03/11/2025
By Maureen Martin
Date: Thursday, March 27, 2025
Time: 1-4 p.m.
Location: This will be a virtual defense via Zoom. Those interested in attending should contact Patcharee_Wangwu@student.uml.edu and committee chair Lisa_Abdallah@uml.edu at least 24 hours prior to the defense to request access to the meeting.
Committee:
Lisa Abdallah, Ph.D., RN, CNE, Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, UMass Lowell
Ainat Koren, Ph.D., DNP, PMHNP, Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, UMass Lowell
Ramraj Gautam, Ph.D., FAGHE, Teaching Professor, Solomont School of Nursing, Zuckerberg College of Health Sciences, UMass
Lowell
Jason Rydberg, Ph.D., Associate Professor, School of Criminology and Justice Studies, UMass Lowell
Abstract
Introduction: Moving into nursing homes marks a major life adjustment for older adults, often bringing about fears and challenges. Studies show that this transition can have varying effects on physical health, mental well-being, social interactions, and quality of life (QoL). Research focusing on older Thai adults indicates that they experience a moderate to good QoL, differing from findings in other countries where QoL ranges from poor to high in older adults. These variations may result from distinct personal and social factors. In Thai culture, family caregiving is highly valued, shaping the approach to elder care. However, there is a lack of quantitative studies that thoroughly examine and holistically address the interplay between the QoL of older Thai adults and their surrounding environment.
Aims: The objectives of this dissertation were twofold: 1) To consolidate the current literature regarding the determinants of QoL among older Thai adults living in nursing homes and 2) To conduct a comprehensive investigation into the factors influencing the QoL among older Thai adults living in nursing homes through an innovative quantitative, cross-sectional predictive study, utilizing the Social Ecological Model (SEM) as a guiding framework.
Method: Whittemore and Knafl’s (2005) integrative review methodology using the SEM for structuring and pinpointing factors guided the review. Drawing from the integrative review outcomes, a total of 294 older Thai adults living in nine nursing homes were selected using convenience sampling from establishments supervised by the Thai government. Data was collected from July to October 2024. Thirteen survey instruments were utilized to gather data, including demographics and well-being self-interest questionnaires, the intrapersonal, institutional, community, and public policy questionnaire, the Gratitude Questionnaire-6, the Life Orientation Test, the Barthel Activities of Daily Living, the Frailty questionnaire, the Pittsburgh Sleep Quality Index, the Mini-Nutrition Assessment Short Form, the Geriatric Anxiety Scale, the Revised UCLA Loneliness Scale, the Geriatric Depression Scale, the Mini-Mental State Examination, the Social Support questionnaire, and the WHOQOL-BREF-THAI Questionnaire. Descriptive statistics, bivariate relationships, and multiple linear regression were employed to analyze factors within the intrapersonal, interpersonal, institutional, community, and public policy domains that predicted QoL among older Thai adults living in nursing homes.
Results: The results for the first aim, the integrative review, identified themes through abstraction and synthesis, creating 33 codes that were further developed into ten sub-themes and five main themes by following the SEM including intrapersonal, interpersonal, institutional, community, and public policy factors. The results for the second aim which explored factors contributing to the QoL among older Thai adult nursing home residents revealed through regression analyses that intrapersonal (satisfaction with mental health, activities of daily living, sleep quality, anxiety, loneliness, and depression) and interpersonal factors (social support and nurse-patient interactions) significantly predicted QoL, explaining 65% of its variance (R² = .65, p < .001).
Conclusion: The integrative review highlighted how factors at all five levels of the SEM contribute to QoL of older adults in nursing homes, pointing to the necessity of delivering all-encompassing care at each level to fully support this population. In addition, the quantitative study analysis revealed that intrapersonal and interpersonal factors significantly shaped the QoL of older Thai adults living in nursing homes. To enhance their QoL, it is crucial to implement culturally adapted strategies and strengthen social support systems.
Impact: The findings of both the integrative review and the quantitative study provide valuable insights for creating targeted interventions to improve the QoL of older Thai adults living in nursing homes. Furthermore, these findings can contribute to developing holistic care practices in nursing education. The results of this dissertation can also serve as a basis for formulating healthcare policies, particularly in establishing nursing practice guidelines for assessing QoL levels and implementing initiatives to enhance QoL for older Thai adults in nursing home settings. Incorporating these findings into nursing education would help students provide better care, considering various factors at intrapersonal, interpersonal, institutional, community, and public policy levels. Ultimately, understanding the perspectives of older adults in nursing homes is essential for healthcare professionals.
Keywords: Quality of life, Older adults, Nursing homes, Social Ecological Model (SEM), Thailand