Current Research

    Individual Differences in End-of-Life Care Preferences, Experiences of Care, and Quality of Life

    In this study we use a theoretical framework derived from the Self-Determination Theory (SDT) of Deci & Ryan to study end-of-life well-being in long-term care.  We predict that fulfillment of the SDT needs of autonomy, competence, and relatedness will be related to improved well-being in long-term care, and that individual differences, including demographic differences, religious and spiritual differences, ethnic/cultural differences, and contextual differences (nursing home vs. assisted living, institutional characteristics, and rural/urban context) will influence end-of-life preferences for care and the degree to which end-of-life needs are met.  We are collecting data via interviews with residents of nursing homes and assisted living facilities to test our hypotheses. 

    Psychological Aspects of Theatre Audience Engagement:  Generational Differences and Lessons from Older Subscribers on Audience Engagement Related to Psychological Flourishing

    Funding: National Endowment for the Arts and the University of Louisville.

    Project Summary:

    In gerontology there is rising interest in the characteristics of a “life well lived,” and in the types of activities and habits that may lead to flourishing in late life.  Audience members of an arts performance experience opportunities for enjoyment, sociability with co-attendees, intellectual stimulation, engagement with the organization and with the art itself, and to contribute to the future of the organization via philanthropy and subscription.  Thus regular participation as an audience member could be one means of promoting flourishing.   This is a collaborative project with Russell Vandenbroucke, Professor of Theatre Arts at the University of Louisville.  We are conducting a three-part, mixed methods study of performing arts engagement with a well-established regional theatre, Actors Theatre of Louisville.  We are focusing on the benefits of sustained engagement experienced by long-time subscribers.  Part I involved an online survey of Actors Theatre ticket purchasers.  Approximately 800 individuals participated in that survey.  Part II involved focus groups about theatre enjoyment and meaning with 20 season ticket holders over the age of 60.  Part III is a prospective study of engagement and well-being involving 40-60 older season ticket holders, over two seasons.


    BE-ACTIV! Treating Depression in Nursing Homes

    Funding: NIMH

    Project Summary:

    The purpose of this project was to test the efficacy of a behavioral intervention for depression in nursing homes. The program, BE-ACTIV, has been adapted and piloted in nursing homes, and shows promise of reducing depression in residents with major and minor depression. The intervention is conceptually based on Lewinsohn's behavioral theory of depression and derived from Teri's effective, outpatient intervention for elders with dementia. It involves collaboration between a mental health therapist and nursing home Activities Department staff, and is tailored to the individual resident. The goal is to increase opportunities for pleasant events, thus increasing activity and positive affect. There are 2 specific aims: (1) using a randomized, controlled, two-group design, to compare outcomes for depressed residents receiving the BE-ACTIV program with those receiving treatment as usual in their nursing homes; and (2) to evaluate the treatment mechanisms, including staff attention, increased activity levels, and increased positive affect, related to improvement following participation in BE-ACTIV. Aim 1 results were published and available online at:  Journals of Gerontology, Series B:  Psychological Sciences.  DOI:  10.1093/geronb/gbu026. We are in the process of analyzing other findings.


    Predicting Trajectories of Flourishing and Failing in New Nursing Home Residents

    Funding: NIMH

    Project Summary:

    In this project we follow nursing home residents from within 30 days of admission to long term care over 6 months.  We are looking at resilience resources such as psychological dispositions (hope and optimism), strong social networks, lack of physical frailty, and allostasis, or the physical capacity for resilience, as predictors of adjustment over time.  We also are looking at emotional and social processes that maintain or promote resilience, especially activity engagement, social contacts, and maintenance of positive affect.  We are currently analyzing data from the first phase of this project, and considering the next steps.



    Student-Led Projects:

    Religious coping measurement in the context of long-term care

    Project Summary:  For many elderly individuals admitted to long-term care (LTC) facilities, the LTC experience may be defined by stressful events such as declining health, changes in social environment, loss of independence, and the loss of control over daily life. However, many LTC residents continue to live fulfilling lives in the midst of suffering and hardship, and religious beliefs and practices may function as a means to this fulfillment. The study of religious coping (RC) has made great strides in recent years, but it is unclear whether the construct is unique and relevant in the context of coping with stressors in LTC. An exploration of religious coping in the context of long-term care can help support older adults in a pursuit of greater well-being and an optimal quality of life in response to challenging situations. This study will examine the construct of religious coping in a unique sample of individuals who may face many significant stressors. The aim of this paper is to examine the extent to which common religious coping measures are valid and applicable in long-term care settings. The specific questions addressed in this paper, in the context of LTC, include: 1) Are RC patterns represented by a simple factor structure reflecting distinct methods of appraisals? 2) Are RC approaches to control, or efforts to problem-solve stressful situations, represented by a simple factor structure reflecting distinct styles of RC? 3) Are current measures of RC patterns and approaches to control internally consistent? 4) Do RC measures demonstrate concurrent, convergent, and discriminant validity in relation to measures of stress, well-being, psychological health, and other measures of religious involvement and RC? 5) Do RC measures demonstrate incremental validity by accounting for significant variance in relevant clinical outcomes after controlling for broader religious variables and non-RC strategies? 6) Is the strength of the relationship between RC and well-being moderated by individual coping resources, and contextual coping resources? To answer these questions, this cross-sectional study will examine RC and non-RC in a sample of elderly long-term care residents through brief, one-time interviews.

    Screening Older Adults for Depression:  The Relationship Among Clinical Discipline Training, Barriers, Attitudes, Norms, and Perceived Behavioral Control

    Project Summary:  This study examines factors that relate to a healthcare professional’s specific clinical decision, specifically screening or referring.  I am interested in the relationship between clinical discipline, barriers in practice such as time, patient cooperation, and level of symptoms patients are presenting with, and how these factors affect screening. I am also interested in whether a clinician’s norms, attitudes, and perceived behavioral control related to screening might explain when they choose to screen or refer in the face of such barriers. The goal of the study is to learn more about which barriers have the greatest impacts on clinical decisions, and whether a clinician’s discipline training or their attitudes, norms, or perceived control can serve as a protective factor against the barriers. The disciplines in the study are graduate students in medicine nursing, clinical/counseling psychology, and social work – students who see patients as part of their clinical training. The study could have scientific implications for training of graduate students, interventions for reducing barriers to practice, and interventions for strengthening knowledge and competency for making clinical decisions.