Rationale and study aims: Persons with mild cognitive impairment (MCI) experience declines in everyday functioning and cognitive performance greater than what is experienced in normal aging but less than that of dementia. Daily stress and daily memory complaints associated with cognitive deficits may contribute to greater psychological distress in the day-to-day experiences of persons with MCI. However, research examining the occurrence of daily stressors, daily memory complaints and psychological distress in MCI is limited, and it is not clear how the daily processes of stress and affect in persons with MCI compare to cognitively healthy older adults. This dissertation examined the occurrence of daily stressors, daily memory complaints, retrospective and daily well-being in persons with MCI compared to cognitively healthy controls. Main analyses examined whether daily stressors and daily memory complaints were associated with worse daily affect in MCI participants compared to controls, and whether increased daily stress was associated with a greater number of memory complaints. Methods: The study used a short-term repeated measures design, and included MCI and control participants recruited from a university-based memory clinic. The interviews consisted of a baseline interview and up to eight consecutive days of brief daily phone interviews. The interviews included both retrospective and daily measures of psychological well-being, daily stressors, daily memory complaints, and open-ended questions about daily experiences. Results: Persons with MCI reported a greater number of daily memory complaints and worse psychological distress, as measured by both retrospective and daily reports. There were no significant differences between MCI and control participants, however, in the frequency of daily stressors. In both unadjusted and adjusted analyses, on days when a participant reported more daily stressors, they had higher negative affect. The stress-negative affect relationship was stronger for MCI participants compared to controls. MCI and control participants who reported more memory complaints, on average, had higher negative affect. Discussion: Daily stressors were disproportionally associated with greater psychological distress in MCI participants as compared to cognitively healthy controls. Interventions targeting the potential distress associated with daily life may be beneficial for psychological well-being in persons with MCI. Future research should examine other potential mechanisms of distress in daily lives of persons with MCI in order to inform relatives and caregivers of persons with MCI, clinicians who give diagnoses to their patients, and individuals providing community support for individuals living with MCI.

The effectiveness of the A Matter of Balance (MOB) program, a multifactorial falls prevention intervention, is uncertain. Although targeting multiple risk factors of falling at the same time seems reasonable and desirable, in that falls are often caused by several risk factors, results from previous studies investigating the effects of multifactorial falls prevention interventions are inconsistent. In addition, research shows that single factor interventions (e.g., exercise) can produce the same effects. The cost-effectiveness of multifactorial falls prevention interventions has varied across studies (e.g., Jenkyn, Hoch, & Speechley, 2012; Tinetti, Baker, et al., 1994). Despite the fact that the American Geriatrics Society and British Geriatrics Society (2001) have incorporated multifactorial falls prevention interventions into geriatric practice guidelines, more studies are needed to better understand the effects of the MOB program on falls and risk factors for falling among older adults. The MOB program aims to reduce fear of falling by increasing self-efficacy and perceived control (Tennstedt et al., 1998). This program provides exercises to enhance older adults' physical capacities, lessons to teach seniors fall-related risk factors, and methods to enhance self-efficacy. Previous studies mainly focused on the effects of the MOB program on fear of falling and falls efficacy. However, falls, fear of falling, and physical frailty (e.g., poor balance) are all correlated. Little is known about the effects of the MOB program on falls and related physical risk factors. Meanwhile, fear of falling and falls efficacy are two constructs often used to delineate psychological consequences of falling, but there has been confusion about these two constructs. As a result, researchers have been using measures developed for falls efficacy to assess fear of falling in error. Previous study also shows that both fear of falling and falls efficacy need to be examined after intervention with separate appropriate measures(e.g., Valentine, Simpson, Worsfold, & Fisher, 2011). Nevertheless, in the research of the MOB program, studies often examined either fear of falling or falls efficacy, but not both (e.g., Tennstedt et al., 1998; Zijlstra et al., 2009). Therefore, whether the MOB program could improve both fear of falling and falls efficacy is uncertain. This dissertation includes three studies to examine the effects of the MOB program. The first study explores whether the program could effectively prevent falls and improve physical risk factors (i.e., mobility, walking speed, and postural control) among older adults. The second study examines the psychometric properties of a modified fear of falling measure and the effects of the program on fear of falling and falls-efficacy. The third study investigates whether the effects of the MOB program on falls, mobility, walking speed, and postural control can be maintained across five months. Three studies using a comparison group design were conducted to examine each objective. Data were collected at baseline (Time 1), the conclusion of the program (Time 2), and at a 3-month follow-up (Time 3). Overall, the studies in this dissertation show that older adults can improve their mobility, walking speed, postural control, fear of falling, and falls efficacy by participating in the MOB program but the program did not affect the total number of falls. The results also showed that older adults who received the MOB program reached their highest performance on mobility and walking speed immediately at the end of the program. However, their performance on postural control continued to improve and was the best at the 3-month follow-up.

Exercise has many physical, cognitive, and social benefits, but the majority of older adults do not meet the recommended level of physical activity (Centers for Disease Control and Prevention, 2014). TAGteach, which combines elements of both behavioral coaching and acoustical feedback, has been demonstrated as an effective way to teach athletic skills (Fogel, Weil, & Burris, 2010; Quinn, Miltenberger, & Fogel, 2015; Stokes, Luiselli, Reed, & Fleming 2010). However, none of the current research on teaching athletic skills targeted an older population. This study evaluated TAGteach in a multiple baseline across behaviors design as a method of teaching 4 basic baton twirling skills to 3 women aged 62-73. Performance accuracy was low in baseline but improved substantially following the implementation of TAGteach. Participants also rated the intervention positively on a social validity survey. Implications and suggestions for future research are discussed.

Caregivers of persons with dementia, who are often older adults, report sleep disturbance, high rates of depressive symptoms and may be at risk for impaired cognition. This dissertation examined sleep, depressive symptoms, and cognition in older adults and caregivers of persons with dementia. The aims of the review of literature were to understand, in community dwelling adults 60 years and older, the relationships among sleep parameters (sleep onset latency, wake after sleep onset, sleep efficiency, total sleep time, and general sleep complaints), and the domains of cognition (Executive Function, Attention, Episodic Memory, Working Memory, Processing Speed), and global cognition. Based on the findings, the research on the association of subjective sleep parameters and cognition is inconclusive and there is insufficient evidence to confirm or deny the existence of a relationship between objective sleep parameters and cognition. The methods section examined whether in adults 60 years and older, Radloff’s postulated 4-factor structure replicates across Afro-Caribbean Americans, African-Americans, Hispanic-Americans, and European-Americans and determine whether there is evidence for measurement invariance across the four ethnic groups in their responses to the Center for Epidemiological Depression Scale (CES-D) statements. Radloff’s postulated 4-factor model fit the data adequately and the results suggest that there is evidence for configural and partial metric invariance. The final section examined the relationships among subjective sleep parameters (Sleep Onset Latency, Wake After Sleep Onset, Total Sleep Time, Time in Bed, Sleep Efficiency, Sleep Quality), depressive symptoms, and, crystallized, fluid and total cognition in caregivers of persons with dementia with poor sleep. Based on the findings, depressive symptoms also did not mediate the ability of the sleep parameters to predict cognitive performance. With the knowledge that there are potential associations among sleep parameters, depressive symptoms and cognition in caregivers, healthcare providers should collect baseline assessments on sleep, depressive symptoms and cognition from caregivers and monitor them on an ongoing basis to identify changes and intervene in a timely manner. More research studies incorporating measures to capture sleep variability and similar cognitive measures, are needed to clarify the relationships both in older adults and caregivers of persons with dementia.

The quality of care in nursing homes has been evaluated from many varying perspectives, but few studies have analyzed quality in light of complaints made to state survey agencies by residents, their family members, or other individuals interacting with the nursing home. This study analyzed complaints, investigation of complaint allegations, and complaint-related deficiency citations to determine their effect, if any, on the quality of care in nationwide nursing homes. Using the Online Survey Certification and Reporting (OSCAR) survey dataset for facility characteristics and the complaint investigation dataset for outcomes of complaint investigation, analyses conducted included descriptives, correlations, conceptual mapping for complaint-related deficiencies, chi-square tests of independence, t-tests, and generalized estimating equations. At baseline, approximately 66% of nursing homes were for-profit and roughly 53% belonged to a chain membership, while the average percent of residents receiving Medicaid for care reimbursement was 60%. Results indicated that nursing homes differed significantly by profit status and chain membership on whether a complaint was received and whether a deficiency citation was issued following a complaint investigation. Additionally, certain facility and resident-aggregated characteristics, as indicated by odds ratios, were associated with an increase in the likelihood of receiving a complaint or a complaint-related citation. With respect to facility characteristics, for-profit nursing homes and those nursing homes belonging to a chain membership were found to have more complaints and more complaint-related deficiency citations than nonprofit nursing homes and non-chain facilities. Resident-aggregated characteristics, such as a nursing home having more residents restrained, more residents with a catheter, or more residents with a diagnosis of depression, indicated a greater likelihood of receiving a complaint or complaint-related deficiency citation in longitudinal analyses. While additional research could aid in interpreting the effect of complaints on quality of care in nursing homes, study results indicate several facility and resident-aggregated factors that may aid in better understanding of quality of care and improve the training of surveyors and nursing home staff to improve quality of care for residents.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (M.Tech.: Homoeopathy)--Durban University of Technology, 2008. xvii, 87 leaves / Homoeopathy is a scientific, reliable and natural system of medicinal therapy, which has been in existence for over 200 years. Recent years have shown a profound shift in health and medicine, increasing numbers of the public are opting for complementary and alternative(CAM) therapies. In South Africa the situation for CAM and homoeopathy in particular looks more favorable. The government, in the form of the department of health, has drawn up specific guidelines for the regulation of homoeopathy and other CAM therapies. Much closer liaison should exist between the Allied health professions council of South Africa (AHPCSA) and the Health professions council of S.A (HPCSA) with the aim of uniting strengths to the advantage of the South African public to achieve an integrated, holistic care (Prinsloo, 2005). OBJECTIVE The purpose of this study is to provide demographic data on the perceptions and interactions of Medical specialists in the greater Durban area toward homoeopathy. Their general knowledge of homoeopathy and their views and communication with homoeopathy have been assessed. iv METHODOLOGY A survey method in the form of a questionnaire was employed to investigate the perceptions and interaction of Medical specialists towards homoeopathy. The sample of Medical specialists was drawn from the medical pages of the Durban Telephone Directory. The data was analyzed by means of descriptive statistics using frequency tables and bar charts. The Pearson’s Chi-square Test was used on selected data. RESULTS One hundred and fifty completed questionnaires were returned for analysis out of the 344 sent out. This gives a response rate of 43.60%. CONCLUSION From this study one can conclude that Medical specialists know very little about homoeopathy, and it can be assumed that this lack of knowledge is a possible reason for the poor communication that currently exists between these practitioners and homoeopaths

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers' perceptions of loved ones' end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones' physical, emotional, and existential suffering, current frequency of thoughts about loved ones' suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers' psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants' perceptions of their spouses' emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones' suffering. High stress-reactive rumination was an important predictor of bereaved spouses' psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones' end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions.

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