample of older adults that included clinical diagnosis of cognition and dementia (Aging, Demographics, and Memory Study …