"Innovative Environments for Individuals with Alzheimer's Disease" examines different architectural designs of Alzheimer care facilities. The purpose of this work is to examine and interpret the existing data on aging, environmental psychology and dementia-related disease and apply it to the architectural design of special care units for individuals with Alzheimer's Disease. The author's intention is to supply long-term care providers and architects with architectural solutions for Alzheimer care units based upon a social model of care. The project will provide models for environments that will enhance the quality of life for cognitively impaired individuals and assist them in living at the highest level of experience possible. Design projects developed at The University of Arizona are similar in scale and appearance to the residential living environments that the impaired individuals experienced earlier in life. Conceptual designs are presented and supported by an in-depth discussion of Alzheimer's Disease and environmental design.

Perceptions are an important component of the decision-making process and interactions between adult children and the older parent. The purposes of this correlational, cross-sectional study were (a) to test the psychometric properties of the Categories of Decision Making Scale; and (b) to describe the perceptions of the mother/daughter dyad and the match of perceptions with a specified theoretical perspective. The major variables in the model included general and specific expectations, dyadic intimacy, partner's decision strategies, and categories of decision-making. The convenience sample consisted of 12 dyads, older mothers and caregiving daughters, in the community who received questionnaires by mail. A model of Perceptual Congruence of the Mother/Daughter of the Dyad was developed to examine the factors "WE" (agreement of the dyad members) and "I" (disagreement of the dyad members). Two methods of analysis were used to analyze the data, Multitrait-Multimethod (MTMM) and Factor Analytic Structural Equation Modeling (FASEM). Key findings indicated that the Categories of Decision Making scale demonstrated sufficient validity and reliability for describing the decision making of daughters and mothers for this small sample. The MTMM analysis demonstrated congruence, indicating agreement on the "WE" factor with dyadic intimacy, mothers' involvement in decision making, and confidence in mothers' decision making abilities. The FASEM models demonstrated "WE" agreement on the variables of dyadic intimacy and positive decision strategies. Comparison of both methods of analysis, MTMM and FASEM indicated mothers and daughters agreed only on dyadic intimacy. In this study, daughters perceived the mothers used more negative decision making strategies than the mothers perceived the daughters to use while making decisions. The daughters believed negative decision making strategies were caused by higher specific parental expectations and resulted in diminished intimacy between mother and daughter. In summary, there was agreement within the dyad on dyadic intimacy, but congruence was not found on expectations, decision strategies, or categories of decision-making. The findings suggest that daughter/mother dyadic decision-making is very complex with both partners perceiving the interaction differently. These differences may cause difficulties with the decision making process and poor outcomes for the dyadic members.

The purpose of the present study was to examine the effects of a control-enhancing intervention among older adults residing in an assisted living facility. The study was designed to investigate whether a control-enhancing intervention would (a) increase personal control among residents when the intervention was implemented by primary caregivers, and (b) increase actual or observed control among residents when the intervention was implemented by primary caregivers. The relationship between control and age, gender, education, and socioeconomic status among residents living in the facility also was examined. A quasi-experimental pretest-posttest control group design was utilized. Two sample groups were evaluated in the study (a) a treatment group consisting of 10 residents that received a message designed to invoke increased responsibility for themselves and (b) a control group consisting of 11 residents that received a message encouraging them to allow staff to assume responsibility for them. The dependent measures used for the study were the Desired Control Measure [DCM], a Participant Questionnaire, and a Behavioral Checklist. The DCM and the Participant Questionnaire were administered to each study group at six week intervals. The Behavioral Checklist was rated at weekly intervals. A significant correlation was found between gender and desire for control. No significant correlations occurred between age, education, socioeconomic status and control. Significant within and between group differences were found on the DCM. Significant within group differences were obtained on the Participant Questionnaire. No significant control-related behavioral changes occurred within or between groups. The results of the study provided evidence that the control-enhancing intervention was effective for increasing personal control among residents living in an assisted living facility. The behavioral findings indicated that the intervention may have been unsuccessful for producing increased control-related behaviors.

Depression is a common source of morbidity and mortality in elders and has a significant impact on their quality of life. Meaning in life and self-transcendence, indicators of spirituality, have been linked to the experience of well-being in the elderly. Nurses are challenged to find ways to tap these natural health resources as a means of addressing the serious problem of depression in the aged. The purpose of this study was to explore and compare patterns of depression, meaning in life and self-transcendence as manifested in instruments and life stories of depressed and nondepressed elders. Life span development psychology, existential psychology and narrative theory provided the conceptual framework for this triangulated study of depression, meaning in life and self-transcendence in those over 75 years of age. The Geriatric Depression Scale, Purpose in Life Scale and Self-Transcendence Scale were completed by 77 people over the age of 75 and living in one of three retirement communities. Those individuals achieving the five highest and five lowest scores on the Geriatric Depression Scale were interviewed. Significant negative relationships were found between depression and meaning in life, and between depression and self-transcendence. A significant positive relationship was found between meaning in life and self-transcendence. Narrative analysis of the interviews generated 11 themes of meaning in life. Different patterns of behaviors and perceptions related to life story themes of meaning in life and self-transcendence were identified in the Depressed and Nondepressed Group. The study conclusions support the importance of meaning in life and self-transcendence for well-being in the elderly.

This dissertation focuses on the effect of aging on two functional aspects of rat hippocampus: cholinergic synaptic transmission and place specific firing of CA1 pyramidal cells. The effect of age on the cholinergic slow EPSP was studied in hippocampal slices of young, adult and old rats. The old rats were impaired on the spatial version of the Morris water task. The amplitude of the slow EPSP was significantly reduced in old rats in all hippocampal subregions (CA1 59%; CA3 55%; and DG 56%). Few statistically significant correlations, however, were found between the age-related deficit in spatial learning and the cholinergic deficit. In the subsequent study, effects of selective neurotoxic lesions of cholinergic afferents to the hippocampus on performance on two versions (spatial working memory and spatial reference memory) of the radial-8-arm maze task were examined. The lesioned rats were impaired in acquisition, but not retention, of the working memory task. There was no treatment effect, however, on acquisition of the reference memory task. The results suggest that the age-related deficits in hippocampal cholinergic function may contribute to behavioral deficits of old rats in working memory situations, but may not be primarily responsible for the spatial reference memory problem in the Morris water task. The spatial and temporal firing characteristics of CA1 neurons were studied in young and old rats performing a simple spatial task on a rectangular track. The average place fields of young rats were larger than those of old rats. Precession of spike discharge relative to the theta rhythm proceeded faster in old rats, while the total phase change remained constant. These age-related changes were apparently due to a loss of experience dependent place field expansion of old rats during the first few laps around the track for a given recording session. The field sizes were not different between groups on lap 1. Because experience-dependent place field expansion is a prediction of two recent theories which invoke asymmetric Hebbian LTP, the present observations point towards a substantial deficit in an LTP-like process in old rats.

Currently 12% of the U.S. population is over the age of 65, and by the year 2030 this number is projected to be 25% (U.S. Senate Special Committee on Aging (SSCA), 1990). It is estimated that 37% of people over age 55 have an alcohol or substance abuse problem (Subcommittee on Health and Long-Term Care (SHLTC), 1992). Failure to recognize the elderly alcoholic results in delayed treatment and as a result, the older drinker suffers adverse effects related to the disease (Metzger & O'Brien, 1990). Extant tools for detecting alcoholism have been developed and used in younger populations, however there is a lack of information about the use of these tools in older populations (Graham, 1986). This study examined differences between two different age groups of known alcoholics using an established instrument, the Alcohol Use Inventory (Horn, Wanberg, & Foster, 1986).

The purpose of this study was to describe the characteristics of falls and risk factors for falls in elderly male veterans residing in a Veterans Affairs nursing home care unit. Risk factors included cognitive status, mobility status, and restraint use. Relationships between risk factors and falls were investigated using a two-phase descriptive correlational design. Nursing and medical records of residents who fell were reviewed retrospectively, and assessment of cognitive status was done using the Mini-mental Status Exam. The convenience sample included 20 male veterans, age 65 and older, who had at least one documented fall from the year of January 1991 through December, 1991. Results were not statistically significant; however, trends in the data were identified. Findings were clinically significant and validated literature on risk factors for falling.

The purpose of this study was to investigate perceptions of the elderly in the southwest with regard to police, crime and safety. A questionnaire was mailed to 2500 elderly adults residing in the southwestern states of California, Nevada, Arizona, Colorado, and New Mexico. Five constructs were developed to measure these perceptions: (1) attitudes toward police, (2) attitudes toward safety, (3) awareness of police, (4) awareness of community policing, and (5) awareness of crime and safety. A t-test and Oneway analysis of variance were conducted to test each of the hypotheses. Results indicated that independent variables of gender, ethnic background, state and area of residence have little effect on the variables of attitudes toward police and attitudes toward safety. However, there was a higher level of significance found for the independent variables toward the awareness of police and awareness of crime and safety variables.

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.

This dissertation examines the potential for professional/community planning to respond pro-actively and strategically to the impending demographic changes which will be brought about by the aging of the baby boom generation. This multi-phased investigation was designed to explore whether professional planning could uncover models and concepts which can be used to make cities and communities more age-friendly. Several conclusions can be drawn from the study. It was found that planners are not ready for demographic change nor are they prepared for helping create age-friendly cities. This is due to several reasons, including a lack of resources forcing them to concentrate on short-term, immediate issues; lack of power and credibility; and a perception that the elderly are a lower priority in society. For planners to become proactive and strategic in planning for age-friendly cities, they will need to re-examine their tendency to focus mainly on land use planning; focus on the long-term agenda; establish credibility with politicians; develop visionary skills; and become educators and facilitators, engaging key stakeholders and community groups. The data indicated that planners have a limited knowledge of gerontology. However, a high level of congruence was found between the newer planning models and key research dimensions in gerontology. If these two fields were to work closer together, each would become better equipped to produce knowledge which will help society deal with aging demographics. Evidence also showed congruence between the newer planning models, building age-friendly cities and the environmental agenda. Common factors such as urban intensification (particularly in the core), building more compact urban form and increasing multi-modal transportation options (including pedestrianism) help reduce sprawl, congestion and pollution and concomitantly help create an environment which is healthier and friendly to all ages, including seniors. Findings from this research are used to develop a hybrid “Wise Growth” planning model to encourage the development of age-friendly cities.