Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



Committee Chair

Jennifer R. Bail

Committee Member

Patricia A. Carter

Committee Member

Gwendolyn L. Hooper

Committee Member

Lenora Smith

Committee Member

Nancy Lerner


Advance directives (Medical care), Dementia, Health--Social aspects


Dementia Advance Care Planning (ACP) promotes quality of life through discussions and decisions about goals of care and end-of-life wishes. However, ACP is rarely introduced in the community setting, and ACP is commonly deferred until advanced dementia when the patient can no longer communicate. The purpose of this three-manuscript dissertation was to advance the understanding of community-based early dementia ACP through an examination of the literature (manuscript one), the development of the dementia public health exposome conceptual framework (manuscript two), and the exploration of perceptions of ACP amongst dementia clinicians, dementia caregivers, and individuals with preclinical dementia in a dementia disparities area of the U.S. (Alabama) (manuscript three). The scoping literature review (manuscript one) highlighted the importance of early dementia ACP which is individualized and adapted for the dementia population. The second manuscript proposed the Dementia Public Health Exposome conceptual framework to understand the complex relationship between modifiable and non-modifiable risk factors for dementia and Social Determinants of Health (i.e., the conditions in the natural, built, and social environments where people live). The third manuscript was a qualitative secondary data analysis guided by Social Cognitive Theory, and study findings suggest that ACP conversations may need to be introduced over time during early dementia, with a focus on the immediate needs of the person living with dementia. Findings from these three manuscripts may be used to guide future nursing education, policy, practice, and research. Another opportunity identified in this dissertation is the need for purposeful recruitment and inclusion of medically underserved and diverse populations in dementia ACP research.


Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the joint Nursing Science Ph.D. Program ...

Available for download on Thursday, December 11, 2025