Psy. D., Antioch University, 2024, Antioch Seattle: Clinical Psychology

Objectives: The 65 and older population is a growing population in the US. In this population there can be marked increases in isolation, loneliness, and depression. Polyvagal Theory holds that a greater sense of safety, security, and sense of engagement improves well-being. A key hypothesis stated that participation will lower self-report ratings of loneliness. Additional hypotheses included improving self-reported purpose in life and feelings of psychological safety. Methods/Design: The present dissertation is a quasi-experimental design, utilizing pre- and post-test measures comparing degree of loneliness, depression, purpose in life (PIL), and Neuroception of Psychological Safety Scale (NPSS) in a 6-week novel somatic-based intervention. Results: Sample consisted of 13 community-dwelling older adults (aged <65). Paired t-tests were used to determine significance of changes from pre- to post-intervention. Although no changes were statistically significant, results show small improvements in loneliness, no change in social engagement and compassion, and decrease in bodily sensations and purpose in life. Thematic analysis of participants'' weekly feedback was also conducted. Conclusion: This novel intervention contributes to an overall body of research in Polyvagal Theory practice and development of polyvagal interventions targeted at the specific community of adults 65 and older.

DNP, Kent State University, 2024, College of Nursing

The management of dementia is a difficult task in all healthcare settings. Behavioral and psychological symptoms of dementia (BPSD) affect 90% of individuals with dementia. One-third of older individuals living with dementia are regularly prescribed antipsychotic medications to handle dementia-related behaviors. For six decades the FDA has been aware that antipsychotics were being used in nursing homes to sedate residents for BPSD, without dementia being an approved diagnosis. The serious side effects and increased risk of death have led to changes in nursing home policy and regulation. The Centers for Medicare and Medicaid (CMS) teamed up with Federal and State agencies and proposed dementia care planning that involves assessing BPSD and utilizing non-pharmacologic interventions. The primary objective of this project is to determine if educating staff in non-pharmacological management of BPSD will reduce antipsychotic medication use. Method This evidence-based quality improvement (QI) project is based on Lewin's Change Theory of unfreezing, moving, and refreezing. Using the PDSA method to move the process forward, a team was established, and a plan of action was developed to reduce the administration of antipsychotics by educating staff in non-pharmacological interventions. Sixteen nursing staff (n-16) were trained over four days in nonpharmacologic dementia care management. A pre-and-post-assessment questionnaire was conducted. Twenty-two resident participant's medications were reviewed by the Psychiatric Mental Health Nurse Practitioner (PMHNP), and gradual drug reductions (GDRs) were ordered. GDRs are a CMS compliance requirement for nursing homes conducted as standard practice based on the pharmacist recommendations and an important recommendation by CMS in antipsychotic reduction are conducted and documented by the consulting PMHNP. Nursing responses to patients with GDRs who presented with behaviors and antipsychotic dose reduction (open full item for complete abstract)

Doctor of Philosophy in Adult Development and Aging, Cleveland State University, 2024, College of Liberal Arts and Social Sciences

Older adults that utilize home- and community-based services demonstrated fewer symptoms of depression and anxiety, reduced loneliness and isolation, and decreased institutionalization rates. Despite these benefits, barriers to service use exist that make it difficult to reach vulnerable older adult populations. These barriers include inadequate methods for identifying risk, issues with transportation, and a lack of consumer-direction in service delivery. Research is needed to identify the individual characteristics particularly relevant for vulnerable older adult populations (e.g., loneliness, isolation, informal support) that predict support service utilization and to test the efficacy of new innovative methods to mitigate service use barriers. Guided by the Behavioral Health Model of Service Use (Andersen & Newman, 1973), this investigation had two aims: (1) describe constructs measuring predisposing, enabling, and need characteristics of vulnerable older adults and identify predictors of support service use, and (2) examine the impact of a consumer-directed telephone screening tool intervention, adapted from an evidence-based program (Bass et al., 2003) on support service use and perceived health outcomes compared to usual care. To address these aims, a randomized pragmatic trial with a two-group pre-test/post-test design was conducted with 43 older adults (intervention group=23, usual care group=20) recruited from a telephone reassurance call program at an Area Agency on Aging. Multiple linear and logistic regressions were used to examine individual differences in participants' use of formal services at baseline and test the efficacy of the consumer-directed telephone screening tool intervention. Variability was found in the volume and type of formal services participants reported using. However, no significant individual predictors of service use were identified in the current sample. Group assignment significantly predicted service use but did not predict per (open full item for complete abstract)

Master of Arts in Psychology, Cleveland State University, 2024, College of Liberal Arts and Social Sciences

There is a balance of gains and losses across the lifespan. One example of a gain is vocabulary, while an example of a loss is in one's reduced ability to understand speech in the presence of background noise. Investigations into the spoken word recognition environment can shed light on the differences in cognitive and auditory processing that occur throughout the lifespan. One component of the spoken word recognition environment is the listener. Patel's OPERA hypothesis (2011) suggests that the benefits listeners derive from musical training on neural encoding of speech is driven by adaptive plasticity in speech-processing networks. In the current research study, I investigated relationships between age, musicianship, and spoken word recognition. Participants heard a male talker say either a word or nonword and responded by pressing a designated key corresponding to word or nonword on their keyboard. Participants then completed the Goldsmiths Musical Sophistication Index, which was used to categorize each participant as either a musician or a nonmusician. Two repeated measures ANCOVAs were used to analyze the data. The covariate was years of musical experience. The results indicate that both younger and older adult musicians had more efficient responses (more accurate & faster) than nonmusicians. Additionally, participants were more efficient at responding to the easy words compared to the hard words. Interestingly, older adults had significantly more accurate responses than younger adults. The current study furthers our understanding of the connections between musicianship and spoken word recognition in younger and older adults.

PHD, Kent State University, 2024, College of Arts and Sciences / Department of History

This dissertation explores African market women's activities by analyzing and emphasizing the significance of their personal networks and connections, emotions, and spatial mobilities in sustaining their businesses and the informal economy in general. I argue that the social, economic, and political systems created by market women rest on their immediate ties to the household, their relationships, and wider networks of kin, friends, or other social connections as well as their performance and experience with emotions. I evaluate how these intricate connections impact women's success or failures in the market. I argue that competition and contestations over urban market spaces that are intensified by the Zimbabwean economic crisis led to different discourses by Zimbabwean citizens to claim spaces. Market women, for example, have used their life histories to make claims to the market and perceive ownership differently than other groups within the city. By primarily using life histories to recollect and explore women's experiences within the city and rural areas, I emphasize women's agency and perceptions of Zimbabwe's history. Starting in the 1960s when women nostalgically recollect their participation in markets, to the present, I follow women's markers of history and explore why they remember the past in that way. I expand debates on women's entrepreneurship and urban informality to emphasize why market women in Zimbabwe help us comprehend how women have reshaped urban spaces, economies, and political systems. In sum, I argue that in the different phases of Zimbabwe's economic volatility, market women have meritoriously supported the informal economy while bringing happiness to the residents.

Doctor of Philosophy, Case Western Reserve University, 2024, Genetics

Alzheimer disease (AD) affects more than 6 million individuals in the US, and accounts for 60-80% of dementia cases. AD demonstrates mixed pathologies of amyloid beta and tau tangle accumulation, leading to symptoms such as cognitive impairment and memory loss. Taking advantage of a closed, isolated population, the Midwestern Amish, variants both in protection against AD as well as risk for AD were explored. The comparative reduction in incidence of AD within the Amish versus a general European population led to the examination cognitive preservation, rather than AD, as the diagnosis of interest. A genome-wide association study (GWAS) was performed on the Amish to identify protective loci for AD via the GENESIS R Package. PC-AiR and PC-Relate were used for principal component analysis to assist in correcting for the highly related sample. Linkage analyses across the entire genome, once again for cognitive preservation, were used to supplement and corroborate GWAS findings. These analyses were initially completed in MERLIN, but certain regions demonstrating repeated 16 significance were run through MORGAN, an MCMC linkage analysis software. These analyses highlighted one region on chromosome 2p11.2-13.1 that demonstrated a protective effect against AD. This region was previously associated with risk for AD in the Midwestern Amish, potentially indicating both protective and risk variants within this locus. Further evaluations of genetic loci implicated in AD took advantage of this unique sample population to examine a potential risk factor. The MGMT locus was previously associated with increased risk for AD in the Hutterites, who are another closed, isolated population of European decent. In the Midwestern Amish, one SNP in the MGMT locus was significantly associated with AD diagnosis. However, this SNP was a novel result, distinct from those detected in a previous study and not in linkage disequilibrium with previously associated MGMT SNPs for (open full item for complete abstract)

Master of Science, The Ohio State University, 2024, Psychology

Traumatic brain injury (TBI) is a prevalent environmental risk factor for dementia that may lead to cognitive and functional decline. TBI-induced demyelination – or loss of the fatty protective layer surrounding axons – may be a key contributor to TBI-related cognitive impairment, as myelin plays an integral role in brain connectivity subserving cognition. Many neuroimaging studies have investigated demyelination in deep white matter tracts following TBI; however, myelin may also extend to the cortical mantle, and these surface regions are not well-captured by existing neuroimaging methodologies. To address this gap, the present study used a novel structural neuroimaging method (T1-weighted [T1w] /T2-weighted [T2w] ratio) to measure cortical myelin content and relate these values to TBI history, cognitive performance, and demographic variables in a sample of 73 older adults (42% Male; Mean age=64.8 years) with (n=31) and without (n=42) a TBI history. Analyses of covariance (ANCOVA) compared myelin values between groups, and partial and semi-partial correlations related myelin to aging and composite cognitive scores. Linear regression models explored interaction effects between TBI history and age on myelination. Mediation models tested the indirect effects of myelination on relationships between TBI history or age and cognition. Covariates in all analyses included sex and an imaging quality assurance metric. Exploratory analyses also explored sex differences in myelination. Results revealed significant relationships between global cortical myelin and repetitive head insults. Age moderated the relationship between TBI history and demyelination in specific parietal lobe ROIs, as age was negatively correlated with superior parietal gyrus and supramarginal gyrus myelin in individuals without a TBI history but not in individuals with a TBI history. Age was also related to worsened cognitive performance across the entire sample, as callosal sulcus myelination had signific (open full item for complete abstract)

Doctor of Philosophy, Miami University, 2024, Psychology

Introduction: This study aims to better understand the psychosocial mechanisms by which individuals who report subjective concerns about their memory (SCI) are at a higher risk for objective cognitive impairments (OCI) over time. It also aims to identify modifiable risk factors that may disrupt this progression. Aim 1 tests if symptoms of affective disorders mediate the relationship between SCI and OCI over time. Aim 2 tests if self-perceptions of aging moderate the relationship between SCI and symptoms of affective disorders over time. Aim 3 tests if self-perceptions of aging moderate the indirect effect of symptoms of affective disorders on the relationship between SCI and OCI over time. Method: Data was sourced from the Health and Retirement Study, a national longitudinal dataset, across 8 years. 4,002 adults, 65 and older, were included in the sample. The moderation, mediation, and moderated mediation analyses were conducted using a path model in Mplus (Version 8 Plus). Relevant covariates including demographic and health variables were controlled for. Results: Analyses confirmed that symptoms of affective disorders partially mediated the relationship between SCI and OCI. For individuals with negative self-perceptions of aging, the relationship between SCI and symptoms of affective disorders strengthened over time, while for individuals with positive self-perceptions of aging, the relationship ceased to exist. Finally, positive self-perceptions of aging weakened, while negative self-perceptions of aging strengthened the indirect effect of symptoms of affective disorders on the relationship between SCI and OCI. Conclusion: Results of the current study clarify the psychosocial mechanisms involved in the progression from SCI to OCI, and add support to literature identifying positive beliefs about aging and mental health as protective factors against cognitive impairment among older adults. This study implicates the need for more interdisciplinary research studying (open full item for complete abstract)

Doctor of Philosophy, Miami University, 2024, Gerontology

Quality end-of-life care necessitates that patient preferences be known and honored by family and health care providers, as well as that care is both accessible and affordable. However, patient preferences are not always assessed, nor is the quality and cost of end-of-life care consistent throughout the United States. For individuals with multiple marginalized identities, achieving high quality end-of-life care is even more challenging, as compounding issues like systemic discrimination on the basis of race/ethnicity and gender are prevalent. The intersectional impact of race/ethnicity and gender on end-of-life care quality is largely understudied. To address this gap, I studied a sample of White, Black, and Hispanic US decedents (N=1,410; representing a weighted sample of nearly six million US adults) with data from the Health and Retirement Study core survey, leave behind questionnaire, and exit survey. Using binary logistic regression analyses, I explored how goal-concordance and satisfaction with end-of-life care are impacted by end-of-life care circumstances and aspects of power and privilege. Race/ethnicity and gender were used as moderating variables. Significant end-of-life care circumstances (i.e., discussing end-of-life care options, receiving home care, and longer length of hospice enrollment) reveal the importance of further integrating person-centered care practices into end-of-life care, educating patients on end-of-life care options, and addressing barriers to hospice enrollment for racial/ethnic minority populations. Several aspects of power and privilege were associated with greater quality of care, including not being eligible for Medicaid and absence of depression, which highlight policy and practice areas in need of reform. Further, race/ethnicity and gender were found to moderate the relationships between adverse childhood experiences and goal-concordant care, and perceived discrimination and satisfaction. These findings may help older adults, c (open full item for complete abstract)

MA, Kent State University, 2024, College of Arts and Sciences / Department of Psychological Sciences

Aging is characterized by changes in numerous cognitive abilities, including disruption in multiple aspects of language. It is unknown whether word choice during spontaneous speech (i.e., unscripted, verbal communication) is also impacted by these changes, as education and life experience may buffer it against age-related cognitive decline. The current study examined word frequency (WF), the rate at which words are produced in natural language, and cognitive test performance in 70 older adults (OAs; ages≥55) and 130 younger adults (YAs; ages 18-25). Consistent with hypotheses, average WF (of all words, as well as content-specific words alone, such as nouns and adjectives) was higher (reflecting the use of more common, less specific words) in YAs and was associated with poorer cognitive test performance in the combined sample. In contrast, average frequency for function words (e.g., conjunctions, determiners) was lower in YAs and better cognitive performance was related to higher average WF in OAs, including exploratory subgroups. Results from the current study indicate that the use of higher frequency words is related to poorer performance on tests of cognitive estimation and semantic fluency in a combined sample, whereas intact cognitive performance in OAs is associated with use of more common words. Future work is needed to clarify these mixed findings, particularly studies that account for methodological and sampling differences across studies.

Doctor of Philosophy, University of Akron, 2024, Psychology-Adult Development and Aging

The aim for this study was to broaden the current understanding of age differences in environment learning by taking a social cognitive lens. This new take on age differences in environment learning stemmed from the age-based stereotype threat (ABST) literature. ABST was explored by testing for interactions between Condition (Neutral and Stereotype Threat) and Age Group (young, middle-aged, older) from 244 participants. Participants were randomly assigned to a neutral condition or a stereotype threat condition that included negative old age stereotype exposure. A significant main effect for Age Group for time taken in allocentric sections and time taken overall was found, with older adults taking longer to complete the task. All of the interactions, for all sections of the task, were nonsignificant. Additional analyses revealed significant main effects for Age Group and Condition on perceived threat and revealed that perceived threat was higher in threat conditions for all age groups. This study adds to the literature by testing ABST effects on a new domain and across various types of environment learning. Furthermore, these findings highlight that older adults may take longer to complete environment learning tasks but may be just as accurate, depending on the task type. The main takeaways from this study were, when exposed to negative old age stereotypes older adults did not perform significantly worse. This suggests that the combination of blatant and subtle stereotypes do not result in ABST effects on environment learning. These findings should be further explored by testing subtle and blatant threat manipulations separately, measuring self-efficacy, and including a task that resembles everyday environment learning.

Doctor of Philosophy, Case Western Reserve University, 2024, Nursing

The study investigates the multifaceted landscape of medication adherence and its intricate ties to health outcomes among older adults living with hypertension in the United States. Employing the Self-Regulation Model (SRM) as a guiding framework, this research delves into the interplay between psychological, demographic, and health-related factors, shedding light on their collective influence on adherence behavior and its consequential impact on blood pressure control, stroke risk, and activities of daily living (ADL). The research reveals significant correlations between psychological perceptions and medication adherence, aligning with the SRM's emphasis on beliefs and attitudes as key determinants of health-related behaviors. Older adults exhibiting positive perceptions of hypertension demonstrated heightened medication adherence, suggesting that viewing hypertension positively fosters a greater commitment to medication regimens as a fundamental self-management strategy. Furthermore, the study uncovers a substantial link between depression and medication non-adherence, underscoring the significance of addressing mental health concerns to improve adherence rates. The impact of medication adherence on health outcomes becomes evident in its correlation with blood pressure control and ADL performance. Adherence to antihypertensive medication emerges as a key determinant of systolic blood pressure levels, emphasizing the pivotal role of consistent adherence in optimizing cardiovascular health. Additionally, medication adherence is linked to enhanced ADL performance, showcasing its broader influence on functional independence and overall well-being. Notably, the study unveils an intriguing aspect of medication tolerability, revealing its potential influence on stroke incidence. Older adults reporting minimal medication side effects demonstrated a lower likelihood of stroke, illustrating the importance of medication tolerability in sustaining adherence and subsequently (open full item for complete abstract)

Psy. D., Antioch University, 2023, Antioch Seattle: Clinical Psychology

The definition of a word helps us understand its context and how it is meant to be used in daily life or research. When a word lacks a universal definition, it is hard to know how to use it. “Resilience” is that type of word. The resilience community in psychological research does not have a concrete, universal definition for this word. It takes on whatever characteristics are useful to the investigator. This study began with seeking a universal definition for the domain known as resilience. This study used a convergent parallel design with adults aged 60 and older living independently to seek out their personal definitions of resilience, then employed a well validated measure—the Conner-Davidson-25 (CD-RISC-25)—to test this population's resiliency and how they felt the measure addressed to domain of resilience. The findings of the study demonstrated that resilience is a complex and nuanced domain and a broad scope, making it challenging to develop a universal definition.

PHD, Kent State University, 2023, College of Arts and Sciences / School of Biomedical Sciences

Activation of centrally expressed luteinizing hormone receptor (LHCGR) rescues spatial memory function and dendritic spine density losses associated with gonadectomy and high circulating gonadotropin levels in females. However, whether this extends to the AD brain, and the mechanisms that underlie these benefits remain unknown. To address this question, we delivered the LHCGR agonist human chorionic gonadotropin (hCG) intracerebroventricularly (ICV), under reproductively intact and ovariectomized conditions to mimic the post-menopausal state in AD model mice. Then, to delve deeper into the fundamental role of this receptor in the CNS, we developed a CRISPR/cas9 conditional knockout system to knockdown LHCGR in the hippocampus and hypothalamus. Central LHCGR activation restored spatial ability, hippocampal dendritic spine density, and BDNF expression in ovariectomized AD model female mice to wild-type levels without altering Aβ. Oppositely, hippocampal LHCGR knockdown in gonadally intact wild-type adult animals lead to spatial memory deficit and reduced BDNF transcription. Additionally, hypothalamic LHCGR knockdown uncovered novel physiological roles of the receptor on HPG and HPA axis function. Together, this work highlights the relevance of the LHCGR on cognition and its therapeutic potential in the “menopausal” AD brain, as well as its functional relevance in the CNS.

Doctor of Philosophy, Case Western Reserve University, 2024, Sociology

The Cultural Revolution in China generated a “sent-down” cohort and interrupted education. People who were born between 1945 and 1954 were known as the People's Republic of China (PRC) cohort, who experienced the Cultural Revolution at high school or college age. This study intends to explore how education policy during the Cultural Revolution shaped the life course and health outcomes among the PRC cohort. Two other cohorts were involved as reference cohorts because they had experienced institutional changes at a non-critical age: people who were born in 1935-1944 (pre-PRC cohort) and 1955-1964 (late-PRC cohort). Data are drawn from the China Health and Retirement Longitudinal Study (CHARLS) and five waves are included: 2011, 2013, 2015, 2018 and life history (wave 2014) data. Health outcomes are measured by functional limitations. Predictors include family background, educational attainment, education trajectory, and work history. Covariates include urban-rural household registration status (hukou), gender and age. State sequences are used to describe the education history and work trajectories, and multilevel growth curve models are used to analyze data. All data analyses are stratified by three cohorts to detect the long-term effects of education policy changes in different life stages on functional limitations in later life. The findings suggest that: first, compared to the pre- and late- PRC cohorts, the PRC cohort presented the highest risk of dropout and the lowest odds to go to college. Second, even though political capital was emphasized during the Cultural Revolution, parents' cultural capital played a more important role than political capital which was measured by the Communist Party membership. In addition, comparatively poor family financial status and rural hukou were associated with higher risk of dropout and lower odds of college education. Third, all three cohorts experienced economic reform (1978) after the Cultural Revolution, which substantia (open full item for complete abstract)

Master of Science (MS), Ohio University, 2023, Food and Nutrition Sciences (Health Sciences and Professions)

Neurodegenerative diseases (NDs) are a broad range of disorders characterized by the chronic and progressive degeneration of neurons and synaptic connections of the nervous system. After Alzheimer's disease (AD), Parkinson's disease (PD) is the most common ND. PD affects ~0.3% of the general population and accounts for an estimated $15.5 billion in medical and non-medical costs each year. PD is a movement disorder characterized by the gradual loss of gross and fine motor control, impaired speech, dyskinesias, postural instability, and a resulting decrease in quality of life. As the disease progresses, interrupted sleep, depression, and cognitive impairment may also arise. Clinically, these symptoms have been associated with the loss of dopamine (DA) production due to the progressive degeneration of dopaminergic neurons of the substantia nigra pars compacta (SNc) region of the midbrain. Another hallmark of PD is the presence of insoluble inclusions called Lewy bodies in neurons due to the pathological aggregation of a protein called α-synuclein. The molecular mechanisms governing the aggregation of α-synuclein and formation of Lewy bodies are not well understood. Emerging research suggests that excitotoxicity, oxidative stress, and neuroinflammation may be important factors in the α-synuclein aggregation-mediated formation of Lewy bodies and associated loss of dopaminergic neurons, and therefore may serve as promising therapeutic targets for PD. The current pharmaceutical therapies available for PD are only effective in providing short-term management of symptoms and are unable to slow the progression of the disease. Furthermore, these treatments have been associated with many adverse side effects, limiting patient compliance and long-term effectiveness. Natural products such as plants, fungi, and microbes have played a pivotal role in pharmaceutical drug discovery for a variety of pathologies. More recently, molecules derived from natural products have been exten (open full item for complete abstract)

Doctor of Philosophy, The Ohio State University, 2023, Biomedical Sciences

The work described herein aims to fill a gap in knowledge regarding specific mechanisms that underlie the development of persistent cognitive impairments following surgery, particularly in aging. These so-called perioperative neurocognitive disorders (PNDs) afflict as many as half of individuals over the age of 65 after a surgical procedure. Of those, many patients experience recovery in the initial days to weeks after surgery, termed post-operative delirium (PD). Yet a subset of patients continue to experience these cognitive deficits for months to years after surgery, referred to as post-operative neurocognitive disorder (POCD). Critically, it remains unclear what factors cause the development of short-term and self-resolving PD vs. persistent POCD. Accumulating evidence from both pre-clinical and clinical studies have established neuroinflammation as a critical mediator in the development of PNDs collectively, but it is still unknown how this contributes to PD vs. POCD pathogenesis. Additionally, specific inflammatory mechanisms have not been fully delineated. A variety of common immune exposures in the perioperative setting have been associated with heightened risk for PNDs, including experiencing an infection and receiving pro-inflammatory opioids as part of a pain management regimen. Additionally, metabolic disturbances associated with increased inflammation at baseline have also been linked to PND risk. In the present body of work, we investigated the impact of two such immune insults – post-operative morphine use and pre-operative consumption of a high-fat diet (HFD) – on post-surgical cognitive and inflammatory outcomes in male rats. We hypothesized that these pro-inflammatory immune challenges would potentiate the neuro-immune response to surgery, causing exaggerated neuroinflammation sufficient to cause long-lasting memory impairments. Indeed, both insults caused long-term memory deficits that lasted at least 8 weeks with morphine and 2 weeks with HFD (open full item for complete abstract)

Doctor of Philosophy, Miami University, 2023, Gerontology

Evidence concerning the role of social and behavioral (SB) determinants in cognitive functioning among older adults with mild cognitive impairment (MCI) is limited. Using hierarchical linear mixed modeling and data from eight waves (2004-2018) of the Health and Retirement Study, this dissertation examined the relationship between SB determinants (physical activity, social engagement, smoking, alcohol consumption, and body mass index) and cognitive functioning (sum of tests of immediate and delayed word recall, a serial seven subtraction test, and counting backwards; range: 0 to 27) among adults aged 60 years and older with MCI at baseline while controlling for other covariates (demographics and other health and lifestyle-related factors that are associated with cognitive functioning). Following that, the moderating effect of SB determinants on the relationship between APOE genotype and cognitive functioning was investigated. The average cognitive score of older adults with MCI at baseline was 9.6 (n=1642), which decreased by 0.14 points each year. Cognitive decline over time was greater in those that had at least one APOEε4 allele. Greater physical activity and social engagement, low to moderate and heavy alcohol consumption, former smoking, and higher BMI were associated with favorable cognitive functioning over time. Although following lifestyle behaviors influenced cognitive functioning among older adults with MCI over time, the effect of having an unfavorable APOE allele (i.e., APOEε4) was not mitigated by SB determinants, except BMI. Higher BMI was positively associated with cognitive functioning for older adults who had at least one APOEε4 allele compared to those with APOEε33 genotype. Although higher BMI reduced the impact of APOEε4, future studies are needed to investigate this association more fully across BMI categories. These findings will help inform public health interventions that aim to minimize the risk of cognitive decline in older adults with MCI.

Doctor of Philosophy, The Ohio State University, 2023, Social Work

Ageism is one of the most commonly accepted forms of discrimination worldwide. Since its inception, it is currently defined as age-related stereotyping, prejudice, and discrimination toward someone (i.e., other-directed ageism) or oneself (i.e., self-directed ageism) due to their age. Both older adults and younger people endure harms associated with both other-directed and self-directed ageism that have been shown to negatively affect all domains of health. Pervasive negative age stereotypes that are socially accepted and internalized are a significant contributing factor of negatively experienced health outcomes. Extant research has well-documented positive effects of ageism-reduction interventions, but much of this research has only focused on other-directed ageism and outcomes achieved by college students. There is therefore a lack of understanding about self-directed ageism and self-directed ageism-reduction interventions within the current literature, demonstrating a need to document the state of the literature and investigate effective evidence-based practices that aim to reduce self-directed ageism to promote healthy aging. The purpose of this dissertation is to apply the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) implementation science framework to gain a better understanding of self-directed ageism-reduction interventions through three papers. The first paper reports on findings of a systematic scoping review that investigated the reach and effectiveness of self-directed ageism-reduction interventions. Despite found variability in populations measured and intervention types implemented within 52 included studies, positive outcomes were primarily associated with in-person intergenerational programming and in-person intergenerational programming that included aging education, especially among traditional age college students. The results of this paper along with empirical evidence and theoretical support informed the development of t (open full item for complete abstract)

Doctor of Philosophy, Case Western Reserve University, 0, Social Welfare

Using data from a sample of female caregivers (age 50 or older) of individuals with Autism Spectrum Disorder (ASD) in greater Cleveland area, this dissertation examined: 1) the relationship between caregiving stressors and depressive symptoms; 2) the mediating effect of secondary stressors on the relationship between caregiving stressors and depressive symptoms; and 3) the moderating effect of informal support on the relationship between caregiving stressors and depressive symptoms. Findings show that neither assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) nor the severity of impairments of the individual with ASD was significantly associated with depressive symptoms. As the secondary stressor, negative caregiving effect on daily routines mediated the relationship between assistance with ADLs and IADLs and depressive symptoms. However, negative caregiving effect on daily routines did not mediate the relationship between severity of impairments and depressive symptoms. Neither general support nor caregiving-specific support was found to moderate the association between caregiving stressors and depressive symptoms. Nonetheless, the protective effect of general support against depressive symptoms was consistently identified in the analyses. Additionally, findings have identified that caregivers' annual household income was a protective factor against depressive symptoms. Overall, the collective findings of this dissertation indicate that older female caregivers who provided care to individuals with ASD not only experience stressors related to caregiving but also encounter challenges in different areas of life due to caregiving. Caregiving stressors may not have a direct effect on caregivers' depressive symptoms directly but instead may indirectly impact them through secondary stressors. This finding highlights the role of secondary stressors as modifiable factors that can impact the mental health of older ca (open full item for complete abstract)