The Gerontologist - Advance Access

Seniors' Online Communities: A Quantitative Content Analysis

Nimrod, G. — Mon, 16 Nov 2009 07:24:49 PST

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.

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

Cooke, V., Arling, G., Lewis, T., Abrahamson, K. A., Mueller, C., Edstrom, L. — Wed, 21 Oct 2009 03:12:03 PDT

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration and shared learning, and establish a solid case for investing in better quality from the perspective of the state, providers, and consumers. We explain PIPP rationale and design, describe projects and participating facilities, and present findings from interviews with project leaders. Design and Methods: Provider-initiated projects lasting from 1 to 3 years are selected through a competitive process and are funded for up to 5% of the daily operating per diem rate. Providers are at risk of losing up to 20% of their project funding if they fail to achieve targets on state nursing facility performance measures. Results: Minnesota has made a major investment in the PIPP by supporting 45 individual or collaborative projects, representing approximately 160 facilities and annual funding of approximately $18 million. Projects involve a wide range of interventions, such as fall reduction, wound prevention, exercise, improved continence, pain management, resident-centered care and culture change, and transitions to the community. Implications: The PIPP can serve as a model for other states seeking to promote nursing facility quality either in combination or in place of conventional pay-for-performance efforts.

The Revised Direct Assessment of Functional Status for Independent Older Adults

McDougall, G. J., Becker, H., Vaughan, P. W., Acee, T. W., Delville, C. L. — Tue, 06 Oct 2009 06:18:37 PDT

Purpose: The original version of the Direct Assessment of Functional Status (DAFS), a measure of instrumental activities of daily living (IADLs), was found to have a ceiling effect in older adults living independently in the community. This suggested that the tasks measured, although relevant, do not require full use of this population’s abilities, and thus, the instrument may not be sensitive to the early decrements in IADLs that can signal initial cognitive impairment and may not detect improvements in IADLs over time, which is especially important in intervention research. Design and Methods: By removing items with little to no variation and adding more difficult subscales that emphasized medication management skills, we designed the DAFS-Extended (Direct Assessment of Functional Status-Revised [DAFS-R]) to be more challenging for elders living independently. Results: Analysis with a sample of 45 older adults suggested that scores on the DAFS-R appear to be more normally distributed than on the original version. The DAFS was able to differentiate individuals with varying standard profile scores on the Rivermead Behavioural Memory Test memory performance instrument (normal, poor, and impaired). In addition, the reliability and validity of the DAFS-R were supported in this sample. Implications: Given the large number of older adults who regularly take multiple prescription medications, deficits in medication management skills can have serious consequences. A performance measure that emphasizes these higher level daily living skills can help providers screen for initial signs of functional decline.

Acceptability and Feasibility Results of a Strength-Based Skills Training Program for Dementia Caregiving Dyads

Judge, K. S., Yarry, S. J., Orsulic-Jeras, S. — Tue, 06 Oct 2009 06:18:34 PDT

Purpose: The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers. Using a strength-based approach, caregiving dyads received skills training across 5 key areas: (a) education regarding dementia and memory loss, (b) effective communication, (c) managing memory loss, (d) staying active, and (e) recognizing emotions and behaviors. Results of the acceptability and feasibility of the intervention protocols are also presented. Design and Methods: Caregiving dyads were randomly assigned to participate in the intervention. Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program. Data were also collected from the intervention specialists who implemented the protocols. Results: Overall, the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists. Implications: This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners. Furthermore, the intervention program was found to be highly acceptable and feasible, which is an important aspect of developing dyadic protocols.

Florida's Model of Nursing Home Medicaid Reimbursement for Disaster-Related Expenses

Thomas, K. S., Hyer, K., Brown, L. M., Polivka-West, L., Branch, L. G. — Sun, 13 Sep 2009 23:08:18 PDT

Purpose: This study describes Florida's model of Medicaid nursing home (NH) reimbursement to compensate NHs for disaster-related expenses incurred as a result of 8 hurricanes within a 2-year period. This Florida model can serve as a demonstration for a national model for disaster-related reimbursement. Design and Methods: Florida reimburses NHs for approved disaster-related costs through hurricane interim rate requests (IRRs). The state developed its unique Medicaid per diem rate temporary add-on by adapting its standard rate-setting reimbursement methodology. To understand the payment mechanisms and the costs that facilities incurred as a result of natural disasters, we examined the IRRs and cost reports for facilities requesting and receiving reimbursement. Results: Cost reports and IRR applications indicated that Florida Medicaid spent close to $16 million to pay for hurricane-related costs to NHs. Implications: Without Florida's Hurricane IRR program, many facilities would have not been reimbursed for their hurricane-related costs. Florida's model is one that Medicare and other states should consider adopting to ensure that NHs receive adequate reimbursement for disaster-related expenses, including tornadoes, earthquakes, floods, blizzards, and other catastrophic events.

Ten Years Down the Road: Predictors of Driving Cessation

Edwards, J. D., Bart, E., O'Connor, M. L., Cissell, G. — Wed, 02 Sep 2009 11:26:05 PDT

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 < .001), days driven per week (HR = 0.83, p = .05), and slower speed of processing as measured by the Useful Field of View Test (HR = 1.76, p < .01). Implications: These results underscore the importance of cognitive speed of processing to the maintenance of driving. Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation. Further research is needed to determine the costs and potential benefits of such screening.

The Development of a Conceptual Model for Understanding Elder Self-Neglect

Iris, M., Ridings, J. W., Conrad, K. J. — Wed, 02 Sep 2009 11:26:04 PDT

Purpose: Elder self-neglect (ESN) represents half or more of all cases reported to adult protective services. ESN directly affects older adults and also their families, neighbors, and the larger communities around them. ESN has public health implications and is associated with higher than expected mortality rates, hospitalizations, long-term care placements, and localized environmental and safety hazards. This article describes results from a study using concept mapping to create a conceptual model of ESN. Design and Methods: Two brainstorming sessions were convened with senior services program supervisors, geriatricians, local policy analysts and program planners, elder law practitioners, and university-based researchers (n = 20), and a list of 73 ESN indicators was generated. Using Concept Systems software, the 20 original panelists and an additional 30 practitioners, including case managers and supervisors from local agencies, social workers specializing in working with older adults, and elder abuse investigators, sorted the 73 items and rated them along the dimension of importance for the concept of self-neglect. Results: Using hierarchical cluster analysis and multidimensional scaling, a conceptual map with 7 clusters was produced. Clusters with the highest importance ratings were Physical Living Conditions and Mental Health. Clusters were highly interrelated, with the exception of the Physical Living Conditions cluster. Implications: This research presents a conceptualization of ESN, identifies the constituent domains, and proposes a conceptual model based on the importance for assessing symptoms and indicators. Findings may help focus programmatic and research efforts, leading to the development of measures that open the field for further research and theory generation.

Distance Learning: A Strategy for Improving Incontinence Care in Nursing Homes

Rahman, A. N., Schnelle, J. F., Yamashita, T., Patry, G., Prasauskas, R. — Mon, 31 Aug 2009 12:25:59 PDT

Purpose: This article describes a distance learning model designed to help nursing homes implement incontinence management best practices. A basic premise is that translating research into practice requires both a feasible intervention and a dissemination strategy responsive to the target audience’s needs. Design and Methods: Over 8 months, nurse supervisors from 14 nursing homes in nine states learned how to implement prompted voiding during monthly 60- to 90-min teleconferences. Supervisors completed field assignments that required them to implement prompted voiding. Descriptive evaluation data were collected using a resident data form, pre- and posttraining quizzes, and a project evaluation survey. Results: Nursing home staff attended an average of 6.5 teleconferences; on average, three staff members typically attended each teleconference. Eighty-nine percent of all survey respondents (N = 28) reported that they (a) would participate in a similar project and (b) would recommend the course to colleagues. Average scores on the quiz increased 16% (p < .05) from pre- to posttraining. Collectively, participating facilities assessed a total of 261 incontinent residents and reported maintaining 117 (44.8%) on prompted voiding, for an average of 10 residents per facility. Implications: The intervention implementation results were promising for a management strategy often described as challenging to maintain. The distance learning model worked as expected. Given its strengths and relatively few weaknesses, it appears to be a feasible, effective, and low-cost strategy for translating research into nursing home practice.

Effects of Guided Care on Family Caregivers

Wed, 26 Aug 2009 10:22:42 PDT

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 reported the overall quality of their recipients' chronic illness care to be significantly higher (adjusted beta = 0.40, 95% confidence interval : 0.14–0.67). Quality was significantly higher in 4 of 5 PACIC subscales, 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.

Role for a Labor-Management Partnership in Nursing Home Person-Centered Care

Leutz, W., Bishop, C. E., Dodson, L. — Wed, 19 Aug 2009 07:51:59 PDT

Purpose: To investigate how a partnership between labor and management works to change the organization and focus of nursing home frontline work, supporting a transition toward person-centered care (PCC) in participating nursing homes. Design and Methods: Using a participatory research approach, we conducted case studies of 2 nursing homes participating in a partnership between a labor union and a provider coalition. The study was designed to reveal whether and how the labor–management partnership supported PCC and to identify challenges to overcome in the future. Results: The partnership provided training and follow-up support to member homes to implement PCC. Management and worker participants used the partnership as a learning collaborative to acquire PCC knowledge and to share implementation experience. Key elements of the implementation in each nursing home were translation of the larger labor–management partnership to each member nursing home, management innovations that developed and supported PCC, and conduct of union actors in each nursing home that supported PCC while maintaining traditional union protections. Frontline workers exhibited strong engagement in PCC practices. Implications: A partnership between labor and management can foster changes in the organization of frontline work aimed at improving nursing home residents’ quality of life and care.

Predictors of Family Conflict at the End of Life: The Experience of Spouses and Adult Children of Persons with Lung Cancer

Kramer, B. J., Kavanaugh, M., Trentham-Dietz, A., Walsh, M., Yonker, J. A. — Tue, 11 Aug 2009 07:12:25 PDT

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.

Dynamics of Volunteering in Older Europeans

Hank, K., Erlinghagen, M. — Fri, 07 Aug 2009 11:29:03 PDT

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 first 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 significant 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.

End-of-Life Caregiver's Perspectives on their Role: Generative Caregiving

Phillips, L. R., Reed, P. G. — Mon, 03 Aug 2009 03:09:55 PDT

Purpose: To describe caregivers’ constructions of their caregiving role in providing care to elders they knew were dying from life-limiting illnesses. Design and Methods: Study involved in-depth interviews with 27 family caregivers. Data were analyzed using constant comparative analysis. Results: Four categories were identified: centering life on the elder, maintaining a sense of normalcy, minimizing suffering, and gift giving. Generative caregiving was the term adopted to describe the end-of-life (EOL) caregiving role. Generative caregiving is situated in the present with a goal to enhance the elder’s present quality of life, but also draws from the past and projects into the future with a goal to create a legacy that honors the elder and the elder–caregiver relationship. Implications: Results contribute to our knowledge about EOL caregiving by providing an explanatory framework and setting the caregiving experience in the context of life-span development.

Dementia and Transitioning From Assisted Living to Memory Care Units: Perspectives of Administrators in Three Facility Types

Kelsey, S. G., Laditka, S. B., Laditka, J. N. — Fri, 24 Jul 2009 11:52:19 PDT

Purpose: This study examines transitioning residents with Alzheimer’s disease or a related disorder (ADRD) from assisted living facilities (ALFs) to memory care units (MCUs) from the perspective of 3 ALF organizational models: freestanding ALFs, ALFs with MCUs, and ALFs in continuing care retirement communities (CCRCs) with MCUs. Design and Methods: In-depth interviews were conducted with 37 ALF administrators, representing the 3 ALF types. Grounded theory identified major themes. Thematic analysis organized content. The constant comparison method compared themes among ALF types. Results: Administrators in freestanding ALFs were notably more likely to discuss transfer policies on admission. CCRCs with MCUs were more likely to make multidisciplinary decisions. In ALFs with MCUs, typically, the administrator and the director of nursing or resident care coordinator decided. In all ALFs, challenges included family resistance and denial of deficits, although there was notably less resistance in freestanding ALFs. CCRCs were much less likely than ALFs with MCUs to have trial admissions. Implications: ALF administrators may reduce family resistance to the MCU transfer by maintaining ongoing dialogue with family, discussing transfers at admission, conducting periodic resident reassessments, and providing opportunities for families to learn about ADRD.

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

Miller, E. A., Mor, V., Clark, M. — Mon, 13 Jul 2009 12:54:28 PDT

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 compromising 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.

Primary Care Physicians' Dementia Care Practices: Evidence of Geographic Variation

Fortinsky, R. H., Zlateva, I., Delaney, C., Kleppinger, A. — Mon, 13 Jul 2009 12:54:27 PDT

Purpose: This article explores primary care physicians’ (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states. Design and Methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in Connecticut and to all 1,017 licensed PCPs in Maine. Results: A total of 422 eligible PCPs responded. Nearly 90% of PCPs prescribed donepezil in the previous year for their dementia patients. Connecticut PCPs were more likely to prescribe several other therapeutics than their Maine counterparts. Connecticut PCPs were more likely to refer dementia patients to adult day care (85% vs. 59%) but less likely to refer to Area Agencies on Aging (21% vs. 44%; both ps < .05); referral rates to Alzheimer’s Association chapters were low in both states (30%). A greater proportion of Connecticut PCPs reported barriers to optimal dementia care, including time constraints (54% vs. 31% of Maine PCPs), unfamiliarity with community resources (46% vs. 30%), and reimbursement constraints (45% vs. 23%; all ps ≤ .05). Two thirds of PCPs were "very" or "somewhat" interested in using information technology to assist with dementia diagnosis and management; controlling for other variables, youngest PCPs were more than twice as likely as oldest to profess such interest (adjusted odds ratio = 2.04; 95% confidence interval [CI] = 1.02–4.08). Implications: Geographic variations are evident in PCP medication prescription patterns, community resource referral patterns, and reported barriers to optimal dementia care. Younger PCPs are more likely to adopt information technology to assist in dementia diagnosis and management.

The Stigma of Hearing Loss

Wallhagen, M. I. — Fri, 10 Jul 2009 11:18:59 PDT

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 influencing 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 self-perception, ageism, and vanity and was influenced 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.

The Psychosocial Impacts of Multimedia Biographies on Persons With Cognitive Impairments

Damianakis, T., Crete-Nishihata, M., Smith, K. L., Baecker, R. M., Marziali, E. — Fri, 10 Jul 2009 11:18:59 PDT

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 benefits. 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 filmed 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 identified in both the filmed 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.

Use of Pressure-Redistributing Support Surfaces Among Elderly Hip Fracture Patients Across the Continuum of Care: Adherence to Pressure Ulcer Prevention Guidelines

Wed, 08 Jul 2009 07:16:39 PDT

Purpose: To estimate the frequency of use of pressure-redistributing support surfaces (PRSS) among hip fracture patients and to determine whether higher pressure ulcer risk is associated with greater PRSS use. Design and Methods: Patients (n = 658) aged ≥65 years who had surgery for hip fracture were examined by research nurses at baseline and on alternating days for 21 days. Information on PRSS use and pressure ulcer risk factors was recorded at each assessment visit. Other information was obtained by interview and chart review. Results: A PRSS was observed at 36.4% of the 5,940 study visits. The odds of PRSS use were lower in the rehabilitation setting (adjusted odds ratio [OR] 0.4, 95% confidence interval [CI] 0.3–0.6), in the nursing home (adjusted OR 0.2, 95% CI 0.1–0.3), and during readmission to the acute setting (adjusted OR 0.6, 95% CI 0.4–0.9) than in the initial acute setting. There was wide variation in frequency of PRSS use by admission hospital, even after adjusting for pressure ulcer risk factors. The relationships between PRSS use and pressure ulcer risk factors were not strong. Implications: In this study of hip fracture patients, adherence to guidelines for PRSS use was low and was based more on facility-related factors than on patient risk. There is an urgent need for health care providers to improve strategies for the prevention of pressure ulcers in high-risk patients.

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

Hong, S.-I. — Thu, 02 Jul 2009 11:57:10 PDT

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.

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

Thu, 02 Jul 2009 11:57:09 PDT

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, identifiably 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 first wave of the second Family Relationships in Late Life study of caregivers of community-dwelling elderly care recipients with whom they coreside. Caregivers (N = 417) completed face-to-face 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 in reductions of PHB. Screening for resentment is warranted, as the relation between resentment and anger is similar to that between depression and anger.

Food Avoidance and Food Modification Practices of Older Rural Adults: Association With Oral Health Status and Implications for Service Provision

Thu, 02 Jul 2009 11:57:08 PDT

Purpose: Dietary variation is important for health maintenance and disease prevention among older adults. However, oral health deficits impair ability to bite and chew foods. This study examines the association between oral health and foods avoided or modified in a multiethnic rural population of older adults. It considers implications for nutrition and medical service provision to this population. Design and Methods: In-home interviews and oral examinations were conducted with 635 adults in rural North Carolina counties with substantial African American and American Indian populations. Avoidance and modification data were obtained for foods representing different dental challenges and dietary contributions. Data were weighted to census data for ethnicity and sex. Bivariate analyses of oral health measures and foods avoided used chi-square and logistic regression tests. Multivariable analyses used proportional odds or nominal regression models. Results: Whole fruits and raw vegetables were the most commonly avoided foods; substantial proportions of older adults also avoided meats, cooked vegetables, and other foods. Food avoidance was significantly associated with self-rated oral health, periodontal disease, bleeding gums, dry mouth, having dentures, and having fewer anterior and posterior occlusal contacts. Associations persisted when controlling for demographic and socioeconomic status indicators. From 24% to 68% of participants reported modifying specific fruits, vegetables, and meats. Modifying harder foods was related to location of teeth and periodontal disease and softer foods to oral pain and dry mouth. Implications: Food services for older adults should consider their oral health status. Policy changes are needed to provide oral health care in benefits for older adults.

Differential Sensitivity to Administration Format of Measures of Attitudes Toward Older Adults

Helmes, E., Campbell, A. — Thu, 02 Jul 2009 11:57:06 PDT

Purpose: Reluctance to reveal sensitive or socially undesirable attitudes has posed a problem for measurement of personal attributes such as attitudes toward older people. These have long been documented to be negative and likely arise both from fears of one’s own aging and the modern societal emphasis on youth. In order to increase our knowledge about the measurement of attitudes toward older people, we compared the administration of attitude measures toward older people by computer and conventional paper-and-pencil methods. Design and Methods: We contrasted the responses of 60 university undergraduates (mean age 24.3 years, SD 8.51; 68% female) to five traditional paper-and-pencil format attitude questionnaires toward older people with responses to the same questionnaires made using an Internet delivery and response mode. Results: Results showed that more negative attitudes were revealed using the computer-based Internet response format for all scales. Only two scales did not show significant differences between formats. Implications: Future research on attitudes toward older people should be aware that results are dependent not only on the particular scale that is used but also on the format of administration, with more negative attitudes revealed with computer administration.

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

Donnelly, E. A., Hinterlong, J. E. — Thu, 01 Jan 2009 00:00:00 PST

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 finding for formal social participation. Unlike Li, we did not find a significant relationship between widowhood and formal or informal volunteerism. Controlling for prior participation, widowhood remained significantly related to informal and formal social participation. Implications: Older adults increase their reliance on sources of other social support following spousal loss but do not change their volunteer activities. This suggests that continuity of volunteer engagement and enhanced social participation are important following widowhood. Given their positive associations with late-life well-being, efforts to help older widows and widowers increase their social participation and maintain established patterns of volunteerism following spousal loss are warranted.

Silver Alerts and the Problem of Missing Adults with Dementia

Thu, 01 Jan 2009 00:00:00 PST

In the months following the introduction of the National AMBER (America's Missing: Broadcast Emergency Response) Alert plan used to locate missing and abducted children, Silver Alert programs began to emerge. These programs use the same infrastructure and approach to find a different missing population, cognitively impaired older adults. By late 2008, 17 states had enacted Silver Alert policies, and several more planned to take advantage of National Silver Alert grant funding to initiate policies in 2009. To date, however, no research has examined the efficacy of such programs, which have widely varying parameters and criteria to initiate the alerts. In this study, we empirically examine the 17 existing state Silver Alert and related policies. The analysis includes an examination of the varieties of programs: dementia related and AMBER extension, the dates of enactment, the criteria for activation, and the process of activation. We conclude with two salient questions that emerged from the analysis. We examine these questions and make recommendations for future research, including examining whether Silver Alerts are an appropriate response to address the problem of missing adults with dementia or cognitive impairments and examining the costs and benefits of the programs including determining how best to balance efforts to keep cognitively impaired elders safe while keeping their basic human rights of autonomy and empowerment intact.

Concordance of Family and Staff Member Reports About End of Life in Assisted Living and Nursing Homes

Rich, S. E., Williams, C. S., Zimmerman, S. — Thu, 01 Jan 2009 00:00:00 PST

Purpose: To identify differences in perspectives that may complicate the process of joint decision making at the end of life, this study determined the agreement of family and staff perspectives about end-of-life experiences in nursing homes and residential care/assisted living communities and whether family and staff roles, involvement in care, and interaction are associated with such agreement. Design and Methods: This cross-sectional study examined agreement in 336 family–staff pairs of postdeath telephone interviews conducted as part of the Collaborative Studies of Long-Term Care. Eligible deaths occurred in or within 3 days of leaving one of a stratified random sample of 113 long-term care facilities in four states and after the resident had lived in the facility ³15 days of the last month of life. McNemar p values and kappas were determined for each concordance variable, and mixed logistic models were run. Results: Chance-adjusted family–staff agreement was poor for expectation of death within weeks (66.9% agreement, K = .33), course of illness (62.9%, 0.18), symptom burden (59.6%, 0.18), and familiarity with resident’s physician (59.2%, 0.05). Staff were more likely than family to expect death (70.2% vs 51.5%, p < .001) and less likely to report low symptom burden (39.6% vs 46.6%, p = .07). Staff involvement in care related to concordance and perspectives of adult children were more similar to those of staff than were other types of family members. Implications: Family and staff perspectives about end-of-life experiences may differ substantially; efforts can be made to improve family–staff communication and interaction for joint decision making.

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?

Hildon, Z., Montgomery, S. M., Blane, D., Wiggins, R. D., Netuveli, G. — Thu, 01 Jan 2009 00:00:00 PST

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.

Exploring the Relationship Between Absolute and Relative Position and Late-Life Depression: Evidence From 10 European Countries

Ladin, K., Daniels, N., Kawachi, I. — Thu, 01 Jan 2009 00:00:00 PST

Purpose: Socioeconomic inequality has been associated with higher levels of morbidity and mortality. This study explores the role of absolute and relative deprivation in predicting late-life depression on both individual and country levels. Design and Methods: Country- and individual-level inequality indicators were used in multivariate logistic regression and in relative indexes of inequality. Data obtained from the Survey of Health, Ageing and Retirement in Europe (SHARE, Wave 1, Release 2) included 22,777 men and women (aged 50–104 years) from 10 European countries. Late-life depression was measured using the EURO-D scale and corresponding clinical cut point. Absolute deprivation was measured using gross domestic product and median household income at the country level and socioeconomic status at the individual level. Relative deprivation was measured by Gini coefficients at the country level and educational attainment at the individual level. Results: Rates of depression ranged from 18.10% in Denmark to 36.84% in Spain reflecting a clear north–south gradient. Measures of absolute and relative deprivation were significant in predicting depression at both country and individual levels. Findings suggest that the adverse impact of societal inequality cannot be overcome by increased individual-level or country-level income. Increases in individual-level income did not mitigate the effect of country-level relative deprivation. Implications: Mental health disparities persist throughout later life whereby persons exposed to higher levels of country-level inequality suffer greater morbidity compared with those in countries with less inequality. Cross-national variation in the relationship between inequality and depression illuminates the need for further research.

Care Partner Responses to the Onset of Mild Cognitive Impairment

Blieszner, R., Roberto, K. A. — Thu, 01 Jan 2009 00:00:00 PST

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 benefit 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 significant others.