The effect of increased age on gene expression has not previously been evaluated in lung tissues. Cancer incidence increases with age, and lung cancer in particular has been found to have an incidence that peaks in the later decades of life. Based on previously published studies of aging effects in human muscle, kidney and retinal tissues, significant transcriptional changes are anticipated in both mouse and human aged lung tissues that may predispose to the development of cancer. We examined lung aging between young and old mice (6 vs. 30 months), using a hybrid mouse model (CB6F1) and an experimental colorectal metastasis model (CT26 cells). We also recruited young (<30 years) and aged (>60 years) human patients. Microarray analysis of mouse lung tissues using MOE430v2 and human lung tissues suing HG U133 2.0+ Affymetrix arrays was performed using total lung RNA, after which expression values were computed from .CEL files by applying RMA normalization within sets of replicate samples. Statistical testing was performed using the significance analysis of microarrays algorithm. Statistically significant transcripts were validated by histochemical staining and quantitative polymerase chain reactions (PCR). In mouse tissues, induced metastatic disease was found to be associated with reduced overall survival in older mice. The pattern of pulmonary metastases was more diffuse as compared to younger mice. Age-related transcriptional changes in the lung of extremely old hybrid mice were related to altered effectors of the immune system, regulators of angiogenesis and elements of DNA repair mechanisms, likely explaining the molecular basis behind the altered patterns of pulmonary metastasis observed in the extremely old mice. In human tissues, eighty-two genes were differentially expressed in a statistically significantly manner. Most genes were downregulated in aged lung tissue and included collagen isoforms and proteins responsible for extracellular matrix synthesis and turnover. A single upregulated transcript was a MYC binding protein. Selected transcripts were validated by PCR and histochemical staining. This is the first examination of lung metastases and the molecular biology of lung tissues at the extremes of age. Alterations to gene expression profiles was observed in both mouse and human lung tissues, and supports the concept of a field defect in normal lung tissues that develops with increased age.

<p> African American older adults have historically been identified as vital members of the African American family and community (Hill, 1972; Cox, 2002; Waites, 2008). Unfortunately, research has shown an increasing number of older African Americans are being admitted into nursing facilities (Paul, 2004; Feng et al., 2011). Between the years of 1998-2008, it was projected African Americans living in nursing homes increased by 10.8% (Feng et al., 2011). This study explores the intergenerational relationships of older African American adults with their grandchildren, family, and community through the lens of Intergenerational Family Systems Theory. By viewing this qualitative study through the lens of Intergenerational Family Systems Theory, changes in the older adults&rsquo; kinscripts were analyzed to obtain a greater understanding of affects associated with nursing home relocation and the older adults&rsquo; relationship with their grandchildren, family, and communities since being admitted. By utilizing a grounded theory approach, this study has found key areas to influence future social work practice and research.</p>

<p>Healthcare provider practices around older adult sexuality are increasingly the focus of scholarship. Researchers use available scales to study health worker knowledge and behavior in their research. This dissertation argues the need for a new scale, because the available measures are dated and do not account for changes in attitudes and medical advances over three decades. After a review of the increasing role of physicians, social workers, and other health workers providing care for sexual issues throughout history, I describe available scales for measuring knowledge and behaviors about older adult sexuality and review research that employs them. The purpose of the dissertation was to develop a contemporary measure regarding older adult sexuality practices among health workers. I utilized a two-phase plan following Bowen and Guo&rsquo;s 12-step mixed-method approach for scale development (2012). Phase I included a literature review and qualitative interviews with experts on older adult sexuality regarding the construct. Then I created a universe of items, reviewed them with the experts, and revised items. In Phase II, I tested the items with 155 healthcare providers and conducted analysis for reliability and validity. Based on the analysis, I culled items to create a shortened scale. I proposed a scale consisting of 52 items with three subscales: a 25-item Knowledge subscale, a 13-item Attitude subscale, and a 14-item Behavior subscale. The Knowledge subscale showed poor internal reliability (<i>KR-20</i> = .625). The Attitudes (&alpha; = .825), and Behavior (&alpha; = .837) subscales showed good internal reliability. I also evaluated content validity and criterion-related validity for the subscales. Flaws in the methods and analysis make the 52-item proposed scale conceptually unsound. Limitations in generating the pool of items, evaluating the items, and testing reliability and validity did not produce a viable scale. I analyze problems with the methodological approach and propose a redesign that corrects for flaws in the approach employed here. I will use an inductive, social justice model that expands scale development to include interviews with practitioners and older adults. I conclude with a number of research, practice, and policy implications that will result from a redesigned scale. </p>

<p> <b>Purpose:</b> The purpose of the study was to determine the impact of the discharge education plan on the 30 day heart failure (HF) hospital readmission rates of elderly patients.</p><p> <b>Research Question:</b> What was the impact of the discharge education plan including medication adherence, dietary discretion, daily exercise tolerance, daily weight recording, recognition of any early symptoms of worsening HF and early follow-up plan with the physician in reducing the 30 day HF hospital readmission rates of the elderly patients? </p><p> Research Hypothesis: The discharge education plan including medication adherence, dietary discretion, daily activity tolerance, daily weight monitoring, recognition of any early symptoms of worsening heart failure, and early follow&ndash;up with the physician will reduce the 30 day heart failure hospital readmission rates of elderly patients. </p><p> <b>Background:</b> HF is one of the most common diagnoses and indications for hospitalization among adults over 65 years in United States (Pang, Komajda, and Gheorghiade, 2010). HF admission results in 6.5 million hospital days annually. In 2010, the total cost of care for patients with HF was 39.2 billion dollars (Gheorghiade, Vaduganathan, Fonarow, and Bonow, 2013). About two million Medicare beneficiaries are readmitted within 30 days of release from the hospital each year, costing Medicare 17.5 billion dollars in additional hospital bills. It is reported that elderly patients with HF are at increased risk for early readmission as a result of behavioral factors such as medication non&ndash;adherence, dietary indiscretion, exercise intolerance, drug and alcohol abuse, inadequate access to follow-up care, and poor transition of care (Gheorghiade, et al., 2013). </p><p> <b>Design and Methods:</b> A retrospective, non&ndash;experimental, and descriptive chart review was used in this study. The quantitative data, using convenience sampling, selected charts of patients with a diagnosis and readmission of HF within 30 days of discharge from the hospital between May 2012 and June 2013, was reviewed. </p><p> <b>Findings:</b> A chi square statistic was used to investigate whether distributions of categorical variables differ and also compare the tallies or counts of categorical responses between the six independent variables. The significant results of the Chi square test for goodness of fit was found only for daily weight monitoring (p=0.0372) and with activity intolerance (p=0.0123). The test compared theoretical (expected) values to experimental (observed) values to determine whether the differences between these values are due to chance (sampling error) alone. The components of the discharge education plan that could not be tested were early recognition of worsening symptoms, early follow&ndash;up with the physician and medication non-compliance because of the low frequency counts of &lt;5, and thus we cannot assume that the data follows a rough normal distribution. Therefore, the hypothesis was not supported.</p>

<p> The purpose of this study was to determine the images of aging of a small sample of Early Baby Boomers born between 1946 and 1951. The Baby Boomers are a generation consisting of those born between 1946 and 1964. This study focuses on a narrower range of birth years in order to capture the images of aging of those now 60 and over who came of age in the 1960s and early 1970s. They represent the first wave of the Baby Boom Generation to reach age 65, society's marker of "old age." Baby Boomers are the largest generation in history and currently 10,000 of them are turning 65 every day. The questions posed in this study were to explore how these Early Baby Boomers expect to age, how their generational experience influences their image of aging, and how that image differs from that of previous generations. </p><p> Using a phenomenological and hermeneutical research method, eight men and eight women with like ethnic, demographic, and socioeconomic characteristics were interviewed. Through recordings and verbatim transcriptions the collective meaning of life, aging influences, fears, and expected life spans were determined. The collective results were compared to literature of aging stereotypes of previous generations. This select group reported that they will not age and are surprised when experiencing small signs of aging. Work is what brings meaning to their lives and they have no plans of retiring. They expect to maintain control over the length and quality of their lives. These Early Baby Boomers expect to establish a new image of aging. </p><p> As the numbers of Baby Boomers age and lifespan lengthens, unavoidable losses will occur. Researchers predict an increase in depression, addiction, and dementia. The Early Baby Boomer expects their needs to be met and as those losses occur they will increasingly seek mental health professionals to "fix" their emotional responses. It is important for mental health professionals to understand the unique generational lens from which Boomers view aging in order to provide quality assessment, recommendations, referral, and treatment. </p><p> Key words: boomer; aging; generation; image; mental health; retirement; lifespan.</p>

<p> As people's life-expectancy prolongs with advanced medical treatments, numbers of individuals who experience widowhood in later life are expected to increase. As a result, grief work will be one of the common challenges that social workers and older adults will face. The purpose of this project was to develop a grant proposal for the Pathways Volunteer Hospice in Lakewood, California, and to identify funding sources for designing a mindfulness focused bereavement support group program for older widows who are age 60 years and over. With funding resources provided by the Weingart Foundation, the proposed program aims to educate participants on the principles of mindfulness and how they can integrate mindfulness principles and philosophy into their grieving process to better facilitate their coping with their loss. The proposed program will be based on empirically supported methods, such as, Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. The actual submission, and/or funding, of this grant was not required for successful completion of this thesis.</p>

<p> Spirituality has been recognized as a positive factor in the lives of older adults, especially as it influences their emotional, mental, and physical well-being. This convenience sample study included 17 older adults residing at a faith based continuing care retirement community in Florida. The sample was represented by Caucasian older adults with an average age of 84 years, highly educated, majority Protestant and mostly female. Spiritual life reviews were conducted using spiritual life maps (Hodge, 2005) and semi-structured interview questions. Erikson's epigenetic stage of ego-integrity was used along with Butler's life review process and Tornstam's gerotranscendence as a conceptual framework for understanding late life development and spirituality in older adults. This mostly qualitative study used a hermeneutic phenomenological approach to analyze the responses to the open-ended interview questions about spirituality across the life-time. Ego-integrity was measured at the beginning and end of the spiritual life review study. </p><p> Paired t-tests found that participation in the spiritual life review did not influence the ego integrity scores of participants. Specifically, there were no statistically significant difference between the pre ego integrity score (M=82.94, SD= 8.235) and the post ego integrity score (M=84.47, SD= 7.551); t (16) = -.769 p= .453. However, in comparison, the qualitative analysis revealed that the spiritual life review does influence ego-integrity in some participants. Additionally, the spiritual life review confirms gerotranscendence and contributes to information about spiritual development in the lives of older adults. The conclusion offers a discussion about the study's limitations, strengths, implications for future research, and suggestions for clinical practice.</p>

<p> In the late 1980's assisted living emerged as a self-proclaimed new style of providing long-term care and supportive services. Assisted living as espoused by its early proponents and by industry leaders embodied certain specific philosophical tenets, such as dignity, autonomy, meeting scheduled and unscheduled needs and aging in place, in their daily operations. These tenets distinguished assisted living from other forms of institutional care such as nursing home care. In the past twenty years the assisted living industry has matured and grown substantially. However, despite the maturing of the industry and the general agreement on the basic tenets little is known about the degree to which the industry embodies these principles. </p><p> In addition public policy and consumer preferences have grown in their focus on substituting assisted living for nursing home care. Moreover, the degree to which assisted living can and does substitute for nursing home care has been largely unexamined. Elder care advocates and researchers have more and more called attention to the increasing acuity level of assisted living residents. </p><p> This study consists of three related components, each of which will broaden the understanding of current assisted living facilities and their residents. The first study examines person environment fit in assisted living. Lawton's theory of person environment fit, has largely defined the construction and physical environment of assisted living since the 1980's. Changes in Lawton's theory were proposed by Guiata and Jones in the Journal of the American Medical Association in 2012 in reaction to the increased level of dementia in assisted living residents. A third non-theoretical analysis using exploratory factor is designed assist with development of new constructs in person environment fit theory. The second study examines changes in assisted living facilities and residents from 1999 to 2010. This study uses the only two national surveys of assisted living, The 1999 National Survey of Assisted Living and the 2010 National Survey of Residential Care Facilities. This study will examine both facility level and resident level characteristics to explicate resident acuities and to examine the degree to which facilities are accommodating these acuities. The third study examines facility characteristics associated with discharge of residents from assisted living facilities. Understanding resident discharge from assisted living will give a better understanding how assisted living facilities meet scheduled and unscheduled needs of residents as well as embody the philosophical concept of aging in place. </p><p> The contribution of this research is improved understanding of the current assisted living facilities and residents and better understand the importance of facility characteristics in person environment fit and in aging in place. This contribution is significant because assisted living residents are a vulnerable population with no protection under federal statutes and limited protection in most states. If indeed, as advocates and researchers assert, assisted living residents mirror nursing home residents in acuity then this research will assist with developing policies to protect this vulnerable population.</p>

<p> Hearing loss and cognitive impairment are significant health problems, threatening the independent function of older adults. While there appears to be a strong relationship between the two conditions, the mechanisms underlying this association are complex and are not fully elucidated.</p><p> The purpose of this secondary analysis was to explore the relationship between hearing ability and cognitive performance in older adults. In addition, this study attempted to examine the role of depressive symptoms in the relationship between hearing loss and cognitive performance. Comprehensive measures of peripheral hearing, central auditory processing and cognitive performance were utilized to examine these relationships in a sample (N = 30) of adults aged 60 years and older. The Geriatric Depression Scale (GDS) was used to assess depressive symptoms.</p><p> Correlational analyses revealed a statistically significant relationship between central auditory processing and executive function. Statistically significant relationships were also observed between speed of processing and peripheral hearing as well as central auditory processing. No significant relationships were noted between depressive symptoms, hearing acuity and cognitive performance. While the correlation coefficients <i>(r)</i> for several of the hearing and cognitive performance measures were not statistically significant, medium effect sizes were detected, suggesting a moderate association may exist between these variables.</p>

<p> Several demographers and scholars have dubbed the baby boomers&rsquo; transition to retirement as the <i>graying society</i>. Therefore, and recognizing its importance, the main objectives of this study were to learn about the transition to retirement process and its related meanings for baby boomers in the public sector. Using a mixed methodology, 382 retirees shared their perceptions on the subjects via questionnaire and 6 via interviews. This study concluded with a validation of previous authors on the importance of being prepared prior to retirement especially in the case of those with disability retirement.</p>