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Electronic Theses and Dissertations
8-2013
Predicting mental well-being in assisted living communities : the
roles of social capital and the built environment.
Sarah Elizabeth Walsh
University of Louisville
Follow this and additional works at: https://ir.library.louisville.edu/etd
Recommended Citation
Walsh, Sarah Elizabeth, "Predicting mental well-being in assisted living communities : the roles of social
capital and the built environment." (2013). Electronic Theses and Dissertations. Paper 1505.
https://doi.org/10.18297/etd/1505
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PREDICTING MENTAL WELL-BEING IN ASSISTED LIVING COMMUNITIES:
THE ROLES OF SOCIAL CAPITAL AND THE BUILT ENVIRONMENT
By
Sarah Elizabeth Walsh
B.S., University of Michigan, 2000
M.P.H., Boston University, 2002
A Dissertation
Submitted to the Faculty of the
School of Public Health and Information Sciences of the University of Louisville
in Partial Fulfillment of the Requirements
for the Degree of
Doctor of Philosophy
Department of Health Promotion and Behavioral Sciences
University of Louisville
Louisville, Kentucky
August 2013
Copyright 2013 by Sarah Elizabeth Walsh
All rights reserved
PREDICTING MENTAL WELL-BEING IN ASSISTED LIVING COMMUNITIES:
THE ROLES OF SOCIAL CAPITAL AND THE BUILT ENVIRONMENT
By
Sarah Elizabeth Walsh
B.S., University of Michigan, 2000
M.P.H., Boston University, 2002
A Dissertation Approved on
August 13, 2013
by the following Dissertation Committee:
________________________________
A. Scott LaJoie, Ph.D., M.S.P.H., Dissertation Director
________________________________
John I. Gilderbloom, Ph.D.
_________________________________
Douglas J. Lorenz, Ph.D.
_________________________________
Suzanne Meeks, Ph.D.
ii
DEDICATION
For my first teachers,
Mary and Rob Walsh.
iii
ACKNOWLEDGEMENTS
I am honored to have had so many shoulders to lean on throughout my studies.
This dissertation would not have been possible without the guidance, input and moral
support of more individuals than I can list.
I am grateful to my mentor, Dr. Scott LaJoie, for pushing me towards a more
ambitious study design and guiding me through the dissertation process. Your faith in
me was flattering and frustrating in equal measure, but my dissertation study is better for
it. Thank you for challenging me to become a better researcher and keeping me moving
forward. Thank you as well to my committee members, Dr. Suzanne Meeks, Dr. John
Gilderbloom and Dr. Douglas Lorenz for sharing your time and expertise.
Thank you to Dr. Richard Wilson, Dr. Muriel Harris, Dr. Deborah Winders Davis
and all of the faculty at the University of Louisville School of Public Health and
Information Sciences for helping me to develop my skills as a researcher and public
health professional.
The daunting task of data collection was made easier by my fantastic team of
research assistants: Susan Buchino, Dr. Joan Buchar, Alecia Kennedy, and Tiffany
Robinson. Kimberly Bramlett, Jeanette Marks, and Mary Walsh were kind enough to
review my study instrumentation before it was fielded.
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I also owe a debt of gratitude to Dr. Susan Zepeda and the staff at the Foundation
for a Healthy Kentucky. Thank you for your flexibility and understanding as I tried to
balance the work of completing a PhD with full-time employment.
Thank you to my amazing family for believing in me and supporting me,
especially Mom, Dad, Emily, Christopher, Eleanor, and Madeline - I love you all more
than I can say. Thank you to my wonderful friends and classmates who were always
willing to cheer for me or commiserate with me, depending on the needs of the day.
Thank you to the professionals who shared their time and contacts to help me
identify study sites and participants: Chiquita Booker, Cristi Cobban, Marci Donnelly,
Sherry Ernst, Dr. Keith Knapp, Jackie Laskee, Jane Mobley, Schu Montgomery, Jill
Phillips, Rachelle Seger, Bill Wallen and Dr. Susan Zepeda.
Finally, thank you, thank you, thank you to all of the assisted living community residents
who generously agreed to share their experiences as participants in this study.
v
ABSTRACT
PREDICTING MENTAL WELL-BEING IN ASSISTED LIVING COMMUNITIES:
THE ROLES OF SOCIAL CAPITAL AND THE BUILT ENVIRONMENT
Sarah Elizabeth Walsh
August 13, 2013
Along the continuum of poor to good health, mental well-being refers to the
positive state of being. Mental well-being connotes the ability to manage stress, maintain
independence, and is indicative of happiness and improved quality of life. Mental well-
being is critical to overall health throughout the lifespan, but it is of particular importance
in the context of healthy aging since older adults are more likely to experience
compromised mental health.
Existing research has identified factors that reduce the risk of poor mental health
outcomes: the built environment and individual and community social capital are
associated with overall health status and the incidence of mental illness. This study
explores the relationship between these variables and mental wellness, currently a gap in
the literature.
This dissertation assessed the roles of social capital and the built environment on
promoting and maintaining positive mental health, specifically for assisted living
residents. The study utilized a quantitative design to determine if built environment
quality, community social capital and individual social connectedness were predictive of
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mental well-being. Site audits were used to assess built environment quality surrounding
twelve assisted living facilities in Greater Louisville. Of these twelve sites, six
authorized individual interviews with their residents, and subsequently 76 individuals
were surveyed.
Social connectedness explained about 15% of the variance in mental well-being.
For older adults, knowing people who can provide them with resources or favors is
predictive of increased happiness and enhanced mental well-being. Although built
environment quality did not emerge as a meaningful variable for predicting mental well-
being, social connectedness and social capital explained about 27% of the variance in
mental well-being. In addition to the resources they may know, increased perceptions of
community trust and reciprocity are associated with increased mental well-being for older
adults. In this regard, social capital and social connectedness are important predictors of
mental wellness for older adults residing in assisted living communities.
Beyond reducing the risk of illness, this study demonstrates that social capital and
social connectedness are associated with mental wellness. In light of this, assisted living
communities should evaluate the impact of their activities and programmatic offerings on
resident social capital. Every effort should be made to help residents maintain their pre-
existing community ties as well as forge new relationships.
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