Date of Award

12-2012

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Social Work

Major Professor

Sherry M. Cummings

Committee Members

William R. Nugent, Janet W. Brown, Robert T. Ladd, Cindy Davis

Abstract

ABSTRACT

Recent evidence and prior research document that increasing numbers of older adults are experiencing relocation to an assisted living facility (ALF), and that involuntary ALF relocatees face a great risk of psychological distress because of the numerous stressors associated with this relocation. However, little empirical research has clearly investigated the interrelationship among major factors and their effects on the psychological well-being of AL residents: relocation control, mediators of stress (e.g., social support, self-reported health, and functional impairment) and psychological well-being.

This study had two aims: (a) to investigate the relationship between relocation control and psychological well-being (e.g., depression, anxiety, and life satisfaction) among assisted living (ALF) residents, controlling for demographic factors; and (b) to evaluate whether social support from family and friends, self-reported health, and functional impairment (e.g., ADLs and IADLs) mediate the relationship between the perceived relocation control and psychological well-being (e.g., depression, anxiety, and life satisfaction).

Guided by the stress process perspective, this cross-sectional study examined the hypothesized relationships of 336 relocated individuals age 65 and older who were purposefully sampled from 19 assisted living facilities in eastern Tennessee. Structural equation modeling analyses revealed that greater resident involvement over relocation was associated with lower levels of depression and higher levels of life satisfaction, whereas resident control over relocation was not associated with anxiety before and after relocation, controlling for demographic factors. The second critical finding from this study was the statistically significant mediation results of a trend for social support to be a mechanism through which relocation control affected psychological well-being (e.g., depression and life satisfaction). However, an indirect linkage of relocation control and anxiety via social support was not statistically significant. Surprisingly, the hypothesis that the mediation relationship from relocation control to self-reported health to psychological well-being (e.g., depression, anxiety, and life satisfaction) was not demonstrated. Furthermore, functional impairment mediated the association between relocation control and psychological well-being (e.g., anxiety and life satisfaction). Functional impairment did not act as a mediator between relocation control and depression. Limitations, implications from the study findings for social work practice, policy, and future directions are also presented.

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