Journal of Applied Gerontology recent issues

Theory as a Necessary Part of Applied Gerontology

Cutchin, M. P. — Fri, 13 Nov 2009 18:34:56 PST

Social Theory, Aging, and Health and Welfare Professionals: A Foucauldian "Toolkit"

Powell, J. L. — Fri, 13 Nov 2009 18:34:56 PST

Health and welfare have emerged as pivotal drivers used to position the identities that older people adopt in contemporary Western societies. Both contain continually changing technologies that function to mediate relations between older people and care professionals. However, they also represent an increase in professional control that can be exerted on lifestyles in old age, and thus, the wider social meanings associated with that part of the life course. The article presents a theoretical analysis of gerontology based on a critical reading of the work of Michel Foucault. It identifies the interrelationship between managerialism and older people in terms of a conceptual toolkit of (a) "medical power," and (b) "assessment," "surveillance," and "resistance"; the key point is that they are relevant in theorizing power relations between health and welfare professionals and user groups such as older people.

Practice Implications: A Commentary on Powell's Foucauldian Toolkit

Castle, N. — Fri, 13 Nov 2009 18:34:56 PST

Challenging Gerontology's Empirical Molehills: A Commentary on Powell's Foucauldian Toolkit

McDaniel, S. A. — Fri, 13 Nov 2009 18:34:56 PST

Gerontology and theory have long been intellectually separate, with empirical studies dominant. Marrying Foucauldian theory, as Powell proposes, with gerontology is clever, timely and potentially fruitful for policy, practice and research. Although Foucault had little to say about age, his insights on power and on bodies are profoundly relevant to the process of ageing. Powell’s proposed application of a Foucauldian toolkit to caring for older people, enables the opening of insights into both the cared for and the carers, the latter of whom are differentially disadvantaged as well by gender, ethnicity, class and often immigration status. Viewed through Foucault’s concept of power, ageing population is observed as a fiction, justifying all manner of policy panics and woes that may not exist as actual challenges. Foucault’s concepts of power, identity, regulation, resistance and the bodily as socially shaped, have transformed sociology. A similar transformation of gerontology would be welcome.

Gerontological Theory: A Commentary on Powell's Foucauldian Toolkit

Svihula, J. — Fri, 13 Nov 2009 18:34:56 PST

A Response to Castle, McDaniel, and Svihula

Powell, J. L. — Fri, 13 Nov 2009 18:34:56 PST

Reconsidering Successful Aging: A Call for Renewed and Expanded Academic Critiques and Conceptualizations

Dillaway, H. E., Byrnes, M. — Fri, 13 Nov 2009 18:34:56 PST

Many scholars now critique successful aging terminology. Nonetheless, there is incomplete analysis of the political motivations behind the development of and/or effects of widespread use of these terms. This article suggests that analysis of the people who developed the terms and the settings within which they work parallels an analysis of the terms themselves and illustrates the continuing negative perception of aging. This study fleshes out a more thorough critique of the sociopolitical contexts surrounding the successful aging paradigm so that it can help renew and expand existing critiques. The authors conclude that researchers need to be wary of adopting successful aging terminology without considering and expanding their understanding of the political motivations and results that accompanies it. New, expanded conceptualizations of successful aging are needed so that socially minded researchers and practitioners of gerontology do not contribute to ageism and discrimination against older adults.

How Do Charge Nurses View Their Roles in Long-Term Care?

McGilton, K. S., Bowers, B., McKenzie-Green, B., Boscart, V., Brown, M. — Fri, 13 Nov 2009 18:34:56 PST

This article explores how registered nurses (RNs) in long-term care (LTC) understand their role as charge nurses. Data are derived from 16 charge nurses employed in 8 facilities in Ontario, Canada. Qualitative methods are used to analyze audiotapings of interviews. The findings reveal a range of dimensions and subdimensions. Charge nurses experience their work as highly complex and unpredictable. Themes that captured the following dimensions of the supervisor role in LTC include (a) against all odds, getting through the day; (b) stepping in work; and (c) leading and supporting unregulated care workers. In addition, analysis within each category reveals a complex intersection between the nurses’ perceptions of the context and their consequent work strategies. The emerging demands placed on supervisors due to the growing complexity of residents, increasing government regulations, and staffing shortages have caused the role of the charge nurse to evolve with little reflection on its impact.

Working Memory, Cues, and Wayfinding in Older Women

Davis, R. L., Therrien, B. A., West, B. T. — Fri, 13 Nov 2009 18:34:56 PST

Individuals create cognitive maps based on relationships between cues in the environment. Older individuals are often impaired in wayfinding, especially in environments that lack distinctive features. This study examines how working memory ability in older women is related to wayfinding performance in the presence of salient (distinctive, prominent) or nonsalient cues. The degree of salient cue complexity is also examined, thus leading to the hypothesis that salient, complex cues are important in wayfinding and that working memory capacity is related to wayfinding performance. The virtual computer-generated arena is used to test this hypothesis in 20 healthy older women in three different environmental cue conditions varying in salience and complexity. Data analyses indicate that older women perform best in salient cue conditions. A greater working memory capacity is related to improved performance in the nonsalient cue condition. These findings offer preliminary evidence that cue salience is especially important in wayfinding.

Using Massage to Reduce Use of Sedative-Hypnotic Drugs With Older Adults A Brief Report From a Pilot Study

Nelson, R., Coyle, C. — Fri, 13 Nov 2009 18:34:56 PST

Despite known adverse effects, sedative-hypnotic drugs (SHDs) are widely used in institutional settings serving the elderly. Using a 2 (Intervention, Control) x 3 (Baseline, Intervention, Withdrawal) mixed design with random assignment to the intervention (n = 15) or control (n = 13) group, the authors sought to determine if a nonpharmacological sleep intervention (massage at bedtime) could reduce "as-needed" SHD (PRN-SHD) usage. Each phase of this pilot lasted 7 days and PRN-SHD usage was monitored via chart review. Results, indicating a 13% greater reduction in requests for PRN-SHD for the intervention group when it received massage, approached statistical significance for the quadratic planned comparisons (p = .17) despite limited power (.28) for the observed effect size of .07. While preliminary, results suggest that massage at bedtime may reduce PRN-SHD usage with older adults. Randomized controlled studies with larger samples are needed.

Inspection Visits in Residential Care Facilities for the Elderly: The Effects of a Policy Change in California

Flores, C., Bostrom, A., Newcomer, R. — Thu, 10 Sep 2009 12:50:02 PDT

This study investigated the effects of a policy change in California that decreased annual state inspections of residential care facilities for the elderly to once every 5 years. Data collection involved a 5-year retrospective review of public facility files. Files were obtained from a probability sample of 340 licensed facilities, stratified by facility size and district office. Generalized estimating equations were used for multivariate analyses of size, office, and period effects of types of visits made and citations relative to quality of care. Routine survey visits were replaced with increases in the number of complaint- or problem-driven visits. Rates of quality of care citations arising from complaints or problems increased. Practice patterns among offices and variations by facility size were identified. Data from the resulting process affect comparisons of the industry and facility trends regarding quality of care. The problem-driven system may affect the rate of proactive consultation and quality-improvement visits.

Does Cognitive Ability Explain Inaccuracy in Older Adults' Self-Reported Medication Adherence?

McDonald-Miszczak, L., Neupert, S. D., Gutman, G. — Thu, 10 Sep 2009 12:50:02 PDT

This study examines the accuracy of younger-old and older-old adults’ self-reported adherence over a 3-month period and the potential interactive relationship between self-report accuracy and cognitive abilities. For 3 months, 71 younger-old (M = 68.10, range = 57 to 74) and 62 older-old (M = 80.31, range = 75 to 89) adults had their actual and self-reported adherence monitored. Cognitive tests assessing episodic and prospective memory were given at the beginning of the study. Multilevel models indicate that 32% of the variability in objective adherence was from between-person differences whereas 68% was from within-person fluctuations. There were age differences in the coupling of actual and self-reported adherence over time, such that younger-old adults’ self-reports less accurately reflected their actual adherence. Subsequent models indicate that age differences in the coupled relationship were further moderated by cognitive abilities. Results suggest that the relationships among age, cognitive abilities, and accuracy of self-reported adherence are far from simple.

Identity Processes and Memory Controllability in Middle and Later Adulthood

Jones, K. M., Krauss Whitbourne, S., Whitbourne, S. B., Skultety, K. M. — Thu, 10 Sep 2009 12:50:02 PDT

Memory is a salient area of functioning in adulthood known to be influenced by beliefs about performance. To date, individual variations in memory beliefs have not been systematically examined. The present study used hierarchical linear regressions to examine the relationship between Memory Controllability Index (MCI) subscales and identity processes in 250 adults (M = 58.01, 40 to 91 years), controlling for age, gender, and self-rated health. The ability to integrate age-related changes into identity was positively related to MCI scales measuring assessment of ability, potential to improve memory, and belief in the value of using memory strategies. The identity scale measuring negative age-related changes was related to lower memory self-assessment, ability to improve, and the belief that memory decline is inevitable. Contrary to expectation, the tendency to resist making changes in identity was not related to controllability. Findings support the utility of understanding memory-related beliefs in middle and later adulthood in terms of identity processes.

One Story at a Time: Narrative Therapy, Older Adults, and Addictions

Gardner, P. J., Poole, J. M. — Thu, 10 Sep 2009 12:50:02 PDT

Various factors including social isolation and financial worries put older adults at risk for addictions. Indeed, older adults are the largest consumers of medication, and alcohol consumption is rising. Yet interventions are limited and problems often go unreported. Unearthing "problem" stories in people’s lives (i.e., "the addiction story") and retelling them in more empowering ways, narrative therapy offers a viable therapeutic alternative, and research on narrative therapy has proven encouraging. However, little is known about narrative therapy with older adults and with addictions. Seeking to address these gaps, an ethnographic study was conducted in Toronto, Canada, with a group of older adults receiving narrative therapy for addictions. Findings suggest that the therapy was "helpful" and participants were able to reduce or halt their substance misuse. Most important, aspects of narrative therapy such as storytelling may be particularly well suited to older adults, offering powerful possibilities for applied gerontology.

Looking Back, Looking Forward: Reflections on Using a Life History Review Tool With Older People

Feldman, S., Howie, L. — Thu, 10 Sep 2009 12:50:02 PDT

The aim of this article is to examine the use of the Self-Discovery Tapestry (SDT) tool, a life history review instrument, and its application to an Australian qualitative study of community-dwelling older people aged 80 years and more. The researchers set out to engage with older people through an innovative research approach that acknowledged their experiences and recognized their skills and capacities across the course of their lives. The article reports and assesses this research instrument as a tool for gathering data in narrative studies involving older people. It proposes that the instrument, with some modifications might be used to further develop specific knowledge of aging to benefit research, education, and practice in gerontology. By undertaking to critique the research processes, the authors hope to show the value of incorporating a critical appraisal approach that may prove useful for strengthening further research in this area of inquiry.

Television Viewing and People With Dementia Living in Long-Term Care: A Pilot Study

de Medeiros, K., Beall, E., Vozzella, S., Brandt, J. — Thu, 10 Sep 2009 12:50:02 PDT

Although televisions are commonplace in many long-term care facilities for people with dementia, little research has been done on the possible effects of television viewing on residents’ behaviors. The authors’ study aims were to document observable behaviors and activities of residents before, during, and after viewing television programs and to determine whether programs had an observable effect on behaviors. The authors enrolled 22 residents in a residential dementia care facility (4 to 5 people in each of the five residential wings). Two raters completed systematic observations for 5 consecutive days at baseline, during the presentation of eight television programs, and for 30 minutes following the program. The authors found that "dozing" was the most common activity during program viewing. In addition, many participants remained in the television area, "watching" a blank television screen in the 30 minutes following the program viewing. Further investigation on television’s effect on sleep or participation in other social activities is needed.

Alcohol Use Risk Levels Among Older Patients Screened in Emergency Departments in Southern California

Woodruff, S. I., Clapp, J. D., Sisneros, D., Clapp, E., McCabe, C., DiCiccio, R. — Thu, 10 Sep 2009 12:50:02 PDT

More information is needed about the spectrum of alcohol use among older individuals, and correlates of problem drinking. This study described the alcohol use risk levels of a large convenience sample of patients 65 years and older visiting two large California hospital emergency departments (EDs). A personal interview, administered in the ED by a trained health educator, collected sociodemographic information and alcohol use using the Alcohol Use Disorders Identification Test instrument. A total of 476 older patients provided complete interviews. This group equally comprised of men and women. Fifty-four percent were White non-Hispanic, 28% were Hispanic, 11% were African American, and 6% Other/Unknown. About 14% were at risk or above for alcohol misuse. No differences in risk-level distribution were found for young-old (65-74 years of age) and old-old (75+) groups. Higher alcohol risk was associated with male gender and higher income. Results are discussed in terms of intervention approaches for older people.

Mobility in Old Age: Beyond the Transportation Perspective

Kaiser, H. J. — Tue, 14 Jul 2009 12:07:59 PDT

For the elderly mobility is a constitutive and essential element of their quality of life. Due to their aging population modern societies intend to intervene and enhance the mobility of the elderly on the basis of research findings. Indeed, numerous research projects pointed out existing barriers to mobility in old age: personal barriers (e.g., achievement deficits, diseases or handicaps), and environmental barriers (e.g., physical obstacles, technical complications). Simply overcoming these barriers does not guarantee mobility without problems and an increase of the quality of life. Beyond a "transportation perspective" of mobility more emphasis is needed with respect to emotional, motivational and social aspects of being mobile. In doing so, decision makers as well as scientists will be confronted with unexpected and non-obvious societal tasks and peculiar demands on social sciences like gerontological psychology, sociology, political science and even education.

Evaluation of an Education and Support Program for Early-Stage Alzheimer's Disease

Roberts, J. S., Silverio, E. — Tue, 14 Jul 2009 12:07:59 PDT

This study evaluated an existing education and support program specifically designed for early stage Alzheimer's disease (AD). The "Taking Control of Alzheimer's Disease" series is an Alzheimer's Association-sponsored, four-session program that combines didactic and interactive activities for both persons with early-stage dementia and their care-partners. Seventy-four participants across nine series (37 persons with dementia, 37 care-partners) provided data. Participants expressed a high degree of satisfaction with the program (e.g., 71% gave it a letter grade of "A," 99% found it helpful). No significant changes from baseline were observed in AD knowledge, coping self-efficacy, or psychosocial adjustment to illness. At 3-month follow-up, participants were more likely than at baseline to be engaged in numerous AD-related coping and health behaviors, including participation in a support group (68% vs. 17%) and legal/financial planning (66% vs. 31%). Findings suggest numerous potential benefits from education and support programs specifically designed for early-stage AD.

Barriers to Outpatient Care in Community-Dwelling Elderly with Dementia: The Role of Caregiver Life Satisfaction

Thorpe, J. M., Van Houtven, C. H., Sleath, B. L. — Tue, 14 Jul 2009 12:07:59 PDT

The purpose of this study was to examine the relationship between informal caregiver life satisfaction and receipt of outpatient medical care in persons with dementia. We obtained data from the National Longitudinal Caregiver Survey (NLCS), a survey of 1,269 veterans with dementia and their primary informal caregivers. NLCS data were merged with 12 months of Veteran Administration outpatient claims. Outpatient visits were classified as (a) primary, (b) specialty, or (c) mental health care. Greater levels of caregiver-reported life dissatisfaction were associated with decreased likelihood of care-recipient outpatient visits for both primary and mental health care. In addition, we found that care-recipients with African American caregivers were less likely to receive a mental health visit, and those coresiding with their caregiver were more likely to receive a specialty care visit. Our findings suggest that low caregiver life satisfaction may signal an impending breakdown in care-recipients' access to primary and mental health care.

The Relationship of Social Engagement to Psychological Well-Being of Older Adults in Assisted Living Facilities

Park, N. S. — Tue, 14 Jul 2009 12:07:59 PDT

The purpose of this study is to explore social engagement and its relationship to the psychological well-being of older adults residing in assisted living facilities (ALFs). Drawing on activity theory, the study focuses on the salience of social relationships on residents' life satisfaction and depressive symptoms. A total of 82 residents were interviewed face-to-face in eight ALFs in a southern state of the United States. The data were analyzed using hierarchical regression models in that demographic and health variables, site characteristics, and social engagement variables were entered into the model in successive steps. Results indicate that perceived friendliness of residents and staff was significantly associated with life satisfaction and depressive symptoms controlling for other variables, and enjoyment of mealtimes was related to low depressive symptoms. Findings suggest that ALFs could promote residents' psychological well-being by encouraging residents to develop meaningful relationships within the facility and by designing enjoyable mealtimes.

Understanding and Improving the Burden and Unmet Needs of Informal Caregivers of Homebound Patients Enrolled in a Home-Based Primary Care Program

Ornstein, K., Smith, K. L., Boal, J. — Tue, 14 Jul 2009 12:07:59 PDT

The growing homebound population is heavily reliant on informal caregivers, who are increasingly burdened by their roles. This study describes informal caregivers of the homebound who remain caregivers at a 9-month follow-up and examines the impact of a home-based primary care (HBPC) program on caregiver burden and unmet needs using a prospective design with a pre—post intervention assessment. Informal caregivers of the urban homebound are similar to caregivers of other populations and have a broad range of unmet needs. The intervention described is the regular provision of multidisciplinary HBPC. Hundred fourteen caregivers of newly admitted patients complete a baseline interview. For the 56 caregivers who complete a 9-month follow-up interview, participation in HBPC is associated with a statistically significant decrease in overall caregiver burden. At 9 months, caregivers demonstrate an overall decrease in unmet needs, with a statistically significant decrease across two measured domains. These results suggest that the regular provision of multidisciplinary care in the home can mitigate the deleterious impact of informal caregiving.

Demographic Determinants of Necessary Dissaving Among Older Persons

Temple, J. B., Brandon, P. D. — Tue, 14 Jul 2009 12:07:59 PDT

Because of population aging, many governments are placing greater responsibility on older persons to fund their retirement. Within this context, older persons' financial self-sufficiency during times of stress is important to understand. Using data from the 2002 Australian General Social Survey, this article reports on the prevalence of older persons drawing on financial resources to meet the cost of everyday living expenses when current income is insufficient, identifies the kinds of resources older persons draw on to meet the costs of everyday necessities, and estimates the effects of demographic factors on different necessary dissaving strategies. Results indicate that about 11% of older persons find it necessary to employ some type of dissaving strategy and that the factors associated with asset dissaving differ from the factors associated with liability dissaving. Future research needs to examine the effects of unanticipated events on necessary dissaving and alternative motives for dissaving.

Late-Life Volunteering and Trajectories of Physical Health

Tang, F. — Tue, 14 Jul 2009 12:07:59 PDT

The purpose of this study was to examine the longitudinal relationship between volunteering engagement and trajectories of physical health. Using three-wave panel data from the Americans' Changing Lives survey, the author tested the association between volunteering engagement and physical health after controlling for health variables from previous waves. Volunteering engagement was measured through volunteer status and hours. Physical health was measured through self-rated health, functional dependency, and chronic conditions. Findings indicated that volunteering engagement was associated with improved self-rated health and decreased functional dependency but not with the number of chronic conditions. Volunteering is a social approach to health maintenance in the older population, and the findings of this study add to the literature suggesting that volunteering probably leads to positive outcomes, but the relationship is also related to resource, status, and network variables.

Gerontology: Adding an Empowerment Paradigm

Haber, D. — Tue, 28 Apr 2009 14:42:15 PDT

With gerontology boomers beginning to collect their social security checks, this article challenges gerontology professionals to transform the jobs, services, programs, and institutions that will allow the boomers to realize their dreams and goals. Gerontology educators, practitioners, and researchers will need to collaborate with boomers who have a history of creating change and are likely to redefine retirement. This article describes the boomer cohort, provides a brief summary of an empowerment paradigm, offers six examples of movements that are beginning to empower boomers, and ends with a call to action. According to the author, there is a need to educate our colleagues and the general public about the innovations that are emerging, evaluate them in a broader and more coordinated way, and help promote them by partnering with the coming cohort of gerontology boomers.

Empowerment of Seniors and Paradigm Change: A Commentary on Haber's Empowerment Paradigm

Kane, R. A. — Tue, 28 Apr 2009 14:42:15 PDT

Empowerment? For Boomers?: A Commentary on Haber's Empowerment Paradigm

Neufeld, S. — Tue, 28 Apr 2009 14:42:15 PDT

Boomer Rumors: A Commentary on Haber's Empowerment Paradigm

Whittington, F. J. — Tue, 28 Apr 2009 14:42:15 PDT

A Response to Neufeld, Kane, and Whittington

Haber, D. — Tue, 28 Apr 2009 14:42:15 PDT

Older Women and Poverty Transition: Consequences of Income Source Changes From Widowhood

Gillen, M., Kim, H. — Tue, 28 Apr 2009 14:42:15 PDT

Older single women are disproportionately vulnerable to poverty. Using data from the 2002 and 2004 waves of the Health and Retirement Study of 5,799 women age 65 or older, this study investigated the effect of change in income sources by recent spousal loss on poverty transition. The focus is on (a) the effect of widowhood on income source change and (b) how such change affects poverty transition of recently widowed older women. Findings indicate that widowhood greatly decreases income from every source. Specifically, a $10 increase in social security benefits decreased the probability of poverty transition for recently widowed older women by 67.2%. These findings call for reconsidering social security survivor benefit rules and women's education with regard to financial security in retirement.

Lay Appraisal of Cognitive Impairment Symptoms and Related Prevention Beliefs in a Community-Dwelling Sample of Midlife and Older Adults

VonDras, D. D. — Tue, 28 Apr 2009 14:42:15 PDT

This study explores how age and health-related quality of life (HRQoL) may be related to the identification and appraisal of cognitive impairment symptoms as well as associated prevention beliefs. Participants were 140 community-dwelling adults ranging in age from 49 to 90 years who completed a survey containing a vignette about an adult with cognitive impairment symptoms and questions about the illness symptoms, prevention beliefs, and HRQoL. Identification of symptoms as Alzheimer's disease or dementia was reported by 83% of respondents. Correlational analyses suggested age and education to be associated with perceived significance of symptoms as well as the recommendation to seek medical care. Multiple regression modeling indicated interactive effects that suggest advancing age and poor HRQoL may be associated with greater delay in seeking care for cognitive impairment symptoms and unrealistic optimism regarding prevention outcomes. Educational interventions to bolster the individuals' and caregivers' knowledge of Alzheimer's disease are discussed.

Exercise and Health-Related Quality of Life in Older Community-Dwelling Adults: A Meta-Analysis of Randomized Controlled Trials

Kelley, G. A., Kelley, K. S., Hootman, J. M., Jones, D. L. — Tue, 28 Apr 2009 14:42:15 PDT

The authors used the meta-analytic approach to examine the effects of physical activity on health-related quality of life (HRQOL) in older community-dwelling adults. A random-effects model was used for all primary analyses. Of the 257 studies screened, 11 randomized controlled trials representing 13 groups and 617 men and women (324 physical activity, 293 control), all older than 50, were included. Overall, a significant (small to moderate) standardized effect size improvement was found for physical function as a result of physical activity (Hedges's g = 0.41, 95% confidence interval [CI] = 0.19, 0.64, p < .001). This was equivalent to a common language effect size of 62% and an odds ratio of 2.14 (95% CI = 1.42, 3.24). No significant differences were found for the other nine HRQOL outcomes. Although additional research is needed, results suggest that physical activity improves self-reported physical function, a component of HRQOL, in older community-dwelling adults.

An Insight Into the Delivery of a Palliative Approach in Residential Aged Care: The General Practitioner Perspective

Phillips, J., Davidson, P. M., Willcock, S. — Tue, 28 Apr 2009 14:42:15 PDT

Managing the complex care needs of older people is a global concern. General practitioners (GPs) play a pivotal role in aged care, yet little is known about their capacity to provide palliative care in nursing homes. This study aimed to investigate GPs' perceptions and understanding of a palliative approach. A convenience sample of rural GPs (n = 13) participated in a series of three focus groups undertaken in August, 2005. These focus groups were all audio-taped, transcribed, and analyzed using thematic content analysis. Four key themes emerged: uncertainty about a palliative approach, a need to reorientate providers, the challenges of managing third parties, and making it work and moving forward. These preliminary findings suggest that integrating a palliative approach in aged care requires GPs to have a greater awareness of this paradigm and to be more effectively engaged in multidisciplinary care planning.