Showing papers in "Gerontologist in 2007"
TL;DR: The findings reveal that although disability measures often show improvement, there is a simultaneous increase in chronic disease and functional impairments-health components that require care resources, suggesting a parallel or increased need for resources in medical care, rehabilitation, and compensatory interventions such as assistive technology.
Abstract: Health trends in the fastest growing sector of the population, the oldest old, have received much attention during the past decade because of the rising costs of medical and long-term care. Many studies have suggested a compression of morbidity in this sector, implying that the future care needs of elderly people will not follow the demographic prognoses. Most of these studies have used health indicators based on disability, a concept that is contextually embedded. We have taken a closer look at health-trend surveys with a focus on the health indicator used. Our findings reveal that although disability measures often show improvement, there is a simultaneous increase in chronic disease and functional impairments-health components that require care resources. That is, an expansion of other health problems may accompany a compression of disability. Therefore, a concept of general morbidity is not sufficient when discussing health trends and the need for care services in the elderly population. Because different indicators do not show the same trends over time, we suggest a more refined discussion that distinguishes between different health components. In addition, different components have different implications for the amount and kind of care resources needed. If the current positive trends in disability continue, future need for social services and long-term care may not parallel demographic projections. Trends in disease and functional limitations seem to have taken a different direction, suggesting a parallel or increased need for resources in medical care, rehabilitation, and compensatory interventions such as assistive technology.
388 citations
TL;DR: In this paper, the authors examined the relationship between aspects of objective and perceived housing and aspects of healthy aging, defined as independence in daily activities and subjective wellbeing, and examined the comparability of relationships between housing and healthy aging in the five European countries.
Abstract: Purpose: The aim of this work is to examine the relationship between aspects of objective and perceived housing and aspects of healthy aging, defined as independence in daily activities and subjective wellbeing. Furthermore, this research examined the comparability of relationships between housing and healthy aging in the five European countries. Design and Methods: Data were drawn from the ENABLE-AGE Project, from home interviews with a sample of 1,918 very old people aged 75. to 89 years living alone in their own homes in Swedish, German, British, Hungarian and Latvian urban areas. Results: Participants living in better accessible homes, who perceive their home as meaningful and useful, and who think that external influences are not responsible for their housing situation are more independent in daily activities and have a better sense of well-being. Moreover, these results apply to all five national samples. Implications: The findings can widen the perspective when striving for barrier-free building standards, to encompass a holistic approach that takes both objective and perceived aspects of housing into account. Home modification and relocation should not be prescribed, but need to be negotiated with older adults to take into account their personal preferences.
358 citations
TL;DR: The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if they are to make significant progress in the next decade as the baby boomers begin to reach age 70.
Abstract: PURPOSE: We review what we currently know about older driver safety and mobility, and we highlight important research needs in a number of key areas that hold promise for achieving the safety and mobility goals for the aging baby boomers and future generations of older drivers. DESIGN AND METHODS: Through the use of a framework for transportation and safe mobility, we describe key areas of screening and assessment, remediation and rehabilitation, vehicle design and modification, technological advancements, roadway design, transitioning to nondriving, and alternative transportation to meet the goals of crash prevention and mobility maintenance for older adults. RESULTS: Four cross-cutting themes emerged from this review: safe transportation for older adults is important; older adults have a variety of needs, abilities, and resources; research to help meet the transportation needs of older adults may be of benefit to persons with disabilities; and transportation issues concerning older adults are multifaceted. IMPLICATIONS: Safe mobility is essential to continued engagement in civic, social, and community life, and to the human interactions necessary for health, well-being, and quality of life. When safe driving is no longer possible for older adults, safe and practicable alternative transportation must be available. Furthermore, older adults are individuals; they have specific needs, abilities, and resources. Not all older adults will have difficulty meeting their transportation needs and no single transportation solution will work for all people. Research and countermeasures intended to help meet the transportation needs of older adults will likely also benefit younger users of the transportation system, particularly those with disabilities. The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if we are to make significant progress in the next decade as the baby boomers begin to reach age 70. Language: en
300 citations
TL;DR: Currently in Europe as well as in the United States, an increasing proportion of very old people remain living in their homes despite declines in physical and mental health.
Abstract: Currently in Europe as well as in the United States, an increasing proportion of very old people remain living in their homes despite declines in physical and mental health Together with the fact that the population of very old people is rapidly increasing (Mathers, Sadana, Salamon, Murray, Lopez, 2001; United Nations Development Programme, 2001), this poses new challenges to societal planning and housing development (Gitlin, 2003)
260 citations
TL;DR: High overall job satisfaction was associated with low scores on thinking about leaving, thinking about a job search, searching for a job, and turnover, and high scores on the Quality of Care subscale were associated with high turnover after 1 year.
Abstract: Purpose: The relationship between job satisfaction of nurse aides and intent to leave and actual turnover after 1 year is examined. Design and Methods: Data came from a random sample of 72 nursing homes from 5 states (Colorado, Florida, Michigan, New York, and Oregon). From these nursing homes, we collected 1,779 surveys from nurse aides (a response rate of 62%). We used a job satisfaction instrument specifically developed for use with nurse aides, as well as previously validated measures of intent to leave and turnover. We used ordered logistic regression and logistic regression to examine the data. Results: High overall job satisfaction was associated with low scores on thinking about leaving, thinking about a job search, searching for a job, and turnover. In examining the association between the job satisfaction subscales and intent to leave and turnover, we found that high Work Schedule subscale scores, high Training subscale scores, and high Rewards subscale scores were associated with low scores on thinking about leaving, thinking about a job search, searching for a job, and turnover. High scores on the Quality of Care subscale were associated with low turnover after 1 year. Implications: These results are important in clearly showing the relationship between job satisfaction and intent to leave and turnover of nurse aides. Training, rewards,
255 citations
TL;DR: A 1-year pilot test in a community-based primary care practice suggested that Guided Care is feasible and acceptable to physicians, patients, and caregivers.
Abstract: Purpose The purpose of this study was to test the feasibility of a new model of health care designed to improve the quality of life and the efficiency of resource use for older adults with multimorbidity. Design and methods Guided Care enhances primary care by infusing the operative principles of seven chronic care innovations: disease management, self-management, case management, lifestyle modification, transitional care, caregiver education and support, and geriatric evaluation and management. To practice Guided Care, a registered nurse completes an educational program and uses a customized electronic health record in working with two to five primary care physicians to meet the health care needs of 50 to 60 older patients with multimorbidity. For each patient, the nurse performs a standardized comprehensive home assessment and then collaborates with the physician, the patient, and the caregiver to create two comprehensive, evidence-based management plans: a Care Guide for health care professionals, and an Action Plan for the patient and caregiver. Based in the primary care office, the nurse then regularly monitors the patient's chronic conditions, coaches the patient in self-management, coordinates the efforts of all involved health care professionals, smoothes the patient's transitions between sites of care, provides education and support for family caregivers, and facilitates access to community resources. Results A 1-year pilot test in a community-based primary care practice suggested that Guided Care is feasible and acceptable to physicians, patients, and caregivers. Implications If successful in a controlled trial, Guided Care could improve the quality of life and efficiency of health care for older adults with multimorbidity.
206 citations
TL;DR: A feminist, structural approach to husbands' experiences of caring for wives with Alzheimer's disease found that these husbands' approaches to caregiving and their strategies for dealing with the work and feelings involved were rooted in their sense of selves as men.
Abstract: Purpose We adopted a feminist, structural approach to husbands' experiences of caring for wives with Alzheimer's disease. This framework posited that men and women draw upon gender repertoires-situational ideals of behavior based upon their respective structural locations-that create gendered experiences of stress and coping strategies. Design and methods We used a qualitative, constructivist approach to analyze in-depth interviews with 22 spousal caregivers and observations within support groups. Our analysis focused on the nine husbands, the strategies these men reported using to deal with problems that arose in their care work, and the extent to which these are congruent with the masculinities of White men in the United States. Results We found that these husbands' approaches to caregiving and their strategies for dealing with the work and feelings involved were rooted in their sense of selves as men. We outline their overall approaches to caregiving, identify six strategies husbands used to deal with problems stemming from care work-exerting force, focusing on tasks, blocking emotions, minimizing disruption, distracting attention, and self-medicating-and tie these to their structural positions as working-, middle-, and professional-class men. Implications Theories of gender differences in the performance or quality of care work should tie these to structural arrangements. Unless the gendered bases upon which different styles or experiences are removed (i.e., structural inequality), designers of interventions cannot and should not expect to use the experience of one group to inform appropriate strategies for the other.
167 citations
TL;DR: Logistic regression showed that Items 1 (describing two risks to participation in the study) and 2 (knowing what is associated with participation) had the greatest overall percentage of agreement with the full ESC, and the Mini-Mental State Exam was the only resident-tested variable to predict the results of the ESC.
Abstract: Purpose: The purpose of this report is to evaluate the reliability and validity of the five-item Evaluation to Sign Consent (ESC), a measure that can guide determination of an older adult’s capacity to consent for research. Design and Methods: Information was obtained from 346 nursing home residents from six facilities who were being enrolled into a randomized controlled trial testing a restorative care intervention. In addition to the ESC, the resident’s cognitive status and demographic information was obtained. Results: The average age of the participants was 86.1 6 7.3 years; most of the participants were female (84%) and Caucasian (95%). The mean Mini-Mental State Exam score was 18.0 6 7.4. A total of 218 residents (63%) did not pass the ESC. According to a Rasch analysis and the inter-rater reliability (r = .81), there was some evidence of reliability and validity with this measure. Logistic regression showed that Items 1 (describing two risks to participation in the study) and 2 (knowing what is associated with participation) had the greatest overall percentage of agreement with the full ESC, and the Mini-Mental State Exam was the only resident-tested variable to predict the results of the ESC. Implications: This study provides useful information about the ESC. It indicates a reason and a method to move beyond cognitive testing that can more appropriately evaluate the capacity to consent to participate in research.
166 citations
TL;DR: Investigating the role of control beliefs in mediating the relationship between driving cessation and change in depressive symptoms in a population-based sample of older adults found interventions aimed at promoting the maintenance of personal agency and associated control beliefs could be protective against the negative psychological concomitants of driving cessation.
Abstract: PURPOSE: The purpose of this article was to investigate the role of control beliefs in mediating the relationship between driving cessation and change in depressive symptoms in a population-based sample of older adults. DESIGN AND METHODS: We report results from a prospective, community-based cohort study that included two waves of data collected in 1992 and 1994. Participants consisted of 700 men and women aged 70 and older, including 647 drivers and 53 participants who ceased driving between baseline (1992) and follow-up (1994). Participants took part in interviews that included assessments of driving status, sociodemographic characteristics, self-rated health, sensory function, depressive symptoms (through the Center for Epidemiologic Studies-Depression scale), and expectancy of control. Using multilevel general linear models, we examined the extent to which driving status, expectancy of control, and relevant covariates explained change in depressive-symptom scores between baseline and follow-up. RESULTS: Driving cessation was associated with an increase in depressive symptoms from baseline to follow-up. The higher depressive-symptom scores of ceased drivers relative to those of individuals who remained drivers at both waves was partly explained by a corresponding decrease in the sense of control among ceased drivers, and increased control beliefs among drivers. IMPLICATIONS: Interventions aimed at promoting the maintenance of personal agency and associated control beliefs could be protective against the negative psychological concomitants of driving cessation. Language: en
163 citations
TL;DR: Health care providers should consider using the Marwit and Meuser Caregiver Grief Inventory to screen for high levels of grief in caregivers of individuals with Alzheimer's disease.
Abstract: Purpose: The purpose of this study was to describe the grief and personal growth experience of spouses and adult children of individuals with Alzheimer’s disease and related dementias and the factors contributing to these experiences. Design and Methods: We used a modification of the Marwit– Meuser–Sanders Caregiver Grief model to examine the factors that contribute to grief and personal growth. We used chi-square tests, t tests, multivariate analyses of variance, correlations, and hierarchical regression analyses in a cross-sectional analysis of 201 spouses and adult children caregivers at various stages of the disease trajectory. Results: Grief increased as the severity of the disease increased. When the spouse with Alzheimer’s disease lived out of the home, spouse caregivers experienced more sadness and longing, worry and isolation, and personal sacrifice burden than did adult children caregivers. Different factors influence grief and personal growth for caregivers of individuals with Alzheimer’s disease. The majority of caregivers experienced personal growth, with more growth experienced by adult children. Implications: Health care providers should consider using the Marwit and Meuser Caregiver Grief Inventory to screen for high levels of grief in caregivers of individuals with Alzheimer’s disease. Supportive services targeted for those with high levels of grief are suggested.
158 citations
TL;DR: It was found that reducing turnover from high to medium levels was associated with increased quality, but the evidence was mixed regarding the quality improvements from further lowering turnover to low levels.
Abstract: Purpose: We used data from a large sample of nursing homes to examine the association between staff turnover and quality. Design and Methods: The staff turnover measures came from primary data collected from 2,840 nursing homes in 2004 (representing a 71% response rate). Data collection included measures for nurse aides, licensed practical nurses, and registered nurses. We examined 14 indicators of care quality that came from the Nursing Home Compare Web site. Results: We found that reducing turnover from high to medium levels was associated with increased quality, but the evidence was mixed regarding the quality improvements from further lowering turnover to low levels. Implications: Our investigation shows that the relationship between turnover and quality might not be linear. Nevertheless, in general, high turnover is associated with poor quality.
TL;DR: It is argued that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy.
Abstract: The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical practices, and social policy. We first define and characterize these constructs, review empirical evidence supporting the distinct role of suffering and compassion in the context of caregiving, and then present a conceptual model linking patient suffering with caregiver compassion. We conclude with a discussion of implications and future directions for clinical intervention, research, and policy.
TL;DR: Logistic regression results were that work overload and lack of upward mobility increased intent to leave and support for many of the management-practice improvements taking place in the field, including those implemented in the BJBC demonstration.
Abstract: Purpose: We assess how perceived rewards and problems with caregiving work and supervision relate to intent to leave among direct care workers who are employed in provider organizations participating in the Better Jobs Better Care (BJBC) demonstration; we also examine how these relationships vary by provider type. Design and Methods: Direct care workers from 50 skilled nursing facilities, 39 home care agencies, 40 assisted living facilities, and 10 adult day services in five states completed a paper survey administered prior to the implementation of the BJBC interventions in each organization. We include direct care workers (n = 3,039) with complete data in the analyses using multinomial regression clustered by provider organization to compare those not at all likely to leave and those very likely to leave in the next year with a middle referent group who are somewhat likely to leave. Results: Logistic regression results were that work overload and lack of upward mobility increased intent to leave. Respondents with positive assessments of their supervisor, who valued helping others, and for whom the income was perceived as rewarding were less likely to be in the very likely to quit category and more likely to be in the stable category. Some differences between provider types are observed, especially between home care workers and those employed in facilities. Implications: These findings provide support for many of the managementpractice improvements taking place in the field, including those implemented in the BJBC demonstration. Follow-up surveys will provide insight into their effectiveness.
TL;DR: Recommendations are considered for change in light of emerging themes, including expanding the definition of caregivers to be more inclusive of gay and lesbian realities, developing specialized services, and advocating to eliminate discrimination faced by these populations.
Abstract: Purpose: This article reports on the findings of a study whose purpose was to explore the experiences of caregivers of gay and lesbian seniors living in the community and to identify issues that emerged from an exploration of access to and equity in health care services for these populations. Design and Methods: The study used a qualitative methodology based upon principles of grounded theory in which open-ended interviewswereundertakenwith17caregiverslivingin threedifferentcitiesacrossCanada. Results: Findings indicatedseveralcriticalthemes,includingtheimpactof felt and anticipated discrimination, complex processes of coming out, the role of caregivers, self-identification as a caregiver, and support. Implications: We consider several recommendations for change in light of emerging themes, including expanding the definition of caregivers to be more inclusive of gay and lesbian realities, developing specialized services, and advocating to eliminate discrimination faced by these populations.
TL;DR: An active, engaged lifestyle, emphasizing mental activity and educational pursuits in early life, can have a positive impact on cognitive functioning in late life, and suggests that reserve is dynamic, but it is most amenable to change in earlylife.
Abstract: Purpose: According to the reserve perspective on cognitive aging, individuals are born with or can develop resources that help them resist normal and disease-related cognitive changes that occur in aging. The reserve perspective is becoming more sophisticated, but gaps in knowledge persist. In the present research, we considered three understudied questions about reserve: Is reserve primarily static (unchangeable) throughout the life course or dynamic (changeable, in terms of increases or decreases)? Can reserve be increased at any point in life, or are there optimal time periods—such as early life, midlife, or late life—to increase it? Does participation in different types of leisure and occupational activities in early life and midlife have different effects depending on specific domains of late-life cognitive functioning? Here we link early cognitive and activity data— gathered from archival sources—with cognitive data from older adults to examine these issues. Design and Methods: 349 participants, all mid-1940s graduates of the same high school, underwent telephone cognitive screening. All participants provided access to adolescent IQ scores; we determined activity levels from yearbooks. We used path analysis to evaluate the complex relationships between early life, midlife, and late-life variables. Results: Adolescent IQ had strong direct effects on global cognitive functioning, episodic memory, verbal fluency, and processing speed. Participants’ high school mental activities had direct effects on verbal fluency, but physical and social activities did not predict any cognitive measure. Education had direct effects on global cognitive functioning, episodic memory, and, most strongly, processing speed, but other midlife factors (notably, occupational demands) were not significant predictors of late-life cognition. There were weak indirect effects of adolescent IQ on global cognitive functioning, episodic memory, and processing speed, working through high school mental activities and education. Verbal fluency, in contrast, was affected by adolescent IQ through links with high school mental activities, but not education. Implications: Our study suggests that reserve is dynamic, but it is most amenable to change in early life. We conclude that an active, engaged lifestyle, emphasizing mental activity and educational pursuits in early life, can have a positive impact on cognitive functioning in late life.
TL;DR: An evidence-based intervention to improve communication and cooperation between staff and families of residents in nursing home dementia programs enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.
Abstract: Purpose: This article reports the results of a randomized,controlledevaluationofPartnersinCaregivingin a Special Care Environment, an intervention designed to improve communication and cooperation between staffandfamiliesofresidentsinnursinghomedementia programs. Design and Methods: Participants included 388 family members and 384 nursing staff members recruited from 20 nursing homes, randomly assigned to treatment and control conditions. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents’ family members, followed by a joint meeting with facility administrators. Results: Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Staff reported reduced conflict with families and reduced depression; burnout for nurses increased for individuals in the control group but not those in the treatment group. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs. Implications: Effective staff and family partnerships are critical in caring forresidentswithdementia.ThePartnersinCaregiving inaSpecialCareEnvironmentprogramisanevidencebased intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.
TL;DR: Evaluated empowered work teams within the long-term-care setting had a variety of modest, positive effects: increased CNA empowerment; better CNA performance; improved resident care and choices; improved procedures, coordination, and cooperation between CNAs and nurses; and possibly reduced turnover.
Abstract: Article on a longitudinal assessment and the consequences of empowered CAN teams in nursing home settings.
TL;DR: There were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations, and particular attention to the most common disease constellations - hypertension, arthritis, and heart disease.
Abstract: Purpose On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. Design and methods We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease. Results An increasing prevalence of multiple morbidity (58% compared with 70% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41%, 85%, and 100%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations. Implications Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.
TL;DR: Objective and perceived aspects of housing have to be considered in order to understand the dynamics of aging in place, and the results can be used in practice contexts that target housing for senior citizens.
Abstract: Purpose: Our purpose in this study was to explore relationships between aspects of objective and perceived housing in five European samples of very old adults, as well as to investigate whether cross-national comparable patterns exist. Design and Methods: We utilized data from the first wave of the ENABLE-AGE Survey Study. The five national samples totalled 1,918 individuals aged 75 to 89 years. Objective assessments of the home environment covered the number of environmental barriers as well as the magnitude of accessibility problems (an aspect of person-environment fit). To assess perceptions of housing, we used instruments on usability, meaning of home, and housing satisfaction. We also assessed housing-related control. Results: Overall, the results revealed that the magnitude of accessibility problems, rather than the number of physical environmental barriers, was associated with perceptions of activity-oriented aspects of housing. That is, very old people living in more accessible housing perceived their homes as more useful and meaningful in relation to their routines and everyday activities, and they were less dependent on external control in relation to their housing. The patterns of such relationships were similar in the five national samples. Implications: Objective and perceived aspects of housing have to be considered in order to understand the dynamics of aging in place, and the results can be used in practice contexts that target housing for senior citizens.
TL;DR: Competencies that facilitate future-oriented self-regulation can be improved by a brief educational program in middle and late adulthood by conceptualizing proactive coping as a set of competencies.
Abstract: Purpose: We tested the effectiveness of a brief educational program that is based on proactive coping theory. The program entails a four-session group intervention for people aged between 50 and 75 years and was intended to improve proactive coping competencies. Furthermore, we investigated the positive as well as negative side effects and differential effectiveness of the program. Design and Methods: A total of 158 middle aged and older men and women participated in the study. In a prospective randomized control trial with an experimental group and a waiting control group, we collected questionnaire data at three points (baseline, after completion of the program, and 3 months postintervention). Results: The program improved proactive coping competencies significantly. Three months after completion of the intervention, these results remained stable. Nearly all effect sizes in the experimental group were medium or higher. The program did not have negative side effects in terms of worrying or negative mood, and it did not change levels of selfefficacy. Demographic characteristics of participants did not predict changes in proactive competencies. Differentialeffectivenesscouldonlybeshownforafew psychological characteristics: Lower levels of well
TL;DR: The high lifetime partner violence occurrence, frequency, duration, and severity, coupled with results from prior studies indicating long-term adverse health effects of partner violence, suggest a need for increased efforts to address partner violence in older women.
Abstract: Purpose: We describe the prevalence, types, duration, frequency, and severity of intimate partner violence (‘‘partner violence’’) in older women. Design and Methods: We randomly sampled a total of 370 English-speaking women (65 years of age and older) from a health care system to participate in a crosssectional telephone interview. Using 5 questions from theBehavioralRisk FactorSurveillanceSystem (BRFSS) and 10 questions from the Women’s Experience with Battering (WEB) Scale, we assessed a woman’s exposure to partner violence. We estimated lifetime partner violence prevalence using the BRFSS questions (physical, forced intercourse, forced sexual contact, verbal threats, and controlling behavior), and we estimated past-5-year and past-year prevalence using the BRFSS and the WEB Scale. We estimated violence frequency, duration, and severity using the BRFSS questions. Results: According to the BRFSS, lifetime partner violence prevalence was 26.5%; 18.4% of women experienced physical or sexual violence and 21.9% experienced nonphysical violence (threats or controlling behavior). According to the BRFSS and WEB Scale, past-5-year violence prevalence was 3.5%, and past-year violence prevalence was 2.2%. Many abused womenreported more than 20episodes of violence in their lifetime (from 18.1% for physical violence to 61.2% for controlling behavior). The median duration ranged from 3 years (forced sexual contact) to 10 years (controlling behavior). The proportion of abused women rating their abuse as severe ranged from 39.1% (forced sex or sexual contact) to 70.7% (threats). Implications: The high lifetime partner violence occurrence, frequency, duration, and severity, coupled with results from prior studies indicating long-term adverse health effects of partner violence, suggest a need for increased efforts to address partner violence in older women.
TL;DR: A historical overview of the emergence of assisted living in the United States over a 25-year period is provided to identify goals and key concepts that underpinned the emerging form of care.
Abstract: Purpose This article provides a historical overview of the emergence of assisted living in the United States over a 25-year period to identify goals and key concepts that underpinned the emerging form of care. Design and methods The method is historical analysis based on records and my own personal experiences in conceptualizing and implementing assisted living in Oregon and nationwide. Results I identified four time periods: (a) 1979 to 1985, when a paradigm shift occurred on both the East and West coasts, motivated by distaste for nursing facilities and idealistic values regarding residential environments, service capacity, and consumer-centered care philosophy; (b) 1986 to 1993, when providers, consumers, and state governments became interested and four identifiable types of assisted living (hybrid, hospitality, housing, and health care) appeared, each of which informed the evolution of assisted living; (c) 1994 to 2000, a period of expansion, Wall Street money, dilution of the ideals, and emerging quality concerns; a crisis of confidence and a crossroads for assisted living; (d) 2000 to the present, a time of regrouping, slow-down in growth, and reexamination of earlier efforts to define and set standards for assisted living. Implications Well-conceptualized and designed research may provide a mechanism to suggest practice, regulatory, and payment models. I recommend that researchers conduct studies from the values premises underlying the assisted living approach.
TL;DR: Using the DRS to measure the impact of family care on positive and negative interactions inclusive of patients and caregivers can assist in identifying areas of difficulty and guide interventions to improve outcomes for both members of the dyad.
Abstract: Purpose This study evaluated the psychometric properties of the Dyadic Relationship Scale (DRS), which measures negative and positive dyadic interactions from the perspective of both the patient and the family caregiver. An important aspect of evaluating the DRS was that it be statistically sound and meaningful for both members of the dyad. Design and methods The study used a cross-sectional design. Survey packages were mailed to home health care patients and their family caregivers. The unit of analysis was the dyad, and exploratory and confirmatory factor analyses were conducted. We examined the reliability, discriminant, and concurrent validities of the instrument. Results The data supported a two-factor DRS that included negative dyadic strain (patient alpha =.84; caregiver alpha =.89) and positive dyadic interaction (patient alpha =.86; caregiver alpha =.85). The analysis supported the DRS's construct, discriminant, and concurrent validity, as well as its reliability for both patients and family caregivers. Implications Using the DRS to measure the impact of family care on positive and negative interactions inclusive of patients and caregivers can assist in identifying areas of difficulty and guide interventions to improve outcomes for both members of the dyad.
TL;DR: Results showed a relationship between ADS use and caregivers' report of fewer nighttime sleep-related problems for their PWDs, and the findings support its utility as part of the continuum of care for P WDs and their caregivers.
Abstract: Purpose: This study explored whether adult day service (ADS) use was associated with reductions in behavioral and psychological symptoms of dementia (BPSD) in individuals with dementia. Design and Methods: We used a quasi-experimental design to compare a group of 133 persons with dementia (PWDs) who initially enrolled in an ADS program to a control group not using these services (n = 68). Caregivers used a 24-hour log on multiple, consecutive days to report on five domains of BPSD. Results: We used growth-mixture modeling techniques to model change in the BPSD domains over a 2-month period as well as to handle the preponderance of zeros that were inherent in the data. Results showed a relationship between ADS use and caregivers’ report of fewer nighttime sleep-related problems for their PWDs. We found trends for other domains, specifically depressive symptoms and agitated behavior, but no significant group differences emerged for these and the other domains. Implications: The findings of ADS use on PWDs’ duration of nighttime sleep problems provide some evidence of the benefits of ADS; the findings also support its utility as part of the continuum of care for PWDs and their caregivers. For other behavior domains, enhanced or more targeted behavioral strategies coupled with ADS might offer caregivers and their PWDs the best possible combination for ameliorating BPSD.
TL;DR: Results indicate that individuals who report more decision-making involvement are younger, female, have more education, have a nonspousal caregiver, have fewer months since their diagnosis, exhibit fewer problems with activities of daily living and fewer depressive symptoms, and place more importance on autonomy/self-identity.
Abstract: Purpose: Research underscores how autonomy and decision-making involvement may help to enhance the quality of life of older adults; however, individuals with dementia are often excluded from decision making that is related to their daily functioning. In this study we use a modified version of the Stress Process Model to consider the stress process of individuals with chronic illness, and in particular to explore the predictors of decision-making involvement among individuals with dementia (n = 215). Design and Methods: We collected data from individual with dementia (IWD)‐ family caregiver dyads. Relying primarily on data from the IWD, we used hierarchical multiple regression analysis to determine the predictors of the IWD’s decision-making involvement. Results: Results indicate that individuals who report more decision-making involvement are younger, female, have more education, have a nonspousal caregiver, have fewer months since their diagnosis, exhibit fewer problems with activities of daily living and fewer depressive symptoms (based on caregiver report), and place more importance on autonomy/self-identity. Implications: In our discussion we examine the importance of autonomy and impairment levels for understanding the decisionmaking involvement of persons with dementia.
TL;DR: A study to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR.
Abstract: Purpose: This study had two goals: (a) to assess the validity of the Online Survey Certification and Reporting (OSCAR) staffing data by comparing them to staffing measures from audited Medicaid Cost Reports and (b) to identify systematic differences between facilities that over-report or underreport staffing in the OSCAR. Design and Methods: We merged the 2002 Texas Nursing Facility Cost Report, the OSCAR for Texas facilities surveyed in 2002, and the 2003 Area Resource File. We eliminated outliers in the OSCAR using three decision rules, resulting in a final sample size of 941 of the total of 1,017 nonhospital-based facilities. We compared OSCAR and Medicaid Cost Report staffing measures for three staff types. We examined differences between facilities that over-reported or underreported staffing levels in the OSCAR by using logistic regression. Results: Average staffing levels were higher in the OSCAR than in the Medicaid Cost Report data. The two sets of measures exhibited correlations ranging between 0.5 and 0.6. For-profit and larger facilities consistently over-reported registered nurse staffing levels. Factors associated with increased odds of over-reporting licensed vocational nursing or certified nursing assistant staffing were lower Medicare or Medicaid censuses and less market competition. Facility characteristics associated with over-reporting were consistent across different levels of over-reporting. Underreporting was much less prevalent. Implications: Certain types of facilities consistently over-report staffing levels. These reporting errors will affect the validity of consumer information systems, regulatory activities, and health services research results, particularly research using OSCAR data to examine the relationship between staffing and quality. Results call for a more accurate reporting system.
TL;DR: The Disablement Process Model was used to predict whether a sample of the oldest-old maintained their disability or disability-free status over a 2- and 4-year follow-up, or whether they transitioned into a state of disability during this time.
Abstract: Physical, Cognitive, and Psychosocial Variables From the Disablement Process Model Predict Patterns of Independence and the Transition Into Disability for the Oldest-Old
TL;DR: There is relative stability in caregiver long-term adaptation to institutionalization, however, the variability in adaptation emphasizes the need to target postplacement clinical interventions to families most at risk for negative outcomes during the transition to institutional care.
Abstract: Purpose: Longitudinal research in dementia has acknowledged the importance of transitions during the course of family caregiving. However, long-term adaptation to institutionalization has received little attention. This study attempts to describe caregivers’ adaptation (changes in stress, well-being, and psychosocial resources) to placement up to 4 years following institutionalization. Design and Methods: Using data from the Caregiver Stress and Coping Study, this analysis constructed four longitudinal panels, each consisting of a preplacement assessment and either two (n = 146), three (n = 109), four (n = 75), or five (n = 38) waves after placement. We used growth curve models to examine longitudinal trajectories of adaptation in various measures of stress, global well-being, and psychosocial resources. Results: The findings suggested sharper decreases in stressors (e.g., role overload) and indicators of negative mental health in the shorter term panels. However, more significant intraindividual variation existed in caregivers’ adaptation to placement in the longer term panels (four and five waves of postplacement). Implications: There is relative stability in caregiver long-term adaptation to institutionalization. However, the variability in adaptation emphasizes the need to target postplacement clinical interventions to families most at risk for negative outcomes during the transition to institutional care.
TL;DR: This work explores the use of family metaphors by nurse's aides to describe their affective care for nursing home residents and uses the theory of boundary work to explain how these aides provided Affective care in the face of racial abuse.
Abstract: Purpose: Using a conceptual framework from the field of care work and the theory of boundary work, we explore the use of family metaphors by nurse’s aides to describe their affective care for nursing home residents. We focus on how nurse’s aides can express affective care in spite of experiencing racial abuse. Methods: Using the technique of domain analysis, we present a secondary analysis of semistructured interviews with 30 African American and immigrant aides working in three nursing homes about their experience of racism on the job. Results: Aides used metaphors associated with family, relationships, and attachment to describe their affective care of residents. They expressed the value of their caring by contrasting it with ‘‘uncaring’’ families. Immigrant aides expressed a form of caring culture shock about the uncared-for situation of American elders. Implications: Through their use of metaphors of family and attachment, these aides define family care as their gold standard of affective care and communicate that they are attempting to provide good care. Aides distinguished caring tasks from affective care in that they applied affective care in an elective way, so that the caring task was the minimum, universal form of care and added affective care created an enriched form of care. They held out informal elder care in their cultures of origin as a model that is superior to the system of formal elder care in which they work. We use the theory of boundary work to explain how these aides provided affective care in the face of racial abuse.
TL;DR: The vast majority of factors identified in this study indicated better outcomes associated with private rooms over shared rooms in nursing homes, regardless of whether there was solid empirical data, information from the focus groups, or other anecdotal evidence.
Abstract: Purpose: There is debate about the relative merits and costs of private versus shared bedrooms in nursing homes, particularly in light of the current efforts at creating both cost-efficient and person-centered care facilities. The purpose of this project was to explore the extent to which there is evidence-based information that supports the merits of three different bedroom configurations: traditional shared, enhanced shared, and private. Design and Methods: We developed a framework of four broad domains that were related to the different bedroom configurations: psychosocial, clinical, operational, and construction or building factors. Within each dimension, we identified individual factors through the literature, interviews, and focus groups, with the goal of determining the breadth, depth, and quality of evidence supporting the benefits of one configuration over another. Results: The vast majority of factors identifiedinthis study,regardless of whether there was solid empirical data, information from the focus groups, or other anecdotal evidence, indicated better outcomes associated with private rooms over shared rooms in nursing homes. Cost estimates suggest that construction cost (plus debt service) differences range from roughly $20,506 per bed for a traditional shared room to $36,515 for a private one, and that such differences are recouped in less than 2 years if beds are occupied, and in less than 3 months if a shared bed remains unoccupied at average private-pay room costs. Implications: Despite limited empirical evidence in some areas, this project provides the foundation for an evidence-based life-cycle costing perspective regarding the relative merits of different bedroom configurations.