This study combined quantitative and qualitative methods to investigate the relationship between Internet use and identity, particularly age-identity, in older Internet users. It has a theoretical basis in symbolic interactionism – particularly the theories of Erving Goffman – and conceptualizes identities as roles that are negotiated during social interaction. The focus on older users was motivated by the strong focus of prior Internet research on younger users. Few studies have examined older users specifically, and fewer still have examined age-identity. Thus, the focus in this study is on how changes in social interaction that occur due to Internet use affect the identity negotiation process. The research is focused around two key areas: whether older users experience the same kinds of online identity processes as younger users, and the impact exposure to novel audiences has on identity negotiation. The study consists of two phases. In the first, a quantitative survey was administered in which a measure of age-identity was assessed and compared with measures of audience novelty. Results showed that a significant increase in variance of ageidentity is associated with communication with people from other countries. This finding supports the theory that identity is formed in negotiation with the audience with whom one communicates, and that expanding this audience may lead to identity effects. To investigate this issue more deeply, a qualitative phase was conducted in which participants were interviewed using rapid ethnography techniques, and at the conclusion of which a model of the interaction between age-identity and Internet communication was developed. This model was then verified with follow-up interviews with key informants and with field observations from sites of online social interaction among seniors. The model developed during the qualitative stage identifies three ways in which ageidentity is influenced by social interaction on the Internet. First, the Internet is used in response to emotional or practical consequences of ageing. Second, older Internet users could take advantage of the ability to manage their personal front online to achieve agelessness, and third, the Internet is used as a backstage area to discuss ageidentity issues. The context of these claims is all-important; each individual’s unique circumstances, emotions and motivations influence the way in which they will use the Internet and respond to others encountered through it. The extension of Goffman’s dramaturgical metaphor to age- identity on the Internet and to include the concept of character development, in which identity evolves over time in response to inner tensions and external events, is a tentative but powerful finding. It poses a challenge for future research into the nature of identity change, both online and offline.

Body cleansing is an integral part of people's everyday life. Between five and seven percent of people over the age of 65 experience problems when using the bathroom. Some investigators have postulated that disability in older persons can further occur when there is a gap, mismatch, or poor fit between personal capabilities and environmental demands. Current bathing fixtures do not support people with limited ability, and so the current bathing environment perpetuates bathing disability. Furthermore, because assistive bathing technology is meant for one particular user, it can impede other users when they need to bathe. A consequence of this is that the assistive bathing technology could be abandoned. The purpose of this study is to design and evaluate a bathtub for body cleansing regardless of an individual's physical ability and allow for all stakeholders to use the tub within the same space.

It is well documented in the caregiving literature that caregivers do not utilize services that may aid in their ability to provide care and help maintain their own well-being. There have been several barriers identified that may deter caregivers from seeking services, especially in rural areas. However, there is less known about how caregivers work to overcome those barriers. The purpose of this study was to increase understanding about how rural caregivers overcome barriers to service utilization. The research was designed to be exploratory, rather than of a confirmatory nature. It is hoped that having rural caregivers identify ways to overcome the barriers themselves will ultimately be more meaningful as their suggestions might then be used to change how services market and deliver services to rural caregivers. This study was a qualitative investigation of what rural caregivers identify as barriers to seeking services and how to overcome those barriers. Eight rural caregivers were interviewed over the phone. Through the interview process, caregivers identified barriers and shared their personal experiences of how to overcome barriers or offered suggestion about how others may overcome barriers. Grounded theory (Strauss & Corbin, 1998; Corbin & Strauss, 2008) was used to analyze the qualitative data. The core phenomenon of this study, often referred to as a storyline, revolved around the concept of caregivers not seeing a need for services. Caregivers' cultural beliefs of staying independent and taking care of others because it is their familial responsibility were prevalent throughout the interviews. The findings from this study ultimately illustrate how caregivers do not seek services because they do not see a need to or chose not to need services. Although barriers to service utilization have previously been identified in the caregiving literature, the greatest barrier for each of the caregivers in this study was their inability to see a need for help or services. This emerged as a higher-order barrier. Although caregivers were able to offer suggestions to overcome some of the other barriers, none were able to offer suggestions on how to help caregivers perceive a need as they themselves had attitudes and/or beliefs that contributed to their not believing they needed services. Awareness of this higher-order barrier or core belief may translate into agencies and services changing the way they market to rural caregivers.

Personality disorders (PD) are among the most complex aspects of human behaviour to understand and manage. Stability is thought to be one of the major distinguishing features between PD’s and other forms of psychopathology, however, recent studies have challenged this notion. Borderline personality disorder (BPD) is the focus of this review and is characterised by interpersonal and emotion regulation difficulties. This thesis aimed to first examine the naturalistic course of BPD, through systematic review of the current literature. Following screening, 12 studies, that met all inclusion/exclusion criteria, were critically evaluated. The results, from studies rated as methodologically sound, suggested that the categorical diagnosis of BPD has poor stability over time, with only 3%-35% of participants retaining a diagnosis of BPD over time. However, the studies reviewed were limited by the population they examined: mainly working age adults with mental health problems. Therefore, studies need to be continued and replicated to increase our understanding of the lifespan course of BPD. PD’s within older adults with mental health problems is a highly debated topic. Clinicians have highlighted the presence of PD symptoms within this group and the need for appropriate therapies. Schema therapy is one intervention that has shown to be effective in the treatment of PD symptoms within a working adult population. A recent Delphi-study led to the consensus that existing therapies for PD, such as schema therapy, that have shown to be effective in working aged adults are applicable to older adults. Therefore, the empirical project focused on exploring the theoretical underpinnings of schema therapy in older adults with mental health problems. 3 self-report questionnaires were administered to 62 participants (aged 65- 85 years); Young’s Schema Questionnaire – Short Form (YSQ-S3), Coolidge Axis-II Inventory (Short) (SCATI-II) and The Regulation of Emotions Questionnaire (REQ- 2). Analysis highlighted that YSQ-S3 and REQ-2 scores significantly predicted 69% of the variance in SCATI-II scores. To the author’s knowledge, this study is the first of its kind to find support for the relationships between early maladaptive schemas (EMS), PD symptoms and the use of dysfunctional emotion regulation (ER) strategies, consistent with the schema therapy model, in older adults with mental health problems.

As the number of people age 65 years or older continues to grow, the need for better designed gerontology programs aimed at addressing the normal memory changes associated with aging, which may lead to treatments designed to offset the effects Alzheimer's (Peterson & Wendt, 1990; Rosen et al., 2002), is also increasing. Therefore, this study compared and systematically replicated two previous studies, Dixon et al. (2011) and Sautter et al. (2011) to investigate if older adults without dementia could learn to recall names of pictures of famous people using problem solving techniques which involve tact training and response prompting versus echoic prompting and immediate intraverbal questions. Results from two participants who completed the study indicate the problem solving techniques can increase picture recall to near 100% levels. One participant also was able to recall 89% of the stimuli that were learned using the problem solving protocol at a two week follow-up.

Millions of Americans are afflicted with dementia and that number is only expected to rise. The diagnosis of dementia comes with impairments, especially in language, and dementia functional declines appear to be affected by the environment and not solely as a result of the disorder (Alzheimer's Association, 2012; American Psychiatric Association, 2000; Engelman et al., 1999; Engelman et al., 2003). Traditional language tests are not likely to assess the mand (Esch et al., 2010), and the mand is a verbal operant about which little is known among this population. The current study investigates whether contriving an EO within a preferred activity using a prompt-probe intermix procedure and a transfer of stimulus control procedure could effectively train mands in older adults with dementia. There were two participants, and varied results were obtained. The procedure was demonstrated to be effective with one participant, but results were inconsistent with the second participant. Modifications had to be made throughout training for both participants, showing the importance of making modifications to training based on data obtained and to individualize the treatment.

abstract: Everyday speech communication typically takes place face-to-face. Accordingly, the task of perceiving speech is a multisensory phenomenon involving both auditory and visual information. The current investigation examines how visual information influences recognition of dysarthric speech. It also explores where the influence of visual information is dependent upon age. Forty adults participated in the study that measured intelligibility (percent words correct) of dysarthric speech in auditory versus audiovisual conditions. Participants were then separated into two groups: older adults (age range 47 to 68) and young adults (age range 19 to 36) to examine the influence of age. Findings revealed that all participants, regardless of age, improved their ability to recognize dysarthric speech when visual speech was added to the auditory signal. The magnitude of this benefit, however, was greater for older adults when compared with younger adults. These results inform our understanding of how visual speech information influences understanding of dysarthric speech. / Dissertation/Thesis / M.S. Speech and Hearing Science 2014

abstract: The treatment of individuals with multiple chronic conditions represents the single largest driver of Medicare costs. The use of prescription drugs is a major component in the treatment/management of chronic disease in the United States. Medication nonadherence, however, is a common problem among older adults and leads to significant morbidity and mortality. Whereas, the problem of medication nonadherence has been a primary focus of research for the last thirty years, much is still unknown about which older adults are most at risk for medication nonadherence, as well as what are effective theory-based interventions to improve a person's medication self-management. The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2014

Class of 2012 Abstract / Specific Aims: The purpose of this study was to test an interactive educational program for older adults on preventing accidental falls. Methods: This was a prospective, descriptive study evaluating the helpfulness of an interactive educational program. English speaking residents were recruited from five independent senior living communities in Arizona. The intervention consisted of a 30-minute interactive PowerPoint presentation followed by a 10-minute question and answer session. Information provided during the presentation focused on information from the CDC and the Fall Prevention Center of Excellence. Participants completed an anonymous questionnaire to rate the helpfulness of the program. The primary dependent variable was overall helpfulness of the educational session. Other variables included: intention of changing future behavior related to preventing falls, whether participants would recommend the program to others, participant perception of gained knowledge, change in fear of falling, and interest in meeting with pharmacist to discuss medications. Categorical data was analyzed by calculating frequencies and percentages and continuous data by calculating means and SDs. A t-test for independent groups was used to compare men and women. Main Results: A total of 93 individuals attended the presentations. Out of 81 completed surveys, 5 did not indicate gender, 7 additional did not indicate age, and 6 were over 89 years of age. Demographic data for the men and women was similar. 90% of participants indicated that the program was either "very helpful" or "moderately helpful". 92% of participants responded “absolutely yes” or “likely” that they would recommend the program. No participants strongly disagreed that they had a better understanding of fall risks or medications that increase fall risk. 87% of participants responded “absolutely yes” or “likely” that they plan to increase daily exercise . 42% of participants said it was “not likely” that they plan to make changes in their living environment. Conclusions: An interactive educational program on fall safety and prevention is helpful for older adults. As one of the most widely accessible health care providers, pharmacists and pharmacy students are well suited to provide patient education and improve outcomes. The results of this study provide preliminary data supporting the usefulness of a patient education program on fall safety prevention administered by pharmacy students.

Benzodiazepine dependence is a significant national problem. Although benzodiazepines — a class of drugs that includes drugs such as alprazolam, lorazepam, temazepam, clonazepam, and diazepam—have a wide range of uses including the treatment of insomnia, anxiety, and seizures; they are addictive. Individuals taking these drugs can quickly develop dangerous tolerances. Therefore, these drugs should not be selected as first choice nor used for more than short periods, yet a significant portion of the population uses benzodiazepines for long periods. This problem is significantly more pronounced in the elderly, a population that scholars have agreed should not use these drugs outside of extreme circumstances. Because benzodiazepines may be wrongfully perceived as an easy treatment for so many common afflictions, providers continue to prescribe them, and patients may be reluctant to discontinue use due to the symptoms associated with withdrawal (i.e., insomnia and anxiety). To avoid these symptoms, the standard discontinuation approach seen in an outpatient setting is a long-term taper that may take eight to 12 weeks of gradual reduction. However, in an inpatient setting, this long-term approach is unfeasible due to the short length of patient stays. The literature has given little consideration to this problem. Thus, it was necessary to review evidence and develop a guideline for benzodiazepine tapering in elderly patients receiving inpatient psychiatric care. The purpose of this project was to develop a guideline to taper benzodiazepines in the elderly using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). The guideline was validated by expert peer reviewers using the AGREE II instrument. The completed guidelines offer recommendations on the tapering of benzodiazepines in an inpatient geropsych unit and best practices for interventions to increase the success rate of discontinuation.