Thesis advisor: Scott D. Slotnick / We are able to consciously remember an incredible amount of information for long periods of time (Brady et al., 2008, 2013). Furthermore, we often think about our memories in terms of how successful we are in retrieving them, such as vividly recalling the smell of your grandmother’s cooking. However, we can also identify the times when we have forgotten information, such as misremembering the name of an acquaintance or misplacing your car keys. Such instances of forgetting have been suggested to be caused by inhibitory processes acting on associated information, such as the inhibitory processing shown in retrieval-induced forgetting where the retrieval of specific items leads to forgetting related information (Anderson et al., 2004; Wimber et al., 2015). Thus, long-term memory is said to rely on both accurately retrieving specific details and inhibiting potentially distracting information. In Chapter 1, I demonstrate that specificity of long-term memory depends on inhibiting related information through a series of behavioral experiments investigating item memory for faces and abstract shapes. In Chapter 2 and Chapter 3, I examine the neural regions associated with long-term memory specificity and inhibitory processing by focusing on the functional roles of the hippocampus and the prefrontal cortex, two key regions associated with long-term memory. In Chapter 2, I provide evidence that the hippocampus is associated with memory specificity by demonstrating that distinct regions of the hippocampus are associated with memory for different visual field locations. Furthermore, I provide evidence that the hippocampus operates in continuous manner during recollection (i.e., conscious retrieval of details). In Chapter 3, I demonstrate that the prefrontal cortex can inhibit both the hippocampus and language processing regions during retrieval of distracting information during episodic and semantic memory, respectively. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Psychology.

The Palliative and Therapeutic Harmonization (PATH) program was designed to help frail older adults and their family members prepare for and make medical decisions, in the context of frailty and dementia. This sandwich thesis includes three manuscripts that present the findings from a mixed methods study exploring the implementation and outcomes of the PATH program, in three long-term care (LTC) home settings. The purpose of the first sub study was to describe both the perceived need for the PATH program, and initial reactions following its training and implementation. Quantitative surveys and qualitative interviews with bereaved family members showed that prior to implementation, they were mostly satisfied with their relatives’ end-of-life care. Through qualitative interviews, clinical leaders shared a positive impression of the training and PATH principles. They also explained how the PATH program could help them improve palliative and end-of-life care planning and communication with residents and families. In the second sub study, qualitative interviews were conducted with family members to learn about their experiences with and perceived outcomes from the PATH program. All family members had a positive experience. They shared perceived outcomes such as, opportunities to share and learn about their relative’s health status and trajectory, creating a mutual understanding of directions for care, and receiving support and reassurance for health care decision making. Finally, the purpose of the third sub study was to describe both the perceived outcomes of the staff who implemented the PATH program, and differences in documenting residents’ advance care plans and discussions. Staff described both personal and practice related outcomes. In addition, documentation around advance care planning changed with the program’s implementation. Overall, the PATH program offered frail older adults, their family members and their professional caregivers an opportunity to communicate about and prepare to make decisions for palliative and end-of-life care. / Dissertation / Doctor of Philosophy (PhD)

The long-term care (LTC) sector in Canada has experienced high numbers of COVID-19 deaths. However, there is a paucity of data on the impact of COVID-19 in LTC by different socio- demographic variables and in LTC homes within different regions. Additionally, the question remains as to how exactly and by how much the pandemic has impacted mortality in LTC in comparison to previous years’ mortality. Ranges for expected mortality by sex, province, and age, for the 2020-21 fiscal year were determined by creating forecasts and confidence intervals based on mortality trends in the preceding four fiscal years. These ranges were then compared to the actual mortality data in 2020-21. Comparisons between expected ranges and actual data were also conducted for the number of active residents, admissions, and discharges in LTC by sex, province, and age. Further, mortality ratios were created and studied by sex, province, age, and health region/authority/local health integration network. Overall, the number of deaths in LTC in Canada increased beyond the expected ranges in quarter one and three of 2020-21, and the patterns in death ratios were similar. Increases were exceptional in comparison to the peaks in deaths in previous years for specific variables, but not all variables. Most commonly, the number of active residents and admissions decreased in 2020-21 and the number of discharges from LTC did not change in quarter one and three and decreased in quarter two and four. However, importantly, these trends also varied across variables. This was the first study to comprehensively examine mortality due to COVID-19 in LTC overall, and by multiple socio- demographic variables while elucidating the complexity in the study of mortality in LTC. Further research is required to concretely understand mortality in LTC by different variables and regions. / Thesis / Master of Arts (MA) / This study examined mortality due to COVID-19 from April 2020 to March 2021 in Canadian long-term care (LTC) homes by sex, age, province, and health region. Ranges of predicted values for mortality were created from mortality data from previous years and then compared with actual mortality. The number of active residents, admissions, and discharges were also examined by sex, age, and province to factor for changes in the population at risk. Overall, mortality increased in some quarters (April-June 2020 and October-December 2020) but was not always exceptional, as similar mortality rates had been observed in the four years prior to the pandemic. Also, the increase in mortality was seen mostly among younger residents (65 to 85); mortality remaining stable for the 85+. Further research is still required to better understand mortality in LTC by regional characteristics.

No description available.

No / This paper examines the extent of mental ill-health and probable depression among older people in long-term care. It presents selected findings from a study in Greater Belfast, Northern Ireland, that compared the quality of life, autonomy and mental health of older people living in nursing and residential homes with those of older people living in private households who were receiving domiciliary care. Structured interviews were conducted with 214 residents in institutions and 44 older people receiving domiciliary care. The study found that those in private households were more severely physically-impaired and had a higher level of mental ill-health than the residents of institutional homes. It is suggested, however, that the mental ill-health effects were associated less with physical impairments than with the restrictions placed on the older person's decisional autonomy, and that long-term care environments that constrain the older person's autonomy contribute to the development of depression. Although the UK National Service Framework for Older People specified that those with depression should be given treatment and support, priority should also be given to preventing the depression associated with living in long-term care settings.

English learners are expected to acquire academic language and content simultaneously. Long Term English Learners (LTELs), a growing English Learner subgroup, struggle academically and do not have the necessary academic vocabulary proficiency to achieve academic success in our current educational system. This mixed-methods study examined the implementation of Academic Vocabulary Instructional protocols in the upper grades in a small urban elementary school district. Semistructured interviews, focus group, observation protocol, and data analysis methods were used as primary methods for data collection. Overall, four key themes emerged in this study. First, all 4th- and 5th-grade teachers implemented the new Academic Vocabulary Toolkit and protocol to address the academic language needs of English learner students. Second, teachers consistently used the academic vocabulary and grammatical frames. Third, teachers regularly modeled the use of an academic register. Finally, there was an increase in the use of grammatical sentence frames and academic vocabulary by students across the content areas. Language Acquisition and Sociocultural Theory in Language conceptual frameworks were used.

Yes / This systematic review identifies and reports the extent and nature of evidence to support the use of Dementia Care Mapping as an intervention in care settings. The review was limited to studies that used Dementia Care Mapping as an intervention and included outcomes involving either care workers and/or people living with dementia. Searches were conducted in PubMed, Web of Knowledge, CINAHL, PsychINFO, EBSCO and Scopus and manually from identified articles reference lists. Studies published up to January 2017 were included. Initial screening of identified papers was based on s read by one author; full-text papers were further evaluated by a second author. The quality of the identified papers was assessed independently by two authors using the Cochrane Risk of Bias Tool. A narrative synthesis of quantitative findings was conducted. We identified 6 papers fulfilling predefined criteria. Studies consist of recent, large scale, good quality trials that had some positive impacts upon care workers’ stress and burnout and benefit people with dementia in terms of agitated behaviours, neuropsychiatric symptoms, falls and quality of life. Available research provides preliminary evidence that Dementia Care Mapping may benefit care workers and people living with dementia in care settings. Future research should build on the successful studies to date and use other outcomes to better understand the benefits of this intervention.

No description available.

The concurrent experience of multiple health conditions (often termed multimorbidity) has become an important issue in recent years. Most research on this topic uses clinical data (e.g. GP or hospital records) that lack important socio-contextual information about the lives of people with multiple conditions. Population health surveys can help to overcome these limitations, but identifying people who have multiple conditions is problematic. Decisions need to be taken regarding what is meant by a condition, which ones should be included, and how multiple should be defined. These decisions tend to be based on what data are available, rather than on any universal inclusion criteria or theoretical underpinnings. This thesis used an approach informed by sociological theory and principles drawn from critical realist philosophy to estimate the prevalence of multiple conditions among adults (16+) in the general population, using data from the 1998 and 2008- 2011 Scottish Health Surveys. It explicitly acknowledged the multiple, contested and constructed nature of health, illness and diagnosis; the limits of empirical enquiry; and the need to approach concepts such as multiple conditions critically. To support the decision-making process, longitudinal analyses of mortality were used to examine the impact of including various contested conditions on people’s long-term chance of survival (if there was no evidence of impact then the definition was rejected). The final measure of multiple conditions arrived at suggested that 24.9% of adults had multiple conditions (compared with 17.2% using the survey’s original, unadjusted, measure). This measure was then used to explore how this status related to people’s wellbeing, which helped to highlight importance differences in experiences. Among adults with multiple conditions, 33.5% of those in the most deprived areas had low wellbeing compared with 13.5% of those in the least deprived areas. Low wellbeing was also higher among people with multiple conditions aged under 65 than those aged 65 and over, especially for those living in areas of high deprivation. There was some evidence that having multiple conditions and additional vulnerabilities (e.g. psychological distress, living in a deprived area, having activity limitations) before the age of 55 increased people’s risk of mortality, which might result in older populations appearing to have better wellbeing due to less healthy people not reaching old age. Working-age people with multiple conditions were also more likely than people of the same age with no conditions to be economically inactive, to not live in an owner-occupied property, and not have a co-resident partner. All of which suggest that poor health at younger ages limits access to the social and economic norms enjoyed by most people. The approach adopted arguably helped to avoid over-classifying largely healthy people as having multiple conditions, while still ensuring that people’s own perspectives on their health were not under-privileged with respect to more traditional biomedically-focused approaches. However, it was also clear that the experiences of adults with multiple conditions are highly varied, and in particular, socially stratified. This heterogeneity has implications for research in this field, as well as clinical practice and public health policy. Recommendations for better reflecting this diversity in future studies included collecting more measures of functional capacity, aspirations, illness experiences, and social stressors (such as financial insecurity).

Long-Term Socio-Ecological Research (LTSER) is an inter- and transdisciplinary research field addressing socio-ecological change over time at various spatial and temporal scales. In the Austrian Eisenwurzen region, an LTSER platform was founded in 2004. It has fostered and documented research projects aiming at advancing LTSER scientifically and at providing regional stakeholders with relevant information for sustainable regional development. Since its establishment, a broad range of research activities has been pursued in the region, integrating information from long-term ecological monitoring sites with approaches from social sciences and the humanities, and in cooperation with regional stakeholders. Based on the experiences gained in the Eisenwurzen LTSER platform, this article presents current activities in the heterogeneous field of LTSER, identifying specific (inter-)disciplinary contributions of three research strands of LTSER: long-term ecological research, socio-ecological basic research, and transdisciplinary research. Given the broad array of diverse contributions to LTSER, we argue that the platform has become a relevant "boundary organization", linking research to its regional non-academic context, and ensuring interdisciplinary exchange among the variety of disciplines. We consider the diversity of LTSER approaches an important resource for future research. Major success criteria of LTSER face specific challenges: (1) existing loose, yet stable networks need to be maintained and extended; (2) continuous generation of and access to relevant data needs to be secured and more data need to be included; and (3) consecutive research projects that have allowed for capacity building in the past may be threatened in the future if national Austrian research funders cease to provide resources.