UNDERSTANDING FUNCTIONAL DECLINE IN OLDER ADULTS: AN EXPLORATION OF COPING, TRAJECTORIES OF DAILY FUNCTIONING, AND FAMILY ENGAGEMENT IN CARE.

This dissertation focused on older adults experiencing functional decline, a population facing significant challenges that adversely affect their daily lives and lead to high risk of poor health outcomes and diminished quality of life. Guided by the adaptive leadership framework, this dissertation investigated coping strategies, trajectories of daily functioning, and family engagement in the care of older adults experiencing functional decline. A scoping review revealed that older adults with mild cognitive impairment or mild dementia employ a range of coping strategies, including problem-solving, problem avoidance, and both positive and negative emotional coping strategies, while also identifying individual conditions or contexts that affect their efforts to develop or use these strategies. A secondary quantitative analysis, using data from the National Health and Aging Trends Study, examined the decline in daily functioning across all levels of cognitive status, highlighting the longitudinal impacts of social supports on daily activities such as activities of daily living, instrumental activities of daily living, physical capacity, and mobility. Additionally, this analysis found that the impacts of social support vary depending on cognitive status. Lastly, a secondary qualitative analysis comprehensively explored family engagement in the care of residents in assisted living communities. It detailed how family caregivers contribute to care, adapt to caregiving roles, and collaborate with residents and assisted living staff. The findings of this dissertation underscore the necessity of multi-level approaches that help older adults with functional decline maintain their daily lives and improve their health and quality of life. The dissertation recommends developing tailored support interventions that enhance coping strategies, optimize family involvement in care, and utilize social support, ultimately aiming to improve the quality of life for older adults facing functional decline.