The dissertation aims to enhance knowledge about bereavement support-seeking among older adults with Complicated Grief (CG) and/or depression and to examine the outcomes of support received. This three-paper dissertation uses data from two studies of bereaved older adults: the Changing Lives of Older Couples (CLOC) Study and the Complicated Grief Treatment in Older Adults (CGTOA) Study. The dissertation draws upon Pescosolido and colleagues' Network Episode Model to frame the exploration of support-seeking. Paper 1 is based on qualitative interviews with eight older adults with CG who completed participation in a National Institute of Mental Health (NIMH) funded randomized clinical trial of CG treatment, the CGTOA study, and seeks to better understand the bereavement support- seeking process. Several primary themes arose, including observing that grief was causing a great deal of emotional distress and role impairment, grief not meeting their own or others' expectations of what grief "should be," influences of social relationships on support-seeking, and a lack of effectiveness of support groups and/or care from mental health professionals. Papers 2 and 3 use secondary analyses of longitudinal surveys from the CLOC Study, a representative community sample of widowed older adults. Paper 2 describes support sought for grief at 6, 18, and 48 months post-widowhood, including religious leader, support group, and family doctor support, and examines the influence of social network variables, the presence of CG and depression, and other demographic (gender, education, age, race, income, and home ownership) and clinical variables (health satisfaction, anxiety severity, attachment anxiety, attachment avoidance) on support sought. Approximately 20% of the sample sought multiple types of support concurrently. Social network, clinical and demographic variables also varied across types of support sought. For example, the presence of CG was associated with a greater likelihood of seeking support, and low instrumental support increased the odds of going to family doctors for support with grief. There were also significant associations between types of support sought. Paper 3 determined whether utilization of bereavement supports at 6 months post-loss was associated with reductions in emotional distress (grief, depression, or anxiety) at 18 months in widows with CG or depression in the CLOC sample. Using a self-help or support group reduced grief symptoms, but did not significantly alter depression or anxiety symptoms. Seeking support from a religious leader decreased depression, but not grief or anxiety. Seeking support from a family doctor did not impact anxiety, depression or grief. Discussion sections for each paper and a conclusion section for the entire dissertation summarize study findings, identify limitations, and detail implications for practice, research, and policy.

Background: Elder abuse is increasingly recognized as a public health crisis and is associated with significant morbidity and premature mortality. At the foundation of this problem, elder abuse risk factors remain misunderstood. Previous elder abuse risk factor research contains methodological limitations that threaten the validity and reliability of existing knowledge. Further population-based research using standard elder abuse definitional/inclusion parameters and adaptations of established measurement tools is required to advance the literature. A major gap in the elder abuse risk factor literature is consideration of problem severity. Previous studies have focused on dichotomous prevalence/incidence outcomes, yet substantial variation exists in the extent, frequency, and self-perceived seriousness of the problem. Using data from the most methodologically rigorous population-based elder abuse study conducted to date - New York State Elder Abuse Prevalence Study (NYSEAPS) - this dissertation identified candidate risk factors of one-year incidence, objective severity, and subjective severity for elder emotional abuse, physical abuse, and neglect among cognitively intact, community-dwelling older adults. Methods: The NYSEAPS used a random digit-dial sampling strategy to conduct direct telephone interviews with a representative sample (n = 4156) of older adults in New York State. Inclusion criteria captured older adults aged 60 years or above living in the community, cognitively intact, and English/Spanish-speaking. Elder emotional and physical abuse types were assessed using a modified version of the Conflict Tactics Scale. Elder neglect was measured using a modified version of the Duke Older Americans Resources and Services scale. Potential risk factors were examined at several ecological levels of influence, including the individual victim, victim-perpetrator relationship, home living environment, and surrounding socio-cultural context. Multivariate regression modelling was used to identify factors associated with one-year elder abuse incidence in the general population, as well as factors associated with objective and subjective elder abuse severity among mistreated older adults. Results - Incidence: Older adults who were younger, functionally impaired, living in a low-income household, and separated/divorced had significantly higher odds of emotional abuse and physical abuse in the past year. Older adults who were younger, separated/divorced, living below the poverty line, non-Hispanic, and in poor health had significantly higher odds of elder neglect in the past year. Results - Objective Severity: Increasingly severe emotional abuse was predicted by younger age, functional impairment, shared living, Hispanic ethnicity, a spousal/partner perpetrator, and living alone with the perpetrator. Higher levels of physical abuse severity were associated with younger age, a grandchild perpetrator, and living alone with the perpetrator. Increasingly severe neglect was predicted by younger age, functional impairment, and low household income. Results - Subjective Severity: Victims of emotional abuse were more likely to perceive the problem as serious if they were functionally impaired, highly educated, or endured more objectively severe mistreatment; victims were less likely to perceive the emotional abuse as serious if they lived with family or lived with their perpetrator. Physical abuse victims had higher odds of viewing their abuse with greater seriousness if they were a widow, single or experienced more objectively severe mistreatment; victims were less likely to perceive physical abuse as serious if they lived with the perpetrator. Neglect victims reported higher perceptions of problems seriousness if they were functionally impaired, male, had a paid attendant perpetrator, or endured more objectively severe mistreatment; neglect victims had lower perceptions of problem seriousness if their perpetrator was an adult child or when they lived with the perpetrator Implications: Using NYSEAPS data, this dissertation contributes the most valid and reliable elder emotional abuse, physical abuse and neglect risk factor knowledge available to date. It also extends existing risk factor research as the first known study to examine factors predicting elder abuse operationalized along a continuum of severity. Incidence-related risk factor information carries direct implications for policy and interventions aimed at preventing new elder abuse cases. Objective severity risk factor findings inform the development of targeted interventions to alleviate the magnitude of existing elder abuse cases and protect victims from heightened risks of mortality and morbidity. A focus on subjective severity carries indirect implications towards understanding victim help-seeking intentions and protective service utilization.

No description available.

No description available.

No description available.

This project proposes to develop a multiple-cause-of-death model of cancer mortality differentials at the older ages (45 and over), and to test its efficacy in comparison with the traditional model. The primary goal is to show that a multiple-cause-of-death model reveals different results of mortality differential by age, race, and sex than those observed under a single underlying-cause-of-death model. If positive findings are observed, then a multiple-cause concept of human mortality needs to be considered as an alternative to the underlying-cause concept in studies of differential mortality. / The specific objectives of the project are to (1) discuss previous research showing the relative importance of examining multiple causes of death in mortality analyses, (2) extend the current research by considering age-race-sex-specific death rates within a multiple-cause-of-death model of cancer mortality differentials at the older ages, (3) design a methodology to utilize multiple-cause data in differential mortality analyses, and (4) compare results from multiple-cause analysis with those from underlying-cause analysis. / The first objective consists of a review of the literature on causes of death, the epidemiological transition, and mortality differentials. Following this review, an argument is given in support of a multiple cause-of-death conceptual model. The second objective consists of applying a multiple-cause-of-death framework to cancer mortality differentials. The third objective consists of designing analytical methods to utilize multiple cause data. / The fourth objective consists of constructing appropriate rates (i.e., underlying, total mention, and multiple cause rates by age, race, and sex), comparing the results, and interpreting the findings. / Findings indicate that a multiple-cause-of-death approach to cancer mortality differentials at the older ages is an alternative to the underlying-cause-of-death approach. Even though cancer is the major cause of death most likely to be cited as an underlying cause, differentials in cancer mortality vary when the two data bases are used. When specific types of cancer are examined, differentials using total mentions may be wider or narrower than those based on underlying causes and may even be reversed. Use of an underlying cause-of-death framework especially understates the level of cancer-related mortality at the older ages. / Source: Dissertation Abstracts International, Volume: 47-05, Section: A, page: 1892. / Thesis (Ph.D.)--The Florida State University, 1986.

Obesity is a global epidemic that is associated with several adverse health consequences. In addition, there is also a growing prevalence of obesity in pregnancy. Maternal obesity places the fetus in an abnormal in utero condition that can produce alterations in development leading to permanent programming of physiological systems. Obesity is also associated with cognitive dysfunction, which calls for investigations into its effects on the hippocampus, a brain area involved in learning and memory. Long-term potentiation (LTP), a neurophysiological correlate for learning and memory, can be examined in hippocampal slices. This study aimed to fill in the gap in literature regarding the effect of obesity on hippocampal synaptic plasticity in female rats, and maternal obesity effects on offspring hippocampal synaptic plasticity. Female Sprague-Dawley rats were fed either a control diet (CD), or a high-fat diet (HFD; 40% of calories from saturated fat) for 16 weeks. Impaired glucose tolerance and greater retroperitoneal fat pad weight indicated an obese phenotype in HFD rats; as well, the modified diet led to impaired LTP: CD rats had 10% more potentiation in amplitude, and 11% more potentiation in slope than HFD rats. Offspring were weaned onto control diet at post-natal day 21. Reduced success rates for achieving LTP, and lowered magnitudes of mean LTP in the offspring, strongly suggest that maternal obesity may have compromised hippocampal synaptic plasticity, and warrants further study.

The population of older adults has grown rapidly in recent years and is expected to continue to grow into the middle of this century. The aging of the population means that nurses need to have specialized gerontological knowledge in order to properly care for older adults. In spite of the current need for specialists in this field, gerontological nursing is not a popular choice and nurses often lack adequate preparation to care for older adults. The complex reasons behind these issues are rooted in the history of the development of this specialty. This study takes a historical look at the development of gerontological nursing in British Columbia through the stories of seven nurse educators who were leaders and innovators in their field. The findings of the study tell a story of the nurses’ work to change unacceptable nursing practice, improve standards of care and professional status of gerontological nursing and advocate for older adults. In doing so, these nurses challenged cultural values about aging and care of older adults and worked toward giving gerontological nurses a voice in policy and decision-making. The findings from this study can be used to guide today’s gerontological nurses as they continue to develop this specialized field of nursing knowledge.

The current study utilizes a life course approach in its exploration of the connection between life stage and psychological well-being, within the context of cancer caregivers. Further the study explores this connection in light of four possible mediating unmet needs factors that is unmet work or financial needs, unmet health care needs, unmet information needs and unmet future concerns needs as well as the extent to which these factors differ within each group. The study utilizes data from The Cancer Support Person’s Unmet Needs Survey (SPUNS) conducted by Campbell et al. in which a random, stratified sample of 1128 cancer survivors and their immediate caregivers, selected from the Cancercare Manitoba Cancer Registry, were surveyed (2009). The sample for the current study included 789 support persons selected for the study by the survivor for whom they cared. The study revealed that caregivers in midlife exhibited higher levels of unmet needs in work/ financial as well as future concerns life aspects. It is the expectation that the results of this study will enable practitioners to better support and fill the needs of caregivers allowing for improved quality of life and quality of care.

Abstract Objectives: This study aimed to investigate the number of food stores (FS) within 500m, 1000m and 1500m of Region of Waterloo schools and describe them by type: full-service restaurants, fast food restaurants, supermarket and convenience stores; and then by elementary and secondary school levels. In addition, the associations among FS counts, median family income for the school neighbourhoods and school level academic performance were also examined. Methods: Data for 2008 and 2010 on food stores, school addresses and school results on provincial academic tests (EQAO) were obtained from publicly available information (Region of Waterloo food inspection premises data; Waterloo Region District School Board and Waterloo Catholic District School Board; and Ontario’s Education Quality and Accountability Office (EQAO) as well as the Fraser Institute, respectively). The 2006 Statistics Canada census data on median household income for Dissemination Areas surrounding schools was used as the proxy for income. Food stores were classified into the four store types based on the North American Industry Classification System (NAICS). The ArcGIS program was used to geocode the addresses of food stores and schools in the Region of Waterloo. It was also used to create the buffer zones (500m, 1000m and 1500m) around schools and to calculate the number of food stores within each buffer. In addition, multiple linear regression and logistic regression were used to explore the associations between food store counts to school neighbourhood income and school level academic performance indicators. School neighbourhood family income, parent education, students’ competency in English and population density were considered as study covariates. Results: From 2008 to 2010, the number food stores of all types increased in the Region of Waterloo as a whole. However, within the three buffer zones (500m, 1000m and 1500m), while the number of full-service restaurants, convenience stores and total stores were higher in 2010 than in 2008, food store counts of fast food restaurants and supermarkets were not always higher in 2010 compared to 2008. Nevertheless, of all food story types, the counts were highest for fast food restaurants in both years (2008 and 2010) and at all buffer zones around schools (500m, 1000m and 1500m) as well as for the Region of Waterloo as a whole. In addition, negative associations were found between fast food restaurant, convenience store and total store counts and school neighbourhood family income. Furthermore, these associations remained robust even after controlling for population density. Regarding food store counts and students’ academic performance, most of the significant associations were negative and were found for supermarkets, convenience stores and total store, with more significant associations in 2010 than in 2008. Most of the significant associations were found for elementary schools and when EQAO scores were treated as continuous versus binary variables. Interestingly, Grade 3 EQAO scores tended to be associated with supermarket and total store counts, whereas Grade 6 EQAO scores tended to be associated with convenience store and total store counts. Although several associations became insignificant after adjusting for study covariates (school neighbourhood family income, parent education and students’ competency in English), many significant associations remained and followed the trends observed before controlling for the covariates. Implications for practice: The totality of evidence from the current study suggests that the number of food stores around a school has a relationship to academic performance even when key factors such as neighbourhood family income and parental education are considered. If such associations were confirmed and explained through further research, there would be potential policy implications, for example, regarding zoning of food stores around schools and school practices.