Perceived Threat of Alzheimer's Disease and Help-Seeking Behavior in Older Adults with Memory ...

175 Pages·2017·1.64 MB·English

by  Jenny Ostergren

Perceived Threat of Alzheimer’s Disease and Help-Seeking Behavior
in Older Adults with Memory Complaints

by

Jenny E. Ostergren

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
(Health Behavior and Health Education)
in the University of Michigan
2017

Doctoral Committee:

Associate Professor J. Scott Roberts, Chair
Professor Cathleen Connell
Research Scientist Steven Heeringa
Professor Carlos Mendes de Leon
© Jenny E. Ostergren 2017
DEDICATION
In loving memory of my grandparents, Robert Ostergren, Sr., and Lorraine Ostergren, who
taught me the value of persistence.
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ACKNOWLEDGEMENTS
This dissertation would not have been possible without the encouragement, support, and
guidance of so many individuals. Foremost, I would like to express my sincere gratitude to my
advisor and committee chair, Dr. Scott Roberts, for his expertise, guidance, patience, and
unwavering support throughout my Ph.D. studies and the process of writing this dissertation.
Thank you, Scott, for seeing the potential in me and always being there. I could not have asked
for a better advisor and mentor.
I would also like to express my thanks and appreciation to my committee members, Dr.
Cathleen Connell, Dr. Steven Heeringa, and Dr. Carlos Mendes de Leon, for their expertise,
insightful comments, and encouragement, which helped to improve and strengthen my
dissertation work. I am grateful for the time and care each of you put into providing constructive
feedback on my dissertation papers and guidance on my statistical analyses.
A very special thank you to the HBHE Genetics Research Group, Lan Le, Natalie Bartnik,
Dr. Michele Gornick, and Wendy Uhlmann, for all their support, help, and valuable feedback
throughout my time in the program. You’ve helped to expand my knowledge and research skills,
and my work is much stronger thanks to you.
I would also like to thank my fellow HBHE doctoral students for their advice,
encouragement, and friendship over the years. In particular, I want to thank Jonathon Vivoda for
his valuable mentorship and advice throughout my time in the program. Thanks also to Aresha
Martinez, Elizabeth Mosley, and Rebecca Leinberger for being the most awesome cohort of
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strong and brilliant ladies I know. You inspire me every day, and I’m grateful for your friendship
and support.
The academic and financial support I received from the Department of Health Behavior and
Health Education has played an integral role in my academic success. I’d like to thank the
department for supporting my Ph.D. studies through a Victor Strecher Scholarship, Summer
Writing Awards, and a Departmental One-Term Dissertation Fellowship. I was also very
fortunate to be the recipient of a Predoctoral Traineeship in Public Health and Aging, which
supported my dissertation research for two years. I’d like to thank Dr. Carlos Mendes de Leon
for the training and research support I received during those years, which has been essential in
getting me to this point.
Finally, I’d like to thank my amazing family and friends who stood by me and supported me
on this journey. My husband, Nick Gutierrez, has been my rock and a constant source of
motivation and inspiration through both the good and tough times in the program. Thank you,
Nick, for believing in me and keeping me grounded. I’d like to thank my parents, Robert and
Carol Ostergren, for always going above and beyond to support my passions and ambitions, and
my brother Jason Ostergren and sister-in-law Maisha Ostergren for housing me in Ann Arbor
and providing moral support and encouragement. Thank you also to my brother Brian Ostergren
and sister-in-law Qiaolan Wan, and to my good friends Yichen and Jeffrey Kuan, for supporting
and encouraging me throughout this process and in life in general.

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TABLE OF CONTENTS
DEDICATION ii
ACKNOWLEDGEMENTS iii
LIST OF TABLES vi
LIST OF FIGURES vii
ABSTRACT viii

CHAPTER
1. Introduction 1
2. Factors Influencing Help-Seeking among Older Adults with Dementia 15
Concerns: A Systematic Review
3. The Influence of Psychosocial and Cognitive Factors on Perceived Threat of 83
Alzheimer’s Disease Among a Representative Sample of U.S. Adults
4. Demographic, Health Care Access, and Health Status Predictors of Help-Seeking 119
Behavior for Subjective Memory Complaints among Older Adults
5. Conclusion 155

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LIST OF TABLES
Table 2-1: Summary of Studies Identified in Systematic Review of Help-Seeking 42
Behavior for SMCs (N = 61)
Table 2-2: Background of Studies (N = 61) 74
Table 2-3: Summary of Domains and Factors Related to Formal Help-Seeking 75
Table 3-1: HRS Population Characteristics (N = 1,641) 105
Table 3-2: Means, SE, and Score Range of Psychosocial and Cognitive Variables 106
(N = 1,641)
Table 3-3: Comparison of Linear Regression Results for Mean Composite Measure 107
of Perceived AD Threat and “You believe you will get AD someday”
(N = 1,625)
Table 3-4: Bivariate Summary of Associations among Categorical Predictors of 108
Perceived AD Threat (Chi-square tests of association; N = 1,641).
Table 3-5: Bivariate Summary with Pearson Correlations for Perceived AD Threat 109
and Psychosocial and Cognitive Predictors (N = 1,641)
Table 3-6: Summary of Linear Regression Analysis of Perceived AD Threat 110
(N= 1,625)
Table 4-1: Comparison of Results from Multiple Imputation and Single Imputation 141
Models
Table 4-2: Unweighted Respondent Counts and Population Weighted Percentages 142
of Demographic Characteristics for the BRFSS Population (N = 6,807)
Table 4-3: Means, SE, and Score Range of Health Status and Health Care Access 143
Variables (N = 6,807)
Table 4-4: Bivariate Summary of Associations among Categorical Predictors of 144
Help-Seeking Behavior (Chi-square tests of association; N = 6,807)
Table 4-5: Bivariate Summary with Pearson Correlations for Help-Seeking Behavior 146
and Health Status Predictors (N = 6,807)
Table 4-6: Summary of Logistic Regression Analysis of Help-Seeking Behavior 147
(N = 6,807)
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LIST OF FIGURES
Figure 1-1: Conceptual Model of Perceived AD Threat and Help-seeking Behavior 10
Figure 2-1: Flow Diagram 41
Figure 3-1: Conceptual Model of Research Question 1: What are the significant 112
psychosocial and cognitive factors associated with perceived AD threat?
Figure 3-2: Conceptual Model of Research Question 2: Does family experience with 113
AD moderate the relationship between cognitive factors and perceived AD
threat?
Figure 3-3: Moderating effect of personal experience with AD on the relationship 114
between subjective memory complaints and perceived AD threat
Figure 3-4: Moderating effect of personal experience with AD on the relationship 115
between age group and perceived AD threat
Figure 4-1: Conceptual Model for Research Study Question: What is the association 148
between specific demographic factors, health care access, health status, and
help seeking behavior for memory complaints?

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ABSTRACT
Alzheimer’s disease (AD) is a chronic disorder with a high burden of suffering for
affected individuals, their caregivers, families, and communities. An increased emphasis on early
AD detection may benefit affected individuals and their caregivers, especially where disparities
already exist in health care and outcomes, but may also unnecessarily heighten perceived AD
threat among healthy older adults. Relatively few studies have examined predictors of perceived
AD threat and help-seeking behavior among a large and diverse sample that is broadly
representative of the U.S. adult population. Informed by health behavior theory, my dissertation
1) identifies factors that influence formal help-seeking for memory complaints through a
systematic review of the literature, 2) examines psychosocial and cognitive predictors of
perceived AD threat, an understudied construct related to help-seeking, among a nationally
representative sample of U.S. adults from the Health and Retirement Study, and 3) explores
demographic, health care access, and health status predictors of help-seeking among older adults
with memory complaints using Behavioral Risk Factor Surveillance System data. Findings from
the systematic review suggest that individual, interpersonal, and structural/policy level factors
each play a key role in help-seeking. Multivariate analyses of perceived AD threat revealed that
perceived threat was significantly higher for respondents aged 50-64 and 65-74 than for those
≥75. Higher perceived threat was also associated with a family history of AD (compared to no
experience), stronger beliefs that stress or genetics are important AD risk factors, more
depressive symptoms, poorer self-rated memory, and lower cognitive function. Respondents with
lower education levels were significantly less likely to seek help. Those who reported more
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memory-related functional difficulty, more frequent days of poor mental health, and having a
primary care provider, were more likely to seek help. These findings highlight the need for
education and community outreach to raise awareness about early dementia symptoms, provide
specific factors that health care providers should consider in clinical encounters, and highlight
the need for careful initial cognitive screening of individuals with memory complaints. These
findings also provide insight about the help-seeking process, and a starting point for
interventions aimed at increasing timely AD diagnosis and treatment.

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