A growing body of research is examining effective treatment(s) for individuals with comorbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). However, treatments for this comorbid population have been inadequately studied in the longer term. This study represents a long-term follow-up assessment of a randomized controlled trial that compared combined therapy (prolonged exposure + naltrexone) with monotherapies (prolonged exposure or naltrexone) for patients with PTSD and AD (see Foa, Yusko, McLean et al., 2013). Attempts were made to contact 120 participants 5-10 years after the original trial to assess the maintenance of treatment gains. Nineteen individuals were located and agreed to participate. A series of mixed ANCOVAs were conducted with PTSD symptom severity and percentage of days drinking and heavy drinking as the dependent variables. Findings revealed that reductions in PTSD symptoms and drinking behaviors generally were maintained 5-10 years after treatment. There was some relapse in heavy drinking days, and combination treatment was most effective for long-term PTSD outcomes. Challenges of conducting follow-up research with this population, implications and limitations of the present findings, and directions for future research are discussed.

Master of Arts / Department of Sociology, Anthropology, and Social Work / Laszlo Kulcsar / This study provided an exploratory qualitative analysis of printed brochures to evaluate the conceptualization of successful aging. Data was collected from a sample of 39 printed brochures derived from Kansas Department on Aging Directory (KDAD) of Adult Care Homes 2009. Content analysis methodology was employed to investigate how these brochures reflect the core elements of successful aging as constructed in the gerontological literature (Rowe and Kahn’s and Baltes and Baltes), as well as compare across the ‘traditional’ and ‘culture-change’ models. Other variables of ‘licensure classification’, ‘residency cost’ and ‘gender’ were explored. An overall perspective indicated several brochures met the core elements of successful aging delineated by the literature. In most cases, these elements showed no significance difference for brochures representing facilities by model types, licensure classifications, residency cost and by the demographic of gender.

In this thesis, basic concepts of populational models are studied from a theoretical point of view, especially the long term behaviours. All models are at least time dependent with additional age structure, spatial structure. The last model which is an extension of the von Foerster equation, is dependent on all o f these structures and have a long-term solution for large values of time. Modeling population is a frequent subject in modern biology. It is hard to create a model that appears as realistic as possible. First one might consider that a population size is governed by the current size of the population, along with rates of how each individual contributes (give birth), so that the population increases. and how frequent an individual dies, causing the population to decrease in size. However these sort of models can only describe the size of population in a shorter span of time.

This research is focused on the experiences of older adults participating in an innovative visual arts program at a long-term care facility in Victoria, British Columbia. The program offers participants an opportunity to explore their creativity and identity as artists. Conceptually, the study draws from Tornstam’s gerotranscendance framework (Tornstam, 2005) and the theory of meaning (Frankl, 1963). A narrative inquiry approach was used with data collected through face-to-face interviews and observations of 10 residents and three staff involved in the visual arts program. Findings indicate that the program fostered a sense of community among participants and enhanced their quality of life. The public exhibition of their artwork at a community-based art exhibit validated the merit of their work and gave meaning and purpose to their participation in the program. Findings contribute to a greater understanding of the importance of arts programs that foster creativity in later life and resonate with Tornstam’s (2005) argument that older people living in institutions can experience multiple dimensions of the self through individualized forms of expression. This study concludes by highlighting the need to increase access to arts programs for older people living in residential care. / Graduate / lyciar@yahoo.com

Magister Curationis - MCur / Worldwide concerns have been raised about the presence and association of depressive symptoms, cognitive impairment, and dementia in older adults (60 years and older), which are often unrecognised and untreated in long-term care facilities (LTCF’s). The progression of cognitive impairment to dementia reduces quality of life with negative consequences of physical, mental, and psychosocial health. In many LTCF’s internationally, the standardised interRAI system is used to capture depressive symptoms and cognitive impairment. However, there is a fragmentation of systems for making evidence-based decisions to plan and manage care for residents with depressive symptoms, cognitive impairment, and dementia. This study, being the first of its kind in South Africa, addressed this gap, by describing a profile of depressive symptoms and cognitive impairment in residents, and analysing their coexistence, using the interRAI-LTCF in a LTCF in the Cape Metropole in South Africa. A quantitative, descriptive, and analytical cross-sectional secondary data analysis was conducted using the records of all 173 resident’s medical records of residents with a last interRAI-LTCF assessment from 2014 and 2016. The objectives were to determine the levels of depressive symptoms and cognitive impairment, and to assess variously associated demographics and clinical variables between depressive symptoms and cognitive impairment of the interRAI-LTCF in residents in a LTCF. Secondary data were analysed, using the IBM Statistical Package for Social Sciences (SPSS) software, version 25, to test any statistically significant relationship between the extracted variables (Significance was set as p˂0.05).

Thesis advisor: Christina Matz-Costa / Despite the fact that older workers (50+) are much overrepresented among the long-term unemployed and often suffer from multiple mental health problems, the social work literature has rarely tackled this issue. In my dissertation, guided by Jahoda’s Latent Deprivation Theory and the productive aging framework, I examined the positive coping strategies of unemployed older workers. I set out to understand whether engaging in formal volunteering in an organization would buffer the negative impact of unemployment on older workers’ mental health. I also fill out the gap in the literature regarding the mechanism of the positive effect of volunteering on mental health by examining two latent benefits from working as mediators: purpose in life and perceived social status. I used fixed effects modeling for the moderation analysis. I analyzed six waves (12 years) of longitudinal data from the Health and Retirement Study (HRS). I used structural equation modeling and analyzed two waves of HRS for the mediation analysis. I used full information maximum likelihood method to handle missing values. I found that there was a significant moderation between engaging in formal volunteering and unemployment status on older workers’ depressive symptoms. Unemployed older workers who engaged in volunteering fared better than those unemployed workers who did not volunteer. Consistent with previous studies using the HRS, I also found that those unemployed older workers who volunteered over 200 hours/year did not benefit from volunteering compared to those volunteered under 100 hours/year. Mediation analysis results showed that perceived social status and purpose in life mediate the protective effect of volunteering. Both the moderation and mediation results varied by race and ethnicity. Results from this dissertation have important implications for future intervention development. For example, interventions targeting the unemployed older workers may incorporate formal volunteering as one element for participants to gain social contact, purpose in life, and enhance perceived social status. Interventions can also create an environment that mirrors an office to enhance these latent benefits (mediators) in order to improve mental health. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

The first chapter investigates whether East German women became used to the requirement of working full-time under communism and thereby continued to work much longer hours than did their counterparts in the West after unification. The second chapter develops a rational habit formation model in labor supply using the idea of habits outlined in the first chapter. I show that the proposed model avoids the extreme behavior observed in the standard model in the literature where in the long-run hours of work could increase indefinitely or decrease to zero over time. The third chapter examines whether disabled elders who have private long-term care insurance consume fewer acute or post-acute Medicare covered services. / Thesis (PhD) — Boston College, 2004. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

Thesis advisor: Lisa S. Cahill / Informed by Gaudium et Spes and Ron Thiemann's "public theology," this dissertation examines the role of the church in responding to the contemporary ethical challenge of providing long-term care for the elderly in a manner that respects and promotes their human dignity. Biblical sources and the theological concepts of discipleship and friendship found in Karl Barth and Paul Wadell insist on the agency of older people as called by God and as participating members of the community. This vision complements and connects with secular visions of justice such as Martha Nussbaum's "capabilities approach" and the concept of justice as participation found in United Nations' documents. Two concrete examples--the Community of Sant'Egidio and the Green House project--provide important models of long-term care that foster the agency of older people and their ongoing participation in human community and fellowship. An ethical vision based upon the elderly themselves as subjects with ongoing agency and purpose demands the church's engagement with the wider society to reform the United States' current long-term care system so that care is provided at a level and in a manner that overcomes marginalization of the frail elderly. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

Thesis advisor: Alicia H. Munnell / This dissertation contains three essays. Each considers an economic decision faced by elderly households. The cost of nursing home care represents a substantial financial risk for older households. Yet, only 10 percent purchase long-term care insurance (LTCI), with many relying on Medicaid. The first essay estimates a structural model of the LTCI purchase decision using Health and Retirement Study data. Estimates indicate that this population has a modest preference for higher quality care and thus Medicaid crowds out LTCI. In addition, housing wealth provides self-insurance against the cost of nursing home care, so that individuals who are "house-rich cash-poor" are less likely to purchase LTCI. I also evaluate public policies designed to stimulate the take-up of LTCI and reduce Medicaid spending. I find that a comprehensive 20 percent subsidy would increase take-up by 160 percent, but the resulting Medicaid savings would amount to only 22 percent of the subsidy cost. A targeted subsidy would be more likely to break even, but would have only a small effect on coverage. Full enforcement of Medicaid estate recovery programs would reduce Medicaid expenditure by 31 percent, but would have insignificant effect on LTCI coverage. The second essay investigates the impact of house prices fluctuations on the non-durable goods consumption decision of older households. House prices in the United States fluctuate over time with significant regional variation. Thus, understanding how these price movements affect households' consumption has important policy implications. Existing studies focus mostly on the working population, leaving the effect of older households, who could be either the largest beneficiaries or victims of house price fluctuations, unexamined. Using Health and Retirement Study data, I show that house price fluctuations significantly affect non-durable goods consumption of older households. Estimates indicate that both the wealth effect and a relaxed borrowing constraint increase consumption when house prices appreciate. In addition, I find that only unexpected changes in house prices lead to changes in consumption of non-credit constrained households, which is consistent with economic theory predictions. Finally, I provide evidence that older households usually fund the additional consumption by increasing mortgage debt, rather than by drawing down financial assets. The third essay evaluates the value of the additional longevity insurance acquired by delaying claiming social security benefit. Individuals can claim Social Security at any age from 62 to 70, although most claim at 62 or soon thereafter. Those who delay claiming receive increases that are approximately actuarially fair. I show that expected present value calculations substantially understate both the optimal claim age and the losses resulting from early claiming because they ignore the value of the additional longevity insurance acquired as a result of delay. Using numerical optimization techniques, I illustrate that for plausible preference parameters, the optimal age for non-liquidity constrained single individuals and married men to claim benefit is between 67 and 70. I calculate that Social Security Equivalent Income, the amount by which benefits payable at suboptimal ages must be increased so that a household is indifferent between claiming at those ages and the optimal combination of ages, can be as high as 19 percent. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Economics.

O objetivo deste trabalho foi identificar as Representações Sociais de pacientes psiquiátricos, sobre suas situações de vida após convívio com a loucura, a internação e o sofrer psíquico. A partir de uma abordagem qualitativa de pesquisa, utilizei a técnica de História de Vida para entrevistar individualmente quatro pacientes (mulheres) internadas no hospital psiquiátrico. Construí os procedimentos teórico-metodológicos desta pesquisa, através da observação, da realização de entrevistas abertas não diretivas, enriquecidas com o uso de Técnica Projetiva (o desenho-estória livre e com tema) e de consulta feita nos prontuários. Utilizei a Análise Temática para analisar os dados, constatando que as pacientes constroem conhecimentos acerca da loucura. Deste modo, pude identificar as Representações Sociais que se constituem em sistemas de pensamentos organizados em verdadeiras teorias psicopatológicas, que se articulam ao redor de concepções sobre a loucura e suas conseqüências. As pacientes, através de vivências concretas, elaboraram teorias que denotam seus difíceis percursos de vida os quais conduziram-nas à condição de doentes mentais. A expressão a triste passagem, a triste paisagem, utilizada por uma paciente, sujeito da pesquisa, traduz o drama daqueles que passaram pela sofrida experiência da loucura, que foram submetidos ao tratamento psiquiátrico e que, conseqüentemente, tiveram longas internações. / This study aimed to identify the Social Representations of psychiatric patients on their circumstances of life after being familiar with insanity, internment and psyche suffering. From a qualitative approach of research, i applied the technique of Life History to interview four female patients interned in a Psychiatric Hospital separately. I made the methodologicaltheoretical procedures of this research through observation, non-directive open interviews enriched with the application of prospective techique (free historydrawing and thematic drawing) and consultation in the reports. I applied the thematic analysys to analyze the data confirming that the patients build up certain knowledge about their insanity. In this way, I could identify the Social Representations which are made in methods of thinking organized in true psycho-pathological theories which are combined with conceptions about insanity and its consequences. Through real grasp of life experience the patients developed theories denoting their difficult ways of life which led them to the status of mentally sick people. The saying the sad journey, the sad scenery used by a patient in this study puts in lay terms the tragedy of those who went through the hard experience of insanity, who underwent psychiatric treatment and therefore had lengthy internments.