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Browsing by Author "Parmelee, Patricia"

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Can Senior Volunteers Deliver Reminiscence and Creative Activity Interventions? Results of the Legacy Intervention Family Enactment Randomized Controlled Trial
(Elsevier, 2014) Allen, Rebecca S.; Harris, Grant M.; Burgio, Louis D.; Azuero, Casey B.; Miller, Leslie A.; Shin, Hae Jung; Eichorst, Morgan K.; Csikai, Ellen L.; DeCoster, Jamie; Dunn, Linda L.; Kvale, Elizabeth; Parmelee, Patricia; University of Alabama Tuscaloosa; University of Virginia; US Department of Veterans Affairs; Veterans Health Administration (VHA); Geriatric Research Education & Clinical Center
Context. Palliative care patients and their family caregivers may have a foreshortened perspective of the time left to live, or the expectation of the patient's death in the near future. Patients and caregivers may report distress in physical, psychological, or existential/spiritual realms. Objectives. To conduct a randomized controlled trial examining the effectiveness of retired senior volunteers (RSVs) in delivering a reminiscence and creative activity intervention aimed at alleviating palliative care patient and caregiver distress. Methods. Of the 45 dyads that completed baseline assessments, 28 completed postintervention and 24 completed follow-up assessments. The intervention group received three home visits by RSVs; control group families received three supportive telephone calls by the research staff. Measures included symptom assessment and associated burden, depression, religiousness/spirituality, and meaning in life. Results. Patients in the intervention group reported a significantly greater reduction in frequency of emotional symptoms (P = 0.02) and emotional symptom bother (P = 0.04) than the control group, as well as improved spiritual functioning. Family caregivers in the intervention group were more likely than control caregivers to endorse items on the Meaning of Life Scale (P = 0.02). Only improvement in intervention patients' emotional symptom bother maintained at follow-up after discontinuing RSV contact (P = 0.024). Conclusion. Delivery of the intervention by RSVs had a positive impact on palliative care patients' emotional symptoms and burden and caregivers' meaning in life. Meaningful prolonged engagement with palliative care patients and caregivers, possibly through alternative modes of treatment delivery such as continued RSV contact, may be necessary for maintenance of therapeutic effects. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Client-therapist alliance for adolescents and young adults with autism: relation to treatment outcomes and client characteristics
(University of Alabama Libraries, 2020-04) Brewe, Alexis Marie; White, Susan W.; University of Alabama Tuscaloosa
Adolescents and adults with autism spectrum disorder (ASD) experience difficulties with emotion regulation (ER), which has been associated with a host of co-occurring problems with mood, anxiety, and aggression. Although treatments targeting ER are available for individuals with ASD, there is a limited understanding of factors that lead to successful outcomes. The therapeutic alliance is considered important for outcomes in non-ASD samples; however, the process of alliance formation and its relation to treatment outcomes is unclear for clients with ASD. The present study aims to examine the trajectory of alliance formation across treatment, as well as examine whether alliance is related to treatment outcomes or specific within-person characteristics. Participants included adolescents and adults with ASD (n = 39, mean age = 15.28 years, age range = 12 to 21 years, 79.50% male) who completed a 16-week intervention designed to treat ER difficulties. Client-therapist alliance was measured at four timepoints throughout treatment using an observational measure of alliance and parents rated their child’s ER difficulties. Interrater reliability on observer-rated alliance was strong. Alliance formation significantly fluctuated throughout treatment. Overall alliance strength, as well as alliance early in treatment, predicted better treatment outcomes. Additionally, ASD symptom severity and co-occurring depression were related to alliance strength. The current study supports the importance of therapeutic alliance for clients with ASD and highlights a need for increased alliance formation during critical stages in treatment. Considerations for future research are discussed.
CNAS' Ratings of Nursing Home Residents' Pain: The Role of Empathy
(University of Alabama Libraries, 2020) Behrens, Emily Anne; Parmelee, Patricia; University of Alabama Tuscaloosa
Long-term care residents with and without cognitive impairment may experience undertreatment of persistent pain (Fain et al., 2017). Certified nursing assistants (CNAs) are important sources of information about resident pain as provide the majority of residents' hands-on care. Therefore, assessing the accuracy of CNAs' pain assessments and potential influencing factors may provide insight regarding the undertreatment of pain. Informed by prior research, this study examined resident pain catastrophizing and cognitive status as predictors of CNAs' pain assessment accuracy. CNA empathy was examined as a moderating variable. Analyses confirmed a relationship between pain catastrophizing and CNA pain rating accuracy. Hypotheses predicting a relationship between resident cognitive status and CNA pain rating accuracy and moderating effects of empathy were disconfirmed. Challenges of conducting research in long-term care are discussed.
Death and Taxes: A Grounded Theory of Financial Stress, Coping, and Decision-Making Among Diverse Female-Identified Dementia Care Partners
(University of Alabama Libraries, 2020) Carden, Keisha Dawn; Allen, Rebecca S.; University of Alabama Tuscaloosa
As the population longevity increases, so does the demand for caregivers. The cost for providing unpaid care also continues to increase significantly. Given the weight of this financial burden, it is imperative scientific and clinical communities strive to understand objective income and financial stress, and how these impact decision-making and planning for end-of-life care. Moreover, a nuanced understanding of the component parts of financial stress and subsequent behavior is necessary in order to develop and implement effective interventions. This study employed a constructivist grounded theory approach to investigate the lived experience of financial stress, coping, and decision-making among 18 female identified spousal dementia caregivers. Although end-of-life financial planning was identified as one of the greatest stressors, results revealed caregivers consistently employed avoidant coping and disengagement from end-of-life financial decision-making. Moreover, findings suggest financial stress is a complex and nuanced construct that manifests at each stage of the stress and coping process. Three categories and 13 themes were identified. Implications for scientific advancement and intervention development are discussed.
Design and evaluation of a wearable bioimpedance system for monitoring multiple localized knee tissue sites
(University of Alabama Libraries, 2020) Critcher, Shelby; Freeborn, Todd; University of Alabama Tuscaloosa
Wearable technologies are becoming increasingly popular throughout society due to their capabilities and unobtrusiveness. The aim of personalized data collection narrows the category of wearable sensor systems to specifically support health related decision making. Wearable technology, specifically related to an Osteoarthritis (OA) population, could assist in tracking disease progression, allowing doctors to determine the optimal time for treatments. An emerging technology, referred to as electrical impedance myography or bioimpedance, has the ability to monitor soft tissues by applying a passive electrical current through a tissue to quantify how the tissue responds. In the case of knee tissues this will be dependent on the joint fluids, soft-tissue, and joint spacings. All of which are impacted by osteoarthritis and the progression of this disease. This thesis aims to design and validate a wearable bioimpedance system, integrated into a knee brace, using the MAX30001 AFE and the use of flexible circuits to integrate to the tissue. This system details the design requirements of a wearable system along with the validation of each individual subsystem through a series of benchmark tests. From the benchmark tests, the system was configured accordingly and integrated and validated on-body.
Free-Living Bioimpedance and Pain Assessment of Healthy and Osteoarthritis (OA) Groups
(University of Alabama Libraries, 2022) Critcher, Shelby; Freeborn, Todd; University of Alabama Tuscaloosa
The drastic increase in the aging population has increased the prevalence of OA inthe United States. The ability to monitor symptoms of OA within a free-livingenvironment and potentially provide an objective measure of pain experienced by those with OA would significantly improve their quality of life. Bioimpedance technology offers anon-invasive sensing solution that could provide physiological information related to theknee such as joint spacing and swelling. This dissertation aims to determine if localized bioimpedance data from knee site tissues can predict the probability of active OA kneepain in older adults. Several additional research aims are addressed in this work. First, a wearable bioimpedance system was designed and validated using commercially availablecircuits for free-living monitoring. Secondly, a signal processing framework was presentedto identify and remove data artifacts that result from data collection in an unsupervised free-living environment. This resulted in the use of the battery voltage, on-board modelmeasurements, and resistance and phase thresholds to ensure adherence to study protocol,confirm sensing operation, and to identify electrode/cable disconnect events. Next, normative impedance values were presented for bioimpedance data collected over theduration of 7 days for older adults. This included identifying the expected range ofimpedance values collected within this population and assessing the variability ofimpedance measurements collected in a free-living environment. Reducing the longitudinal datasets to a single metric for comparisons between healthy and OA groups did not resultin significant differences. This led to the use of a multi-level model, which identified 128kHz resistance and 40 kHz reactance parameters, as significant predictors for theprobability of active OA knee pain.
Gene by Environment Interactions on Late-Life Cognitive Functioning: Integrative Roles of Polygenic Score, Early Life Trauma, and Psychological Resilience
(University of Alabama Libraries, 2021) Park, Soohyun; Allen, Rebecca S.; Kim, Giyeon; University of Alabama Tuscaloosa
BACKGROUND: Little is known about the integrative roles of genetic, environmental, and psychological factors on late-life cognitive functioning. This study investigated (a) whether early life trauma could moderate the effect of genetic predisposition on late-life cognitive functioning, and (b) whether psychological resilience could moderate the interactive effect of early life trauma and genetic predisposition on late-life cognitive functioning.METHODS: Growth curve modeling was conducted on a nationally representative sample of adults from the European ancestry group aged 50 or older (4,479 females and 3,502 males) from the 2004 – 2016 waves (7 waves) of the Health and Retirement Study. Global cognitive functioning was measured by a total cognition score, composed of fluid and crystallized intelligence. Genetic predisposition for cognitive functioning was measured by polygenic score for general cognition (PGS-gc), and early life trauma was measured by parental alcohol/drug use, physical abuse, and trouble with the police before the age of 18. Psychological resilience was measured as purpose in life and perceived control. RESULTS: After controlling for covariates, PGS-gc, purpose in life, and perceived control, respectively, were significantly and positively associated with global cognitive functioning. Moreover, a significant PGS-gc by early life trauma interaction existed on fluid intelligence. Parental alcohol/substance abuse for older females, and trouble with police for older males, respectively, were significant moderators which decreased the beneficial effect of high PGS-gc on fluid intelligence. Higher perceived control was associated with higher crystallized intelligence (a) among older females with a history of early life trauma and with high PGS-gc; and (b) among males with a history of early life trauma with low PGS-gc, respectively. IMPLICATIONS: The findings demonstrate a gene-by-environment interaction, as early life trauma serves as a significant moderator which attenuates the genetic benefits of PGS-gc on late-life cognitive functioning. Psychological resilience, such as perceived control, has a positive effect on cognitive functioning, and also moderates the interaction effect of PGS-gc and early life trauma on crystallized intelligence. These findings not only provide a clear rationale for trauma-informed care for geriatric populations but also highlight psychological resilience as a modifiable target for effective intervention to promote late-life cognitive health.
Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services
(American Psychiatric Publishing, 2014) Kim, Giyeon; Parton, Jason M.; Ford, Katy-Lauren; Bryant, Ami N.; Shim, Ruth S.; Parmelee, Patricia; University of Alabama Tuscaloosa; Morehouse School of Medicine
Objective: This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. Results: In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. Conclusions: The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.
Geographic Region Matters in the Relation Between Perceived Racial Discrimination and Psychiatric Disorders Among Black Older Adults
(Oxford University Press, 2017) Kim, Giyeon; Parmelee, Patricia; Bryant, Ami N.; Crowther, Martha R.; Park, Soohyun; Parton, Jason M.; Chae, David H.; University of Alabama Tuscaloosa; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA Pittsburgh Healthcare System; Auburn University
This study examined whether the relation between perceived racial discrimination and psychiatric disorders varied by large geographic region among Black older adults in the United States. Black adults aged 55 or older who had experienced racial/ethnic-specific discrimination were drawn from the National Survey of American Life (NSAL). Logistic regression analysis was used to examine main and interaction effects. Results show that there was a significant main effect of perceived racial discrimination, indicating that greater perceived discrimination was significantly associated with increased odds of having any past-year psychiatric disorder. The interaction of region by perceived racial discrimination was significant: The effect of perceived racial discrimination on any past-year psychiatric disorder was stronger among Blacks in the West than those in the South. Findings suggest that whereas, in general, perceived racial discrimination is a risk factor for poor mental health among older Blacks, this association may differ by geographic region. Additional research examining reasons for this variation is needed.
Health Disparities Grants Funded by National Institute on Aging: Trends Between 2000 and 2010
(Oxford University Press, 2012) Kim, Giyeon; DeCoster, Jamie; Huang, Chao-Hui; Parmelee, Patricia; University of Alabama Tuscaloosa; University of Virginia
Purpose of the Study: The present study examined the characteristics of health disparities grants funded by National Institute on Aging (NIA) from 2000 to 2010. Objectives were (a) to examine longitudinal trends in health disparities-related grants funded by NIA and (b) to identify moderators of these trends. Design and Methods: Our primary data source was the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) system. The RePORTER data were merged with data from the Carnegie Classification of Institutions of Higher Education. General linear models were used to examine the longitudinal trends and how these trends were associated with type of grant and institutional characteristics. Results: NIA funded 825 grants on health disparities between 2000 and 2010, expending approximately 330 million dollars. There was an overall linear increase over time in both the total number of grants and amount of funding, with an outlying spike during 2009. These trends were significantly influenced by several moderators including funding mechanism and type of institution. Implications: The findings highlight NIA's current efforts to fund health disparities grants to reduce disparities among older adults. Gerontology researchers may find this information very useful for their future grant submissions.
The impact of subjective well-being on longevity among older adults: a detailed examination of the racial/ethnic differences
(University of Alabama Libraries, 2019) Wang, Sylvia Yanlian; Kim, Giyeon; Gilpin, Ansley; University of Alabama Tuscaloosa
Limited studies have investigated the relationship between subjective well-being (SWB) and longevity among older adults. Additionally, no existing research has explored racial/ethnic differences between SWB and longevity in the U.S. Guided by the Main Effect Model, the Stress-Buffering Model, and the Stratification Theory, this study aimed to determine the impact of SWB on longevity. Furthermore, I sought to determine which component(s) of SWB, whether positive affect, negative affect, and/or cognitive evaluation, independently predicted longevity. Lastly, the interaction effect of race/ethnicity and SWB on longevity was assessed. Using the Kaplan-Meier Estimator and the Cox Proportional Hazards (PH) Model, I found that SWB was predictive of longevity among older adults. A higher level of SWB was associated with a lower mortality risk. More importantly, a one-point increase in SWB was associated with a 3% lower mortality risk after adjusting for demographic factors (age, gender, and race/ethnicity), socioeconomic status (SES) covariates (income, education attainment, marital status, and number of health insurances), physical health (number of physical health conditions and self-rated health), and mental health status (depression and anxiety). In addition, positive affect was associated with mortality risk after adjusting for demographic and SES factors, and cognitive evaluation was a significant predictor of longevity after adjusting for all covariates. However, negative affect was not associated with mortality risk. Lastly, the interaction between SWB and race/ethnicity did not predict longevity. These findings highlighted the importance of SWB for longevity among older adults in the U.S. Suggestions for future research and implication for public policy and clinical intervention are discussed.
Localized Multi-Site Knee Bioimpedance as a Predictor for Knee Osteoarthritis Associated Pain Within Older Adults During Free-Living
(IEEE, 2023) Critcher, Shelby; Parmelee, Patricia; Freeborn, Todd J.; University of Alabama Tuscaloosa
The drastic increase in the aging population has increased the prevalence of osteoarthritis in the United States. The ability to monitor symptoms of osteoarthritis (such as pain) within a free-living environment could improve understanding of each person's experiences with this disease and provide opportunities to personalize treatments specific to each person and their experience. In this work, localized knee tissue bioimpedance and self-reports of knee pain were collected from older adults ($N=20$) with and without knee osteoarthritis over 7 days of free-living to evaluate if knee tissue bioimpedance is associated with persons' knee pain experience. Within the group of persons' with knee osteoarthritis increases in 128 kHz per-length resistance and decreases in 40 kHz per-length reactance were associated with increased probability of persons having active knee pain ($p=0.038$ and $p=0.044$).
A Person-Centered Examination of Trauma, Adversity, Distress, and Resilience: the Role of Age/Cohort Membership
(University of Alabama Libraries, 2022) Dorman, Hillary; Allen, Rebecca S.; University of Alabama Tuscaloosa
BACKGROUND: Post-traumatic Stress Disorder (PTSD) represents a significant public health problem involving pronounced adverse psychological comorbidities, physical ailments, and social deficits. Therefore, it is imperative to better understand the relationship between potentially traumatic event (PTE) exposure and stress-related outcomes across the adult lifespan. METHODS: A community sample (N=511) was recruited using Qualtrics Panels and grouped by age/cohort demographics. An Exploratory Factor Analysis (EFA) was first conducted to identify distinct clusters of latent PTE factors based on event exposure and appraisal. These latent factors were then used in a Latent Profile Analysis (LPA) to identify distinct patterns of exposure risk. Finally, age and various trauma-related characteristics were explored as predictors and outcomes of profile membership. RESULTS: EFA revealed four distinct factors of PTEs (Adverse Childhood Experiences, High Intentionality Violence Across the Lifespan, Situational Deprivation, and Low Intentionality/Agency Adversity). These four factors were then used within the LPA model discovering three distinct profiles of risk (Overall Low Risk, Moderately High Risk, and Overall High Risk). Based on this 3-class model, older adults were more likely (4x) to be in the low-risk profile compared to their younger counterparts. The low-risk profile was associated with higher levels of physical and mental wellness, resilience, and distress tolerance, and lower levels of PTSD. There was no significant difference between the moderately-high and overall high-risk profiles, which were associated with lower mental and physical health scores, levels of resilience and distress tolerance, and greater PTSD severity. However, on average, participants within the overall high-risk profile met criteria for PTSD. They displayed low levels of resilience compared to the moderately high-risk group who reported subclinical levels of PTSD and normal levels of resilience. Both high-risk groups were associated with low levels of distress tolerance. IMPLICATIONS: Study findings have the potential to improve predictive vulnerability models based on specific exposures and their subsequent effects, drive tailored interventions and assessments that are developmentally and culturally informed, and both create and mobilize actionable protective resources that can promote resilience in the face of adversity across the adult lifespan. Recommendations are outlined at each level of prevention.
The Relation Between Body Mass Index and Self-Rated Mental Health Among Older Adults: Do Racial/Ethnic Differences Exist?
(Elsevier, 2014) Kim, Giyeon; Parmelee, Patricia; DeCoster, Jamie; Bryant, Ami N.; Chiriboga, David A.; University of Alabama Tuscaloosa; University of Virginia; University of South Florida
Objectives: To examine racial and ethnic differences in the relation between body mass index (BMI) and self-rated mental health (SRMH) among community-dwelling older adults. Design: Cross-sectional analyses of nationally representative data from the Collaborative Psychiatric Epidemiology Surveys. Setting: In-person household interviews. Participants: Older adults aged 60 and older (N = 2,017), including non-Hispanic white (N 547), black (N 814), Hispanic (N 401), and Asian (N 255) patients. Measurements: SRMH was measured with a single item, "How would you rate your own mental health?" BMI categories were underweight (<18.5 kg/m(2)), healthy weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), and obese (>30.0 kg/m(2)). Results: A two-way analysis of covariance showed that after controlling for covariates, there was a significant main effect of race/ethnicity on SRMH, but the main effect of BMI was not significant. A significant interaction between BMI and race/ethnicity on SRMH was also found. The linear contrasts showed that white adults had a significant trend showing that SRMH decreased with increases in BMI, whereas black adults had a significant trend showing that SRMH increased with increases in BMI. The linear trends for Hispanic and Asian adults were not significant. Conclusions: There were significant racial/ethnic differences in the relation between BMI and SRMH. Understanding the role of race/ethnicity as a moderator of the relation between BMI and mental health may help improve treatment for older adults with unhealthy weights. Clinical implications are also discussed.
The Relation Between Multiple Informal Caregiving Roles and Subjective Physical and Mental Health Status Among Older Adults: Do Racial/Ethnic Differences Exist?
(Oxford University Press, 2019) Kim, Giyeon; Allen, Rebecca S.; Wang, Sylvia Y.; Park, Soohyun; Perkins, Elizabeth A.; Parmelee, Patricia; Chung Ang University; University of Alabama Tuscaloosa; University of South Florida
Purpose of the Study: The present study examined whether race/ethnicity moderated the relation between type of caregiving role (none, one, or multiple care recipients) and subjective physical and mental health among older adults. Design and Methods: The sample was drawn from the 2009 California Health Interview Survey. Racially/ethnically diverse adults aged 55 and older (n = 24,241) were categorized into 3 groups by caregiving roles: noncaregivers (n = 18,626; referent), caregivers with a single caregiving role (n = 4,023), and caregivers with multiple caregiving roles (n = 1,772). A 2-way analysis of covariance was conducted to test main and interaction effects. Results: After adjustment for covariates, noncaregivers reported significantly worse self-rated health and lower psychological distress than caregivers with any type of role. The interaction between race/ethnicity and caregiving roles was significant only for self-rated health (p < .05). Blacks with multiple caregiving roles had poorer self-rated health than those with a single caregiving role and better self-rated health than noncaregivers, whereas other racial/ethnic groups with multiple caregiving roles had better self-rated health compared to both noncaregivers and those with a single caregiving role. Our sensitivity analysis showed that controlling caregiving-related variables present only among caregivers eliminated the differences in self-rated health between the two types of caregivers. Implications: Findings suggest that caregivers report better self-rated health than noncaregivers and that the relation of multiple caregiving roles with self-rated health differs by race/ethnicity, with blacks differing from other racial/ethnic groups. This implies that caregivers experience gain, or are selected into the role of caregiving by virtue of having good health.

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Browsing by Author "Parmelee, Patricia"

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