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Hospital Readmissions: the Need for a Coordinated Transitional Care Model: Analysis and Synthesis of Research on Medicare Policy and Interventions for the Elderly

Description: The transition from hospital to home or alternate care setting is a time of vulnerability for all patients and particularly for our elders. If not handled appropriately there is a risk to our elders for readmission to the hospital environment that may decrease their overall quality of life and further compromise their health status. in addition to the individual risks associated with patient readmissions, there are societal impacts that reach far beyond our current generation of elders 65 and older. This impact may have dire implications for the future fiscal health of the next generation. a review of the current and past literature shows that there are a limited number of resources available for hospitals to use in order to comply with the new Value Based Purchasing initiatives that are being implemented by CMS regarding the reduction in readmission rates. the problem of hospital readmissions is confounded by the many processes that are available for study, from pre-hospitalization conditions and care through hospitalization, discharge, and finally to post discharge processes. While most research and literature reviews have focused on individual disease causes, there is a need to provide hospitals with a resource that outlines the available options and interventions that have been shown to be effective in reducing hospital readmissions. the purpose of this study is to review relevant literature related to the problem of hospital readmissions for our elder population. This study is designed to look at interventions, both disease based and non-disease based, that have been previously implemented and have shown effective reductions in readmission rates. This analysis and synthesis can provide an important contribution to our understanding of the factors and variables that influence the readmission rates of our elder population. This review has the potential to assist and direct hospital administrators and to discharge planners, social ...
Date: May 2012
Creator: Wolfe, Laura M.
Partner: UNT Libraries

Investigating the Effects of Polypharmacy Among Elderly Patients with Diabetes on Glycemic Control and Clinical Outcomes in Home Health Care

Description: The focus of this research study is glycemic control in the presence of multiple morbidities and polypharmacy in homebound individuals with Type 2 diabetes aged 65 years and older. The research method is a quantitative retrospective cohort study of discharged patients of a nonprofit community-based home health agency from January 1, 2010, to December 31, 2011, using OASIS data. Glycemic control is assessed using the hA1C laboratory test following the recommendation of the American Diabetes Association. The study documents a moderate significant association between glycemic control, polypharmacy and comorbid conditions, indicating that homebound individuals with Type 2 diabetes aged 65 years and older are less likely to have optimal glycemic control in the presence of multiple morbidities and polypharmacy. There continues to be a need for scientific research in this population cohort; and the dose-response association between antidiabetic therapy interventions designed to lower blood glucose levels in the presence of chronic disease and polypharmacy.
Date: December 2012
Creator: Bernier, Shelia Alathia
Partner: UNT Libraries

Long-Term Care Administrator Licensure and Certification: An Emerging Health Profession

Description: The long-term care administrator profession is one that is both new and evolving. The unique historical perspective of this health profession is brief in the number of years it encompasses and crucial in understanding the current issues facing the profession. Administrator experiences provide a point of reference regarding the profession's structural problems. Ethical considerations play a dynamic role in administrators' daily jobs as well as their continued licensure. The significance of the profession's ongoing problems at the state and national level causes the need for alternatives to the current system. A combination of these alternatives must be embraced to assist in the recruitment and retention of long-term care administrators.
Access: This item is restricted to UNT Community Members. Login required if off-campus.
Date: May 2000
Creator: Syverson, Thomas
Partner: UNT Libraries

Humor and Nursing Home Residents

Description: Although humor is a generally accepted part of everyday life for humans, its existence, importance, and positive influence on older persons are often underestimated. The purposes of this study are to determine whether humor is a normal experience for nursing home residents, enhancing their activities of daily living, and whether it plays a role in contributing to their psychological well-being. The study includes a discussion of research on humor, particularly as it relates to the elderly and the aging process; analysis and comparisons based on interviews with residents on the subject of humor and review of their psychological state as evaluated by the MDS 2.0 nursing facility assessment; individual case studies, and anecdotes illustrating the beneficial contributions humor brings to the lives of nursing home residents.
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Date: May 2000
Creator: Cecil, David P.
Partner: UNT Libraries

Disaster Preparedness: A Procedure Manual for a Nursing Home

Description: Disaster or emergency situations have the potential for serious impact on the safety and security of both residents and staff in a nursing home. Furthermore, federal and state laws require that all nursing facilities be prepared in case of an emergency or disaster. The first part of this document is an introduction and rationale for the development of a nursing home disaster plan. The second part is a procedure manual developed for a nursing home in Oklahoma, outlining emergency actions and recovery procedures for various types of disasters, followed by a list of emergency telephone contacts of key personnel and services both inside and outside the nursing facility.
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Date: May 2000
Creator: Reimer, Carmen Schmidt
Partner: UNT Libraries

Tuberculosis in the Nursing Home: A Policy and Procedure Manual

Description: Tuberculosis in the nursing home is an ever-growing problem for the health care community. The incidence of tuberculosis in the United States has risen alarmingly since 1982, and high-population environments such as nursing homes are among the places where it is most prevalent. The first part of this document is an introduction to the current concerns faced by nursing home infection control personnel. It includes information about the history, symptoms, and epidemiology of the disease, as well as other topics. The second part is a policy and procedure manual that contains a basic guide to methodical testing for tuberculosis, steps for dealing with active cases of the disease, and suggestions for education of nursing home health care workers.
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Date: May 2000
Creator: Mounts, Camilla M.
Partner: UNT Libraries

Are the Needs of North Dakota's Aging Population with Developmental Disabilities Being Overlooked?

Description: North Dakota is faced with the challenge of meeting the needs of its growing population of elderly persons aging with a developmental disability. The challenge of creating new service models presents itself to professionals in the fields of Aging and Developmental Disabilities. Traditionally, the aging person with a developmental disability has been sent to nursing homes or grouped into community programs with younger persons with developmental disability. North Dakota is looking toward the future of caring for this special population through integration with elderly without disabilities.
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Date: May 2002
Creator: Clark, Amy Klein
Partner: UNT Libraries

Assisted Living: The Need for Creation of Affordable Options

Description: Assisted living, the fastest growing segment of the senior housing industry, allows individuals to remain as independent as they prefer and still receive necessary services. However, assisted living residences exist primarily to serve those seniors who can pay for the services from their own savings/income. We are facing a critical need for housing options for both the current senior generation and the soon-to-be-retired baby boomers. How will access to assisted living be opened to all types of payors? How will states fund the growth of assisted living? The purpose of this paper is to discuss opportunities for expansion that will make assisted living an affordable option for the low- and moderate-income elderly.
Access: This item is restricted to UNT Community Members. Login required if off-campus.
Date: August 2000
Creator: Kretzinger, Robert W.
Partner: UNT Libraries

Domestic Violence Shelters in Texas: Responding to Programming Needs of Older Victims of Intimate Partner Violence

Description: This study examined if domestic violence shelters in Texas are responding to the needs of older female victims of intimate partner violence. Data for this study was collected through online questionnaire surveys of 45% of Texas domestic violence shelters. Findings of this study indicated that less than 10% of Texas shelters are providing specialized programming for older victims of IPV. In Texas, the demographic growth of older adults has remained comparable to increased national trends. The state of Texas will face several policy implications and social issues related to an older population that is rapidly growing. This includes, the importance of addressing certain members of an aging population who continue to fall victim to domestic violence. Furthermore, an unchanged resource of safety for victims of IPV is domestic violence shelters. Therefore, this study challenges current domestic violence shelter policies to address this issue of a rapidly growing segment of the Texas population. This study found less than 10% of shelters in Texas, who participated in this study, were providing specialized programming and outreach for older victims. Important practical implications for domestic violence shelter programming in Texas is provided.
Date: December 2010
Creator: Lozano, Yvonne M.
Partner: UNT Libraries

A Program Committed to the Persistence of African-American Males in Higher Education

Description: This qualitative study described and examined the characteristics, components and theoretical design of the Student African-American Brother (SAAB). The SAAB is a national program that seeks to increase the academic and social integration of African-American males in higher education to increase their potential to graduate with an undergraduate degree. The SAAB's academic and social integration strategies were compared to Bean and Bennett's conceptual model of black student attrition to determine the congruency between the organization's strategies and the theoretical framework. The methodology was case study. Thirty semi-structured interviews were held with past and current members of the organization to gain a broader knowledge of the SAAB strategies and interventions used to promote their academic and social integration. The research revealed the SAAB applies a three dimensional approach which consists of providing a supportive environment, supporting academic goals, and encouraging campus and community involvement. This approach increases the students' understanding of the organization and structure of the higher education setting to yield successful matriculation through a four year college or university.
Date: August 2008
Creator: Jackson, Princess D.
Partner: UNT Libraries

The Willingness of Older Adults to Evacuate in the Event of a Disaster

Description: The issue of rising number of disasters, the overwhelming increase in number of older adults, and historically flawed evacuations presents real challenges. Disasters can strike anywhere, any time, and have devastating consequences. Since 1900, the number of Americans 65 and older has increased 12 times (from 3.1 million to 36.3 million). During the next two decades, the number of American baby boomers, now aged 45-64, who turn 65, will increase by 40%. As evidenced by recent disasters, the imperfections and vulnerabilities of flawed evacuations for older adults are still present. This study examined the level of willingness to evacuate among older adults in the event of a disaster. Despite the extensive literature on disasters and evacuation, some significant questions regarding evacuation and older adults have not been addressed. This study addressed the following concerns: (1) What is the willingness among older adults to evacuate when asked to do so by emergency management officials? (2) Does the call to evacuate being mandatory versus voluntary influence the willingness of seniors to evacuate? (3) Do preconditions (Gender, Marital Status, Age, Ethnic Origin, and Education Levels) influence the willingness to evacuate among older adults? The sample population consisted of 765 voluntary participants aged 60 years and older from thirty senior/community centers within seven counties in the State of Oklahoma. A group administered survey (The Disaster Evacuation Survey) included a total of 15 questions. This study revealed the following findings: older adults are more likely to comply with a mandatory evacuation order. Individuals with college degrees are more likely to comply with mandatory evacuations. African Americans are more likely to comply with a voluntary request. American Indian/Alaskan Native are more likely to comply with mandatory evacuation orders from emergency officials. Important practical implications for emergency officials responding to vulnerable older adults in disaster situations are ...
Date: May 2009
Creator: Gray-Graves, Amy Michael
Partner: UNT Libraries

Does Prostate Cancer Begin in the Prostate? Key Predictors of Diagnosis

Description: The purpose of this exploratory study was to identify the key predictors of prostate cancer; such study may lead to the development of appropriate interventions and prevention. Previous epidemiological studies have found these following factors to be key predictors for being diagnosed with hormone-associated carcinoma such as prostate cancer: age, ethnicity, physical activity, family history, diet, sleep amount, marital status, and having another form of carcinoma. Many studies have included results only for men over the age of 65, however, prostate cancer is claiming the lives of many African American, Hispanic and White American men over the age of 35, and younger men are more likely to battle it if they are genetically predisposed. The sample population (N =21,646) was selected because men aged 35 or over have the highest prevalence of prostate cancer. Of this sample, 619 reported having prostate cancer, and 1,401 reported having some other type of cancer. This study employs a logistic regression model using SAS® and utilizes the National Health Interview Survey data set and a multivariate analysis of the years 2006, 2007, and 2008. To improve the quality of future research the methods need modification, the subpopulation being studied should be larger, and the studies should be longitudinal. This particular study found the aforementioned factors to be critical in predicting prostate cancer. Maximum sun exposure was found to be also related to having prostate cancer. Key predictors for prostate cancer diagnosis are age, ethnicity, having some other cancer and maximum sun exposure, and education. Though previous studies have found physical activity, sleep amount, and occupation to be beneficial in reducing the risk for prostate cancer, it was not confirmed in this particular study.
Date: August 2011
Creator: Orakpo, W. Nnamdi
Partner: UNT Libraries

Senior Graduating Nursing Students: Career Choices in Gerontological Nursing in Response to Expanding Geriatric Population

Description: Access to healthcare is needed and wanted by people of all ages and especially by those of the older population. The number of people in the 65 years of age and older population is rapidly growing with their needs expected to have a significant impact on the existing healthcare system and healthcare providers. The impact will be critical given the severe shortage of healthcare providers, especially of nurses and the rate of services being more often provided in non-hospital settings. The objectives of the study were to discover the plans of graduating nursing students as they choose their first place of employment, if they have future plans to pursue a nursing advance practice degree, and if they are very happy with their decision to become a nurse. Data for the study were obtained from a questionnaire presented to senior graduating nursing students. The findings were: (a) Most students prefer a hospital setting. (b) Younger students are three times as likely to seek out the hospital, and 1/3 of the students seek out the hospital setting because they were encouraged to become a nurse. (c) About 70% of the students want to work with their friends while 1/3 will seek the hospital worksite, as it is perceived as being the strongest resource in paying back loans. (d) Nearly 87% are considering the nursing advance practice role, and 52% have interest in the nurse practitioner role. The majority of students identified as very happy with their decision to become a nurse. This study provided insight for schools of nursing as they make curriculum decisions and to businesses as they learn of the preferences and plans of the new emerging nurses.
Date: December 2011
Creator: Anders, Judith E.
Partner: UNT Libraries

Pets and the level of loneliness in community dwelling older adults.

Description: Loneliness is a significant problem for older adults and can lead to negative health and social outcomes. Having a companion pet is beginning to be recognized as a way loneliness can be reduced for older persons. The purpose of this descriptive study was to determine the effect of pets on the level of loneliness in persons 60 years old or older who live alone and independently in a large metropolitan community in the North Central Texas area. Using a non-random snowball sample of older individuals (N = 252), who met the study criteria, each subject was administered the researcher-developed demographic data survey instrument containing the following variables: (a) pets - having a pet/wanting a pet, (b) age, (c) gender, (d) marital status, (e) living alone, (f) losses within the last six months, (g) interactions with family members, (h) interactions with others outside of the family, (i) highest educational level achieved, (j) employment or volunteer involvement in the community, (k) religious participation, and (l) self perceived health status. The UCLA Loneliness Scale Version 3 was used to obtain the loneliness scores. Prediction of loneliness and relationship with the independent variables was tested using frequency, correlation, analysis of variance (ANOVA), and multivariate analysis using ordinary least-squares (OLS) regression analysis. The findings from this study showed that those older adults living alone who did not have a pet but would like to have a companion pet had higher levels of loneliness (p<0.05). Other findings suggested that older adults' loneliness was less if they had moderate religious participation and interactions with others (p< 0.05). Future studies are needed to examine the effects that pets have on feelings of loneliness and the ability of older individuals to cope effectively with those feelings.
Date: December 2006
Creator: Nunnelee, Jane Baker
Partner: UNT Libraries

An Evaluation Model for Identifying Lewisville and San Angelo, Texas, as Senior Ready Communities

Description: This research portrays a paradigm for the assessment of aging services to support populations aging in place. The dissertation was designed to establish a model to identify and evaluate senior ready communities. Area specific social programs and services are identified. In order to meet the growing needs of aging populations, the dynamic representation of existing services and the need for services that could be developed in certain communities require reevaluation in current planning, restructuring, and/or community development.
Date: December 2009
Creator: Sanders, David N.
Partner: UNT Libraries

Sex and Older Americans: Exploring the Relationship Between Frequency of Sexual Activity and Happiness

Description: The purpose of this study is two-fold: (1) to examine the correlation between frequency of sexual activity and general happiness among older Americans and (2) to examine the correlation between frequency of sexual activity and marital happiness among older married Americans. This study employed quantitative data drawn from the 2004-2008 General Social Surveys. Two samples were used. The first sample included all respondents 65 years of age and older with valid responses for the dependent, independent, and control variables. The second sample was a subset of the first and included only the married respondents. Both bivariate cross-tabulations and binary logistic regression analyses were conducted. As expected, the data support a positive association between sexual activity and general happiness in both the total elder sample and the married elder sample (p < 0.05). Also, as expected, the data support a positive association between frequency of sexual activity and marital happiness in the married elder sample (p < 0.05). Even with the introduction of control variables, frequency of sexual activity was found to be a significant predictor of both general and marital happiness (p < 0.05). This study suggests that sexual activity does indeed contribute the happiness and well-being of older Americans.
Date: August 2010
Creator: Jackson, Adrienne
Partner: UNT Libraries

Perceptions of Careproviders Concerning the Normalization/Developmental Model's Replacement of the Medical Model as the Basis for Providing Education and Training to the Institutionalized Adult with Developmental Disabilities

Description: Previous research suggests that careproviders' attitudes and perceptions significantly influence the type and quality of services received by institutionalized adults with developmental disabilities (IADD). This study explored attitudes careproviders hold concerning training needs of the IADD and their service model orientation. It traced the history of training people with developmental disabilities and provided a brief review of the medical, developmental, and normalization models of service delivery. The conceptual framework upon which this study was based proposed that staff perceptions and orientation concerning service delivery to the IADD can be conceptually related to five factors in a research model. They were identified as: (a) careprovider's characteristics; (b) working environment; (c) previous careprovider experience; (d) developmental disability history within the careprovider's family; and (e) self-reporting of a service delivery orientation. This study examined only a portion of this model (factors a, b, and e). The response sample included 370 professionals and paraprofessionals, aged 17 to 72 years, who were employed at a large residential facility serving individuals with developmental disabilities in Denton, Texas. The respondents were predominantly female (76.5%), Caucasian (72.2%) with slightly less than 75% having more than a high school diploma. The instrument, a self-administered questionnaire, consisted of three parts; Careprovider's Service Model Orientation; Careprovider's Perception of Training Needs; and, Demographic Information. Data were analyzed through the use of regression, chi square, and analysis of variance tests. Findings revealed several significant relationships between: professional status and perceptions of training needs of the IADD; professional status and service model orientation; professional status and reported service model orientation; professional status and attitude toward the medical model; and, professional status and attitude toward the developmental model. Significant relationships were not found for four additional hypotheses that were included the study.
Date: May 1993
Creator: Coutryer, Sharon M.
Partner: UNT Libraries

Working Baby Boomers’ Knowledge of Retiree Health Benefits and Costs

Description: This study was exploratory in nature, with the purpose of examining the relationships between working Baby Boomers’ knowledge of retirement health benefits and health costs and actions they have taken to prepare for retirement. An online survey was completed by 209 Baby Boomers who are employed by three city governments in the Dallas-Fort Worth Metroplex. The research showed that health benefits knowledge does not predict retirement preparation but that Baby Boomers who demonstrate higher levels of knowledge-seeking behavior are more likely to undertake retirement preparation, specifically by purchasing an annuity. Among public sector working Baby Boomers, retirement preparation activities are found to be minimal. Age was found to predict knowledge-seeking behavior, in that older vs. younger Baby Boomers are more likely to engage in knowledge-seeking behavior related to retirement preparation. Current knowledge about health benefits does not predict retirement preparation.
Date: August 2012
Creator: Henning, Janet L.
Partner: UNT Libraries

An Exploratory Study of Factors Influencing the Effectiveness of the Amob/vll Program for Participants in North Central Texas

Description: This study assessed falls efficacy and confidence-related changes among participants attending the a Matters of Balance/Volunteer Lay Leader (AMOB/VLL) falls prevention program for older adults, based on their residential location. Data were examined from 431 older Texans enrolled in AMOB/VLL during a two-year period, and assessed at baseline and post-intervention. Results indicate that participants significantly increased falls efficacy, reduced activity interference due to their health, and decreased the number of days limited from usual activity. Regression models show that participants, despite entering the program with lower reported health status, reported greater rates of positive change for falls efficacy and health interference compared with their baseline pre-intervention counterparts. Overall program attendance and attendance at major sessions showed the greatest influence. Findings contribute to the understanding of cognitive restructuring and strengthening variations with falls prevention program outcomes.
Date: December 2011
Creator: Ewing, Charles W.
Partner: UNT Libraries

Disaster Experience and Self-efficacy As Factors Influencing Emergency Planning in Community-dwelling Older Adults

Description: This study design was to identify and examine how disaster experience, self-efficacy, and demographic factors influence disaster preparedness in community-dwelling older adults. Current data indicates the United States is rapidly aging. Parallel to this significant increase among the elderly population, natural disasters are more prevalent. Consequently, older adults are affected adversely by these disasters and exposure to social vulnerabilities during the disaster cycle. For the purpose of this study, non-identifiable secondary data were analyzed. Sources of the data were the 2007 and 2008 National Center for Disaster Preparedness surveys. The sample focus of this study was adults 50 and older. Regression analyses identified important predictors of disaster preparedness in the survey respondents. Sample adults with previous disaster experience are two times more likely to be in a higher category for having an emergency plan than those respondents with no observable effects of self-efficacy and no previous disaster experience. The frequency of natural disasters in the United States has generated a renewed interest in disaster management, in particular, disaster preparedness. Nevertheless, the focal point of disaster preparedness is no longer the rudimentary stockpile of water, a first aid kit, and a battery operated radio. To advance the field of disaster management it is vital for gerontologist to approach disaster preparedness by differentiating between stockpiling supplies and social cognitive interventions that fundamentally alters preparedness behavior.
Date: August 2014
Creator: Symonette, Erika
Partner: UNT Libraries

An Application of Marxian and Weberian Theories of Capitalism: the Emergence of Big Businesses in the United States, 1861 to 1890

Description: This study was an examination of businesses that became big businesses in the United States during the time period between the years of 1861 and 1890, a period of time frequently referred to as the “big business era.” The purpose of the study was to identify actions taken by businesses that enabled them to become and remain big businesses. A secondary purpose of the study was to show that these actions were explained by theories of Karl Marx and Max Weber. The results of the study showed that businesses which took specific actions were able to become and remain big businesses and these actions were explained by the theories of Marx and Weber. The results of the study demonstrate the ability of classical sociological theory to explain macro-level social change.
Date: May 2015
Creator: Magness, Penny J.
Partner: UNT Libraries