Showing papers in "Gerontologist in 2006"
TL;DR: Evaluating the performance of an abbreviated version of the Lubben Social Network Scale (LSNS-6), which was used to screen for social isolation among community-dwelling older adult populations in three European countries, concludes that abbreviated scales such as the LSNS- 6 should be considered for inclusion in practice protocols of gerontological practitioners.
Abstract: PURPOSE: There is a need for valid and reliable short scales that can be used to assess social networks and social supports and to screen for social isolation in older persons. DESIGN AND METHODS: The present study is a cross-national and cross-cultural evaluation of the performance of an abbreviated version of the Lubben Social Network Scale (LSNS-6), which was used to screen for social isolation among community-dwelling older adult populations in three European countries. Based on the concept of lack of redundancy of social ties we defined clinical cut-points of the LSNS-6 for identifying persons deemed at risk for social isolation. RESULTS: Among all three samples, the LSNS-6 and two subscales (Family and Friends) demonstrated high levels of internal consistency, stable factor structures, and high correlations with criterion variables. The proposed clinical cut-points showed good convergent validity, and classified 20% of the respondents in Hamburg, 11% of those in Solothurn (Switzerland), and 15% of those in London as at risk for social isolation. IMPLICATIONS: We conclude that abbreviated scales such as the LSNS-6 should be considered for inclusion in practice protocols of gerontological practitioners. Screening older persons based on the LSNS-6 provides quantitative information on their family and friendship ties, and identifies persons at increased risk for social isolation who might benefit from in-depth assessment and targeted interventions.
1,178 citations
TL;DR: The positive impact of participatory art programs for older adults in this study on overall health, doctor visits, medication use, falls, loneliness, morale, and activities reflects important health promotion and prevention effects and a reduction of risk factors driving the need for long-term care.
Abstract: Purpose: The aim of this study was to measure the impact of professionally conducted community-based cultural programs on the physical health, mental health, and social activities of individuals aged 65 and older. Design and Methods: Participants in the study were 166 healthy, ambulatory older adults from the Washington, DC, area. We assigned them to either an intervention (chorale) or comparison (usual activity) group and assessed them at baseline and after 12 months. Results: Results obtained from utilizing established assessment questionnaires and self-reported measures, controlling for any baseline differences, revealed positive findings for the effectiveness of the intervention such that the intervention group reported a higher overall rating of physical health, fewer doctor visits, less medication use, fewer instances of falls, and fewer other health problems than the comparison group. The intervention group also evidenced better morale and less loneliness than the comparison group. In terms of activity level, the comparison group evidenced a significant decline in total number of activities, whereas the intervention group reported a trend toward increased activity. Implications: The positive impact of participatory art programs for older adults in this study on overall health, doctor visits, medication use, falls, loneliness, morale, and activities reflects important health promotion and prevention effects and a reduction of risk factors driving the need for long-term care.
426 citations
TL;DR: The proportion of chronically disabled community-dwelling older adults who were receiving informal assistance from family or friends declined over the period of interest, whereas the proportion receiving no human help increased.
Abstract: Purpose: Family caregivers comprise the backbone of long-term-care provision in the United States, yet little is known about how the composition and experience of family caregiving has changed over time. Design and Methods: Data are drawn from the 1989 and 1999 National Long-Term Care Survey and Informal Caregiver Survey to develop nationally representative profiles of disabled older adults and their primary informal caregivers at two points in time. Results: The proportion of chronically disabled community-dwelling older adults who were receiving informal assistance from family or friends declined over the period of interest, whereas the proportion receiving no human help increased. On average, recipients of informal care were older and more disabled in 1999 than in 1989. Primary caregivers were children (41.3%), spouses (38.4%), and other family or friends (20.4%); children were more likely and others less likely to serve as primary caregivers in 1999 relative to 1989. Primary caregivers provided frequent and high levels of help at both points in time. A striking increase was found (from 34.9% to 52.8%) in the proportion of primary caregivers working alone, without secondary caregiver involvement. Implications: In the context of projected demographic trends and budgetary constraints to public health insurance programs, these data underscore the importance of identifying viable strategies to monitor and support family caregivers in the coming years.
376 citations
TL;DR: Whether older adults with HIV/AIDS experience both ageism and HIV stigma and how those experiences manifest in their lives is examined to identify themes that may be sources of felt as well as enacted stigma and discrimination related to both aging and HIV.
Abstract: Purpose: Older adults living with HIV infection may be doubly stigmatized, as they are branded by both age as well as HIV status. Through semistructured interviews, this study sought to examine whether older adults with HIV/AIDS experience both ageism and HIV stigma and how those experiences manifest in their lives. Design and Methods: This was a qualitative study in which 25 in-depth interviews were completed with adults aged 50 years and older who were living with HIV or AIDS. Purposive sampling was used to recruit these individuals who shared their experiences. Open coding and axial coding of interview transcripts were completed on all interviews, resulting in the development of a framework of these experiences. Results: The majority (68%) of the respondents experienced both ageism and HIV-associated stigma. The experiences were often separate, although some interrelated stigma did occur. Nine themes emerged from the interviews, including rejection, stereotyping, fear of contagion, violations of confidentiality, and internalized ageism. All themes fell into four categories: social discrimination, institutional discrimination, anticipatory stigma, and other. Implications: The research identified themes that may be sources of felt as well as enacted stigma and discrimination related to both aging and HIV. This concept of double jeopardy exists in the lives of the majority of people interviewed and has relevance to the creation of appropriate intervention
302 citations
TL;DR: It is found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once, and many are already doing so by moving to bridge jobs after leaving their career employment.
Abstract: Purpose: This article investigates how older Americans leave their career jobs and estimates the extent of intermediate labor force activity (bridge jobs) between full-time work on a career job and complete labor-force withdrawal. Design and Methods: Using data from the Health and Retirement Study, we explored the work histories and retirement patterns of a cohort of retirees aged 51 to 61 in 1992 during a 10-year period in both cross-sectional and longitudinal contexts. We examined determinants of retirement patterns in a multinomial logistic regression model. Results: We found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once. We also found that the utilization of bridge jobs was more common among younger respondents, respondents without defined-benefit pension plans, and respondents at both the lower and upper ends of the wage distribution. Implications: Older Americans are now working longer than pre-1980s trends would have predicted. Given concerns about the traditional sources of retirement income (Social Security, employer pensions, and prior savings), older Americans may have to rely more on earnings. This article suggests that many are already doing so by moving to bridge jobs after leaving their career employment.
276 citations
TL;DR: The purpose of this study was to obtain information about the perceptions held by seniors and health care providers concerning what constitutes a fall and potential reasons for falling, and to compare these perceptions to the research literature.
Abstract: Purpose: The purpose of this study was (a) to obtain information about the perceptions held by seniors and health care providers concerning what constitutes a fall and potential reasons for falling, and (b) to compare these perceptions to the research literature. Design and Methods: As part of a larger telephone survey, interviewers asked 477 communitydwelling seniors to define a fall and to provide reasons for falling. In addition, we interviewed 31 health care providers from the community on the same topics. In order to capture patterns in conceptualized thinking, we used content analysis to develop codes and categories for a fall definition and reasons for falling. We reviewed selected articles in order to obtain a comprehensive overview of fall definitions currently used in the research and prevention literature. Results: A fall had different meanings for different groups. Seniors and health care providers focused mainly on antecedents and consequences of falling, whereas researchers described the fall event itself. There were substantial differences between the reasons for falling as reported by seniors and the risk factors as identified in the research literature. Implications: If not provided with an appropriate definition, seniors can interpret the meaning of a fall in many different ways. This has the potential to reduce the validity in studies comparing fallers to nonfallers. Research reports and prevention programs should always provide an operational definition of a fall. In communication between health care providers and seniors, an appropriate definition increases the possibility for early detection of seniors in greater need of care and services.
274 citations
TL;DR: It is demonstrated that caregiving task demand and a single-item measure of caregiver life satisfaction significantly predict placement and that institutionalization of dementia patients results from caregiver and patient factors evident in the year before placement.
Abstract: Purpose This study identifies the relative importance of reasons for institutionalization endorsed by caregivers of patients with dementia; examines the relationship between caregivers' reasons for institutionalization and indicators of caregiver and patient physical and emotional functioning measured in the prior year; and compares, on these indicators, caregivers who institutionalized their care recipients with caregivers who did not. Design and methods Participants were 2,200 caregivers from the National Longitudinal Caregiver Study, including 580 who institutionalized their care recipient during the 3-year interval. Caregivers' reason(s) for institutionalization were examined and correlated with indicators of caregiver and patient physical and emotional functioning. These indicators were used in a proportional hazards model to determine independent predictors. Results Caregivers' reasons for placement included (a) the need for more skilled care (65%); (b) the caregivers' health (49%); (c) the patients' dementia-related behaviors (46%); and (d) the need for more assistance (23%). Each of these reasons was significantly associated with indicators in the prior year's survey. This study uniquely demonstrates that caregiving task demand and a single-item measure of caregiver life satisfaction significantly predict placement. Implications These findings emphasize that caregivers' reasons have valid underpinnings and that institutionalization of dementia patients results from caregiver and patient factors evident in the year prior to placement. In routine office visits, caregivers should be systematically screened; accounts of low life satisfaction, dementia problem behaviors, or high task demand should cue clinicians that discussions of nursing home placement would be timely and appropriate.
273 citations
TL;DR: A critical gerontology framework is used, emphasizing both political economy analysis and perspectives from the humanities, to explore underlying questions such as these: What roles are older adults being encouraged to play in civic life?
Abstract: The aging of the baby boom generation, together with research that links volunteerism and positive health outcomes in later life, has contributed to a burgeoning of interest in initiatives and programs promoting civic engagement among older adults. Although useful in potentially expanding role options in later life, this growing attention also underscores the importance of stepping back to critically examine frequently overlooked questions concerning the framing and potential consequences of the new emphasis on civic engagement. Following a brief review of semantics and definitional issues in this area, we use a critical gerontology framework, emphasizing both political economy analysis and perspectives from the humanities, to explore underlying questions such as these: What roles are older adults being encouraged to play in civic life? What meanings are implied by these roles? What political and economic forces underlie these roles? What types of civic engagement are left out of the conversation? Our goal is to encourage a broadening of the dialogue to include potentially problematic normative and political economic dimensions of civic engagement, particularly volunteerism, as they pertain to older adults.
271 citations
TL;DR: Older people reject the idea that they are at risk of falling, so the uptake of strength and balance training programs may be promoted more effectively by maximizing and emphasizing their multiple positive benefits for health and well-being.
Abstract: PURPOSE: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. DESIGN AND METHODS: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries with 69 people aged 68 to 97 years. The sample was selected to include people with very different experiences of participation or nonparticipation in falls-related interventions, but all individuals were asked about interventions that included strength and balance training. RESULTS: Attitudes were similar in all countries and contexts. People were motivated to participate in strength and balance training by a wide range of perceived benefits (interest and enjoyment, improved health, mood, and independence) and not just reduction of falling risk. Participation also was encouraged by a personal invitation from a health practitioner and social approval from family and friends. Barriers to participation included denial of falling risk, the belief that no additional falls-prevention measures were necessary, practical barriers to attendance at groups (e.g., transport, effort, and cost), and a dislike of group activities. IMPLICATIONS: Because many older people reject the idea that they are at risk of falling, the uptake of strength and balance training programs may be promoted more effectively by maximizing and emphasizing their multiple positive benefits for health and well-being. A personal invitation from a health professional to participate is important, and it also may be helpful to provide home-based programs for those who dislike or find it difficult to attend groups. Language: en
270 citations
TL;DR: Receipt of preferred treatment did not predict satisfaction or depression outcomes; these outcomes were most strongly impacted by treatment condition.
Abstract: Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older primary care patients who participated in a multisite, randomized clinical trial comparing usual care to collaborative care, which offered medication and counseling for up to 12 months. Baseline assessment included demographics, depression, health information, prior depression treatment, potential barriers, and treatment preferences (medication, counseling). At 12 months, services received, satisfaction, and depression outcomes were assessed. Results: More patients preferred counseling (57%) than medication (43%). Previous experience with a treatment type was the strongest predictor of preference. In addition, medication preference was predicted by male gender and diagnosis of major depression (vs dysthymia). The collaborative care model greatly improved access to preferred treatment, especially for counseling (74% vs 33% in usual care). Receipt of preferred treatment did not predict satisfaction or depression outcomes; these outcomes were most strongly impacted by treatment condition. Implications: Many depressed older primary care patients desire counseling, which is infrequently available in usual primary care. Discussion of treatment preferences should include an assessment of prior treatment experiences. A collaborative care model that increases collaboration between primary care and mental health professionals can increase access to preferred treatment. If preferred treatment is not available, collaborative care still results in good satisfaction and depression outcomes.
264 citations
TL;DR: The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover.
Abstract: Purpose: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Design and Methods: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). Results: The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. Implications: Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.
TL;DR: Women who experienced psychological/emotional abuse--alone, repeatedly, or with other types of abuse--had significantly increased odds of reporting bone or joint problems, digestive problems, depression or anxiety, chronic pain, and high blood pressure or heart problems.
Abstract: PURPOSE: This study assessed the extent of different types of abuse, repeated and multiple abuse experiences among women aged 60 and older, and their effects on the women's self-reported health. DESIGN AND METHODS: A cross-sectional study of a clinical sample of 842 community-dwelling women aged 60 and older completed a telephone survey about type and frequency of abuse, self-reported health status and health conditions, and demographic characteristics. Bivariate and multivariate analyses were performed using SPSS 11.5 and STATA 7.0. RESULTS: Nearly half of the women had experienced at least one type of abuse-psychological/emotional, control, threat, physical, or sexual-since turning 55 years old. Sizable proportions were victims of repeat abuse. Many women experienced multiple types of abuse and experienced abuse often. Abused older women were significantly more likely to report more health conditions than those who were not abused. Women who experienced psychological/emotional abuse-alone, repeatedly, or with other types of abuse-had significantly increased odds of reporting bone or joint problems, digestive problems, depression or anxiety, chronic pain, and high blood pressure or heart problems. IMPLICATIONS: It is important that health care and service providers acknowledge psychological/emotional, control, threat, physical, and sexual abuse against older women and understand their health implications. In addition, it is important for providers to be trained in both aging and domestic violence services and resources. Language: en
TL;DR: The burden of falls is presented, evidence concerning the effectiveness of fall-prevention services is reviewed, barriers for clinicians and for payers in promotingThese services are described, and strategies to encourage greater use of these services are suggested.
Abstract: One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence concerning the effectiveness of fall-prevention services, describe barriers for clinicians and for payers in promoting these services, and suggest strategies to encourage greater use of these services. The challenges are substantial, but strategies for incremental change are available while more broad-based changes in health care financing and clinical practice evolve to better manage the multiple chronic health conditions, including falls, experienced by older Americans.
TL;DR: Findings indicate that individuals with early-stage dementia and their family caregivers are able to participate in and benefit from a structured intervention that focuses on care planning for future needs.
Abstract: Purpose The Early Diagnosis Dyadic Intervention (EDDI) program provides a structured, time-limited protocol of one-on-one and dyadic counseling for family caregivers and care receivers who are in the early stages of dementia. The goals and procedures of EDDI are based on previous research suggesting that dyads would benefit from an intervention that increases the care receiver's active participation in his or her care plan, develops positive communication patterns between the caregiver and care receiver, increases knowledge and understanding about available services, and assists the dyad through the emotional turbulence of a diagnosis of Alzheimer's disease or other dementing condition. Design and methods EDDI was developed in response to research and clinical findings that suggested that care dyads in the early stages of dementia and dementia care are able to engage in a dialogue about future preferences for care, and that this discussion could address some of the uncertainty and worry experienced by each member of the dyad. As part of a feasibility trial, 31 dyads participated in the EDDI program. Measures were obtained on the intervention's implementation, including the number of sessions attended, caregiver and care receiver ratings of treatment acceptability and effectiveness, and counselor ratings of treatment effectiveness. Results Participant and counselor evaluations of the EDDI protocol indicated that the intervention was acceptable and satisfactory to the caregivers, care receivers, and counselors, and that the intervention's goals and objectives were achievable. Implications These findings indicate that individuals with early-stage dementia and their family caregivers are able to participate in and benefit from a structured intervention that focuses on care planning for future needs.
TL;DR: Investigation of relationships between health literacy and general cognitive and sensory abilities, as well as education, health, and demographic variables, in a community sample of middle-aged and older adults found that education and cognitive ability were independently associated with the STOFHLA measure and explained age differences in health literacy.
Abstract: in health literacy. Implications: The association of cognitive abilities and literacy has important implications for health literacy models and for interventions to reduce the impact of low health literacy on health outcomes.Forexample,medicationinstructionsshould be designed to reduce comprehension demands on general cognitive abilities as well as literacy skills.
TL;DR: The results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease.
Abstract: Purpose: The aim of this pilot feasibility study was to evaluate the effects of an innovative, Internet-based psychosocial intervention for family caregivers of older adults with neurodegenerative disease. Design and Methods: After receiving signed informed consent from each participant, we randomly assigned 66 caregivers to an Internet-based intervention or to a no-intervention control group. The intervention group received computers and training in order to access a password-protected Web site with links to information, e-mail, and threaded discussion. Unique to the Web site was a video-conferencing link that supported caregivers' participation in a 10-session, manual-guided psychosocial support group, followed by 12 additional online sessions facilitated by a group member. Participants completed health-status and stress-response measures at baseline and 6-month follow-up. Results: Content analysis of archived video sessions showed (a) reliable adherence to the manual-guided support-group intervention and (b) online group discussion themes similar to those in face-to-face caregiver support groups. Analyses of stress-response outcome data showed significant between-group differences, with the intervention group experiencing a decline in stress compared with an escalation in stress for the control group. Implications: Despite the limitations of this pilot study in terms of limited sample size and 54% dropout of control participants at 6-month follow-up, the results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease.
TL;DR: Early experience suggests that Green Houses are feasible and that outcomes are likely to be positive, and it also suggests that there are some potential issues to overcome in such a dramatic reengineering of nursing homes.
Abstract: Purpose: We present the concept of the Green House, articulated by William Thomas as a radically changed, ‘‘deinstitutionalized’’ nursing home well before its first implementation, and we describe and discuss implications from the first Green Houses in Tupelo, Mississippi. Design and Methods: Green Houses are small, selfcontained houses for 10 or fewer elders, each with private rooms and full bathrooms and sharing family-style communal space, including hearth, dining area, and full kitchen. Line staff at the level of certified nursing assistants, called Shahbazim, are ‘‘universal workers,’’ who cook meals, do laundry, provide personal care, assist with habilitation, and promote the elders’ quality of life. Nurses, doctors, and other professionals comprise a visiting clinical support team for the residents and Shahbazim. Multiple Green Houses comprise a nursing home, meeting all nursing facility regulations and working within state-reimbursement levels. In 2003, four Green Houses were built on the campus of a retirement community; in June of that year, 40 residents relocated from the 140-bed nursing home to the Green Houses, including 20 residents previously living in the locked dementia unit. Results: Experiences to date are positive for residents, family, and staff. The sponsor is converting the entire facility to Green Houses, and other providers around the country plan to implement Green House variants. Implications: Because nursing home stock is aging, many physical plants are or soon will be slated for major rebuilding, thereby providing sponsors with an opportunity to consider Green Houses. Early experience suggests that Green Houses are feasible and that outcomes are likely to be positive, and it also suggests that there are some potential issues to overcome in such a dramatic reengineering of nursing homes.
TL;DR: This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis.
Abstract: Purpose: We present final outcomes from the multiplecomponent Fit and Strong! intervention for older adults with lower extremity osteoarthritis. Design and Methods: A randomized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement (n = 115) with a wait list control (n = 100) at 2, 6, and 12 months. Fit and Strong! combined flexibility, aerobic walking, and resistance training with education and group problem solving to enhance selfefficacy for exercise and maintenance of physical activity. All participants developed individualized plans for long-term maintenance. Results: Relative to controls, treatment participants experienced statistically significant improvements in self-efficacy for exercise (p =.001), minutes of exercise per week (p = .000), and lower extremity stiffness (p = .018) at 2 months. These benefits were maintained at 6 months and were accompanied by increased self-efficacy for adherence to exercise over time (p =.001), reduced pain (p =.040), and a marginally significant increase in self-efficacy for arthritis pain management (p = .052). Despite a substantially smaller sample size at 12 months, significant treatment-group effects were maintained on self-efficacy for exercise (p = .006) and minutes of exercise per week (p = .001), accompanied by marginally significant reductions in lower extremity stiffness (p = .056) and pain (p = .066). No adverse health effects were seen. Effect sizes for self-efficacy for exercise and for maintenance of physical activity were 0.798 and 0.713, and 0.905 and 0.669, respectively, in the treatment group at 6 and 12 months. Implications: This consistent pattern of benefits indicates that this lowcost intervention is efficacious for older adults with lower extremity osteoarthritis.
TL;DR: Network types were associated with mortality in the 70-79 and 80 and older age groups, and respondents located in diverse and friend-focused network types, and to a lesser degree those located in community-clan network types had a lower risk of mortality compared to individuals belonging to restricted networks.
Abstract: Purpose: The purpose of this study was to examine the association of baseline network type and 7-year mortality risk in later life. Design and Methods: We executed secondary analysis of all-cause mortality in Israel using data from a 1997 national survey of adults aged 60 and older (N =5,055) that was linked to records from the National Death Registry up to 2004. We considered six network types—diverse, friend focused, neighbor focused, family focused, community–clan, and restricted—in the analysis, controlling for population group, sociodemographic background, and health factors. We carried out Cox proportional hazards regressions for the entire sample and separately by age group at baseline: 60–69, 70– 79, and 80 and older. Results: Network types were associated with mortality in the 70–79 and 80 and older age groups. Respondents located in diverse and friend-focused network types, and to a lesser degree those located in community–clan network types, had a lower risk of mortality compared to individuals belonging to restricted networks. Implications: Gerontological practitioners should address older adults’ social networks in their assessments of clients. The parameters used to derive network types in this study can serve toward the development of practical network type inventories. Moreover, practitioners should tailor the interventions theyimplementto the different network types in which their elderly clients are embedded. This article considers the association of social network type and survival in later life. The social networks of older people tend to vary in size and composition. Such variations, reflected in a range of
TL;DR: Among older Americans living in the community and experiencing difficulty with self-care activities, assistive-technology use increased substantially whereas use of personal care declined, and it is demonstrated that shifts in assistance toward technology account for half the decline in the number of people dependent on personal care.
Abstract: We describe national trends during the 1990s in late-life difficulty and assistance with self-care activities. Among older Americans living in the community and experiencing difficulty with self-care activities, assistive-technology use increased substantially whereas use of personal care declined. Using a decomposition technique, we demonstrate that these shifts in assistance toward technology account for half the decline in the number of people dependent on personal care.
TL;DR: The short- and long-term effects of Adult Day Services Plus (ADS Plus), a low-cost care management intervention designed to enhance family caregiver well-being, increase service utilization, and decrease nursing home placement of impaired older adults enrolled in adult day care, are examined.
Abstract: Purpose: This study examined the short- and long-term effects ofAdult DayServices Plus (ADSPlus), a low-cost care management intervention designed to enhance family caregiver well-being, increase service utilization, and decrease nursing home placement of impaired older adults enrolled in adult day care. Design and Methods: We used a quasi-experimental design, to recruit 129 caregivers from three adult day centers. Two centers offered adult day services and ADSPlus(n=67);thethirdcenter(n=62)offeredonly routine adult day services. ADS Plus involved a staff social worker who provided care management and support to family caregivers through face-to-face and telephonecontact. Education, counseling, andreferral services were offered for 12 months. Results: At 3month follow-up, ADS Plus participants (n = 106) reported less depression (p = .016), improved confidence managing behaviors (p = .013) and enhanced well-being (p = .001) compared with controls. Long-term effects analyses (n = 69) showed that, compared with controls, ADS Plus participants continued to report less depression (p = .005) and enhanced confidence managing behaviors (p = .007). Also, intervention participants used adult day services on average 37 days more than controls (p = .003) and had fewer nursing home placements (n=8) than controls (n=17). Implications: ADS Plus is cost efficient and is easy to implement within adult day centers. It affords important clinical and public health benefits, including enhanced caregiver well-being, greater adult day service use, and fewer nursing home
TL;DR: Findings show that the definition of turnover used could influence the relative difference between these reported rates by as much as 47%.
Abstract: Purpose: In this study the levels of staff turnover reported in the nursing home literature (1990–2003) are reviewed, as well as the definitions of turnover used in these prior studies. With the use of primary data collected from 354 facilities, the study addresses the various degrees of bias that result, depending on how staff turnover is defined in nursing homes. Design and Methods: Data came from a survey mailed to administrators of 526 nursing homes during March 2003. Facilities were located in four states: Missouri, Texas, Connecticut, and New Jersey. Three hundred and fifty-four responses were received, giving a response rate of 67%. Results: The 1-year turnover rates identified in these facilities were 119%, 89%, 87%, 57%, and 48%, for nurse aides, licensed practical nurses, registered nurses, administrators, and directors of nursing, respectively. However, findings show that the definition of turnover used could influence the relative difference between these reported rates by as much as 47%. Implications: As a result of measurement error, turnover rates may be misrepresented in prior studies. On the basis of the results of this investigation, several recommendations are made for future data-collection initiatives that will eliminate some of this measurement error.
TL;DR: Understanding and coming to terms with the syndrome, or assigning meaning, constituted a fundamental aspect of living with a diagnosis of mild cognitive impairment, and this process comprised interrelated emotional and cognitive dimensions.
Abstract: Purpose: The proposed dementia precursor state of mild cognitive impairment is emerging as a primary target of aging research. Yet, little is known about the subjective experience of living with a diagnosis of mild cognitive impairment. This study examines, from the patient’s perspective, the experience of living with and making sense of the diagnosis. Design and Methods: We recruited 12 older adults with amnestic or nonamnestic mild cognitive impairment from a university-based memory disorders clinic. We conducted in-home, semistructured interviews in order to elicit rich descriptions of the personal experience of having mild cognitive impairment. We used the qualitative method of grounded theory to analyze narrative data. Results: Understanding and coming to terms with the syndrome, or assigning meaning, constituted a fundamental aspect of living with a diagnosis of mild cognitive impairment. This process comprised interrelated emotional and cognitive dimensions. Participants employed a range of positive, neutral, and negative phrasing in order to depict their emotional reactions to receiving a diagnosis. Cognitive representations of mild cognitive impairment included both prognosis-focused and face-value appraisals. Expectations of normal aging, personal experience with dementia, and concurrent health problems were key contextual factors that provided the backdrop against which participants assigned meaning to a diagnosis of mild cognitive impairment. Implications: Clinicians who disclose diagnoses of mild cognitive impairment need to be mindful of the potential for varying interpretations of
TL;DR: Emotional closeness and similarity of gender and attitudes were strongly associated with which children mothers identified as probable caregivers and a discrepancy between maternal preference for care and actual patterns of support from adult children was indicated.
Abstract: Purpose: This article reports on a within-family study to identify factors that lead mothers to expect that a particular child will serve in the role of primary caregiver. Design and Methods: Data for this study were collected by in-person interviews with a representative sample of 566 mothers between the ages of 65 and 75 years residing in the greater Boston area, who provided detailed information regarding all of their adult children. Both multivariate and qualitative data analyses were conducted. Results: Emotional closeness and similarity of gender and attitudes were strongly associated with which children mothers identified as probable caregivers. Findings regarding exchange were mixed. Mothers were more likely to name adult children who had provided them with support; however, mothers’ past provision of assistance to children was unrelated to expectations regarding care. No aspects of children’s availability besides proximity and employment of adult children affected mothers’ expectations. In selecting a primary caregiver, mothers emphasized expressive characteristics of intergenerational relationships, rather than instrumental and contextual factors associated with children’s availability. Implications: The findings indicated a discrepancy between maternal preference for care and actual patterns of support from adult children. Practitioners who work with older adults and their families should incorporate parents’ views of the ‘‘likely’’ caregiver into family counseling protocols. Family counseling in both the precaregiving and actual care provision stages may be useful to clarify expected roles for children.
TL;DR: This study reviews staffing standards from the 50 states to determine if these standards are related to nursing home staffing levels, and finds facilities in states with high staffing standards had somewhat higher staffing than states with no standards or low standards.
Abstract: Purpose: This study reviews staffing standards from the 50 states and the District of Columbia to determine if these standards are related to nursing home staffing levels. Design and Methods: Rules and regulations for states’ nursing home staffing standards were obtained for the 50 states and the District of Columbia. Nurse staffing data were obtained from the Centers for Medicare and Medicaid Services OnLine Survey, Certification, and Reporting (known as OSCAR) database. The minimum hours per resident day (HPRD) staffing standards for each state were categorized according to the following: no statespecific HPRD standard (adheres only to federal staffing guidelines); low HPRD standard (� 2.5 HPRD); and high HPRD standard (. 2.5 HPRD). A series of hierarchical linear models examined the relationships between state staffing standards and actual facility staffing (total, licensed, and certified nurse aide HPRD), using a number of covariates. Results: The variance in facility staffing was much greater within than between states. Facilities in states with high staffing standards had somewhat higher staffing than states with no standards or low standards, whereas facility staffing in states with low standards was not significantly different from that in states with no standards. Other factors, such as resident acuity and average state Medicaid rate, also were related to staffing. Implications: State staffing standards may not be effective policy tools because they are only one of many factors that affect facility staffing levels. Setting a low minimum HPRD standard may fail to raise staffing, or it may even have a dampening effect on staffing rates in facilities.
TL;DR: The authors' data suggest that many older adults would respond to probing by primary care physicians about their mood, and a social model of depression is closer to the beliefs of older people than the traditional medical model.
Abstract: Purpose: This U.K. study explored how older adults with depression (treated and untreated) and the general older population conceptualize depression. A multicultural approach was used that incorporated the perspectives of Black Caribbean, South Asian, and White British older adults. The study sought to explore and compare beliefs about the nature and causes of depression, and to suggest ways in which these beliefs act to facilitate or deter older people from accessing treatment. Design and Methods: One hundred and ten in-depth separate interviews were conducted for 45 White British, 33 South Asian, and 32 Black Caribbean individuals. The interviews explored what the word depression meant to participants, and their beliefs regarding depression’s causes. Results: Depression was often viewed as an illness arising from adverse personal and social circumstances that accrue in old age. White British and Black Caribbean participants defined depression in terms of low mood and hopelessness; South Asian and Black Caribbean participants frequently defined depression in terms of worry. Those receiving antidepressants were more likely to acknowledge psychological symptoms of depression. Differences in attribution were found between the ethnic groups. Implications: A social model of depression is closer to the beliefs of older people than the traditional medical model. Culturally appropriate inquiries about recent life events could be used to facilitate discussion about depression. Our data suggest that many older adults would respond to probing by primary care physicians about their mood. Health and social care professionals need to be sensitive to the language of depression used by different ethnic groups.
TL;DR: The findings demonstrate that telecommunications technology can overcome the often formidable logistical problems faced by both English- and Spanish-speaking caregivers, and it can provide benefits similar to those obtained in face-to-face support groups.
Abstract: Purpose: Dementia caregiving is a rapidly growing public health problem. Logistical problems prevent many caregivers from utilizing available interventions. This article provides a demonstration of the usefulness of technology for conducting telephone-based support groups in ethnically diverse dementia caregivers. Design and Methods: Participants were 41 White American and Cuban American dementia caregivers participating at the Miami site of the Resources for Enhancing Alzheimer's Caregiver Health (known as REACH) program. Support groups were conducted over the telephone in English and Spanish as appropriate. Results: Eighty-one percent of the participants found the group "valuable," largely because of the social and emotional support and useful information obtained from other group members. The majority of caregivers also reported that their participation had increased their knowledge and skills as caregivers. Implications: The findings demonstrate that telecommunications technology can overcome the often formidable logistical problems faced by both English- and Spanish-speaking caregivers, and it can provide benefits similar to those obtained in face-to-face support groups.
TL;DR: In this paper, the authors evaluated the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework and found that family functioning to partially mediate the relationship between objective burden and distress and significantly account for the prediction of distress beyond well-recognized predictors.
Abstract: Purpose
The purpose of the study was to evaluate the role of family functioning in the stress process in a sample of caregivers of dementia patients by using a structural family framework. The stress-process model of caregiver distress included family functioning as an intervening variable in the relationship between objective burden and distress. We theorized family functioning to partially mediate the relationship between objective burden and distress and to significantly account for the prediction of distress beyond well-recognized predictors.
TL;DR: A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents.
Abstract: Purpose When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors (gentleness and verbal support) and experienced greater preparedness (confidence and ease) and less distress (hassles) when assisting residents with bathing. Design and methods We used a crossover design and randomized 15 nursing homes into two treatment groups and a control group of 5 facilities each. In one treatment group, CNAs received person-centered training, first with showering for 6 weeks (Time 1) and then with the towel bath for 6 weeks (Time 2). We reversed the treatment order in the other treatment group. Control group CNAs used usual showering procedures without person-centered training. We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes. We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline. Results Compared with the control group, treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease. Implications A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents.
TL;DR: The action-oriented approach that focused on friendship development in this intervention might be applied to other goals considered important in later life (optimal health, autonomy, harmonious family relations).
Abstract: Purpose: This study explores the effects of participation in a program designed to enrich friendship and reduce loneliness among women in later life. Several hypotheses based on the need to belong, socioemotional selectivity theory, and the social compensation model were tested. Design and Methods: Study 1 involved two measurement points, one at the end of the program and the other 1-year later. Study 2 used a pretest–post-test control group design with a followup measurement. A combination of semistructured interviews and structured questionnaires was used to collect data. A comparison group was also drawn from a nationwide representative sample. Results: Participants were characterized by deprivation on the need to belong; that is, loss of a partner, higher levels of loneliness and negative affect, and lower positive affect compared with a nationwide representative sample of same-aged women. Participants were more likely than women in a control group to report the development of new friendships and an improvement in friendship. The combination of new and improved friendships contributed to a significant reduction in loneliness within a year. There was no evidence of satiation of the need to belong among those who did not expand or improve friendships. Loss of a partner had no influence on friendship development; however, age did. Older participants were less likely to improve friendships. Implications: The actionoriented approach that focused on friendship development in this intervention might be applied to other goals considered important in later life (optimal health, autonomy, harmonious family relations).