Theses and Dissertations from UMD
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Item FOOD SECURITY AMONG OLDER ADULTS IN SUB-SAHARAN AFRICA: A MULTISECTORAL APPROACH(2018) Wambogo, Edwina; Sahyoun, Nadine; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: The Food and Agriculture Organization of the United Nations recently developed the Food Insecurity Experience Scale (FIES) and tested its latent dimensional structure and psychometric properties using the 2014 Gallup World Poll (GWP) data. However, the similarities in psychometric structure of FIES across Sub-Saharan Africa (SSA) that would allow aggregation of food insecurity (FI) results for SSA was not tested. Aims: To, 1) assess the validity of FIES for use in SSA, determine the prevalence of FI by country, age group, and gender, and examine sociodemographic and economic characteristics of individuals with FI, 2) explore the association between FI and place of residence, and poverty in adults aged 50 years and older, and examine whether social capital (networks), social participation (volunteerism, donations, and helpfulness) and social support (emotional and instrumental) attenuate these associations, and whether such associations may differ by gender, 3) examine the associations between proximate factors (food security and physical health) and measures of Subjective well-being (SWB), and other distal risk factors independently associated with SWB, and 4) identify patterns of risk factors associated with SFI among older adults 60 years and above in SSA, and determine the bivariate and multivariate associations between the identified risk factors with severe FI (SFI). Methods: Rasch modeling, classification tree analysis, and logistic regression analyses were applied to SSA data on 57,792 respondents aged 19 years and above in the 2014 and 2015 GWP surveys. Results: FIES has acceptable internal validity for use in SSA. Older adults and women in SSA are at higher risk of FI, and compared to other older adults, urban-poor older men and women are at higher risk for SFI. A broad range of factors explain FI and SWB among older adults in SSA, including social capital, social support and social participation. Other less investigated factors, such as cost of housing and respect of women were also found to be major predictors of SFI among older adults. Conclusions: FI, as measured by FIES, continues to be highly prevalent and needs continued monitoring and multisectoral intervention strategies. Improvements in food security will lead to higher well-being in SSA.Item Community Living and Health Services Utilization among the Aging Services Network Population(2017) Gaeta, Raphael; Simon-Rusinowitz, Lori; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)By 2050, the number of older adults will increase from 67 million to 111 million, or roughly 28 percent of the total U.S. population. Age is a principal predictor of physical health status as well as functional and cognitive limitation. As the aging population grows, so too will the demand for long-term services and supports (LTSS) and healthcare services. Despite this intersection, LTSS and healthcare systems are highly disconnected. The Aging Services Network, authorized and partially financed by the Older Americans Act (OAA), may play an important role in an emerging trend toward integrating services. Yet, OAA research is lacking. Existing OAA research faces several obstacles, including handling program variation resulting from a decentralized Aging Services Network, identifying non-user comparison groups for OAA study samples, and limited utility of national datasets. Studies often rely on highly descriptive methods, indirect comparisons to the general population of older adults, or state-restricted analysis. This dissertation addresses several gaps in the research. The first study aims to identify factors associated with community tenure and participation among low-income elderly living in subsidized housing. The research is grounded in conceptual frameworks from the World Health Organization. In-depth interviews and focus groups are used to explore these associations among elderly HUD building residents in Prince George's County, Maryland. The second study aims to identify multilevel predictors of OAA Title III services participation. This study develops a conceptual framework based on the Andersen Behavioral Model of Health Services Use, and uses a merged data set from the nationally representative Health and Retirement Study with geographic data and relevant state policies. The third study further examines the relationship between OAA Title III services participation and patterns of healthcare utilization. This dissertation research provides evidence for the importance of OAA Title III services, including for elderly HUD beneficiaries. Findings from multivariate regression analyses provide evidence for (1) county level targeting criteria used to measure LTSS need and direct OAA Title III funding, (2) substantial influence of Medicaid on access to OAA Title III services, and (3) changes in mix of health care services use among OAA Title III services participants over time.Item Depression and Hardiness and their Association with Appetite in Older Adults(2009) Engel, Julia; Sahyoun, Nadine; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Poor appetite is common among older adults, and is influenced by factors including chronic disease and depression. The aim of this research is to examine the associations of hardiness (defined as the ability to manage stress), depression, and emotional well-being with appetite in older adults. A survey evaluating hardiness, depression and appetite was administered to 292 adults (60 years and older), at assisted-living facilities or senior centers in the Washington D.C. area. In univariate models, depression, hardiness, and emotional well-being are associated with appetite. In multivariate models, fair/poor emotional well-being increases risk for poor appetite (OR=5.60, 95% CI= 2.60-12.07) and commitment (a dimension of hardiness - which indicates an individual's involvement in life) is associated with appetite (OR=1.35, 95% CI= 1.13-1.61). These variables maintained the strongest associations with appetite in multivariate models. These associations further elucidate the components of mental health which contribute to poor appetite in this population.Item Role Occupancy, Physical Health and the Diminishment of the Sense of Mattering in Late Life(2007-11-28) Fazio, Elena Marie; Milkie, Melissa A; Sociology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Mattering is an important but understudied part of the self-concept. Morris Rosenberg and Claire McCullough (1981) suggested that older adults feel they matter less than middle-aged adults and this discrepancy may in part be explained by a lack of role occupancies such as paid work, and a devaluation of the old in society at large. This dissertation examines sense of mattering in older adults and two mechanisms that may explain the decline of the self-concept in later life - fewer role occupancies and poorer physical health. It examines whether these processes differ for men versus women and for African-Americans versus whites. The study employs the first wave (2001) of data from the Aging, Stress and Health (ASH) Study, which includes over 1100 white and African-American adults over age 65 living in the Washington, D.C. metropolitan area. Results indicate that there is a negative relationship between age and both dependence mattering and importance mattering and that it is in part explained by role occupancies as well as physical health status. Compared to informal ties, work and volunteer roles (productive or formal roles), are more important in explaining the relationship between age and mattering. Additionally, the total number of roles held is significantly and positively related to dependence and importance mattering. How roles mediate the relationship between age and dependence mattering depends on race and gender. The work role significantly mediates the age/mattering relationship for whites, but not for African-Americans. For African-Americans, the volunteer role mediates the relationship between age and dependence mattering, but this is not the case for whites. Also, self-rated health mediates the age-dependence mattering relationship for whites but not African-Americans. These findings point to the need to employ multiple mattering measures in analyses of older adults as well to study diverse samples; results differ depending on the outcome variable and group examined. Mattering is critical to the comprehensive study of the self-concept in later phases of the life course, as it is sensitive to social roles and physical health both of which are locations for key changes occurring during late life.