Master of Arts in Gerontology, Youngstown State University, 2020, Department of Sociology, Anthropology and Gerontology

An outbreak of a previously unknown virus that is now identified as the severe acute respiratory coronavirus 2 (SARS-CoV-2) has proven to be pathogenic and easily spread between humans, which has caused a worldwide pandemic. Although the virus has not discriminated against spreading through various ages, races, and geographies, the group the highest at risk are older adults and those who have underlying medical conditions. Older adults not only have a higher likelihood of having a chronic health condition, but are also at high risk of developing malnutrition. This subgroup of patients is not only at the highest risk of contracting the virus, but also has the highest risk of becoming severely ill. These patients will likely need post-acute care to recover. Implementing a nutrition program for rehab patients that addresses concerns around post-acute recovery and nutritional outcomes is an important and timely topic as no conclusive data is found currently in the literature to provide practice recommendations on how to optimize recovery from the infection. Current clinical practice guidelines focus around what has been identified as treatments in other conditions, and no SARS-CoV-2 specific clinical recommendations currently exist. Additionally, the need for quarantine and community-wide shutdown has opened up a need to provide health services through telemedicine. New programs across the continuum of care are in need of more data supporting their efficacy to help older adults, especially in the time between their hospital stay and home.

Committee: Daniel Van Dussen PhD (Committee Chair); Rachael Pohle-Krauza PhD, RD (Committee Member); Tiffany Hughes PhD (Committee Member) Subjects: Gerontology; Health Care; Nutrition; Public Health

Master of Arts in Gerontology, Youngstown State University, 2019, Department of Sociology, Anthropology and Gerontology

Background: Reminiscence therapy (RT) is a therapeutic technique which has been shown to elicit conversation and memories in those with dementia. Compared to structured activities, RT has been associated with a greater sense of well-being following the activity, and has been rated as more meaningful to participate in. Although there has been immense research done on the use of RT, little is known about the effect of these activities on care staff. Methods: The current study was a pilot and implemented autobiographical materials from LifeBio™ Inc. in a memory care facility. Care-staff attended an educational in-service which discussed the use of RT and quality of life for those with dementia. Following the presentation, care-staff were administered a pre-intervention survey assessing perceptions of relationships with residents and job satisfaction. After a month, care-staff were administered a post-intervention survey assessing perceived relationships, job satisfaction and the practicality of the LifeBio™ materials. Results: This pilot study had a small sample size (n= 14) therefore frequency analysis and qualitative analysis was used to assess the data. Frequency distributions found increases in rates of agreement in perceived relationships with residents and job satisfaction following the implementation of autobiographical materials. Conclusions: Results suggest that the use of autobiographical materials can have a positive influence on the perception of their relationships with residents as well as potential benefits on job satisfaction. The current study has important clinical implications as well as potential for future research.

Committee: Tiffany Hughes PhD (Advisor); Amy Weaver PhD (Committee Member); Daniel Van Dussen PhD (Committee Member) Subjects: Gerontology

Doctor of Psychology (Psy.D.), Xavier University, 2019, Psychology

Obese patients are more likely to experience mistreatment from healthcare professionals compared to average-weight patients (Puhl & Brownell, 2001; Vartanian, Pinkus, & Smyth, 2014). The poor provision of care provided to obese patients may be explained by the negative, avoidance-oriented, emotions that healthcare providers experience in response to obesity (Hall, 2010; Phelan et al., 2014). The current study examined if nursing students' negative affective reactions to obese patients explains the intentions to provide quality care, especially among nursing students with heightened levels of weight-based prejudice. Nursing students from a private university in the Midwest completed a measure of anti-fat attitudes and then reviewed a patient profile depicting an older adult female as average-weight or obese. Subsequently, participants reported their emotional response toward, and intentions to care for, the patient. Results revealed no differences in participants' self-reported positive affect, negative affect, or intention to provide quality care for older adult patients described as average-weight or obese. Participants' affective reactions did not explain the relationship between their weight-based prejudice and intentions to provide quality care for obese patients. Although results were inconsistent with predictions, the non-significant findings may reveal a positive shift in nursing students' willingness to care for obese patients. Future research should continue to explore nursing students' affective reactions to obesity in actual healthcare settings to better understand intentions to provide quality care to obese patients.

Committee: Tammy L. Sonnentag Ph.D. (Committee Chair); John J. Barrett Ph.D. (Committee Member); Reneé Zucchero Ph.D. (Committee Member) Subjects: Clinical Psychology

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2017, Nursing

Abstract Aims and Objectives: This performance improvement project was designed to increase patient's knowledge of their medication purposes and side effects. Background: A majority of older adults take anywhere from five to ten medications per day. With one in nine visits to the emergency department a direct result of drug related adverse events (ADEs), patients do not clearly understand their medications and side effects. Despite the increased focus on prevention of adverse medication events no one intervention has been successful in preventing ADEs. Design: Institute for Healthcare Improvement's (IHI) Performance Improvement Method as an intervention to prevent adverse medication events. Methods: Nursing and pharmacy staff created a medication “time out” where medications were reviewed with patients on a medical-surgical unit in Hospital A, during the hospitalized patient's stay in specific manner. When the patient was discharged home, random patients were contacted by phone to validate their knowledge of their medications and the effectiveness of the medication “time out” intervention. Results: Implementation of medication “time outs” enabled patients to verify their medication's purposes, special instructions, and taking their medication as prescribed. Results from the telephone interviews along with scores from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys regarding if the patients specifically recalled if hospital staff told them what their medication was for and described its side effects were used to evaluate the intervention.

Committee: Elizabeth Bragg PhD, RN (Committee Chair); Cynthia Sublett PhD, RN (Committee Member); Susan Allen PhD, RN (Committee Member) Subjects: Nursing

Bachelor of Science, Ashland University, 2017, Sport Sciences

Falls are a common occurrence in the geriatric population that lead to several complications. Solutions should be sought to reduce costs and morbidity of the elderly population related to the fall epidemic. This study investigated a connection between a person's posture and their risk for falling. A survey was created to obtain opinions of a representative geriatric population regarding posture. Fall history and information on chronic health conditions were then voluntarily reported, and fear of falling was assessed using the Falls Efficacy Scale. Thoracic kyphosis was measured using the occiput-to-wall distance and the Flexicurve Index, and the final element of the study was to determine the risk of falling using the Tinetti Balance Test. Data came from twenty geriatric participants aged 65 and older from skilled nursing facilities and the community of a rural northeastern area of Ohio. The postural measurements were compared to fall history, fear of falling, and fall risk. Statistical analysis was completed with IBM SPSS 24 using crosstabulations, chi-squares, and correlations. A trend was observed between posture and fall history but without a significant relationship (p = .343). There was significance displayed with an increased fear of falling and increased kyphosis (p = .025). A positive correlation was also discovered between posture and fall risk (r = 0.742, p = .001). Hypotheses of this study observed relationships between posture and fall history, fear of falling, and fall risk. There was significant support for most of the hypothesized relationships, indicating relevance of posture in the topic of falls with geriatrics. Although causation cannot be determined from this study, the relationship observed implies a suggestion to focus more on posture in its course through aging to improve the fall epidemic in the elderly.

Committee: Beth Patton Ph.D. (Advisor); Randall Gearhart Ph.D. (Other) Subjects: Aging; Anatomy and Physiology; Gerontology

Master of Arts in Psychology, Cleveland State University, 2015, College of Sciences and Health Professions

The current study was designed as a preliminary analysis to design an alternative intelligence scale for older adults ages 65 plus. This study was predominantly administered to White participants with a females being the prominent gender (30 females, 14males). 44 participants were administered the four subtests Analogies, Matrices, Geometric Shapes and Information. The Block Design and Vocabulary from the Wechsler Adult Intelligence Scale was administered to assess the validity of the current study. By creating a more tailored intelligence test for older adults, problems such as fatigue, administrator bias and physical limitations can be addressed. With the population of older adults increasing there is more of a demand for age specific intelligence tests. The results section of this study was able to identify items difficulty and eliminate items that did not provide adequate representation of that particular representation of that subtest.

Committee: Amir Poreh Ph.D. (Committee Chair); Boaz Kahana Ph.D. (Committee Member); Christopher France Psy.D. (Committee Member) Subjects: Psychological Tests; Psychology

Master of Social Work, The Ohio State University, 2015, Social Work

This study looked at differences between live and recorded music in the assisted living population by splitting participants into two groups. One group listened to live music and the second group listened to the recorded version. The focus of this study was looking at observable differences using the Observed Emotion Rating Scale and how the participants were feeling when listening to the music using the General Self-Rated Health Questions. The results suggested that there are differences in participation and mood between the two groups and participants reported that they felt better when they listened to the live music. This research will be able to assist assisted living facilities in determining activities for their residents and stresses the impact of musicians in their community.

Committee: Holly Dabelko-Schoeny (Advisor); Keith Warren (Committee Member) Subjects: Gerontology; Music; Social Work

DNP, Kent State University, 2014, College of Nursing

Purpose: The purpose of the Doctorate of Nursing Practice (DNP) scholarly project was to develop an evidence-based wound care protocol tool to assist clinicians practicing in the long term care (LTC) setting in the initial assessment, documentation, and treatment plan of wounds for patients in this setting. Methodology: The evidence-based wound care protocol tool consisted of National Clearinghouse Guidelines or Recommendations. Twenty clinicians practicing in Ohio volunteered to participate. A pre and post survey assessed the clinicians' wound care knowledge before and after using the tool. The post survey also assessed the clinicians' perceived effectiveness and usefulness of the tool in clinical practice. Results: The Statistical Package for the Social Sciences analyzed the responses from the pre and post surveys (SPSS). Significant differences occurred in the assessment and initiation of treatments, confidence, and working knowledge of state regulations, etiology, and overall knowledge of wounds after using the wound care protocol tool. The analysis found positive correlations between usefulness of tool, improvement of clinical skills, and ease of use of the tool. Implications for Practice: The evidence-based protocol tool provides clinicians with evidence-based practice to guide them in the initial assessment, documentation, and treatment plan for patients with wounds residing in LTC. The goal of the tool was to improve clinical skills, decrease litigation, improve quality care for wound management, decrease facility deficiencies related to wound care, and improve patient outcomes related to wound care.

Committee: Connie Tezie DNP, NP-C (Committee Chair); Lisa Echeverry DNP, NP-C (Committee Member); Bong Kauh MD, CMD (Committee Member); Dana Rogers DNP, NP-C (Committee Member); Mary Jane Maloney MSN, CWS (Committee Member) Subjects: Gerontology; Health Care; Health Education; Medicine; Nursing

MA, University of Cincinnati, 2003, Allied Health Sciences : Communication Sciences and Disorders

The purpose of this study was to find out how hearing aids are cared for in nursing homes by examining the condition of the hearing aids, resident satisfaction with the hearing aids, healthcare provider attitudes about hearing aid maintenance, and amount of knowledge on the part of both the residents and healthcare providers about how to maintain proper function of hearing aids. Thirty-four non-demented nursing home residents who owned at least one hearing aid and 17 healthcare providers that worked closely with the residents were asked specific questions related to hearing healthcare. The overall results indicated that the majority of nursing home residents and staff do not possess adequate knowledge about maintaining hearing aids to keep them properly functioning. Implications of this finding are discussed. It is recommended that a hearing aid reference guide created specifically for healthcare providers become available for use when faced with a hearing aid issue.

Committee: DR. ROBERT KEITH (Advisor) Subjects:

Master of Arts, The Ohio State University, 2011, Speech Language Pathology

The purpose of this study was to explore the changes in Deaf individuals' ASL usage as their cognitive status declines. To date, there have been no published systematic studies describing the deterioration of native ASL users' signing abilities among those with dementia. This study involved 10 participants: 5 with no cognitive impairments (Control group) and 5 with cognitive impairments (Experimental group) as considered by the Mini-Mental State Examination (adapted version of the MMSE; Dean, Feldman, Morere, & Morton, 2009). Each participant was allowed up to 2 minutes to describe the The Cookie Theft picture (Goodglass & Kaplan, 1972). Discourse was analyzed for the dependent variables of number of utterances, number of words per utterance, correct use of phonology, morphology, and syntax, an error analysis of phonology, morphology and syntax, and content units. The results of this study revealed there were significant differences between the number of words per utterance of the Control group and the Experimental group. The Experimental group produced phonological errors. There were no phonological, morphological, or syntactic errors among the Control group utterances. The frequency of content units was higher in the Control group than the Experimental group. The correlations revealed there is a strong positive relationship among the Experimental groups' MMSE scores and number of content units. In conclusion, the data revealed ASL usage does change as cognitive status declines, while morphology and syntax remain relatively preserved.

Committee: Michelle Bourgeois PhD (Advisor); Lisa Milman PhD (Committee Member) Subjects: Aging; Behavioral Sciences; Behaviorial Sciences; Cognitive Psychology; Families and Family Life; Foreign Language; Gerontology; Health Care; Language; Linguistics; Mental Health; Modern Language; Morphology; Neurology; Occupational Therapy; Physical Therapy; Psychology

Doctor of Philosophy, The Ohio State University, 2006, Physical Activity and Educational Services

The United States population of individuals over the age of 65 is projected to double by the year 2030, placing considerable strain on the healthcare system. This aging cohort will also contribute to a growing demand for Healthcare Professionals (HCP) trained and interested in working with this patient population. However, pre-professional students in the health professions have been shown to place low priority in working with older adults. The purpose of this study was to investigate pre-professional allied health students' attitudes, knowledge, beliefs and subjective norms about working with older adults and determine which variables contribute to predicting intention to work with the older adult patient population. Using Palmore's Facts on Aging Quiz: Part 1 (FAQ1) and Kogan's Old People Scale (KOPS), the survey also compared differences in knowledge level about aging and attitudes toward older adults based on intention to work with the older adult or not. Data collection for the study occurred during an introductory course at a large mid-western university, which included pre-professional students with plans to enroll in one of eleven allied health professional programs. Of the 205 students participating in the study, only 7 (3.4%) stated an intention to work with older adults after graduation despite all participants' close relationships and work experience with older adults. The pre-professional students' scores reflect a limited knowledge of aging and positive attitudes toward aging. Students intending to work with older adults were less influenced by subjective norms than those students not intending to work in geriatrics. The results of this study indicate a need for further research regarding variables influencing career intentions to work with aging patients. Recommendations include further qualitative study, education in professional programs and curriculum modification to include geriatric content in Allied Health Professional preparation.

Committee: David Stein (Advisor) Subjects:

Master of Science (MS), Ohio University, 2003, Psychology (Arts and Sciences)

This secondary data analytic effort identified psychosocial predictors of adherence to antiretroviral therapies in middle-aged and older adults living with HIV/AIDS. The current study is needed because rates and predictors of adherence identified in research with younger samples of HIV-infected persons may not generalize to older populations. In particular, this study examined relationships between depression, pain, and self-reported cognitive functioning with intentional and unintentional nonadherence to medications in middle-aged and older adults with HIV disease. Depression significantly predicted adherence in this group in logistic multiple regression analyses; however, this association was less clear when escape-avoidant coping was included in the model. Pain and cognitive functioning showed no correlational relationship with medication adherence. Findings from this research can delineate rates of adherence in HIV-infected older adults and inform the conceptualization of interventions intended to optimize rates of adherence in this understudied population.

Committee: Timothy Heckman (Advisor) Subjects: Psychology, Clinical

Master of Gerontological Studies, Miami University, 2004, Gerontology

As the older population rapidly grows, the shortage of physicians trained in geriatrics will become more critical. Physicians trained to understand the complexities that can accompany the aging processes will become increasingly important for a high-quality health care system in an aging society. This report explores this problem known as the geriatric imperative, and suggests training the “gerontological physician” as a solution. Data from the AAMC's Graduate Questionnaire was analyzed for trends in perceptions of geriatrics education and training from 1978 to 2003. Results indicate increasing trends in student perceptions of adequate geriatrics training; increasing enrollment in geriatrics electives; and greater confidence in geriatric knowledge and skills. This analysis and the geriatrics literature demonstrate that we have begun to address the geriatric imperative, but more work is needed to ensure all elders received effective, high-quality health care.

Committee: Suzanne Kunkel (Advisor) Subjects: Gerontology