Browsing by Subject "Gerontology"

Behavioral symptoms of dementia cause considerable distress for persons with dementia and their caregivers and are related to adverse outcomes that have significant social and economic impact. Thus, behavioral symptoms represent one of the most challenging aspects of dementia care. Over the past three decades, research on behavioral symptoms of dementia has laid the foundation for development of non-pharmacological interventions by identifying underlying mechanisms of symptom development. However, the research has largely overlooked how the needs of military veterans may influence development and treatment of behavioral symptoms of dementia, including those needs associated with co-occurring dementia and posttraumatic stress disorder (PTSD). This dissertation aimed to develop knowledge related to behavioral symptoms of dementia among older veterans with and without PTSD by synthesizing current understanding of neurocognitive and psychiatric comorbidities of PTSD among veterans as well as explicating relationships among background factors, proximal factors, and behavioral symptoms of dementia among veterans living in residential care using the need-driven, dementia-compromised behavior (NDB) model.

This dissertation includes a systematic review in Chapter 2 that synthesized the patterns of neurocognitive and psychiatric comorbidities of PTSD in older veterans and revealed a substantial gap in the literature with regards to understanding manifestations and treatment of behavioral symptoms of dementia among older veterans with co-occurring dementia and PTSD. The primary study of this dissertation that encompasses Chapters 3 and 4 utilized an exploratory sequential mixed methods design using secondary data derived from the evaluation dataset of the STAR-VA training program. In Chapter 3, a qualitative study, as the first phase of the mixed methods study, analyzed text data that captured the interdisciplinary care team’s observation of behavioral symptoms of dementia and their circumstances for the subsample of 33 veterans from the STAR-VA dataset. This qualitative study described how behavioral symptoms of dementia are manifested among veterans with and without PTSD in the context of personal, interpersonal/social, and environmental factors that trigger the symptoms. Findings demonstrated that behavioral symptoms of dementia are heterogeneous, with distinct clusters of triggers that are multi-level, thereby warranting an interdisciplinary, multi-level approach to developing person-centered interventions. In addition, findings from this qualitative study informed the development of the second phase of the sequential mixed methods study in Chapter 4 that aimed to test hypothesized pathways between background factors, interpersonal triggers (proximal factors), and behavioral symptoms of rejection of care and aggression and to explore the moderating effect of PTSD on the hypothesized pathways. The mixed methods approach integrated quantitative data measured by standardized scales and text data for 315 veterans derived from the STAR-VA dataset. After converting text data into categorical variables, structural equation modeling (SEM) was performed to compare the patterns of relationships among background factors, interpersonal triggers, and behavioral symptoms of rejection of care and aggression between veterans with and without PTSD. The direct effect of interpersonal triggers and the indirect effect of background factors through interpersonal triggers on rejection of care and aggression emphasizes the importance of developing and implementing psychosocial interventions that improve interpersonal relationships. The multi-group SEM revealed that the full model was not moderated by PTSD. However, the differential direct and indirect effect of background factors and interpersonal triggers as a proximal factor on the behavioral outcomes between veterans with and without PTSD suggest potential different mechanisms of behavioral outcomes between veterans depending upon whether or not PTSD is present. Evidence for the PTSD-moderated mediating effect of interpersonal triggers on the relationship between depression and rejection of care was demonstrated, suggesting the need to develop targeted interventions for veterans with dementia and PTSD who have greater depressive symptoms.

The new knowledge generated from this dissertation helps to clarify complex patterns of associations among background factors such as PTSD and proximal factors and behavioral symptoms of dementia consistent with the NDB model, strengthening the foundation for development of novel approaches to designing and implementing person-centered care for veterans with co-occurring dementia and PTSD.

In the context of rapid global aging, cognitive decline among older adults has become a major public health and social issue. A better understanding of the risk factors for cognitive decline is important for developing interventions to preserve cognitive function among older adults. Knowledge gaps still exist in understanding the impact of sensory loss (i.e., hearing loss and vision loss) and psychosocial factors (i.e., social support and loneliness) on cognitive function and cognitive decline. This dissertation aims to fill these knowledge gaps by (1) examining the relationship between psychosocial factors and cognitive function in a unique population: community-dwelling Chinese older adults in the United States (U.S.); (2) understanding the longitudinal relationship between sensory loss and cognitive decline among community-dwelling older adults in the United States; and (3) exploring the mechanisms that accelerate or decelerate cognitive decline by examining the inter-relationships between sensory loss, psychosocial factors, and cognitive decline. The primary study conducted for this dissertation used structural equational modeling (SEM) to model the potential moderation or mediation effect of psychosocial factors on the relationship between sensory loss and cognitive decline over time. Findings from this dissertation deepen our understanding of the important roles that social support, loneliness, and sensory loss can play in cognitive function and decline among community-dwelling older adults. Findings from this dissertation also highlight the importance of adequately addressing the physical and psychological challenges encountered by older adults. Subsequent recommendations are provided to health providers and policy makers to help better preserve and promote cognitive health among older adults using a more holistic approach.

Caregivers of individuals with dementia describe a wide spectrum of caregiving experiences, ranging from very negative to very positive. Previous literature acknowledges these differing experiences, but how and why they differ has rarely been investigated. Dementia caregiving can be burdensome with many psychological, physical, social and financial challenges. However, it can also be an opportunity for growth and transcendence as caregivers find meaning in caregiving. High levels of mutuality (the perception that the quality of the care relationship is positive), reportedly ameliorates negative caregiver outcomes. Thus, this dissertation consists of three studies that explore aspects of the caregiver-care recipient relationship that may enhance positive caregiving experiences.

The first study was a secondary analysis of factors related to caregivers' perceptions of care relationship mutuality over a 12 month period. Caregivers who reported high mutuality were less likely to be depressed and more likely to provide care for longer periods before deciding to institutionalize the care recipient. The second study was a secondary analysis of caregiver interviews. It revealed that caregivers who reported a positive caregiving experience described both their past and present relationship in loving terms and reported that they understood their care recipient could not reciprocate. These caregivers focused on aspects of the relationship that still existed, rather than on what they had lost. They expressed satisfaction with caregiving, were other-focused, and reported little caregiving burden. The third study was a qualitative descriptive study. Caregivers who reported finding meaning in caregiving were interviewed to explore how they were able to do so. These caregivers used strategies such as accepting the situation, deciding to care, choosing a positive attitude, focusing on the blessings of caregiving, and actively seeking care resources. They demonstrated altruistic values and the determination and discipline to live those values. They also possessed strong faith, love, and social support, and said they had derived strength from past challenges.

Clinicians and researchers should explore the quality of the caregiving relationship as a critical factor in caregiver and care recipient outcomes. Caregiver interventions should include relationship-building skills and empathy building techniques to offset adverse caregiver outcomes and enhance understanding and acceptance of changes that occur in the care recipient over time.

Psychological research on aging typically characterizes it as a period of decline. Numerous studies have reported age-related deficits in episodic memory, sensory perception, and fluid intelligence. These reports only add to society’s negative views of aging, which inevitably have a detrimental impact on older adults’ cognition, health, and general well-being. However, there are several other domains of cognition that remain stable or improve during healthy aging. For example, emotional functioning increases with age: older adults can better regulate their emotions and resist their desires compared to younger adults. Older adults are also more skilled at solving interpersonal problems and display intact implicit and procedural memory. This dissertation highlights two other areas that show improvement with age (i.e., decision making and knowledge) and considers how we can use these positive aspects to offset the negative aspects of aging. Chapter 2 investigates heuristic decision making. While some work suggests that older adults are more reliant on these shortcuts, there is little evidence to support this claim. To clarify this issue, participants from across the adult lifespan solved decision scenarios that tapped each of the following classic heuristics: anchoring, availability, recognition, representativeness, and sunk cost fallacy. Chapter 3 further explores knowledge. While the literature confirms that knowledge increases across the lifespan, it is unclear 1) if people are generally aware of this increase and 2) whether they hold expectations about the scope of younger vs. older adults' knowledge. To address these questions, younger and older participants predicted the knowledge of hypothetical younger and older adults. Chapter 4 focuses on application. While many studies have demonstrated that negative aging stereotypes negatively impact older adults’ memory performance, research on positive aging stereotypes’ influence is still inconclusive. In order to address this gap, older participants demonstrated their memory performance before and after viewing a neutral intervention or positive stereotype intervention about their knowledge advantage. Altogether, I find that older adults continue to use cognitively efficient decision strategies; they are not more reliant on classic heuristics and use them to the same degree as younger adults. Furthermore, I demonstrate that adults of all ages recognize that older individuals have a knowledge advantage over younger individuals, regardless of the difficulty of the information. Critically, if older adults are reminded of this advantage, they remember more words during a memory test. Taken together, this body of work sheds light on the cognitive improvements that accompany healthy aging and considers ways to leverage these positive aspects, with the goal of offsetting age-related deficits and promoting positive self-perceptions of aging.

Background: Psychological disposition has been linked with health outcomes and longevity; however, existing research has yielded inconsistent evidence. This study aims to investigate the associations between psychological disposition and all-cause mortality among older Chinese individuals, and to assess potential mediating effects of health-related factors.

Methods: Utilizing data from seven waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this community-based, prospective cohort study included Chinese adults aged 65 and above who were recruited from 1998 to 2014 and followed until 2018. The main outcome was all-cause mortality. Psychological disposition scores were measured with a 7-item scale. Categorical psychological disposition indexes were generated based on quartiles of continuous scores. Kaplan-Meier method was employed to fit survival curves. Cox proportional hazard models were established to evaluate the relationships between categorical or continuous psychological disposition and mortality, adjusting for sociodemographic characteristics and selected health-related factors including lifestyle behavior factors, self-rated health, cognitive function, functional disability, and chronic diseases. Restricted cubic spline analyses were utilized to estimate linear relationships between continuous psychological disposition and mortality. The indirect effects of psychological disposition on all-cause mortality attributable to selected health-related factors were quantified through calculating the percentage excess risk mediated (PERM). Subgroup analyses were carried out to determine whether the associations differed by gender and age. Sensitivity analyses were performed to assess the robustness of the study.

Results: A total of 21,891 participants (56.5% female, 80.6% oldest-old) were followed over a cumulative 105,033.6 person-years. Participants who were male and aged 65-79 years old had a higher likelihood of being classified into higher quartiles of psychological disposition indexes. Dose-response associations were delineated between psychological disposition and all-cause mortality. The Cox regression adjusted for sociodemographic characteristics showed hazard ratios of highest quartile compared to lowest quartile as 0.75 (95%CI: 0.72, 0.79), 0.80 (95%CI: 0.76, 0.83), and 0.81 (95%CI: 0.78, 0.85) for total, positive, and negative psychological disposition indexes, respectively. After adjusting for the selected health-related factors, the associations were mediated by 49.5%, 45.0%, and 61.8% for total, positive, and negative psychological disposition indexes, respectively. The associations remained significant only at the 3rd and 4th quartiles after being fully adjusted. The most potent mediators were self-rated health and cognitive function. Gender subgroup analysis showed that among males, overall mediation in the association was 57.2% and 53.3% for total and positive psychological disposition, respectively; while among females, overall mediation was 42.0% and 38.3% for total and positive psychological disposition, respectively. Gender difference in mediation effect was inconsequential for negative psychological disposition. The age subgroup analysis showed no significant overall mediation but revealed variations in the extent of mediation for cognitive function (PERM from 1.2% to 3.1% among younger-old; PERM from 38.8% to 43.4% among oldest-old). The mediating effects of functional disability and chronic diseases were more potent among the younger-old. The associations between continuous total and negative psychological disposition, but not positive disposition, and mortality were linear. Sensitivity analyses showed consistent findings.

Conclusions: The findings suggested dose-response associations between psychological disposition and all-cause mortality, which were largely attributable to health-related factors, notably self-reported health and cognitive function. Tailored interventions targeting cognitive function enhancement for the oldest-old, and preventive measures addressing disability and chronic diseases for the younger old are essential for fostering successful ageing across diverse age groups.

Growing "old" in contemporary American society often means being seen as a problem: you threaten the stability of Social Security and Medicare; cutting-edge science seeks a cure for what ages you; cosmetic companies and health magazines sell you products and strategies for holding on to your youth as long as possible. The Age of Obsolescence: Senescence and Scientific Rejuvenation in Twentieth Century America traces the emergence of these attitudes toward old age back to the turn of the twentieth century when a publicly shared conception of aging was emerging in relation to advances in science and medicine, industrialized labor practices, a slowly developing welfare state, demographic observations of increased life expectancy, changing gender roles and expressions of national identity. During that time, the quest for the fountain of youth shifted from the stuff of legend to a driving motivation behind modern science.

In the four chapters of this dissertation, I bring literary critical methods to bear on literary and scientific texts, public health tracts, journalistic accounts, advertisements and public records. Through this survey of science, government and popular culture, I document the formation of several cultural narratives of aging--or, formulaic ways of addressing aging produced by repeated metaphors, imagery and story lines--that circulated with reciprocal influence through all of these spheres, determining attitudes toward, and experiences of, aging at that moment and into the present. After briefly exploring our contemporary "anti-aging" culture, the four chapters of The Age of Obsolescence address the framing of a moral responsibility for aging individuals to "take care of themselves" as a duty to their nation; the association of aging with obsolescence and its influence on worker's experiences and industrial practices; the scientific and cultural construction of aging as a disease in need of professional intervention; and the proposed "cure" for this problem of aging: scientific rejuvenation, particularly the glandular rejuvenation fad of the 1920s. My conclusion traces this fervor for scientific rejuvenation into the present, showing how the turn-of-the-century cultural logic of aging has become a taken-for-granted framework of American popular culture today. In illuminating the historical moment when the "problem" of aging was located in the bodies of aged individuals, I point toward solutions that may arise not from scientific discovery, but from rewriting these cultural narratives of aging and old age and restructuring the national practices that stem from them.