Browsing by Author "Huber, Lesa"
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Item Activities and support provided by family caregivers of persons with type 2 diabetes(2016-03-11) Scarton, Lisa J.; Bakas, Tamilyn; Miller, Wendy; McLennon, Susan M.; Huber, LesaType 2 diabetes, a chronic condition affecting millions, continues to rise in epidemic proportions. Type 2 diabetes, managed through lifestyle changes, affects the entire family. Family caregivers provide vital support to these individuals; however, little research has been conducted surrounding the perceived difficulty or ease of caregiver activity and supportive behaviors. The purpose of this dissertation was to develop and psychometrically test a scale that measures this difficulty or ease of activities and behaviors. This was accomplished through the compilation of three distinct manuscripts. First, an integrative review was conducted to identify what is known regarding needs and concerns of family caregivers of persons with type 2 diabetes; findings revealed a need for more research. Then, based on these recommendations, a qualitative study was conducted that explored the needs and concerns identified by 33 American Indian, African American, and White family caregivers. All these caregivers had similar concerns related to needing general diabetes information, providing support to the family member, and taking care of their own health. Study themes were used to develop items for a new instrument, the Diabetes Caregiver Activity and Support Scale (D-CASS) that was psychometrically tested with 101 American Indian, African American, and White family caregivers of persons with type 2 diabetes. This study used a cross-sectional, descriptive-correlational design and provided evidence of internal consistency reliability (α = .82) and two-week test-retest reliability (intraclass correlation coefficient = .70) for the D-CASS. Criterion-related validity was established using a single-item criterion measuring overall how easy or difficult it was for caregivers to provide care for their loved ones (r = .65, p < .01). Unidimensionality was supported by factor analysis, with loadings ranging from .45 to .70, with 32% of the variance explained by the first factor (eigenvalue = 4.02). Model testing through a series of three hierarchical multiple regressions guided by a conceptual model provided further evidence of construct validity for the D-CASS. This dissertation provided better understanding of needs and concerns of family caregivers of persons with type 2 diabetes and led to the development of a psychometrically sound diabetes-specific instrument for future research.Item Cognitive Dysfunction in Older Breast Cancer Survivors(2020-09) Crouch, Adele Deborah Lenae; Von Ah, Diane; Champion, Victoria; Pressler, Susan J.; Unverzagt, Frederick; Huber, LesaUp to 75% of the more than 3.5 million breast cancer survivors (BCS) living in the United States report cognitive dysfunction. However, little is known about cognitive dysfunction among older BCS, who may be at greater risk. Therefore, the purpose of this dissertation was to characterize cognitive dysfunction in older BCS. Specific aims included: (1) synthesize the literature regarding cognitive dysfunction in older BCS; and (2) examine the relationships between a) objective cognitive function (immediate memory, delayed memory, attention, executive function-working memory, verbal fluency) and subjective cognitive function (attention); b) demographic factors, medical factors, treatment factors, and cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive function; and c) comorbidity and cognitive function and physical functioning, and quality of life (QoL) in older BCS. In an integrative review, to address aim 1, 12 studies were identified. Up to 41% of older BCS showed objective cognitive dysfunction on neuropsychological assessment, up to 64% reported subjective cognitive dysfunction concerns pre-treatment, and 50% incurred cognitive decline from pre- to post-treatment. Cognitive dysfunction was associated with older age, multiple comorbidities, chemotherapy, sleep disturbance, neuropsychological symptom cluster, frailty, and poorer QoL. To address aim 2, data were leveraged from a large, nationwide, QoL in younger versus older BCS study (PI: Champion), which included 335 older BCS who were ≥60 years of age, had breast cancer (stage I-IIIa), received chemotherapy, and were 3-8 years post-diagnosis without recurrence. Findings included up to 19% of older BCS had mild-moderate objective cognitive dysfunction on at least one neuropsychological assessment, with 26% reporting poor-moderate subjective attention function. BCS, who were older, had less education and more depressive symptoms had greater cognitive dysfunction. Objective attention and executive function-working memory significantly and positively correlated with subjective attention. In turn, subjective cognitive dysfunction and increased number of comorbidities were related to poorer physical functioning. Subjective cognitive dysfunction was also related to poorer QoL. The findings from this study highlights the prevalence and complexity of cognitive dysfunction in older BCS. Further research is needed to better understand the intersection of aging, cancer, comorbidities and cognitive dysfunction and the negative implications in older BCS.Item Cognitive Dysfunction Prevalence and Associated Factors in Older Breast Cancer Survivors(Elsevier, 2022) Crouch, Adele; Champion, Victoria L.; Unverzagt, Frederick W.; Pressler, Susan J.; Huber, Lesa; Moser, Lyndsi R.; Cella, David; Von Ah, Diane; School of NursingObjectives: The purpose of this study was to examine the prevalence and factors associated with objective and subjective cognitive dysfunction in older breast cancer survivors (BCS). Materials and methods: This cross-sectional descriptive study leveraged previously collected data from older BCS (n = 335). Separate linear regression models were used to determine relationships between demographic factors (age, education), medical factors (comorbidities), disease factors (time since diagnosis, cancer stage), cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive dysfunction measures, including objective learning, delayed recall, attention, executive function-working memory, verbal fluency and subjective attentional function. Results: Cognitive dysfunction was prevalent with up to 18.6% of older BCS experiencing mild-moderate dysfunction (1.5 standard deviations below mean of non-cancer controls) in at least one cognitive domain. Poor to moderate subjective attentional function was reported by 26% of older BCS. More depressive symptoms were significantly related to poorer cognitive function including learning (p < .01), delayed recall (p < .05), verbal fluency (p < .001), and subjective attentional function (p < .001) but not attention and executive function-working memory. Age, education, anxiety, and fatigue were also negatively associated with cognitive function in some models (p < .05-0.001). Conclusion: Cognitive dysfunction is common among older BCS and depressive symptoms, anxiety, and fatigue are related factors. Importantly, depressive symptoms were not only related to self-report, but also to cognitive performance. Healthcare providers should be aware of and assess for related factors and cognitive dysfunction itself in older BCS even years after diagnosis and treatment thorough geriatric assessment. Future longitudinal research is needed to discern these relationships.Item The Experience of Burmese Refugee Students in Higher Education: Blooming out of Concrete(2022-09) Lim, Minyoung; Adamek, Margaret E.; Pierce, Barbara; Lee, Jessica E.; Huber, LesaThe United States is the world’s top resettlement country for refugees and the third largest community of Burmese refugees lives in the state of Indiana. Many refugee families look to their college-age youth to enhance their well-being. This study explored the lived experiences of Burmese refugee college students’ resettlement and the role that social support plays in that approach. In order to explore the refugee students’ resettlement experiences and the role of social support, social support theory and conservation of resources theory were used to explain the importance of social support for refugee students’ successful resettlement. A qualitative study using thematic analysis was conducted using 32 in-depth individual interviews with Burmese refugee students in higher education. Through an indepth examination of the lived experiences of Burmese refugee college students’ resettlement, four main themes were identified: challenges of resettlement, resettlement needs, the resources of social support, and resettlement experiences. Refugee students actively cultivated their life and showed aspirations of being successful members of this new environment. Even though they faced many challenges and needs identified through interviews, the participants overcame these barriers including a different culture and language and prosper in their lives in the host country. The social support from the coethnic community and people in the host country both affected the participants’ successful resettlement. Co-ethnic community also plays an important role to pursue higher education. The study findings will be used by social work practice, programs, and policies to improve the success of Burmese refugee students' resettlement. This study would serve as a foundation for enhancing refugee students’ resettlement and understanding the critical role of social support resources during the resettlement period. Burmese refugee students would be an important avenue to develop international relations and achieve social justice. In spite of a variety of barriers and prejudices, Burmese refugee students bloom and flourish in their new environment in the United States. They are beneficiaries but also currently benefactors. The perspectives on refugees need to change and move from victims to the citizens of the world.Item Hospital Transfers: Perspectives of Nursing Home Residents and Nurses(2022-05) Ahmetovic, Alma; Hickman, Susan E.; Draucker, Claire Burke; Huber, Lesa; Unroe, Kathleen T.Between 1 million and 2.2 million nursing home residents are transferred to a hospital emergency department each year. These transfers are costly, have negative health outcomes, and can increase the morbidity and mortality of residents. Few studies, however, have provided in-depth descriptions of transfer experiences. The purpose of this study was to examine the transfer process between the nursing home and the hospital from the perspectives of nursing home residents and nurses, focusing on how decisions were made to transfer residents. Using a qualitative descriptive method, 22 participants (10 residents and 12 nurses) were recruited from four nursing homes located in rural Indiana. Purposive sampling, semi-structured interviews, and conventional content analysis were used to collect and analyze narratives obtained from residents and nurses about their experiences with a recent transfer and to develop four in-depth case descriptions of these transfers. The participants described four aspects of the transfer process: transfer decisions, transport experiences, hospital stays, and returns to the nursing home. The most common reason for transfers was an acute exacerbation of a chronic condition, and the decision to transfer was often made by a nurse. Most participants found aspects of the transfer, including their hospital stay, to be aversive or upsetting. The return to the nursing home was typically welcomed but often challenging due to problems with mobility, medication adjustments, and cognitive changes. Participants also provided several recommendations for avoiding potentially preventable transfers including adding “in-house” diagnostic testing and treatment equipment, improving staff competencies in managing acute exacerbations, increasing staffing, improving communication among staff, and increasing staff familiarity with resident histories and preferences. The findings have several clinical and policy implications for preventing or decreasing the negative effects of hospital transfers.Item Hospital Transfers: Perspectives of Nursing Home Residents and Nurses(Oxford University Press, 2022) Ahmetovic, Alma; Drucker, Claire; Huber, Lesa; Unroe, Kathleen; Hickman, Susan; School of NursingBetween 1 million and 2.2 million nursing home residents are transferred to a hospital emergency department each year. These transfers are costly, have negative health outcomes, and can increase the morbidity and mortality of residents. The purpose of this study was to examine the transfer process between the nursing home and the hospital from the perspective of nursing home residents and nurses, focusing on how decisions were made to transfer residents. Using a qualitative descriptive method, 22 participants were recruited from four nursing homes located in rural Indiana. Purposive sampling, semi-structured interviews, and conventional content analysis were used to collect and analyze narratives obtained from residents and nurses about their experiences with a recent transfer. The participants described four aspects of the transfer process: transfer decisions, transport experiences, hospital stays, and returns to the nursing home. The most common reason for transfers was an acute exacerbation of a chronic condition, and the decision to transfer was often made by a nurse. Most residents found aspects of the transfer aversive or upsetting. The return to the nursing home was typically welcomed but often challenging due to problems with mobility, medications, and cognitive changes. Participants also provided several recommendations for avoiding potentially preventable transfers including adding “in-house” diagnostic testing and treatment equipment, improving staff competencies in managing acute exacerbations, increasing staffing, improving communication among staff, and increasing staff familiarity with resident histories and preferences. The findings have several clinical and policy implications for preventing or decreasing the negative effects of hospital transfers.Item How Older Adult Caregivers Manage Wound Care Procedures, Resources Needed, and Public Policy Implications(2022-10) Swartzell, Kristen Leigh; Fulton, Janet S.; von Gaudecker, Jane R.; Bartlett Ellis, Rebecca J.; Huber, LesaAs healthcare increasingly shifts to home and community-based settings, informal caregiver responsibilities are increasing beyond assistance with activities of daily living to include complex care procedures previously performed by licensed caregivers in clinical settings. With an aging population, increasing numbers of older adults are assuming a caregiving role, a trend that is projected to continue into the foreseeable future. These older caregivers performing complex care procedures such as wound care. The purpose of this dissertation study was to understand how older adult caregivers manage complex wound care procedures. Aims were to 1) develop a theory for how caregivers manage; 2) identify themes related to resources needed, and 3) determine resources available through the existing Medicaid 1915(c) waivers program. Aims 1 and 2 were achieved using qualitative analysis of interviews with 18 older adult caregivers aged 65 and older who were performing wound care in the home for a care recipient. Grounded theory methods were used to develop a theoretical framework describing the process of how the participants managed caregiving. The resultant theory, Pushing Through, consisted of five phases: 1) accepting the role, 2) lacking confidence, 3) creating a system, 4) trusting in self, 5) owning the outcomes. Secondary analysis of the interview data used thematic analysis methods to identify resources used or needed for the caregiver role. The resultant themes were (a) connection to a healthcare professional, (b) written instructions, (c) access to wound care supplies, (d) access to durable medical equipment, (e) financial resources, (f) personal care coverage, and (g) socialization and emotional support. Aim 3 used descriptive analysis of Medicaid 1915(c) home- and community-based services waivers for adults aged 65 and older for all 50 states plus the District of Columbia to identify the frequency and type of waiver services available for supporting caregivers. Results revealed that the number of services offered by state Medicaid waiver programs varied greatly across the country. Respite in varying forms was the most frequently available service. Findings from this dissertation will contribute to the development of evidence-based strategies to sustain older adult caregivers within their caregiving role.Item The Influence of Social Isolation and Other Risk Factors on Older African Immigrants' Emotional Well-Being(2022-08) Adeniji, Dolapo Omolola; Adamek, Margaret; Hong, Michin; Gentle-Genitty, Carolyn; Huber, LesaSocial isolation has been documented as a significant challenge for older adults, including those who are immigrants. The conventional wisdom blames social isolation among older immigrant adults on language barriers, living arrangements, and age at migration, however, this does not allow for analytical clarity on how social isolation interacts with other important risk factors to influence emotional well-being among older African immigrants. This study offers an important contribution to the existing knowledge by examining how social isolation and other risk factors interact to impact emotional well-being among older African immigrants. It uses life course theory, acculturation theory, resilience theory, and cumulative risk theory to identify the relevant stressors or risk factors such as living arrangements, financial satisfaction, acculturation predictors, transportation, and grandchild care. A mixed-methods approach integrating quantitative and qualitative research methods was used in the study. For the collection of quantitative data, 163 participants aged 60 and over completed an online or mailed survey. Hierarchical regression was used to analyze the quantitative data. Findings showed that ethnic social relations and living arrangements had a unique contribution to the social isolation of the participants. Also, social isolation, ethnic social relations, and financial satisfaction significantly influenced the emotional well-being of study participants. For the study’s qualitative data, the researcher conducted in-depth interviews with 11 participants, age 63-79, by telephone. Five major themes were generated from the data using a thematic analysis approach, which included (a) minimal social engagement outside of the home, (b) barriers to social engagement, (c) satisfaction with finances, (d) fewer socialization consequences, and (e) coping strategies. The overall finding showed that the participants lacked social engagement outside of the home, which negatively affected their emotional well-being. Implications for social work practice and policy as well as recommendations were emphasized in the study.Item The meaning of successful aging among older adults with long-term disabilities(2015-07-30) Hanson, Victoria Marie; Adamek, Margaret E.; Vernon, Robert; Chang, Valerie N.; Huber, LesaIn this study, I explore the meaning of successful aging among older adults with long-term disabilities. The study is a review of scholarly literature on the subject of successful aging, with a specific focus on older adults with long-term disabilities. The objective is to shed light on the issue by critically examining what research exists and what research is still needed. The purpose of this study was to investigate the following question: What does it mean for an older adult with long-term disability to age successfully? Seven older adults with sensory impairment, either deaf, hearing impaired, blind, visually impaired or a combination of these, were interviewed using qualitative phenomenological research methods. Findings include themes of aging as inevitable, frequent activity, social and family interaction as essential, sense of worth, acceptance of disability, coping and resilience as well as advice to others.Item Severe Sepsis and Septic Shock Readmissions in Older Adults(2020-08) Hodge, Kimberly Sue; Fulton, Janet; Ebright, Patricia; Davis-Ajami, Mary Lynn; Huber, LesaHospital readmission is of growing importance in the healthcare industry because of associated patient and system costs, impact to the quality of patient care, and hospital Medicare payment penalties. The increasing interest in sepsis readmission prevention has highlighted the uniqueness of severe sepsis or septic shock survivors. The results of this study provide insight into the relationship between index hospital length of stay (LOS) and 30-day readmissions for older adults (> 65 years) who discharged home from an index hospital with a principle or secondary discharge diagnosis of severe sepsis or septic shock. The purpose of this study was to investigate the relationship between index hospital LOS and 30-day readmissions in older adults (> 65 years) whose expected primary payer was Medicare and who discharged home with a principle or secondary diagnosis of severe sepsis or septic shock. Data used to answer the proposed research questions consisted of older adult discharge records from the 2014 Nationwide Readmissions Database (NRD), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Differences in 30-day readmissions between older adult age groups, gender, and older adult location were examined. The number of days to readmission since discharge was evaluated for the subset of older adults with a readmission. Approximately 15.6% of older adults were readmitted within 30 days of their discharge. Readmissions were statistically different based on the older adult’s age, gender, and LOS. Location did not have a significant effect on readmissions. Mean LOS among readmitted older adults was 10.1 days. Analysis indicates that an older adult’s LOS had a significant effect on readmissions, although models performed poorly. Findings suggest that there are certain factors that can predict older adults who are at risk for being readmitted after being discharged with a principle or secondary discharge diagnosis of severe sepsis or septic shock.