Scholarly Works, Center for Gerontology

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Adult Day Services Participation and Client Depressive Symptoms: A Longitudinal Analysis
Bivens, Rebecca; Norouzi, Neda; Jarrott, Shannon E. (Virginia Tech, 2013-04-04)
Our study explores whether adult day service (ADS) use is associated with the reduction of Geriatric Depression Scale (GDS) scores of older adults who participated in ADS for at least six months.
“All the World’s a Stage” – Bridging the Generational Gap through Theatre
Norouzi, Neda; Lyon-Hill, Sarah (Virginia Tech, 2014-11-05)
This research arose from a shared interest and collaboration between two colleagues in different academic fields. Neda Norouzi is a doctoral student in Architecture and Human Development, interested in how the physical environment affects intergenerational collaboration. Sarah Lyon-Hill is a doctoral student in Urban Planning, studying community-based theatre as an alternative approach to community and economic development. Both authors have theatre backgrounds due to their fathers’ professorial careers in script writing and set design. Understanding their common background and interest in building collaborative relationships among diverse groups, these authors turned to the growing presence and effects of intergenerational theatre programs (IG theatre). IG theatre emerged from the community-based theatre movement, which focuses on building the capacity and voice of different and often marginalized groups within communities through intergroup collaboration and helping diverse groups find a shared community identity (Strimling 2004).
Assuring Quality Care: Exploring Strategies of Medicaid E&D Waiver Providers
Brossoie, Nancy; Roberto, Karen A.; Teaster, Pamela B.; Glass, Anne (Virginia Tech, 2004)
Implementing quality assurance (QA) programs in unregulated noninstitutional settings remains a challenge for home and community-based service providers. A sample of 65 Elderly & Disabled (E&D) Waiver providers in Virginia were presented with eight problem scenarios commonly found in home-care services. Each of the respondents was able to identify strategies they would use to recognize and address each problem. Findings suggest providers currently use multiple mechanisms as part of their overall QA program. Discussion focuses on the strengths of using multiple approaches and on increasing provider awareness of complementary QA strategies and reducing the reliance on staff report as a major QA strategy.
Caregivers of Persons with Mild Cognitive Impairment: Information and Support Needs
Wilcox, Karen L.; Roberto, Karen A.; Blieszner, Rosemary; Winston, Brianne L. (Virginia Tech, 2004-11)
One of the newer concepts of age-related memory deficit is mild cognitive impairment (MCI). MCI reflects self-reported changes in cognitive function that do not necessarily interfere with work or social relations; it is viewed as a transitional phase between normal cognitive aging and dementia. Researchers and practitioners lack a comprehensive understanding of what relatives of persons with MCI are actually experiencing and what they realistically believe would be helpful to manage their situation now and in the future. In a multi-method, mini-longitudinal design that incorporated quantitative and qualitative approaches, we collected information from patient charts and semi-structured family interviews to investigate the information and support needs of 20 (out of 100 to be interviewed) family members of older adults with MCI. We found that, apart from information available about potential later diagnoses such as dementia or Alzheimer’s disease, families reported having little information available to them to assist in decision making and caregiving for early stages of memory loss. Family members were hesitant to think about and plan very far into the future and were more likely to take things a day at a time. Past experiences with family members or friends with memory difficulties or other serious health conditions enabled some family members to feel more at ease and knowledgeable with the process of seeking help for themselves and the older adult they were supporting. Findings suggest that earlier identification of memory loss has implications for clinical practice and the delivery of health care and social services to older individuals and their relatives.
Caregiving Stress, Coping Strategies, and Health Outcomes: Results from the REACH II Study
Butner-Kozimor, L. Michelle (Virginia Tech, 2015-11-21)
The objective of this study was to understand CGs of PwD use of social support and religious and spiritual coping as coping mechanisms and potential impacts on physical and psychological outcomes, in line with the Stress Process Model (Pearlin, Menaghan, Lieberman, & Mullan, 1981).
Change in Reports of Unmet Need For Help with ADL or Mobility Disabilities
Sands, Laura P.; Yuan, Miao; Xie, Yimeng; Hong, Yili (Virginia Tech, 2015)
Self-care (SC) and Mobility (MO) disabled older adults require the help of others to successfully complete daily tasks. Thirty percent of respondents to the 2011 NHATS survey reported unmet need for one or more SC or MO disabilities. Reports of unmet need for disabilities is associated with: Future hospitalization¹ Readmission² Emergency Department use³ Mortality⁴ Little is known about patterns of unmet need over time, especially the degree to which unmet need resolves, varies, or begins. Determination of predictors of change in unmet need status would inform the development of interventions to reduce unmet need.
Community Connections and Sense of Community among Older Adults
Brossoie, Nancy; Mancini, Jay A.; Roberto, Karen A.; Blieszner, Rosemary (Virginia Tech, 2003)
The goal of this exploratory study is to identify what factors predict sense of community in older adult community members.
Daily Stressors and Marital Interactions Affect Diurnal Cortisol and Alpha-Amylase Rhythm in Spouses of Persons with Mild Cognitive Impairment
Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary (Virginia Tech, 2011)
Research aims: 1. To document daily symptoms and behaviors of persons with MCI 2. To assess how MCI-related symptoms, care needs and other stressors influence psychological well-being of care partners 3. To examine effects of MCI-related symptoms, care needs and other stressors on spouse care partner’s physiological indicators of health (Diurnal Rhythm of Coritsol and Alpha-Amylase)
Dual Caregivers of Persons Living with Dementia: The Added Stress of COVID-19 Pandemic
Atkinson, Emily; Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; McCann, Brandy R.; Knight, Aubrey L. (SAGE, 2022-02-17)
Serving in dual caregiving roles presents challenges and has consequences for caregivers’ physical and mental health. Forty-six dual caregivers in rural southwest Virginia participated in one semi-structured telephone interview pre-pandemic. Of these caregivers, nine dual caregivers of multiple older adults (MOA) and six caregivers of multiple generations (MG) participated in two telephone interviews during the COVID-19 pandemic. Pre-pandemic health, stress, and support data were used to compare dual caregivers of MOA and MG; differences were minimal. Responses to interviews conducted during the pandemic highlighted the effects of social restrictions on MOA and MG caregivers, revealing five themes (1) Increased isolation, (2) Increased need for vigilance, (3) Negative impact on mental health, (4) Tendency to “do it all,” and (5) Increased informal help. MOA and MG caregivers differed on managing care responsibilities and ensuring the health of care recipients. In general, dual caregivers experienced decreased mental health, increased social isolation, and increased caregiving responsibilities. Antecedents of the pandemic experiences differentiated MOA and MG caregiver. Findings suggest that programs and services should target dual caregivers’ unique needs.
Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults
Frames, Christopher W.; Soangra, Rahul; Lockhart, Thurmon E.; Lach, John; Ha, Dong Sam; Roberto, Karen A.; Lieberman, Abraham (MDPI, 2018-05-24)
Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m², using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance.
Elderly & Disabled Waiver Services: What Do We Know About Providers?
Glass, Anne; Roberto, Karen A.; Teaster, Pamela B.; Brossoie, Nancy (Virginia Tech, 2003)
Little is known about home and community based services (HCBS) and even less about the quality of those services. As part of a “Real Choice Systems Change” grant received by the Virginia Department of Medical Assistance Services, the Center for Gerontology at Virginia Tech conducted a survey of agencies providing HCBS under the Medicaid Elderly and Disabled (E & D) Waiver. A written survey was sent to 160 providers across the state, based on a sampling plan designed to ensure representation of all planning districts and services mixes. Seventy surveys were returned for a response rate of 44%.
Evidence that Community-Based Long-Term Care is Preventive Care
Sands, Laura P. (Virginia Tech, 2014)
This presentation outlines the benefits of community-based long-term care, including reduced hospitalization rates.
An Exploration of Older Men’s Acceptance of Age Inequality
King, Neal M.; Pietilä, Ilkka; Calasanti, Toni M.; Ojala, Hanna (Virginia Tech, 2014)
Age relations treat old people as marginal to occupational and dating networks, stigmatizing them as unattractive and unfit to do valuable work (Calasanti 2003; King 2006). Those systems intersect with gender, in which men gain privilege by associating themselves with skilled, valuable work and athletic performance, and women with sexual receptivity and artificial display (Calasanti and King 2007). In the intersection of age and gender, men lose much of their privileges as they grow old and leave the workplace, dismissed as no longer able to perform on valued jobs (King and Calasanti 2013). A large anti-aging industry markets to men products that promise to restore sexual potency and workplace assertiveness, as ways to counter the emasculating effects of old age (Calasanti 2007). Among studies of inequality, that of age relations provides a unique opportunity to test the extent to which a group can reify its own eventual subordination. This is due to the temporal nature of age relations (Calasanti 2007; Spector-Mersel 2006). We test for the hegemonic effect of masculinity.
Extended Family Caregivers for Persons Living With Dementia
Roberto, Karen A.; Savla, Jyoti S. (SAGE, 2022-11-01)
Despite changes in the structure of contemporary families, little is known about extended family members—siblings, grandchildren, nieces/nephews, stepkin—who are primary caregivers for a relative living with dementia. Information about these caregivers is needed to help ensure their needs are understood by providers in health care and social service settings. The focus of this research was on the care situations of extended family caregivers and the impact of caregiving on their health and well-being. In Study 1, data from the National Study of Caregiving were used to describe the experiences of 107 extended family caregivers. In Study 2, case study techniques elicited additional information about the experiences of 10 extended family caregivers. Collectively, these caregivers provide care with little or no formal support and occasional help from a small informal network. Caregiving affected their physical and emotional health, depending on the strength of the relationship between the caregiver and the person living with dementia and the type of care provided. Findings contribute new knowledge about extended family caregivers and highlight the important role extended family dementia caregivers play and the challenges they face.
Extended parallel process model (EPPM) in evaluating lung Cancer risk perception among older smokers
Zarghami, Fatemeh; Allahverdipour, Hamid; Jafarabadi, Mohammad Asghari (2021-10-17)
Background There is a lack of scientific literature on the application of fear appeals theories to evaluate lung cancer risk perception among smokers. The aim of the present study is to apply the Extended Parallel Process Model (EPPM) to discover the perception of the smokers about their lifetime risk of developing lung cancer (perceived susceptibility), their perception of lung cancer survival (perceived severity), response efficacy, self-efficacy, and readiness to quit. Methods In this cross-sectional study, 215 eligible smokers (aged 45 years and over who have smoked at least 1 pack per day in the last 5 years) were recruited. The data collection tool was designed using validate self-report questionnaires and it was contained items on the perceived risk of a smoker contracting lung cancer and perceived lung cancer survival rate. It also had questions to measure the main constructs of the EPPM and Readiness to quit (“Low_Readiness”, and “High_Readiness”). To test how the data support conceptual EPPM to data, Generalized Structural Equation Modeling (GSEM) was used. Results Findings showed a significant relationship between Perceived_Susceptibility and Perceived_Response Efficacy; (B = 1.16, P < 0.001); between Perceived_Susceptibility and Perceived_Self Efficacy, (B = -0.93, P < 0.001), Perceived_Severity, and Perceived_Response Efficacy (B = 1.07, P < 0.001). There was also a significant relationship between Perceived_Threat and Perceived_Response Efficacy; between Perceived_Threat and Perceived_Self Efficacy. The relationship between High_Readiness and Perceived_Self Efficacy, and between High_Readiness and Perceived_Severity also were significant. However, the relationships between High_Readiness and Perceived_Threat were not significant (P > 0.05). Conclusion Perceived_threat and Perceived_efficacy were important for smokers with low readiness to quit, while Perceived_efficacy was most important for smokers with high readiness to quit. These findings could be used in promoting lung cancer awareness and designing smoking cessation programs based on smokers’ stages of change.
Extending Terror Management Theory to Increase Understanding of Older Adults’ Views of Death
Ogletree, Aaron M.; Blieszner, Rosemary (Virginia Tech, 2015-11-19)
We applied Baltes’ lifespan development perspective to TMT to examine how experiences influence worldview change over time. We argue that worldview adaptations can bolster older adults against death threat and ameliorate death anxiety.
Family Caregivers in Rural Appalachia Caring for Older Relatives With Dementia: Predictors of Service Use
Savla, Jyoti S.; Roberto, Karen A.; Blieszner, Rosemary; Knight, Aubrey L. (Oxford University Press, 2022-01-01)
Background and Objectives Residents of rural Appalachia tend to experience poorer health and greater economic distress than rural dwellers elsewhere in the United States. Although family is the first line of support for older adults needing care, it is unclear whether dementia caregivers in Appalachia assume these care responsibilities because of strong informal networks that support them in their caregiving role, underresourced formal services for persons with dementia, or culture-based reluctance to accept help from outsiders. This research examines how rural residents of Appalachia manage the care of relatives with dementia. Research Design and Methods The study was grounded in the Andersen Behavioral Model, supplemented with culturally relevant variables. Family caregivers from rural Appalachian counties in Virginia caring for community-dwelling relatives with dementia participated in a structured phone interview (N = 163). Generalized structural equation models were estimated, with predisposing, need, and enabling variables as predictors. Use of support services (e.g., meal delivery) and personal services (e.g., home health nurse) by family caregivers to care for the person with dementia were the dependent variables, and caregiver's rural community identity and attitude toward services were moderators. Results Approximately half the sample utilized at least one support service and one personal service. Predisposing and need factors predicted the use of support services, whereas predisposing, need, and enabling factors predicted personal services. Caregivers who strongly identified with their cultural roots were less likely to use personal services unless they held a generally positive view of formal services. Discussion and Implications Although the extent of needs and the caregiver's economic situation were essential influences on formal service utilization, the main drivers were the caregiver's identification with rural Appalachian culture and attitude toward services. Findings point to within-group heterogeneity that requires differential approaches to delivery of community-based services accounting for varying attitudes, preferences, and family resources.
Family Perceptions of Mild Cognitive Impairment
Roberto, Karen A.; Blieszner, Rosemary (Center for Gerontology, Virginia Tech, 2007-11)
Financial Abuse in the Headlines: Prevalence of National Newsfeeds
Roberto, Karen A.; Teaster, Pamela B.; Migliaccio, John; Blancato, Robert; Lawrence, Susie (Virginia Tech, 2010)
This presentation provides an overview of elder financial abuse, including causes and effects.
Friendship in Later Life: A Research Agenda
Blieszner, Rosemary; Ogletree, Aaron M.; Adams, Rebecca G. (Oxford University Press, 2019-01-01)
Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.

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