Theses and Dissertations from UMD
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Item Health, Self-Tracking Technologies, and the Emotional Impacts they have on Older Adults with Memory Concerns(2022) Short, Amelia; Lazar, Amanda; Library & Information Services; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Most individuals, including older adults, in the United States are not meeting the recommended levels of physical activity for their age group. Research has shown that adopting self-tracking technologies can be one way to motivate users to increase their physical activity levels. Further, tracking progress in terms of health and wellbeing has the potential to support individuals with memory concerns; however, most older adults do not use technology to track progress towards their health-related goals. While traditional qualitative research might aim to uncover the reason behind this lack of adoption, this thesis instead focuses on how the topics of health and self-tracking technologies affect the lives of older adults with memory concerns. Leaning on a style of writing and analysis from anthropologist Kathleen Stewart, this thesis offers the reader a series of resonating stories– stories that have no obvious meaning, classification, or rationalization. Rather, these narratives gather the textures and intensities that participants face in their everyday lives and offer us a brief look into their habitus and interactions with the world around them. By taking this approach, this thesis calls for more detail into participants’ lived experiences that would otherwise be overlooked by traditional qualitative analysis.Item Perceived Discrimination and Multimorbidity Among Middle-Aged and Older Adults(2020) Howard, Jianna; White, Kellee; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Multimorbidity, the presence of multiple chronic conditions, is increasingly recognized by researchers as a major health priority. Relative to younger adults, the burden is much higher among middle-aged and older adults with prevalence estimates ranging from 25-98%. Variations in the burden of multimorbidity within the aging population exist with a growing body of research showing racial/ethnic differences in the incidence, prevalence, and severity of multimorbidity. This study analyzed the association between perceived racial discrimination and multimorbidity among middle-aged and older adults and whether or not existing associations vary by race/ethnicity. Findings show that individuals reporting perceived discrimination are more likely to have multimorbidity. While racial/ethnic differences in the association between perceived discrimination and multimorbidity were not observed, Black respondents displayed the greatest risk for multimorbidity. Perceived discrimination may provide insight into why multimorbidity varies by race/ethnicity through the mechanisms of stress responses and health behaviors.Item DIET, FOOD SECURITY, SOCIAL RELATIONSHIPS AND DEPRESSIVE SYMPTOMS IN HOMEBOUND OLDER ADULTS IN THE UNITED STATES AND THEIR IMPACT ON HEALTHCARE UTILIZATION(2020) Ashour, Fayrouz A.; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Homebound older adults may be at increased risk for malnutrition and social isolation, posing a potential threat to them aging in their communities and increasing healthcare cost. The Nutrition Service Program under Older Americans Act (OAANSP) was established to support older adults aging in place by delivering meals and providing nutrition-related services. Aims: 1) Examine diet quality of home-delivered meal (HDM) recipients; 2) examine direct and indirect associations between social relationships, depressive symptoms, food insecurity (FI) and diet quality; and 3) examine direct and indirect associations between social relationships, FI, diet quality and hospitalization. Methods: Data obtained from OAANSP Outcomes Evaluation study included: 1) client outcomes survey, 2) two 24-hour dietary recalls, and 3) Medicare healthcare utilization data. Dietary recalls examined diet quality by calculating 1) population-level mean HEI scores; and 2) usual vegetable and protein intakes. Diet quantity was compared to Dietary Guidelines for Americans 2010 (DGA), and structural equation modeling was used to examine direct and indirect relationships. Results: HDM recipients and controls have high prevalence of FI, 22.4% and 16.5%, respectively. HDM recipients who did not receive a meal on day of dietary recall (no-meal recipients) had significantly poorer diet quality than HDM recipients who received a meal (meal recipients) that day and control group. Quality of overall diet for meal recipients, no-meal recipients and controls did not meet recommendations for several food groups/nutrients. Compared to DGA, HDM and complementary foods were low in whole grains, dairy, fiber, and surpassed upper limit of consumption for saturated fats, refined grains, sodium and added sugar. High FI was associated with greater depressive symptoms and lower usual vegetable intake in control group. High FI was associated with lower usual protein intake in HDM recipients and controls. Both groups were at high risk for protein insufficiency, which was associated with greater hospitalization in the control group. Conclusions: HDM recipients and controls have high prevalence of FI, poor diet quality, and insufficient protein intake. Increasing funding for OAANSP can allow program expansion and improvement of HDM. Validated tools to examine social relationships and additional contributors to FI are neededItem The Impact of Acute Aerobic Exercise on Semantic Memory Activation in Healthy Older Adults(2018) Won, Junyeon; Smith, Jerome C; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: A growing body of exercise literature use functional magnetic resonance imaging (fMRI) technique to measure the effects of exercise on the brain. Findings suggest that regular participation of long-term exercise is associated with enhanced cognitive function. However, fundamental questions regarding the beneficial effects of acute exercise on semantic memory have been ignored. Purpose: This study investigated the effects of a single session of exercise on brain activation during recognition of Famous names and Non-Famous names compared to seated-rest in healthy older adults (age 65-85) using fMRI. We also aimed to measure whether there are differences in brain activation during retrieval of Famous names from three distinct time epochs (Remote, Enduring, and Recent) following acute exercise. Methods: Using a within-subjects counterbalanced design, 30 participants (ages 55-85) will undergo two experimental visits on separate days. During each visit, participants will engage in 30-minutes of rest or stationary cycling exercise immediately followed by the famous name discrimination task (FNT). Neuroimaging and behavioral data will be processed using AFNI (version 17.1.06) and SPSS (version 23), respectively. Results: HR and RPE were significantly higher during exercise. Acute exercise was associated with significantly greater semantic memory activation (Famous > Non-Famous) in five out of nine regions (p-value ranged 0.027 to 0.046). In an exploratory epoch analysis, five out of 14 brain regions activated ruing the semantic memory task showed significantly greater activation intensity following the exercise intervention (Enduringly Famous > Non-Famous). Conclusions: Enhanced semantic memory processing is observed following acute exercise, characterized by greater fMRI response to Famous than Non-Famous names. Enduringly Famous names exhibited significantly greater activation after exercise compared to Non-Famous names. These findings suggest that exercise may improve semantic memory retrieval in healthy older adults, and may lead to enhancement of cognitive function.Item CONDOM USE IN OLDER AFRICAN AMERICANS: AN EXPLORATORY STUDY(2012) Ramos, Ina Ananda; Desmond, Sharon M; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The purpose of this mixed methods exploratory study was to examine perceptions regarding condom use and sexual intercourse among African Americans 50 to 65 years of age, specifically attitudes, norms, self-efficacy and barriers regarding condom use behavior. There were three study phases: 1) a pilot study of the survey instrument (N=31), 2) an on-line survey (N=175), and 3) post survey explanatory interviews (N=10). The online survey contained items from the Sexual Risk Behavior Beliefs and Self-Efficacy Scales (SRBBS) (Basen-Enquist et al., 1999). Pilot study data indicated the online survey was understandable, acceptable, readable and appropriate for use by this sample of African Americans. Factor analyses of the survey items yielded similar constructs to the original SRBBS with seven of eight scales demonstrating internal consistency; Cronbach's alpha reliabilities ranged from .49 to 1.0. Logistic regression models found two independent variables increased the likelihood of condom use (condoms should be used even if people know each other well and friends feel condoms should be used even if pregnancy isn't possible) and two decreased the likelihood of condom use (friends feel you should use condoms even if people know each other well, and using condoms would be a hassle). A logistic regression model of significant independent variables found that provider speaking to patients about safer sex and male gender increased condom use, while being married and lower educational level decreased condom use behavior. Post-survey interviews, where participants (N = 10) were asked to elaborate on study findings, yielded six themes (the importance of trust and relationships, lack of knowledge, attitudes about condom use, sexual activity, health care providers, and friends opinions) that further explained statistical findings. Findings from this study have the potential to reduce the spread of HIV/STDs in this population through the use of educational programs that include empowerment and risk reduction components. Additionally, health care providers can potentially play a key role in these efforts and should be trained on how to communicate effectively with older adults around sexual health.Item Short-term Home-Delivered Meal Intervention and the Health, Nutrition and Functional Status of Hospital-discharged Older Adults(2008-11-21) Akobundu, Ucheoma Onyinyechi; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Following discharge from the hospital, homebound older adults remain at risk of poor dietary intake and adverse outcomes due to declines in health experienced during hospitalization. However, once home, timely receipt of in-home nutrition services by older adults is challenged by gaps in the continuum of care. Greater insight into the nutrition and wellness service needs of this population is needed to improve service coordination. Methods: Staff at six home-delivered meal (HDM) programs in six US states enrolled 566 hospital-discharged, homebound older adults into a five-month HDM intervention project. Sociodemographic, nutrition and health risk data were collected at baseline, at 2 months after the initial assessment or at termination of home delivered meal services, and at 5 months after the initial assessment. Statistical Analyses: Bivariate and multivariate analyses were used to examine relationships between sociodemographic, social, nutritional, and health risk factors, and participant food shopping/meal preparation ability. In addition, associations between these risk factors, adverse changes in living arrangement and short-term HDM program participation were evaluated. An assessment of the food items and cooking appliances available in the home was also performed. Results: This dissertation suggests that among the hospital-discharged older adults studied: (a) many had a variety of foods available but reported being unable to prepare meals, (b) those who experienced adverse changes in living arrangement over the course of the intervention were more likely to report poor health and nutrition status, functional impairment, and social isolation following hospital discharge, and finally, (c) those who maintained or restored their ability to accomplish food-related instrumental activities of daily living such as shopping and preparing meals were shorter-term users of HDM compared to longer-term users. Conclusion: Homebound older adults can benefit from timely enrollment to community-based programs nutrition and wellness services like HDM, especially those who are unable to shop and prepare meals. There is also a need at discharge to identify social, functional and nutritional risk factors for adverse outcomes in older adult patients in order to provide appropriate referrals to nutrition and wellness services that can facilitate successful transitions from hospital to home.Item Dietary Patterns, Metabolic Risk and Survival in Older Adults(2008-10-28) Anderson, Amy Louise; Sahyoun, Nadine R.; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Recent evidence suggests that older adults' diets can appreciably impact their health. Dietary patterns may better capture the multifaceted effects of diet on health than individual nutrients or foods. Objectives: The purpose of this study was to identify the dietary patterns of a cohort of older adults, and examine relationships with body composition, insulin sensitivity, systemic inflammation, and survival. The influence of a polymorphism in the peroxisome proliferator-activated receptor-γ (PPAR-γ) gene was considered. Design: The Health, Aging and Body Composition (Health ABC) Study is a prospective cohort study of 3075 older adults. Participants' body composition, genetic variation, glucose metabolism, systemic inflammation, and vital status were evaluated in detail. Food intake was assessed with a modified Block food frequency questionnaire (FFQ), and dietary patterns were derived by cluster analysis. Results: Six clusters were identified, including a 'Healthy foods' cluster characterized by higher intake of lowfat dairy products, fruit, whole grains, poultry, fish and vegetables. An interaction was found between dietary pattern and PPAR-γ Pro12Ala genotype in relation to body composition. While Pro homozygotes in the 'Healthy foods' cluster did not differ significantly in body composition from those in other clusters, men with the Ala allele in the 'Healthy foods' cluster had significantly lower adiposity than those in other clusters. The 'Healthy foods' cluster had lower fasting insulin and HOMA-IR values than the 'High-fat dairy products' and 'Breakfast cereal' clusters, while no differences were found in fasting or 2-hour glucose. With respect to inflammation, the 'Healthy foods' cluster had lower levels of IL-6 than the 'High-fat dairy products' and 'Sweets and desserts' clusters, and did not differ in CRP or TNF-α. The 'Healthy foods' cluster also had a lower risk of mortality than the 'High-fat dairy products' and 'Sweets and desserts' clusters, and more years of healthy life and more optimal nutritional status than the other clusters. Conclusion: A dietary pattern consistent with current guidelines to consume relatively high amounts of vegetables, fruit, whole grains, poultry, fish and lowfat dairy products may reduce the metabolic risk and improve the nutritional status, quality of life and survival of older adults.Item What Does This Question Mean To You? Cognitive Interviewing to Pretest a Questionnaire for Older Adults(2006-08-10) Enagonio, Elisabeth Mary; Sahyoun, Nadine; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Seven cognitive interviews were conducted in adults aged 80 and older to pretest a questionnaire for the Community Connections - Moving Seniors Toward Wellness research project. Respondents participated in intensive one-on-one interviews. The questionnaire was administered, and respondents were probed for comprehension of question content. Older adults with physical limitations answered questions about depression based on physical rather than emotional status, made distinctions between capacity and performance regarding physical function, and failed to understand key medical terms. Wording of questions about personal hardiness was confusing to older adults. The findings were used to simplify wording throughout the questionnaire. Survey designers should be aware that questions about depression may be testing physical rather than emotional status. Questions about physical function should make a distinction between capacity and performance. Common language rather than medical terminology should be used when surveying older adults. Rewritten hardiness questions may be useful in assessing older adults.Item THE FORMS AND MECHANISMS BY WHICH SOCIAL RELATIONSHIPS IMPACT DEPRESSION IN LATE LIFE: EXPLORING THE ROLE AND SIGNIFICANCE OF MATTERING.(2004-05-12) Sergeant, Candice A.; Pearlin, Leonard I; SociologyThis thesis examined the significance of two aspects of social life for psychological well-being among a community sample of older adults. I proposed, first, that the degree to which elders engage in both informal interpersonal relationships and formal social affiliations are directly and positively related to psychological well-being; second, that these relationships are mediated through two elements of the sense of mattering. Contrary to expectations, it was found that states of mattering do not operate as mediating mechanisms linking social engagement and depression. Instead, the findings suggest that perceptions of mattering play roles independent of social engagement in promoting psychological well-being. Further conceptual and methodological development of the concept of mattering are needed to better understand the ways in which it is linked to social relationships and how these possible interlinked factors promote optimal health outcomes.