This study explored the meaning of community engagement of older adults, within a social capital framework, in a community noted for its relatively high concentration of active, older adults. The multiple meanings of community engagement within the creation of a place of age were investigated using concepts derived from a social capital framework. A place of age is where older adults are integral to family life, participate in community life, and bring collective life experiences and wisdom to civic life. This research addresses gaps in the current literature about suburban places and the meanings of community engagement for an aging population within these places. The importance of this research lies with expanding the understanding of the multiple meanings of community engagement and the potential for reinforcing, through public policy, these meanings through the development and support of the social capital created by older adults in places of age. The research methodology was an in-depth case study analysis of West Saint Paul, Minnesota. In-person, semistructured interviews were conducted with 21 individuals, aged 65 years and older, who had been residents of West Saint Paul for at least 25 years. Findings of this study revealed multiple meanings of community and community engagement for study participants, but all had a strong sense of community relative to their neighborhoods and the city of West Saint Paul. All had well-developed social networks that involved family members, friends, and neighbors. Nearly all engaged in neighboring behaviors of helping out when needed and generally looking out for one another. All participants expressed a feeling of trust of others within their own neighborhoods, and most did not feel trusting of others beyond their neighborhoods. All participants had consistently voted, and all engaged in formal civic activities at some point in their lives. All participants, lifelong volunteers, were members of a Christian church, and much of their volunteer time was given to church activities. The key finding from this study was the important role of neighboring behaviors, faith-based affiliation, and family in the meaning of community engagement within each participant's life. / Ph. D.

This research addressed how older adults experience their mobile phones in their everyday lives and how mobile phones could be designed to best meet their needs. Two studies were conducted using a mixed-research method to identify representative user clusters and to understand user experiences. In Study 1, 154 older adult mobile phone users completed a questionnaire to investigate 1) functional usage, 2) perception about mobile phone quality, and 3) other aspects of user experiences (e.g., motivations of acquisition and learning method). Results showed that older adults are generally conservative mobile phone users who use a few functions of mobile phones and perceive their phone to be difficult to use. Understanding error messages, menu navigation, and text input were found to be most difficult for them. Female users perceived their phones to be more difficult to use than male users. Three user clusters (explorers, basicians, and minimalists) were identified based on mobile phone usage behavior, and their characteristics were described. User satisfaction was effected by three attributes of mobile phones: usefulness, ease of use, and pleasure of use, indicating that developers need to focus on improving all factors when designing a mobile phone for older adults. Study 2 used a more holistic approach to describe older adults' user experiences. The aims of Study 2 were 1) to capture stories that reflected user experiences, 2) to identify barriers that older adults faced through the course of user experience and 3) to provide recommendations to improve user experiences. Qualitative data was collected in the form of existential phenomenology-based interviews. Twelve older adult mobile phone users (over age 56), representing the three clusters found from Study 1, participated in this study. The domestication of technology theory was adopted as a framework to describe instances and themes represented in users' utterances and behaviors. Results showed that, regardless of their abilities to operate technology, older adults used a limited number of mobile phone functions because of their parsimonious cost-benefit analyses when integrating technologies into their lives. A theoretical explanation for this phenomenon was provided using socio-emotional selectivity theory. Barriers (perceptual, cognitive, attitudinal, knowledge, and information barriers) were found to hinder older adults' utilization of mobile phone technology over the four dimensions of the domestication process (appropriation, objectification, incorporation, and conversion). Recommendations to resolve those barriers were provided and related to published literature. This study proved that the domestication of technology theory can be a useful analytical tool for describing and understanding user experiences and capturing users' needs. Detailed discussion about its applicability to user needs analysis process was provided. A set of user requirements along with diverse user profiles were developed as outcomes of this research. / Ph. D.

People age 55 and over will dramatically increase in the next 25 years, and will comprise approximately 30% of the total population. They may want to maintain their current lifestyle, and at the same time, they will experience changes of their lifecycle stage that could affect their housing choices. Even though single-family, detached housing is the most dominant housing type in the U.S., a significant number of older adults could choose to live in multifamily housing if their motivations and background are understood. The choice to live in multifamily housing by adults in their later life may be influenced by their past experiences living in multifamily housing, and by their current satisfaction with multifamily housing living. The purpose of this study was to investigate the past, current, and future housing behavior of residents 55 and older living in multifamily housing. The research framework for this study was developed based on Morris and Winter's (1975, 1978) theory of housing adjustment and Wiseman's (1980) model of elderly migration. The research framework was comprised of five major sections: (a) Current Demographic Characteristics, (b) Previous Demographic Characteristics, (c) Reasons for Moving into Current housing, (d) Residential Satisfaction, and (e) Intention to Move in the Future. Five major hypotheses were tested. This study was designed as a quantitative study, using a self-administered questionnaire administered by an online survey company. Between February 2, 2012 and February 4, 2012, a total of 431 usable surveys for this study were collected. Several statistical methods were employed: descriptive statistics, one-way ANOVA, Pearson's correlation, crosstabs, exploratory factor analysis (EFA), and structural equation model (SEM). From EFA, three major reasons for moving into current housing (the multifamily living reason, the nearby activities reason, and the financial reason), and three residential satisfaction factors (satisfaction with the unit design, the multifamily community, and the location) were derived. Multifamily living reason significantly positively influenced satisfaction with the unit design, the multifamily community, and the location. There was a significant influence of the nearby activities reason only on satisfaction with the location. Financial reason significantly negatively influenced satisfaction with the unit design, the multifamily community, and the location. Satisfaction with the unit design and the multifamily community significantly negatively related to the intention to move. The findings from this study can help older adults and their advisors to better understand the housing decision-making process in later life, and inform the housing industry about the perceived potential benefits and challenges in developing multifamily housing for older adults. / Ph. D.

A variety of individual and geographic factors influence the mix of formal and informal services utilized by older adults and their families along the continuum of care. This study focuses on a specific rural population in the United States - Central and South Central Appalachia, which experiences the triple jeopardy of vulnerable people (older adults) in vulnerable places (rural Appalachia), with cultural views and beliefs that may negatively impact the care they receive. Using Andersen’s behavioral model of service utilization, Soldo’s supplementation model of care, and Bronfenbrenner’s ecological theory as the theoretical frameworks, data from the Older Families in Rural Communities: Personal and Social Influences on Service Use project and the United States 2000 Census were used to examine the utilization of informal and formal care services and nursing home placement risk in a rural Appalachian population. The main goals of this research were to (a) examine the relationships among individual and geographic characteristics and determine how those relationships affect the utilization of informal-formal care-mix, and (b) determine how the informal-formal care-mix is associated with nursing home placement risk in older adults living in rural southwest Virginia. Two separate analyses were completed in order to address the research objectives. First, a multinomial regression model, including both individual and geographic data, was used to predict care-mix. Second, after calculating the outcome variable “nursing home placement risk” via a derived logistic regression equation, a log-linear analysis with a 3×4 contingency table was computed in order to understand the association between care-mix and nursing home placement risk. Results indicate that disparities in sex and poverty level in an area that already suffers from healthcare disparities significantly affect the type of care an older adult receives. When formal care was utilized, it was more often added to existing informal care systems, supplementing them, rather than replacing them. The type of care-mix individuals received was also associated with nursing home placement risk. Specifically, when informal support was the only source of care, nursing home placement risk was significantly higher than when informal-formal care-mix was received. Research and policy implications for disparity-ridden areas are discussed. / Ph. D.

Limited literacy remains a prevailing issue among older adult populations. This qualitative study sought to answer the following research questions: How do older adults with limited literacy skills navigate and learn to navigate their daily lives in an advanced literate community such as the United States? What types of informal learning strategies and coping mechanisms have been used by these adults, and what perceived barriers and hindrances have participants faced and are facing in their lives? The study included the interviews, data collection and analysis of five women and two men, ages 67-87, two of whose activities also were observed by the researcher. The objective was to investigate their informal learning strategies and coping mechanisms within their current living environment. A thematic analysis of the seven narrative 'life stories' resulted in the emergence of four themes, which represented how these adults with limited literacy skills learned to navigate their daily lives and use informal learning strategies and coping mechanisms to survive in a changing environment: (a) Family support (or lack thereof), (b) social networks, (c) desired GED Program engagement, (d) self-directed gained knowledge. The study concluded that although none of the participants received a high school diploma, all successfully obtained employment and navigated their daily lives by incorporating various strategies. Likewise, given their implementation of self-directed learning strategies (Ausubel, 2000; Knowles, 1990; McClusky, 1974; Tough, 1982), participants viewed some of the dispositional, institutional, and situational obstacles (Cross, 1982), not as barriers, but as navigable and surmountable challenges. Implications of the study suggested limited literacy adults relied upon family support, social networks and self-direction to pursue knowledge and conceal limited literacy. They gained confidence and developed coping mechanisms to navigate daily activities, circumvent barriers and function in an advanced literate society. Future professional practice recommendations included incorporating ABE/GED programs at adult living facilities/community centers; invalidating false assumptions regarding limited literacy older adults; volunteering time and building trust with these adults; and validating their current and desired needs. Research recommendations included investigating limited literacy adult capabilities; shadowing their navigation; conducting similar studies in other U.S. regions; and investigating comparative life-span research. / Ph.D.

The purpose of this study was to describe, analyze, and better understand the lived experiences of women age 50 and older in Alcoholics Anonymous (AA). Guiding this inquiry were the following research questions: 1) How do the older women participants experience the AA program? 2) What aspects of AA do older women consider beneficial? 3) What aspects of AA do older women consider detrimental? 4) What do older women consider as important conditions to succeed in the AA program? 5) How did these older women elicit meaning in their involvement with AA? and 6) How was the narrative aspect of AA experienced by the participants? Fourteen older women from AA meetings in Southwest Virginia participated in two qualitative interviews. The results were represented by narrative descriptions of each participan's experiences and analyzed for common themes across the stories, which were presented and discussed. For these participants, the AA program was found to intersect with narrative therapy. AA, like narrative therapy, highlights deconstructing and re-authoring life stories through personal narratives. Storytelling itself proved to be among the most important traditions of AA and a core benefit to the storyteller (and to a lesser extent, the listener). Study participants found that telling their stories allowed for 1) a way to give back to the program, 2) a feeling of belonging to the group, 3) a welcome reminder to the speaker of her past struggles with alcoholism, and 4) a spiritual experience. Many of the women articulated their early concerns with publicly sharing at meetings, as well as their ongoing considerations of boundaries, over-sharing, and conflicts of interest in storytelling. Finally, in an unexpected finding, the women cultivated and maintained intimate friendships with other women in AA that addressed relevant issues beyond sobriety including everyday needs and life challenges. Social activities often transcended the boundaries of the meetings. / Ph. D.

Home and community based services (HCBS) are designed to provide services that meet the increasing and diverse needs of the older adult population who wish to age-in-place for as long as possible in their homes and community. Yet, little is known about the choices people make when selecting services. The purpose of this study was to assess HCBS use among vulnerable older adults. Andersen’s (1995) behavioral model of health services use provided theoretical guidance for selecting and explaining predisposing, enabling, and need-based variables associated with service use within the Community Living Program (CLP) federal initiative. Through consumer direction of services, 18 routine or one-time services were offered to 76 participants enrolled in the Virginia CLP. Two-step cluster analysis identified four distinct profiles of service users, ranging in size from 7 to 34 members. Services used within the groups ranged from 11 to 16 services. Use of personal care services (p=.033) and respite (p=.010) were significantly associated with group membership differentiation. Within each cluster, the percentage of participants using each service varied greatly. The most important variables that differentiated service user membership were caregiver relationship to participant, participant living arrangement, participant disability type, and length of time caregiver provided care. Between-cluster membership was significantly different with regard to average service cost per day for services used (p=.002) and the likelihood of moving to a nursing home if services were not provided (p=.034). Findings inform future research and have implications for practitioners assisting vulnerable older adults in selecting services to meet different care needs. / Master of Science

For older couples facing a skin cancer diagnosis, the experience is stressful, not only for the individual with the diagnosis, but also for the healthy partner. Couples may use various types of coping and styles of support to deal with the stress, including relationship-focused support, which addresses the needs and coping efforts of both partners in response to and in conjunction with one another. The current study examined associations between perceptions of three styles of relationship-focused partner support, namely active engagement, protective buffering, and overprotection, and body image of the partner with skin cancer and quality of life of the partner with skin cancer and the healthy partner. Using data collected from 30 older couples (Mage = 70; SD = 7.25) with diagnoses of melanoma (n = 14; 47%) or nonmelanoma (n = 16, 53%), linear regression models, adjusted for the stressor appraisal by both partners, revealed that when partners with skin cancer reported receiving higher active engagement support, they were more likely to have a positive body image (B [unstandardized] = 35.54, p = .04). A significant interaction was found between active engagement support used by both partners (B = -8.78, p = .05), indicating that active engagement from healthy partners appears to benefit the body image of the partner with skin cancer when they themselves use less active engagement support. Both protective buffering and overprotection support were not associated with body image. Multivariate actor-partner interdependence models (APIM) assessed the relationships between support received by each partner and its association with their quality of life (actor effects) and their partner's quality of life (partner effects). Results suggest that active engagement support perceived by either partner was not associated with quality of life. In contrast, overprotection perceived by partners with skin cancer was significantly associated with their quality of life (actor effect: B = -10.81, p < .001), but was not associated with the healthy partners' quality of life. Additionally, protective buffering perceived by healthy partners was associated with their own quality of life (actor effect; B = -6.91, p = .05) as well as their partner with skin cancer's quality of life (partner effect; B = -8.15, p = .01). Nuances based on the sex of the person with skin cancer, type of skin cancer, the stage of skin cancer and couple's appraisal of the stressors of skin cancer are also discussed. Findings suggest that actively engaging with the stressors of skin cancer can contribute to positive views of one's body, whereas ignoring or avoiding conversations about skin cancer and overprotection provided by healthy partners might lead to poorer quality of life for both partners. These findings illustrate the influence of healthy partners, highlighting that how they give support when their partner is facing a skin cancer diagnosis may affect the overall quality of the couple relationship and couple outcomes. / Ph. D.

The goal of this investigation was to assess service use, self-management strategies, and health status of older adults (60+ years) with perceived need who sought assistance from the Virginia Medicaid Elderly and Disabled Consumer-Direction (EDCD) waiver services. A sequential explanatory mixed method design was used to address the overall research question: How do older adults manage unmet needs? Using health services data from two independent State agencies, regression techniques were used to examine predictors of service use, hospitalization, and mortality among 1,008 individuals. A purposive subsample of eight rural-dwelling waiver-ineligible individuals was identified for follow-up semi-structured telephone interviews to explore self-management strategies for confronting functional care needs. Waiver-ineligible individuals were at risk for hospitalization and mortality; rural-dwelling individuals were more likely to be waiver-ineligible and had increased risk of mortality. Analysis of interviews revealed individuals had ongoing unmet needs and relied on family and community services and used internal and external strategies to manage them; plans were not in place should their health continued to decline. For this group of near-risk older adults who are waiver-ineligible and do not have financial means to pay for more help, accessible preventive services are necessary to reduce risk of adverse health outcomes. Policymakers are encouraged to advocate for preventive services that assist individuals before care needs become unmanageable. Agencies responsible for service delivery need to target efforts toward this group, particularly those residing in rural areas. Researchers must continue forging partnerships that permit use of health services data to identify when and how older adults use services, and explore how self-management strategies influence health and functioning over time. / Ph. D.

Intervention trials that reduce visual impairment in older adults have not produced the expected improvements in reducing falls rate. We hypothesised that this may be caused by adaptation problems in older adults due to changes in magnification provided by new spectacles and cataract surgery. This study assessed the effects of ocular magnification on adaptive gait in young and older adults. Methods: Adaptive gait was measured in 10 young (mean age 22.3 ± 4.6 years) and 10 older adults (mean age 74.2 ± 4.3 years) with the participants' habitual refractive correction (0%) and with size lenses producing ocular magnification of ±1%, ±2%, ±3%, and ±5%. Adaptive gait parameters were measured when participants approached and stepped up onto a raised surface. Results: Adaptive gait changes in the young and older age groups were similar. Increasing amounts of magnification (+1% to +5%) led to an increased distance of the feet from the raised surface, increased vertical toe clearance and reduced distance of the lead heel position on the raised surface (p < 0.0001). Increasing amounts of minification (¿1% to ¿5%) led to the opposite of these changes (p < 0.0001). Adaptation to ocular magnification did not occur in the short term in young or older adults. Conclusion: The observed adaptive gait changes were driven by the magnification changes provided by the size lenses. The raised surface appeared closer and larger with magnification and further away and smaller with minification and gait was adjusted accordingly. Magnification may explain the mobility problems some older adults have with updated spectacles and after cataract surgery.