Thesis--University of Michigan. / eContent provider-neutral record in process. Description based on print version record. Bibliography: leaves 263-296.

Thesis (M.A.)--Central Michigan University. / Typescript. Includes bibliographical references (leaves 76-79).

Thesis (Ph.D.)--University of California, San Francisco, 2009. / Source: Dissertation Abstracts International, Volume: 70-10, Section: B, page: 6119. Adviser: Glenna A. Dowling.

Thesis (Ed.D.)--Fairleigh Dickinson University, 1987. / Source: Dissertation Abstracts International, Volume: 49-05, Section: B, page: 1619. Adviser: Melvyn Hill.

Thesis (Ph. D.)--Syracuse University, 2005. / "Publication number AAT 3193854."

Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 2006. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 4128. Adviser: Arthur F. Kramer. Includes bibliographical references (leaves 72-84) Available on microfilm from Pro Quest Information and Learning.

<p> In longitudinal studies of older adults, some participants are unable to provide responses by themselves due to advancing severity of their conditions. Therefore, a designated proxy provides responses whenever the participant is unavailable to respond. In practice, sometimes, the proxy responses are excluded from the dataset before conducting the analyses, while sometimes proxy responses are included in the analyses and treated as if they are self responses. Both approaches are problematic as they result in biased parameter estimates. In this study, we consider a framework where self and proxy responses may be both included in the analyses and postulate a model where both are treated as coming from separate sources. The framework accommodates the estimation of the parameters corresponding to the distributions of both self and proxy data separately and facilitates statistical comparison of these parameters. Statistical testing of the equality of the self and proxy parameters and the joint distribution could be used to determine if proxy may be used in place of self responses. First, we utilize Weighted Generalized Estimating Equations (WGEE) method for the combined datasets containing both self and proxy data to obtain separate self and proxy parameter estimates where self responses follow a dropout structure. Different approaches for obtaining the weights are also explored. Then, we extend an available framework for modeling self and proxy data using the conditional distributions of the self and proxy responses given the response pattern, and the conditional distribution of the pattern given the data to derive a joint likelihood for the complete data vector corresponding to a subject. The likelihood obtained by this approach can be maximized using numerical optimization methods. Performance of the various approaches is investigated via simulation studies. Both approaches, the WGEE method and the Maximum Likelihood (ML) approach, are used to analyze the data from &ldquo;Baltimore Hip Study Cohort 7&rdquo;.</p><p>

<p> This narrative research offers an inquiry that intends to inspire thinking about a culturally competent dementia care framework in the United States. The main research question is: How does a culture hold dementia care? A subquestion is: What can we in the United States learn from other cultures about dementia care to enhance this care for all? The inquiry was designed to conduct narrative research focusing on Japanese culture in the context of caregiving to people with dementia; 4 professional and 4 family caregivers from this culture, who have cared or have been caring for persons with dementia, were interviewed. The narratives reflected the caregivers' lived experiences and how they were culturally compelled to give and sustain care. </p><p> This inquiry assumes that a person-centered dementia care model is challenging for the U.S. healthcare system, despite attempts to do so, due to the prevailing values and beliefs in the United States that center around a cure model as opposed to a care model. It also assumes that ideal person-centered dementia care in the United States needs to pay close attention to the cultural competence of caregivers and healthcare professionals, as their clients identify as persons through their cultural ways of being. These assumptions are grounded in the literature review. </p><p> As a result of narrative data analysis, 5 themes emerged from the data among family caregivers, and 2 themes among professional caregivers as the commonality. In addition, 4 themes emerged not as common themes but as unique themes. This dissertation examined Japanese interdependent construal of the self and demonstrated that these themes could be explained through understanding Japanese sense of self. </p><p> It is evident that interdependence between the self and others is deeply embedded in Japanese culture. Without a doubt, interdependence uniquely manifests in the caregivers&rsquo; attitudes, values and worldviews of caregiving in Japanese culture. Although the limited number of participants should be considered, these findings/caregivers&rsquo; insights generated from this study aim to promote and encourage dialogues regarding what culturally competent dementia care looks like among caregivers and beyond in the United States when taking care of people from different cultures.</p><p>

Thesis (M.S.)--Boston University

<p> Atypical symptoms, multiple co-morbidities and a lack of public awareness make it difficult for older adults to know when to seek help for sepsis. Diagnosis delays contribute to older adults&rsquo; higher sepsis mortality rates. This research describes patients&rsquo; and caregivers&rsquo; experiences with the symptom appraisal process, self-management strategies, provider-nurse-patient interactions, and barriers when seeking sepsis care. Convenience and purposive stratified sampling were utilized on two data sources. A nurse-patient and nurse-family caregivers were interviewed. Online stories by older adult patient survivors or family members from the Faces of Sepsis&trade; Sepsis Alliance website were analyzed. Emergent themes were identified using qualitative descriptive methods. Listlessness and fatigue were most bothersome symptoms for the nurse-family caregivers. Fever, pain and low blood pressure were most common complaints, followed by breathing difficulty, mental status changes and weakness. Patients expressed &ldquo;excruciating pain&rdquo; with abdominal and soft tissue sources of infection, and with post-operative sepsis. Concern was expressed that self-management strategies and medications create barriers by masking typical sepsis signs. Health care providers&rsquo; interpersonal interactions, lack of awareness of sepsis symptoms and guidelines, complacency towards older adults, and denial by patients were barriers. Further barriers were staff inexperience, delays, care omissions, and tension between health care providers, patients and caregivers&mdash;with emerging advocacy by patients and family. In conclusion, providers should assess previous self-management strategies when evaluating symptoms. At primary care visits or hospital discharge, older patients with risk factors need anticipatory guidance for sepsis symptoms and possible emergent infections&mdash;specifically patients with pre-existing risk factors such as urinary tract infections, pneumonia, or operative events. Public and professional education are needed to overcome a lack of urgency and understanding of symptoms for diagnosis, treatment and guideline adherence for inpatients and outpatient clinics. Further research on subjective sepsis symptoms may improve patient-clinician communications when evaluating sepsis in older adults. </p><p>