Degree Type

Dissertation

Date of Award

2019

Degree Name

Doctor of Philosophy

Department

Human Development and Family Studies

Major

Gerontology

First Advisor

Peter Martin

Abstract

Surviving into late life has been shown to be a highly gendered process because there are substantially more centenarian women than men. Women may live longer than men, however, they do so at higher rates of disability. The disablement process model (DPM, Verbrugge & Jette, 1994) was used as a theoretical model to evaluate two hundred and eight oldest old adults from the current Georgia Centenarian Study (2001 – 2009). The DPM is a theoretical model that tests the progression of disablement through a pathway from pathology to impairment to functional limitations to disability. In this study, the original model illustrates pathology as measured through a sum of nine chronic diseases and two single measures of headache and arthritis. Impairment is measured by daily interference from pain, functional limitations is measured by the Multidimensional Fatigue Inventory (MFI, Smets, Garssen, Bonke & De Haes, 1995) and disability is measured by the multidimensional functional assessment of older adults (Fillenbaum, 1981). In the alternative theoretical model, the Direct Assessment of Functional Ability replaces the multidimensional functional assessment of older adults (Fillenbaum, 1981) as the outcome to demonstrate a successful aging model. This process also examines external factors, dimensions outside of the main pathway, which include intra-individual factors (i.e., NEO Personality Inventory tendermindedness and vulnerability, Costa & McCrae, 1992), extra-individual factors (i.e., social provisions, Cutrona, Russell, & Rose, 1986) and gender, that have positive or negative effects on the categories of the main pathway. This research sought to examine whether gender contributes to higher levels of impairment for women and men in late life. This study included a sample of centenarians and octogenarians, 153 women and 55 men. Measures included self-reported diseases, arthritis and headache, pain, fatigue, self-report of functional capacity, a direct assessment of functional status, gender, vulnerability, human perspective and social provisions. A univariate analysis found age effects for fatigue, instrumental and physical impairment, showing centenarians reported higher levels on each measure compared to octogenarians. An age effect was also found for Direct Assessment of Functional Ability (DAFS), showing centenarians reported higher levels on each measure compared to octogenarians. There was an age and gender interaction for more daily interference from headache for centenarian men and more daily interference from pain for all groups except for centenarian women. Several measures including fatigue, instrumental activities of daily living (IADL) and physical activities of daily living (PADL) impairment, social provisions, vulnerability, and tendermindedness were not equivalent across gender groups and those measures were adjusted for comparability.

There were three significant gender differences in instrumental activities of daily living, objective activity, and vulnerability. Measures of instrumental impairment and objective ability (Direct Assessment of Functional Ability, DAFS) showed women reported to be more impaired (IADL) and less able to carry out functional tasks than their male counterparts. Men reported feeling less vulnerable than women.

Structural equation modeling was used to determine the direct effects, mediation and moderating effects of gender on a modified disablement process model for the combined group. The model fit well. Fatigue was a pivotal measure within the hypothesized disablement process model. Fatigue was the strongest predictor of both instrumental and physical impairment, as well as strongly associated with more social provisions. There was one statistically significant mediation. The path from social provisions to instrumental impairment was mediated by fatigue. This is the first time that the disablement process model was used to specifically look at gender effects of disablement through personality facets. This research sheds some light on the understanding of how gender plays a role in pain, fatigue and impairment.

Copyright Owner

Mary Ellen Joynt

Language

en

File Format

application/pdf

File Size

113 pages

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