http://gerontologist.oxfordjournals.org The Gerontologist - RSS feed of current issue 1758-5341 February 2010 The Gerontologist 0016-9013 http://gerontologist.oxfordjournals.org/current_cover.gif http://gerontologist.oxfordjournals.org http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/NP?rss=1 Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnq002 The Gerontological Society of America 1 50 NP 2010-02-01 NP STANDING MATERIAL http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/NP-a?rss=1 Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnq003 The Gerontological Society of America 1 50 NP 2010-02-01 NP COVER http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/NP-b?rss=1 Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnq004 The Gerontological Society of America 1 50 NP 2010-02-01 NP STANDING MATERIAL http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/NP-c?rss=1 Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnq005 The Gerontological Society of America 1 50 NP 2010-02-01 NP STANDING MATERIAL http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/1?rss=1 Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnp169 The Gerontological Society of America 1 50 1 2010-02-01 1 EDITOR'S NOTE http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/2?rss=1 Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnp143 The Gerontological Society of America 1 50 10 2010-02-01 2 50TH ANNIVERSARY FEATURE ARTICLE http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/11?rss=1 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.

]]> Wed, 13 Jan 2010 00:34:59 PST info:doi/10.1093/geront/gnp068 The Gerontological Society of America 1 50 22 2010-02-01 11 COGNITIVE IMPAIRMENT http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/23?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp104 The Gerontological Society of America 1 50 35 2010-02-01 23 COGNITIVE IMPAIRMENT http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/36?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp067 The Gerontological Society of America 1 50 47 2010-02-01 36 RESILIENCE AND DEPRESSION http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/48?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp065 The Gerontological Society of America 1 50 59 2010-02-01 48 RESILIENCE AND DEPRESSION http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/60?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp094 The Gerontological Society of America 1 50 65 2010-02-01 60 STIGMA AND ATTITUDES http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/66?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp107 The Gerontological Society of America 1 50 75 2010-02-01 66 STIGMA AND ATTITUDES http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/76?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp099 The Gerontological Society of America 1 50 86 2010-02-01 76 INFORMAL CAREGIVING http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/87?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp105 The Gerontological Society of America 1 50 99 2010-02-01 87 INFORMAL CAREGIVING http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/100?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp096 The Gerontological Society of America 1 50 111 2010-02-01 100 NUTRITION http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/112?rss=1 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, = .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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp089 The Gerontological Society of America 1 50 120 2010-02-01 112 BRIEF REPORT http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/121?rss=1 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.

]]> Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp126 The Gerontological Society of America 1 50 132 2010-02-01 121 PRACTICE CONCEPTS http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/133?rss=1 Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp161 The Gerontological Society of America 1 50 137 2010-02-01 133 BOOK REVIEWS http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/138?rss=1 Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp160 The Gerontological Society of America 1 50 139 2010-02-01 138 BOOK REVIEWS http://gerontologist.oxfordjournals.org/cgi/content/short/50/1/139?rss=1 Wed, 13 Jan 2010 00:35:00 PST info:doi/10.1093/geront/gnp159 The Gerontological Society of America 1 50 140 2010-02-01 139 BOOKS RECEIVED