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Mattos, Meghan (2016) MILD COGNITIVE IMPAIRMENT IN OLDER, RURAL-DWELLING ADULTS. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Introduction: Rural-dwelling adults are particularly vulnerable to cognitive problems given known higher rates of associated risk factors and limited resources and access to care. Early cognitive changes remain understudied in this population.

Objective: To determine if and how rural residence is a unique risk factor for delayed detection of early-stage cognitive impairment.

Methods: Studies 1 and 2 involved secondary data analyses of the National Alzheimer’s Coordinating Center Uniform Data Set and compared older rural- and urban-dwelling adults on key characteristics and cognitive symptom severity. Study 1 used a cross-sectional design to examine sociodemographic factors, comorbid conditions and cognitive symptom severity between groups. Study 2 used the same variables from Study 1, to examine possible differences in results using two geographic classification schemes. Studies 3 and 4 used qualitative methods including semi-structured, in-home interviews with participants with early cognitive changes and care partners. Study 3 explored perceived determinants of health in these rural-dwelling dyads using thematic content analysis. Study 4 described their subjective experiences at three time periods around a specialty research center visit.

Results: Study 1. Rural and urban groups differed significantly in mean (±SD) years since onset of cognitive symptoms (2.98±1.91 in rural and 3.89±2.70 in urban adults, t[260]= -2.23, P = .03), but they did not differ across sociodemographic features, comorbid conditions, or cognitive symptom severity. Study 2. Results varied both in magnitude and direction of odds ratio differences between two geographic classification schemes for outcome variables. Study 3. Six themes emerged about perceived determinants of health: 1) Staying active, 2) Eating well, 3) Living with cognitive changes, 4) Living rural, 5) Connecting with neighbors and community, and 6) Relying on children. Study 4. Dyad experiences varied across the three time periods. Dyads sought to learn more about cognitive symptoms and described the impact of cognitive changes on everyday life.

Conclusions: There were no significant differences in cognitive symptom severity between rural- and urban-dwelling participants. Qualitative findings highlight critical aspects of rural adults’ perceived determinants of health and reactions to cognitive symptoms and diagnosis, which may be used to help target earlier diagnosis and improve long-term disease management.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Mattos, Meghanmkm65@pitt.eduMKM65
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee CoChairBurke, Loralbu100@pitt.eduLBU100
Committee CoChairLinger, Jenniferlinglerj@pitt.eduLINGLERJ
Committee MemberSereika, Susanssereika@pitt.eduSSEREIKA
Committee MemberSnitz,
Committee MemberNovosel, Lorrainelmn35@pitt.eduLMN35
Date: 8 November 2016
Date Type: Publication
Defense Date: 22 September 2016
Approval Date: 8 November 2016
Submission Date: 4 November 2016
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 170
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Alzheimer's disease, health disparities, Mild Cognitive Impairment, qualitative methods, rural health
Date Deposited: 08 Nov 2016 16:31
Last Modified: 08 Nov 2017 06:15


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