Doctor of Philosophy / Department of Hospitality Management and Dietetics / Rebecca A. Gould / Congregate meal programs under Older Americans Act Title IIIC provide hot meals for individuals 65 and older in a community setting during lunch time. The program focuses on preventing the problems associated with malnutrition and social isolation. From 1980 to 2002, the number of congregate meals served decreased by 18% while home-delivered meals increased almost 290%. To further understand reasons for declining program participation factors that impact participation were examined. The Theory of Planned Behavior (TPB) was used in this study to explain participation intention of community-dwelling elderly who lived in the Kansas North Central-Flint Hill region. A two-phased elicitation study including: 1) focus groups and 2) salient beliefs study was administered to uncover participation beliefs and identify and clarify salient belief items. Based on the results of an elicitation study and a literature review, a valid questionnaire was developed. Data were collected at a senior fair, senior centers, senior living facilities, senior exercise classes, and a monthly meeting of retired seniors yielding a total of 238 samples. Descriptive statistical analysis was used to summarize the respondent’s demographic characteristics. A two-step modeling approach including confirmatory factor analysis and structural equation modeling was performed to assess measurement model fit and checked causal relationships between factors. Five advantages that respondents believe influence participation include: convenience, social interaction, low-price, nutritious and balanced meals, and less waste. Family members, friends, neighbors, cooks at the meal site, and heath professionals were important referents who affected seniors’ program participation intention. The salient facilitators of program participation were activities at senior centers, the availability of transportation, the inclusive culture of senior centers, the lack of motivation and ability to cook, and poor weather. Results show the data fits the TPB moderately well: all predictor variables (attitude, subjective norm, perceived behavior control (PBC), and past behavior) had a significant positive effect on participation intention. Among the four factors, PBC had the greatest predictive power on intention. Attitude had the least impact on participation intention. Seniors provide thoughtful and insightful opinions about meal program. Results suggest program provider should focus on remove participation barriers and implement effective strategies to increase congregate meal program participation. The ultimate goal is to encourage the elderly to participate, improving their nutritional intake and thus, their quality of life.

Master of Science / Department of Family Studies and Human Services / Candyce S. Russell / As the number of Americans aged 60 and over increases substantially in the coming years, so is the incidence of depression among this age group. The purpose of this report is to explore the mental health needs of older Americans, the ways in which they are undiagnosed or under-diagnosed for depression, the clinical challenges associated with treating depression in the elderly, and the barriers that are in place due to social, psychological, financial and governmental factors. With the “Baby Boom” generation (those born between 1946-1964) entering their senior years, there will be an increased need for Marriage and Family Therapists to be cognizant of the rise in depression and familiar with the treatment options and limitations. Marriage and Family Therapists adhere to the Systems Theory and thus are uniquely qualified to act as a bridge between the medical and mental health communities. This report will promote the collaborative approach to healthcare and the way in which Marriage and Family Therapists can contribute to the treatment of depression in the aged.

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.

This study was based on the premise that most people made funeral arrangements only after a death had occurred and within a setting of emotional turmoil. The desire of the study was to make available material, and instruction which would help to prepare the practical materials, providing information for the survivors of the deceased listing the desires of the deceased for his or her bodily disposal. When this material had been completed it was found that over seventy percent of those who used the material, made their actual funeral arrangements or consciously made known their desires for their funeral arrangements, either in writing or verbally, before any time of trauma or crisis, and made others significantly more alert to the planners real desires for such a time. The over sixty-five (65+) age group is closer in years to the time of death when time is considered in the biological development of life. This age group will naturally have a larger percentage of deaths per thousand of population than any other age group in America. Florida contains the largest number of persons within this age group of any state. Our ministry location presents added problems in death crisis times because of location and problems of relationships to other geographic locations. Age, also, opens a door to the awareness of the need for pre-preparation that is usually ignored at other times of life. This same 'age' provides for the opportunity for an unusual ministry of pre-preparation. It is this ministry which was planned for and evolved from this study project. The average age and health conditions of the membership of the congregation to which the study was directed, provided a sense of urgency and emphasized the need for this act of ministry. This program resulted in financial outlay decrease. Emotional upset was seemingly eased for each participant. The study reflects information that could be available to any group that shows elements of interest for such a ministry. Although the study deals with an emotionally sensitive area, it also helps to remove the concept of morbidity which is found ingrained into the minds of many of the people who are approached on this subject. This study is, above all, a report of what is (in age and death) and what can or should be accomplished through a ministry of pre-preparation. Chapter VI stands alone as the focus of this study. It contains the goals toward which and from which the act of ministry evolved.

Master of Science / Department of Family Studies and Human Services / Rick J. Scheidt / In 2011, about 13 percent of the U.S. population, approximately 40 million people, were foreign born in the United States. Many of them participate in transnational caregiving, either as children supporting their parents in their country of origin or parents moving to the U.S. to help their children. This report examines research on transnational caregiving between immigrant adult children and their parents. Following the caregiving definitions of Finch (1989), the articles were reviewed and categorized as economic support, accommodation, personal care, practical support and childcare, and emotional and moral support. Changes in family norms and roles, and the caregiving responsibilities after immigration, are also presented. Keywords: transnational, caregiving, immigrant, elderly, economic support, accommodation, personal care, practical support and childcare, and emotional and moral support, living arrangement.

Master of Science / Department of Landscape Architecture/Regional and Community Planning / Stephanie Rolley / More than 5% of the 65 and older population utilize nursing homes, congregate care, assisted living, and board-and-care homes, with about 4.2% of these individuals occupying nursing homes at any given time (Administration on Aging, 2008). The rate of nursing home use generally increases with age and studies have shown that by the year 2030, the number of lesbian, gay, bisexual and transgender (LGBT) adults over the age of 65 is expected to be nearly 3 million (SAGE, 2010). With this overall increase in potential resident populations, those aging adults who identify as LGBT are faced with additional unique challenges commonly not encountered by their heterosexual counterparts. The majority of LGBT elders fear they will experience discrimination in long-term care organizations, with more than half maintaining that staff or even other residents will abuse or neglect them (Knochel, et al., 2010). Unrevised long-term care organizational rules combined with prejudice and hostile treatment from staff members can create unwelcoming environments for LGBT elders who are generally unable to advocate for themselves. Challenges that aging LGBT adults face in long-term care settings will be reviewed and discussed in this report. In addition, this report will provide educational guidelines to assist long-term care organizations in developing an educational model targeted at addressing LGBT elders’ concerns. When staff within a long-term care community lack proper training on and understanding of LGBT concerns, it can negatively affect the quality of care provided to these members. As such, the educational guidelines will encourage an educational model incorporating cultural competency training among the long-term care staff and organizational leadership, and will utilize community development principles to ensure inclusiveness and increase social capital.

Master of Science / Department of Hotel, Restaurant, Institution Management and Dietetics / Carol W. Shanklin / The purposes of this study were to explore factors associated with residents’ dining experience in assisted living facilities and to investigate the influence that these factors had on perceived quality and residents’ satisfaction with their dining experience. Food quality, service quality, mealtime customization, and dining room environment were the four constructs explored. Focus groups were conducted with residents of three assisted living facilities to determine attributes of the constructs that were important to them. A total of 22 residents participated in the three focus groups. A questionnaire developed by Huang was revised to include measurement items identified in the focus groups. The questionnaire was distributed to residents of 16 randomly selected assisted living facilities within a 110 mile radius of the research institution. Of the 492 residents in 16 facilities, 246 completed the questionnaire for a response rate of 50%. Residents evaluated the attributes on a 5-point likert scale (1-strongly disagree; 5-strongly agree). Service quality (4.03) and dining room environment (3.97) attributes were rated significantly higher than food quality (3.64) and customization attributes (3.42). Resident satisfaction also was evaluated on a 5-point scale (1-very dissatisfied; 5-very satisfied). Residents were satisfied with the overall dining experience (3.94) and the overall facility (3.97). Residents were less satisfied with food served (3.67) or the amount of choices they had at meals (3.58). Residents were satisfied with services (3.95) and the dining room atmosphere (3.98). Satisfaction with services and the dining room atmosphere were significantly higher than food served and amount of choices at mealtimes. Residents’ perceptions of food quality, service quality, level of customization, and dining room environment had a positive influence on their satisfaction with the overall dining experience. Residents’ perceptions of food quality had a positive influence on satisfaction with the food served, service quality impacted satisfaction with services, level of customization effected satisfaction with the amount of choices, and dining room environment influenced satisfaction with the dining room atmosphere. Administrators, foodservice directors, and dietitians employed in assisted living facilities can use the results to improve the dining experience for residents and ultimately improve residents’ quality of life.

Doctor of Philosophy / Department of Sociology, Anthropology, and Social Work / Laszlo Kulcsar / Retirement age migration is not new. However, it has recently been garnering the attention of both researchers and local policy makers. Older migrants present the possibility of economic stimulus without creating additional pressure on the labor market. That said, a majority of works on retirement migration come to the same conclusions. Conventional theories state that older people move to places based on natural amenities and recreation opportunities. Further, these findings are often utilize a binary dependent variable based on whether a county has achieved a certain level of growth from inmigration of all people age 60+. I argue that this view is too narrow. Older age migrants move for a variety of reasons. These motives also vary across different age, sex, and race-ethnicity characteristics of the migrants in question. Further, not all counties that attract older migrants have bountiful natural or recreation amenities. Not only have these unconventional retirement destinations (URDs) had different historical trajectories, they also possess a different kind of amenities that appeal to older people who have relocated to the area. Finally, a focus on binary retirement classifications misses both diversity in retirement patterns and fails to explicitly account for the influence of space in county desirability. The goal of this work is to address these issues. First, I discuss the history and theories of retirement migration. Second, I develop models accounting for variation across older age migrant groups with varying demographic characteristics. Third, I identify and describe URD counties. Fourth, I present the results of a small-scale survey, community leader interviews, and a new model with additional variables to get at what other kinds of things should be labeled as “amenities.” Finally, I examine the role of space in migration research. My analysis demonstrates that there is much to be learned from looking at spatial models, micro-regional effects, and relative advantage between neighboring counties. Results indicate that conventional theories of retirement migration, while not necessarily wrong, are at least incomplete. The addition of diversity, new amenities, and space may greatly enhance our understanding of older age migration and migration research as a whole.

Master of Science / Department of Family Studies and Human Services / Melinda Markham / The number of grandparents who are taking over the responsibility of raising their grandchildren is increasing over time. Despite society’s reliance on them, society is failing to meet the needs of these families. Grandparents consistently lack the necessary resources that could reduce and minimize their stress in what is usually an unexpected family situation. Family Life Education has failed to meet the needs of grandfamilies. Using Family Stress Theory as a theoretical framework, this study asked the question How can Family Life Education be used as a resource for grandparents raising grandchildren to avoid crisis? Focus groups and individual interviews were used to gather qualitative data from grandparents who are currently raising their grandchildren near a midwestern university. Findings suggest grandparents raising grandchildren could benefit from education regarding finding resources and answers to questions as they navigate the many systems they are involved with, communicating and guiding their grandchildren, balancing and maintaining the shifting family dynamics and changing family relationships, information regarding the growth and development of children across the lifespan, and education regarding content that is unique to their family situation. However there are multiple barriers that participants identified toward the utilization of FLE. Ultimately, there is a lack of collaboration among services for grandparents raising grandchildren and they lack support that could potentially come from support groups. Impact and implications for practice, research and policy were discussed. Strengths and limitations of the study were also presented.

Doctor of Philosophy / Department of Family Studies and Human Services / Rick J. Scheidt / Alzheimer's disease (AD) is a chronic illness that has the capacity to impact several domains of a person's life. The purpose of this qualitative study was to explore four particular domains of meaning of an AD diagnosis to gain a systemic understanding of couples' experiences when one spouse had recently been diagnosed with Alzheimer's disease. A social constructionist framework was used in conjunction with the biopsychosocial-spiritual model, to explore the biological, psychological, social, and spiritual factors which inform and possibly influence couples' experiences in relation to an AD diagnosis. The interview guide was constructed using the underlying biopsychosocial-spiritual framework for the purpose of exploring couples' experiences in a systemic manner. Four couples were interviewed in their homes, no more than two months following a formal diagnosis of AD. This particular time frame captured the raw experience couples went through when receiving an AD diagnosis. All interviews were recorded, transcribed, and analyzed according to a modified version of Moustakas' phenomenological method of analysis. A family medicine physician served as the co-interpreter throughout the entire analysis process. Results consisted of unique descriptions for each couple's case and a composite description of the cross-case analysis, highlighting similarities and differences among cases. The biopsychosocial-spiritual model was found to be a significant tool for elliciting a systemic understanding of each couple's experience, and recognizing unique aspects of couples' experiences. Analysis across cases revealed 14 common themes that emerged across the four (five biological, four psychological, four social and two spiritual) domains. Results revealed that of the 14 common emerging themes, five themes were shared by all cases: Recognizing a Problem, Experience of Diagnosis Process, Experience of Symptoms, Social Support, and Social Activities. The overall analysis illustrated many more similarities among biological experiences than any other domain of experience. One case, #3, displayed a particularly unique psychological experience, as well as a significant spiritual foundation. Overall, this study emphasized the importance of using a systemic framework, such as the biopsychosocial-spiritual model, to gain a rich, in-depth understanding of how different couples experience the diagnosis process of AD.