Showing papers in "Gerontologist in 2010"

Mobility in Older Adults: A Comprehensive Framework

Abstract: Mobility is fundamental to active aging and is intimately linked to health status and quality of life. Although there is widespread acceptance regarding the importance of mobility in older adults, there have been few attempts to comprehensively portray mobility, and research has to a large extent been discipline specific. In this article, a new theoretical framework for mobility is presented with the goals of raising awareness of the complexity of factors that influence mobility and stimulating new integrative and interdisciplinary research ideas. Mobility is broadly defined as the ability to move oneself (e.g., by walking, by using assistive devices, or by using transportation) within community environments that expand from one's home, to the neighborhood, and to regions beyond. The concept of mobility is portrayed through 5 fundamental categories of determinants (cognitive, psychosocial, physical, environmental, and financial), with gender, culture, and biography (personal life history) conceptualized as critical cross-cutting influences. Each category of determinants consists of an increasing number of factors, demonstrating greater complexity, as the mobility environment expands farther from the home. The framework illustrates how mobility impairments can lead to limitations in accessing different life-spaces and stresses the associations among determinants that influence mobility. By bridging disciplines and representing mobility in an inclusive manner, the model suggests that research needs to be more interdisciplinary and current mobility findings should be interpreted more comprehensively, and new more complex strategies should be developed to address mobility concerns.

Financial Exploitation and Psychological Mistreatment Among Older Adults: Differences Between African Americans and Non-African Americans in a Population-Based Survey

Abstract: 744 Purpose: To examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience—perpetrator, frequency, and degree of upset—of psychological mistreatment in the past 6 months. Design and methods: Random digit dial telephone recruitment and population-based survey (telephone and in-person) of 903 adults aged 60 years and older in Allegheny County (Pittsburgh), Pennsylvania (693 non-African American and 210 African American). Covariates included sex, age, education, marital status, household composition, cognitive function, instrumental activities of daily living/ activities of daily living difficulties, and depression symptoms. Results: Prevalence rates were signifi cantly higher for African Americans than for nonAfrican Americans for financial exploitation since turning 60 (23.0% vs. 8.4%) and in the past 6 months (12.9% vs. 2.4%) and for psychological mistreatment since turning 60 (24.4% vs. 13.2%) and in the past 6 months (16.1% vs. 7.2%). These differences remained once all covariates were controlled in logistic regression models. There were also racial differences in the experience of psychological mistreatment in the past 6 months. Risk for clinical depression was also a consistent predictor of financial exploitation and psy chological mistreatment. Implications: Although the results will need to be replicated in national surveys, the study suggests that racial differences in elder mistreatment are a potentially serious issue deserving of continued attention from researchers, health providers, and social service professionals.

What Is Nursing Home Quality and How Is It Measured

Abstract: In the past, nursing home care and long-term care were synonymous. If elders needed long-term care, it would invariably be provided in a nursing home. In recent years, the long-term care sector has changed considerably and is arguably evolving into a “system” in which care can be provided in settings that are more appropriate for consumers’ needs. This includes care by home health providers, adult day care, residential care, and assisted living (to name just four). However, nursing homes are still an essential component of the current long-term care system. In the United States, approximately 1.6 million elderly and disabled persons receive care in 1 of the 17,000 nursing homes (National Nursing Home Survey, 2004). Enduring issues surrounding nursing homes have been quality related. The often-poor quality of nursing homes has been a consistent issue of concern for consumers, government, and researchers. In this commentary, we first provide a brief review of the history of nursing home quality. This centers on how nursing home quality has been measured and provides some context and insight into currently used quality indicators in the nursing home industry. In doing so, we note that the concepts of what is measured, who does the measuring, and why measures are used are intertwined. We secondly provide our opinion on the relative merits of indicators of quality. Notable current quality indicators are presented. We then speculate on steps that need to be taken in the future to address and potentially improve the quality of care provided by nursing homes. These steps include policy changes and future research that is needed. Numerous definitions of quality exist. A current well-cited example comes from the Institute of Medicine (IOM) (1996): “The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (p. 5). Operationalizing “quality” from definitions such as these proffered by the IOM can be problematic as the definitions are extremely general and subjective and as such resulting measures tend to be unable to fully realize the quality concept (Castle, Zinn, Brannon, & Mor, 1996). Because of this inability to adequately realize “quality” in nursing homes, quality indicators are prevalent rather than quality measures. This helps denote a less precise association between the “indicator” and actual quality (i.e., they are surrogate measures). This has also fostered the creation of many quality indicators. For example, in choosing the quality indicators to be reported in Nursing Home Compare (www.medicare.gov/NHCompare; discussed subsequently), 181 indicators were considered. With many quality indicators available, some organization is useful. In this regard, in conceptualizing and organizing quality indicators, the approach of Donabedian (1985) is valuable. Donabedian proposed that quality could be measured in terms of structures (S), processes (P), and outcomes (O). Structural measures are the organizational characteristics associated with the provision of care. Process measures are characteristics of things done to and for the resident. Outcome measures are the desired states one would (or would not) like to achieve for the resident. Donabedian's SPO approach is somewhat pervasive in the quality literature. For example, in MEDLINE (2005–2010), 57% (N = 3,950) of nursing home studies either directly or indirectly applied this approach of conceptualizing quality indicators. This approach of conceptualizing quality indicators as SPO measures is also used in this commentary. The SPO approach also has theoretical underpinnings in that good structure should facilitate good process and good process should facilitate good outcomes. However, we note that the theoretical SPO underpinnings were not developed specifically for nursing homes and some have questioned its suitability for this setting (Glass, 1991). Moreover, SPO linkages are not always validated in the nursing home literature (Gustafson, Sainfort, Van Konigsveld, & Zimmerman, 1990). Some scholars have also further substantially developed components of this approach by including factors such as culture (S) and work groups (P) (Scott Poole & Van De Ven, 2004), whereas others in long-term care have modified the SPO theory, for example by combining it with contingency theory (Zinn & Mor, 1998).

The Stigma of Hearing Loss

Abstract: Purpose: To explore dimensions of stigma experienced by older adults with hearing loss and those with whom they frequently communicate to target interventions promoting engagement and positive aging. Design and Methods: This longitudinal qualitative study conducted interviews over 1 year with dyads where one partner had hearing loss. Participants were naive to or had not worn hearing aids in the past year. Data were analyzed using grounded theory, constant comparative methodology. Results: Perceived stigma emerged as infl uencing decision-making processes at multiple points along the experiential continuum of hearing loss, such as initial acceptance of hearing loss, whether to be tested, type of hearing aid selected, and when and where hearing aids were worn. Stigma was related to 3 interrelated experiences, alterations in selfperception , ageism , and vanity and was infl uenced by dyadic relationships and external societal forces, such as health and hearing professionals and media. Implications: Findings are discussed in relation to theoretical perspectives regarding stigma and ageism and suggest the need to destigmatize hearing loss by promoting its assessment and treatment as well as emphasizing the importance of remaining actively engaged to support positive physical and cognitive functioning.

Successful Aging: Early Influences and Contemporary Characteristics

Abstract: Purpose: Positing that successful aging has independent, yet related, dimensions that are both objective and subjective, we examine how early influences and contemporary characteristics define 4 groups of people. Design and Methods: Data were gathered from 5,688 persons aged 50–74 years living in New Jersey who participated in telephone interviews. Latent profile analysis defined people who age successfully according to both objective and subjective criteria, neither criteria, and one, but not the other, criteria. Multinomial logistic regression was used to examine the extent to which early influences and contemporary characteristics predict group membership. Results: Although characteristics observable early in life predict group membership, their influence is modified by current health behaviors and social support. The roles of education and incarceration feature prominently. Marital, work, and volunteer statuses, as well as moderate alcohol consumption, distinguish those aging successfully according to both criteria from the other 3 groups. Implications: Results help to define successful aging as a multidimensional construct having both objective and subjective dimensions, provide greater clarity regarding its correlates, and increase understanding of its modifiable aspects.

Measuring Person-centered Care: A Critical Comparative Review of Published Tools

Abstract: Purpose of the study: To present a critical comparative review of published tools measuring the person-centeredness of care for older people and people with dementia. DESIGN AND METHODS: Included t ...

Examining Resilience of Quality of Life in the Face of Health-Related and Psychosocial Adversity at Older Ages: What is “Right” About the Way We Age?

Abstract: PURPOSE: This article examines resilience at older ages, focusing on the relationships between quality of life (qol) and adversity. Our objectives are to identify (a) the basis of adversity, (b) the characteristics of resilient individuals, and (c) the attributes that attenuate the full impact of adversity. DESIGN AND METHODS: Resilience is defined as flourishing despite adversity. Analysis is carried out in a subsample of the Boyd Orr cohort (aged between 68 and 82 years) using questionnaire data. Adversity was identified as circumstances that produce a significant average decrease in qol (CASP-19 scores). Participants were classified into resilient and vulnerable groups based on high or low qol (CASP-19 scores dichotomized at the median) in the face of significant adversity. Shared characteristics that define these outcomes are reported. Attributes that attenuate the negative impact of adversity were analyzed using stratified logistic regression. RESULTS: Adversity was typified by functional limitation; life getting worse in the domains of health, stress, and general living circumstances; and experiencing a negative life event. The resilient tended to report fewer multiple adversities. Indicators of protective attributes, which also characterized resilient outcomes relative to qol, included good quality relationships (5.105, confidence interval [CI] 95% 1.323-19.699), integration in the community (10.800, 95% CI 1.227-95.014), developmental coping (3.397, 95% CI 1.079-10.690), and adaptive coping styles (3.211, 95% CI 1.041-9.910). IMPLICATION: Overall results indicate that policies that offer access to protection and help minimize adversity exposure where possible will promote resilience.

Expert Consensus on Characteristics of Wisdom: A Delphi Method Study

Abstract: Purpose: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent defini tions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. Design and Methods: A survey questionnaire comprised 53 Likert scale statements related to the concepts of wisdom, intelligence, and spirituality was developed to determine if and how wisdom was viewed as being distinct from the latter 2 concepts. Of the 57 international wisdom experts contacted by e-mail, 30 completed the Phase 1 survey and 27 also completed the Phase 2 survey. Results: In Phase 1, there were significant group differences among the con cepts of wisdom, intelligence, and spirituality on 49 of the 53 items rated by the experts. Wisdom differed from intelligence on 46 of these 49 items, whereas wisdom differed from spirituality on 31 items. In Phase 2, we sought to define wisdom further by selecting 12 items based on Phase 1 results. Most experts agreed on many of the suggested characteristics of wisdom—that is, it is uniquely human; a form of advanced cognitive and emotional development that is experience driven; and a personal quality, albeit a rare one, which can be learned, increases with age, can be measured, and is not likely to be enhanced by taking medication. Implications: There was considerable agreement among the expert participants on wisdom being a distinct entity and a number of its characteristic qualities. These data should help in designing additional empirical research on wisdom.

Seniors’ Online Communities: A Quantitative Content Analysis

Abstract: Purpose: To examine the contents and characteristics of seniors’ online communities and to explore their potential benefits to older adults. Design and Methods: Quantitative content analysis of a full year’s data from 14 leading online communities using a novel computerized system. The overall database included 686,283 messages. Results: There was a constant increase in the daily activity level during the research period. Content analysis identified 13 main subjects discussed in the communities, including (in descending order) “Fun on line,” “Retirement,” “Family,” “Health,” “Work and Study,” “Recreation” “Finance,” “Religion and Spirituality,” “Technology,” “Aging,” “Civic and Social,” “Shopping,” and “Travels.” The overall tone was somewhat more positive than negative. Implications: The findings suggest that the utilities of Information and Communications Technologies for older adults that were identified in previous research are valid for seniors’ online communities as well. However, the findings suggest several other possible benefits, which may be available only to online communities. The communities may provide social support, contribute to self-preservation, and serve as an opportunity for self-discovery and growth. Because they offer both leisure activity and an expanded social network, it is suggested that active participation in the communities may contribute to the well-being of older adults. Directions for future research and applied implications are further discussed.

Organizational Support and Volunteering Benefits for Older Adults

Abstract: Purpose: This study tested a theoretical model of volunteering benefits and examined the mechanism through which volunteering benefits older adults. Design and Methods: This is a 2-wave study of 253 older adult volunteers serving in 10 volunteer programs. Older volunteers completed the mailed surveys in 2005 and 2006. Structural equation modeling was used to define the latent variables and to test direct and indirect relationships among organizational support, socioemotional benefits, and self-reported health. Results: Organizational support (measured by choice of volunteer activity, training, and ongoing support) had significant direct associations with 2 latent factors of socioemotional benefits, that is, perceived contribu tion and personal benefits. Perceived contribution was significantly related to mental health. Additionally, older volunteers with lower socioeconomic status (SES) committed more hours and perceived more personal benefits than higher SES peers. Implications: These findings suggest that volunteer programs can pro vide various organizational supports to older volunteers, especially to low-SES volunteers, in order to promote the socioemotional and health benefits of volunteering to older adults. Psychological well-being of older adults can be improved through engagement in meaningful volunteer activities and contribution to others.

From Compassionate Ageism to Intergenerational Conflict

Abstract: During the 50 years in which The Gerontologist has been publishing, the politics of aging in the United States has undergone distinct changes. The political behavior of older individuals has remained largely the same even though different birth cohorts have succeeded each other in populating the ranks of older people. But the politics of policies on aging-the organized interest and advocacy groups active in this arena, the tenor of public discourse about older people as beneficiaries of policies on aging, the national political agendas regarding public old-age benefits, and the broader U.S. political economy-have changed substantially over these five decades. Now, in the contexts of the aging of the baby boom and concerns about reducing large federal fiscal deficits (annual and cumulative), the politics of U.S. policies on aging may change considerably from those of yesterday and today. Is there a possibility of future intergenerational political conflict over taxes and expenditures for the major old-age benefit programs? If so, what might prevent or mitigate it?

Changes in Social Participation and Volunteer Activity Among Recently Widowed Older Adults

Abstract: Purpose: Widowhood eliminates a key source of support that may trigger greater involvement in social activities and volunteer participation, which are related to better late-life health and functioning. We reexamine and build upon 2 recent studies exploring recent widowhood and social participation. Using different data, we perform a quasi-replication of Utz, Carr, Nesse, and Wortman ’ s (2002; “ The effect of widowhood on older adults ’ social participation: An evaluation of activity, disengagement, and continuity theories, ” The Gerontologist , 42, 522 – 533) study and employ different analytic strategies to Li ’ s (2007; “ Recovering from spousal bereavement in later life: Does volunteer participation play a role? ” Journal of Gerontology Series B: Psychological Sciences and Social Sciences , 62, S257 – S266) study. Design and Methods: A synthetic cohort of recently widowed individuals aged 60 years and older ( n = 228) was compared with random, non-widowed older adult controls ( n = 228) across 3 waves of Americans ’ Changing Lives data. Generalized estimating equations were used to assess the impact of widowhood on levels of social participation and formal and informal volunteerism, controlling for social, economic, demographic, and psychological factors. Results: Similar to Utz and colleagues, we found that widowhood was positively related to informal social participation, net of other effects, but did not reproduce this fi nding for formal social participation. Unlike Li, we did not fi nd a signifi cant relationship between widowhood and formal or informal volunteerism. Controlling for prior participation, widowhood remained signifi cantly related to informal and formal social participation. Implications: Older

Improvement in Personal Meaning Mediates the Effects of a Life Review Intervention on Depressive Symptoms in a Randomized Controlled Trial

Abstract: Purpose: The purpose of the study was to assess the impact of a life review intervention on personal meaning in life and the mediating effect of personal meaning on depressive symptoms as the primary outcome of this form of indicated prevention. Design and Methods: A multicenter randomized controlled trial was conducted with one group of older adults obtaining life review (N = 83) and the other watching a video about the art of growing older (N = 88). Measurements took place before and after the intervention as well as 6 months later at follow-up. Results: It was found that those who followed life review improved more in personal meaning than those in the control group, although at follow-up the difference was no longer significant. Improvements in meaning during the intervention predicted decreases in depressive symptoms later in time and mediated the effects of the program on depressive symptoms. Implications: Personal meaning is an important asset in contemporary society, which some older adults find difficult to achieve. The findings from this study show that it is possible to support older persons in their search for meaning by means of life review and that this helps in alleviating depressive symptoms

Caregiver Mental Health and Potentially Harmful Caregiving Behavior: The Central Role of Caregiver Anger

Abstract: Purpose: Caregivers feeling stress and experiencing mental health problems can be at risk for engaging in abusive acts against elderly care recipients. Potentially harmful behavior (PHB) was used as a measure of caregivers ’ engagement in, or fear of engagement in, behavior that places dependent care recipients at risk of physical and/or psychological maltreatment and may be seen as an antecedent of, or a proxy for, identifi ably abusive behavior. The study examined the ability of anger to mediate and moderate the relations of depression, resentment, and anxiety with PBH. Design and Methods: Data are from the fi rst wave of the second Family Relationships in Late Life study of caregivers of communitydwelling elderly care recipients with whom they coreside. Caregivers ( N = 417) completed face-toface interviews. Results: Anger was found to mediate the relation between anxiety and PHB. Anger both mediates and moderates the relations of both depression and resentment with PHB in a dynamic way such that the mediating effect of anger increases substantially with increased scores on both depression and resentment. Implications: Identifying anger levels among caregivers who report symptoms of depression is warranted. Reducing depression in caregivers who report high levels of anger may result

Gender Relations and Applied Research on Aging

Abstract: As a concept in gerontology, gender appears as lists of traits learned through socialization when theorized at all. I argue for a framework that theorizes the intersections of relations of gender inequality with those of age. This framework holds that men and women gain resources and bear responsibilities, in relation to one another, by virtue of mundane categorization into naturalized stratified groups. Current research shows that this approach allows explanation of gender differences, which appear in many reports but which usually go untheorized, as responses to social inequality. I illustrate applications to research and practice in relation to three areas of old age experiences: financial security, spousal care work, and health. Throughout, I discuss implications of focusing on inequality to enhance our abilities to engage in effective research, practice, and policy for older people, women and men alike. For instance, an understanding of the gender division of labor and workplace discrimination makes clear that financial status in later life cannot be reduced to individual choices concerning paid labor or retirement planning. And understanding that people orient their behaviors to gender ideals allows us to see that men and women perform spousal care in similar and different ways that require varied responses from practitioners; it also reveals contexts in which men engage in positive health behaviors. Finally, I argue that gerontologists interested in facilitating favorable outcomes for old people should consider research and practice that would disrupt, not reinforce, the bases of gender inequalities in later life.

Dynamics of Volunteering in Older Europeans

Abstract: Purpose: To investigate the dynamics of volunteering in the population aged 50 years or older across 11 Continental European countries. Design and Methods: Using longitudinal data from the fi rst 2 waves of the Survey of Health, Ageing and Retirement in Europe, we run multivariate regressions on a set of binary-dependent variables indicating transitions from active volunteering to inactivity and vice versa. Results: Volunteer transitions were affected by both time-invariant individual resources and changes in individuals ’ resources. Moreover, we found that the societal context in which older persons live not only has a signifi cant impact on the prevalence of volunteering at a given point in time but that the dynamics of volunteering also vary by country. Implications: Our study supports the notion of volunteering as an important productive aging activity and underlines the importance of both life-course and social context factors as determinants of volunteer dynamics at older ages.

Self-Report Measure of Financial Exploitation of Older Adults

Abstract: Purpose: This study was designed to improve the measurement of financial exploitation (FE) by testing psychometric properties of the older adult financial exploitation measure (OAFEM), a client self-report instrument. Design and Methods: Rasch item response theory and traditional validation approaches were used. Questionnaires were administered by 22 adult protective services investigators from 7 agencies in Illinois to 227 substantiated abuse clients. Analyses included tests for dimensionality, model fit, and addi tional construct validation. Results from the OAFEM were also compared with the substantiation decision of abuse and with investigators’ assessments of FE using a staff report version. Hypotheses were generated to test hypothesized relationships. Results: The OAFEM, including the original 79-, 54-, and 30-item measures, met stringent Rasch analysis fit and unidi mensionality criteria and had high internal consistency and item reliability. The validation results were supportive, while leading to reconsideration of aspects of the hypothesized theoretical hierarchy. Thresholds were suggested to demonstrate levels of severity. Implications: The measure is now available to aid in the assessment of FE of older adults by both clinicians and researchers. Theoretical refinements devel oped using the empirically generated item hierarchy may help to improve assessment and intervention.

Neglecting the Importance of the Decision Making and Care Regimes of Personal Support Workers: A Critique of Standardization of Care Planning Through the RAI/MDS

Abstract: Purpose: The Resident Assessment Instrument– Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the decision making and care practices of personal support workers (PSWs) in relation to the RAI/MDS standardized process. Design and Methods: This qualitative study utilized focus groups and semistructured interviews with PSWs (n = 26) and supervisors (n = 9) in two nursing homes in central Canada. Results: PSWs evidenced unique occupational contributions to assessment via proximal familiarity and biographical information as well as to individualizing care by empathetically linking their own bodily experiences and forging bonds of fictive kinship with residents. These contributions were neither captured by RAI/MDS categories nor relayed to the interdisciplinary team. Causal factors for PSW exclusion included computerized records, low status, and poor interprofessional collaboration. Intraprofessional collaboration by PSWs aimed to compensate for exclusion and to individualize care. Implications: Exclusive institutional reliance on the RAI/MDS undermines quality care because it fails to capture residents’ preferences and excludes input by PSWs. Recommendations include incorporating PSW knowledge in care planning and documentation and examining PSWs’ nascent occupational identity and their role as interprofessional brokers in long-term care.

Environmental Volunteering and Health Outcomes over a 20-Year Period

Abstract: Purpose: This study tested the hypothesis that volunteering in environmental organizations in midlife is associated with greater physical activity and improved mental and physical health over a 20-year period. Design and Methods: The study used data from two waves (1974 and 1994) of the Alameda County Study, a longitudinal study of health and mortality that has followed a cohort of 6,928 adults since 1965. Using logistic and multiple regression models, we examined the prospective association between environmental and other volunteerism and three outcomes (physical activity, self-reported health, and depression), with 1974 volunteerism predicting 1994 outcomes, controlling for a number of relevant covariates. Results: Midlife environmental volunteering was significantly associated with physical activity, self-reported health, and depressive symptoms. Implications: This population-based study offers the first epidemiological evidence for a signifi cant positive relationship between environmental volunteering and health and well-being outcomes. Further research, including intervention studies, is needed to confirm and shed additional light on these initial findings.

Care Management’s Challenges and Opportunities to Reduce the Rapid Rehospitalization of Frail Community-Dwelling Older Adults

Abstract: Community-based frail older adults, burdened with complex medical and social needs, are at great risk for preventable rapid rehospitalizations. Although federal and state regulations are in place to address the care transitions between the hospital and nursing home, no such guidelines exist for the much larger population of community-dwelling frail older adults. Few studies have looked at interventions to prevent rehospitalizations in this large segment of the older adult population. Similarly, standardized disease management approaches that lower hospitalization rates in an independent adult population may not suffice for guiding the care of frail persons. Care management interventions currently face unique challenges in their attempt to improve the transitional care of community-dwelling older adults. However, impending national imperatives aimed at reducing potentially avoidable hospitalizations will soon demand and reward care management strategies that identify frail persons early in the discharge process and promote the sharing of critical information among patients, caregivers, and health care professionals. Opportunities to improve the quality and efficiency of care-related communications must focus on the effective blending of training and technology for improving communications vital to successful care transitions.

Ten Years Down the Road: Predictors of Driving Cessation

Abstract: PURPOSE: Recent prospective studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults. However, these studies have been limited to 5 years of follow-up. The current study used data from the Maryland Older Drivers Project to examine predictors of driving cessation in older adults over a 10-year period. DESIGN AND METHODS: Participants (N = 1,248) completed baseline and 5-year assessments of physical and cognitive abilities. Driving status was ascertained at baseline and annually thereafter. RESULTS: Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic, physical, and cognitive predictors. The final model indicated three significant predictors of driving cessation, older age at baseline (hazard ratio [HR] = 1.12, p Language: en

Care Partner Responses to the Onset of Mild Cognitive Impairment

Abstract: Purpose: We examined characteristics, responses, and psychological well-being of care partners who support and assist older adults recently diagnosed with mild cognitive impairment (MCI). Design and Methods: Based on a sample of 106 care partners of community residents diagnosed with MCI at memory clinics, we conducted face-to-face interviews including scales and open-ended questions. Measures tapped elements of the caregiver stress process model advanced by Pearlin and associates (1990, Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist , 30 , 583 – 594), including background characteristics, knowledge and attitude resources, stressors, strains, and protective conditions. The outcome was psychological well-being as indexed by depressive symptoms. Results: Care partners ’ depressive symptoms were higher in the context of poorer health, lower perceived importance of religion, less knowledge about dementia, being more bothered by the older adult ’ s MCI symptoms, having a lower sense of environmental mastery, more perceived burden, more frequent use of coping strategies, and more social support. Narratives revealed multiple dimensions of stress, strain, and frustration, regardless of the level of depressive symptoms. Implications: Assisting a relative with MCI presents new and complex challenges, even though it is an early caregiving role. Care partners likely would benefi t from strategies aimed at reducing self-blame, enhancing coping skills, sustaining their sense of mastery, managing their health, seeking and accepting respite, and communicating effectively with the person with MCI and signifi cant others.

Predictors of family conflict at the end of life: the experience of spouses and adult children of persons with lung cancer.

Abstract: Purpose: Guided by an explanatory matrix of family conflict at the end of life, the purpose of this article was to examine the correlates and predictors of family conflict reported by 155 spouses and adult children of persons with lung cancer. Design and Methods: A cross-sectional statewide survey of family members of persons who died from lung cancer was conducted as part of the larger study on the Assessment of Cancer CarE and SatiSfaction in Wisconsin. Results: Significant bivariate correlations were found between family conflict and family context variables (i.e., a history of conflict, younger respondent age, race, and specified end-of-life care wishes of the patient), conditions (i.e., greater physical and psychological clinical care needs of the patient), and contributing factors (i.e., communication constraints and family asserting control). In the multivariate model, significant predictors of family conflict included prior family conflict, race, communication constraints, and family members asserting control; the model explained 72% of the variance in conflict. Implications: Implications for routine assessment and screening to identify families at risk and recommendations for the development and testing of interventions to facilitate shared decision making and enhance open communication among at-risk families are highlighted.

Stress Process Model for Individuals With Dementia

Abstract: Purpose: Individuals with dementia (IWDs) face particular challenges in managing and coping with their illness. The experience of dementia may be affected by the etiology, stage, and severity of symptoms, preexisting and related chronic conditions, and available informal and formal supportive services. Although several studies have examined particular features of IWD’s illness experience, few draw upon a conceptual model that outlines the global illness experience and the resulting stressors that commence with symptom onset, proliferate over time, and continue through the later stages of cognitive loss. Building on the work of Pearlin and colleagues (1990, Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583–594), this article proposes a stress process model (SPM) for IWDs that conceptualizes and examines the illness experience of IWDs. Implications: The proposed SPM for IWDs serves as a guide to (a) consider and understand the short- and long-term complexities of the illness experience for IWDs, (b) investigate specific hypotheses by outlin ing key stressors in the illness experience and by positing relationships among stressors and outcomes, and (c) help inform the development of interventions to prevent or reduce the negative stressors and

The Psychosocial Impacts of Multimedia Biographies on Persons With Cognitive Impairments

Abstract: Purpose: The purpose of this feasibility pilot project was to observe Alzheimer ’ s disease (AD) and mild cognitive impairment (MCI) patients ’ responses to personalized multimedia biographies (MBs). We developed a procedure for using digital video technology to construct DVD-based MBs of persons with AD or MCI, documented their responses to observing their MBs, and evaluated the psychosocial benefi ts. Methods: An interdisciplinary team consisting of multimedia biographers and social workers interviewed 12 family members of persons with AD and MCI and collected archival materials to best capture the families ’ and patients ’ life histories. We fi lmed patients ’ responses to watching the MBs and conducted follow-up interviews with the families and patients at 3 and 6 months following the initial viewing. Qualitative analytic strategies were used for extracting themes and key issues identifi ed in both the fi lmed and the interview response data. Results: Analysis of the interview and video data showed how evoked long-term memories stimulated reminiscing, brought mostly joy but occasionally moments of sadness to the persons with cognitive impairments, aided family members in remembering and better understanding their loved ones, and stimulated social interactions with family members and with formal caregivers. Implication: This study demonstrates the feasibility of using readily available digital video technology to produce MBs that hold special meaning for individuals experiencing AD or MCI and their families.

Suicide Ideation in Older Adults: Relationship to Mental Health Problems and Service Use

Abstract: PURPOSE: To assess the prevalence of suicide ideation among community-dwelling older adults and the relationship between suicide ideation, major psychiatric disorder, and mental health service use. DESIGN AND METHODS: We use data from the Canadian Community Health Survey 1.2: Mental Health and Well-being (CCHS 1.2). We estimate the prevalence of suicide ideation and the prevalence of major psychiatric disorder and service use among ideators versus nonideators. In multivariate models, we consider the sociodemographic, social, and mental health correlates of suicide ideation and mental health care use. RESULTS: In our sample, more than 2% of older adults reported suicide ideation in the past year and more than two thirds of these respondents did not meet the criteria for any of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders assessed in the CCHS 1.2. In multivariate models, being male, younger, or widowed, reporting lower social support and higher psychological distress increased the likelihood of suicide ideation. More than 50% of the respondents who reported suicidal thoughts did not access any type of mental health care use. IMPLICATIONS: Although suicide ideation is associated with depression and anxiety disorders, many older adults with suicidal thoughts do not meet the criteria for these clinical disorders. The low prevalence of service use among older adults with suicide ideation suggests the need for further inquiry into the factors associated with discussing mental health concerns with health care providers, particularly among older adults who do not meet the criteria for clinical disorder. Language: en

Effects of Guided Care on Family Caregivers

Abstract: Purpose: Guided Care (GC) is a model of health care for multimorbid older adults that is provided by a registered nurse who works with the patients’ primary care physician (PCP). The purpose of this study was to determine whether GC improves patients’ primary caregivers’ depressive symptoms, strain, productivity, and perceptions of the quality of care recipients’ chronic illness care. Design and Methods: A cluster-randomized controlled trial of GC was conducted within 14 PCP teams. The study sample included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months. Caregiver outcomes included the following: depressive symptoms (Center for Epidemiological Studies-Depression scale), strain (Modified Caregiver Strain Index), the quality of care recipients’ chronic illness care [Patient Assessment of Chronic Illness Care (PACIC)], and personal productivity (Work Productivity and Activity Impairment questionnaire, adapted for caregiving). Results: In multivariate regression models, between-group differences in depression, strain, work productivity, and regular activity productivity were not statistically significant after 18 months, but GC caregivers report ed the overall quality of their recipients’ chronic illness care to be significantly higher (adjusted beta = 0.40, 95% confidence interval : 0.14–0.67). Qual ity was significantly higher in 4 of 5 PACIC sub scales, reflecting the dimensions of goal setting, coordination of care, decision support, and patient activation. Implications: GC improved the quality of chronic illness care received by multimorbid care recipients but did not improve caregivers’ depressive symptoms, affect, or productivity.

Measuring the Experience and Perception of Suffering

Abstract: Purpose: Assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals. Design and Methods: Scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimer’s disease (AD) and their family caregivers (N = 105 dyads), married couples in whom 1 partner had osteoarthritis (N = 53 dyads), and African American and Hispanic caregivers of care recipients with AD (N = 121). Care recipients rated their own suffering, whereas caregivers provided ratings of perceived suffering of their respective care recipients. In addition, quality of life, health, and functional status data were collected from all respondents via structured in-person interviews. Results: Three scales showed high levels of internal consistency, test–retest reliability, and convergent and discriminant validity. The scales were able to discriminate differences in suffering as a function of type of disease, demonstrated high intra-person correlations and moderately high inter-person correlations and exhibited predicted patterns of association between each type of suffering and indicators of quality of life, health status, and caregiver outcomes of depression and burden. Implications: Suffering is an important but understudied domain. This article provides valuable tools for assessing the experience and perception of suffering in humans.

Understanding Patterns of Service Utilization Among Informal Caregivers of Community Older Adults

Abstract: Purpose The article seeks to identify patterns of service utilization among informal caregivers of frail older adults. In particular, the study examined determinants that explain heterogeneous variations in caregivers' service use patterns. Methods Using a latent class analysis (LCA) on the 2004 National Long-Term Care Survey and Informal Caregiver data (n = 1,908), this study classifies overall patterns of caregiver service utilization: financial information, support group, respite service, day care or senior center, personal or nursing care, housework, meal delivery, transportation, house modification, and assistive devices. With an emphasis on caregivers' service use patterns and social network derived from the Network Episode Model, the modified Andersen model guides determinants of these patterns. Results The LCA classified a hierarchical structure of service use patterns: multiple service users, selective in-home service users, and light service users. Caregivers' network compositions signified heterogeneity in service use patterns. Care recipient- and caregiver-related needs contributed to distinguishing service use patterns. Implications Differentiation of services may be important for meeting caregivers' needs and distributing program resources by identifying target populations for intervention. This typology process may tailor specific interventions to better support caregivers.

Reforming Long-Term Care in the United States: Findings From a National Survey of Specialists

Abstract: Purpose: Theories of the policy process recognize that policy proposals are typically generated, debated, redrafted, and accepted for consideration through the gradual accumulation of knowledge within communities of specialists. Thus, to inform long-term care (LTC) reform efforts, we conducted a Web-based survey of 1,147 LTC specialists nationwide. Design and Methods: Survey respondents included consumer advocates, provider representatives, public officials, policy experts, and others with experience in LTC. Administration took place between September 2007 and March 2008 and addressed prevailing challenges and options for reform. Results: Although differences could be discerned, constituency group views converged in several areas. There was general agreement that LTC financing needed to be socialized more and that impediments to organizational change needed to be overcome. Respondents also felt that LTC needed to be rebalanced toward home- and community-based settings, though few supported doing so by limiting nursing home (NH) bed supply. Although virtually all felt that the federal government was doing a poor job regulating LTC providers, most believed that the approaches used to oversee NHs should also be applied to assisted living. Payment incentives were highlighted as the most effective strategy for improving quality even though it suffers from the same informational deficits com promising consumer reporting. Implications: By giving voice to those who know LTC very well, and identifying areas of agreement and disagreement, this study should prove useful in promoting LTC reform where it might otherwise remain politically intransigent.