Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Nancy A. Hodgson


Anxiety is a common and distressing neuropsychiatric symptom in people with cognitive impairment (CI) such as mild cognitive impairment (MCI) or dementia, and up to 71% of individuals with CI experience anxiety. Anxiety in persons with CI is one of the most burdensome symptoms that family caregivers report. Although persons with CI are at risk of social isolation, there is limited information on social isolation among people who have already developed CI and how it contributes to their anxiety. Therefore, this dissertation focused on factors associated with anxiety, especially focusing on how social factors contributes to anxiety in persons with CI. In paper 1, we conducted an integrative review in order to examine factors related to anxiety in persons with CI. The integrative review was conducted using seven databases. Factors associated with anxiety in persons with CI included physical functioning, embarrassment about memory problems, social rejection, and social isolation. For Paper 2 and paper 3, secondary data analyses were conducted using the National Social Life, Health, and Aging Project (NSHAP) Wave 2 (2010-2011) and Wave 3 (2015-2016) datasets. Paper 2 aimed to determine whether social isolation is associated with anxiety in people with CI (n=1,343). We found that greater social isolation increased anxiety in people with CI. Paper 3 aimed (1) to compare social isolation and anxiety among people who develop CI and those who do not over a five-year period and (2) to determine whether CI moderates the relationship between changes in social isolation and changes in anxiety (n=1,119). The two groups who developed MCI and dementia tended to have increased social isolation compared to people who maintained intact cognition. Feeling of increased social isolation over five years was related to increased anxiety over five years regardless of cognitive groups. As older adults still have social needs even when their cognition is impaired, healthcare professionals need to evaluate one’s social needs when they make clinical assessments. It is also imperative to educate family members of persons with CI on the importance of meeting the social needs of their loved ones.


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