Journal of Applied Gerontology recent issues

Nursing Home Caregiver Staffing Levels and Quality of Care: A Literature Review

Castle, N. G. — 2008-07-18

In this research, the author reviewed 70 studies that had examined the relationship between staffing levels and quality in nursing homes (covering the years 1991 to 2006). The results of the review including all of this literature show that approximately 40% of the quality indicators examined show an association with nursing home staffing levels. Nevertheless, this finding is further interpreted in the context of the limitations of many of these prior studies. The author discusses the limitations of poor quality staffing data, small sample size, quality indicators used, methodological concerns, and underspecified models inherent to many prior studies. The author finds no study representing a "gold standard" exists in this area. Still, the few studies that seem methodologically most robust would seem to indicate that an association between nursing home staffing levels and quality exists. However, the author concludes that studies in this area need to be further enhanced.

Self-Reported Vision, Upper/Lower Limb Disability, and Fall Risk in Older Adults

Steinman, B. A. — 2008-07-18

The purpose of this study was to examine independent and interactive roles of self-reported vision status and upper and lower limb disability as predictors of falls in people 65 and older. Data from the 2002 and 2004 panels of the Health and Retirement Study were analyzed using binary logistic regression. Results indicated a reduced or eliminated role of vision status after upper and lower limb disabilities were controlled. Gender differences were found with respect to health conditions that predicted falls; however, vision status was not found to have a moderating influence on upper and lower limb disability in predicting falls for men or women. Implications for exercise programs designed for older people with visual impairments are discussed.

Civic Engagement Among Older Chinese Internet Users

Bo Xie, — 2008-07-18

This study examines older Chinese Internet users' participation in voluntary associations, communities, and politics, focusing on members of a senior-oriented computer training organization based in Shanghai, China. The results show that the Internet can facilitate the civic engagement of these older Chinese, as illustrated by their active participation in Internet-promoting activities, devotion to starting new computer clubs in local communities, and efforts in persuading government officials to provide necessary resources for establishing and maintaining local computer clubs. The findings suggest the following: The Internet can be a useful concept (in contrast to its online informative and communicative functions per se) to facilitate civic engagement in the offline world, computer clubs might be a more attractive approach to civic engagement among older Chinese, and the Internet's impact is mediated by the historical and political contexts of older Chinese. These findings call for a broader understanding of the impact of the Internet on civic engagement.

On the Malleability of Performance: Implications for Seniors

Horton, S., Baker, J., Pearce, G. W., Deakin, J. M. — 2008-07-18

Popular stereotypes of aging affect the performance of seniors in a number of different domains, from memory performance to physiological response. The authors undertook a review of this area, in which they examined 17 studies that looked at the impact of stereotype primes on older individuals' cognitive, physical, physiological and psychological performance. Analyses included investigating the effects of both positive and negative age stereotypes, and implicit and explicit priming methodologies. The authors utilized a meta-analytic technique on a subset of studies that examined the impact of priming on memory performance. This yielded an effect size of 0.38. The results suggest that popular stereotypes of aging (and the corresponding subtle changes in the testing environment) are important variables to consider for those researchers testing performance of seniors.

Family Caregivers' Future Planning for Younger and Older Adults With Serious Mental Illness (SMI)

Corsentino, E. A., Molinari, V., Gum, A. M., Roscoe, L. A., Mills, W. L. — 2008-07-18

This study examines plans for future caregiving made by family members of younger (n = 59) and older adults (n = 16) with serious mental illness (SMI). An online survey was advertised through a newsletter of the National Alliance on Mental Illness. Qualitative analyses yielded four areas of caregiver concern: health of the care recipient over time, ability of caregivers to sustain support, social support available for the care recipient, and financial burden of care. Despite these concerns, few caregivers reported completed plans for future caregiving. One fourth of the caregivers had made no plans, nor had they discussed future caregiving with others. Although most would prefer other relatives to assume care in the event they could not sustain support, these expectations may not be communicated openly. Generating discussion on this pertinent topic has implications for the aging society regarding how best to care for those with SMI and their caregivers.

Advance Directive Decision Making Among Independent Community-Dwelling Older Adults: A Systematic Review of Health Science Literature

Sessanna, L., Jezewski, M. A. — 2008-07-18

The purpose of this systematic review of health science literature was to examine the current state of science regarding advance directive decision making (ADDM) among independent community-dwelling older adults. Seventeen studies fitting study inclusion criteria established for the purpose of this systematic review were examined. Findings revealed that ADDM has predominantly been explored among widowed, divorced, or never married female Caucasian independent community-dwelling older adults aged 65 years and older possessing a high school level of education. Numerous older adult/health care provider barriers to advance directive discussion and completion were found to exist. There is a lack of research regarding ADDM among independent community-dwelling male older adults, older adults from various ethnic and cultural backgrounds, and older adults receiving lower levels of education. Study replication and the implementation of new studies are needed to strengthen the existing body of older adult, advance directive, evidence-based research.

Relationships Among Walking Aids, Physical Activity, Depression, Fatigue, and Perceived Health in Assisted-Living Residents: A Pilot Study

Wyrick, S., Parker, D., Grabowski, D., Feuling, H. M., Ng, A. V. — 2008-07-18

This study assesses whether physical activity, depression, fatigue, or perceived health are affected by use of a walking aid in residents of an assisted-living facility. From an assisted-living facility, 21 participants who were independent ambulators (n = 8) or who used a cane or walker (n = 13) participated. Physical activity was measured with accelerometers, and depression, fatigue, and perceived heath status were assessed with questionnaires. There were no differences in physical activity, depression, fatigue, or perceived health status between those using and those not using assistive devices. However, 15% of the participants reported moderate to severe depression, and 40% of participants reported at least mild depression. Depression was strongly correlated to fatigue. Thus, physical activity, depression, fatigue, and perceived health are not associated with walker or cane use in assisted-living facilities. Nevertheless, among all, mild depression is prevalent and strongly correlated to fatigue.

Taking Care of Our Elders: An Initial Study of an Assisted-Living Facility for American Indians

Brown, C. M., Gibbons, J. L. — 2008-07-18

The present study is an initial exploration of the psychological well-being of residents of an assisted-living facility (ALF) designed and managed for elders of an American Indian tribe. A total of 56 tribal member elders, including 13 facility residents and 43 nonresidents, completed scales measuring happiness, quality of life, perceived social support, and loneliness. In addition, 5 residents participated in one-on-one interviews. Compared to nonresidents, facility residents reported significantly greater happiness and perceived social support and significantly less loneliness. Furthermore, loneliness was found to mediate the relationship between ALF residence and happiness. Interviews with the residents revealed four themes related to the ALF that contribute to the residents' well-being. Although this study is limited by its small sample size, it indicates that tribally owned and/or managed ALFs may be a good long-term care option for many American Indian elders. Further investigation of long-term care options for American Indian elders is needed.

Negotiating Transitions in Later Life: Married Couples in Assisted Living

Kemp, C. L. — 2008-05-06

Although a minority in assisted living facilities (ALFs), couples do reside in these settings and the numbers are predicted to rise. Despite this prediction, little is known about these couples' experiences. Endeavoring to advance knowledge and inform policy and practice, this article presents an analysis of qualitative data from an exploratory study involving 20 married couples living in ALFs. Analysis considers couples' pathways and responses to assisted living. Findings show couples' pathways to ALFs typically involved a major health transition for one or both spouses and required enabling resources paired with the desire to remain together. For most, the need for relocation was asynchronous. Couples' ALF experiences were variable in terms of how spouses reported interacting with one another and how they interacted with others. A couple's degree of health synchronicity, level of disability, and previous social patterns influenced activity in ALFs. Implications for research, policy, and practice are discussed.

Mental Health Services for Older Adults in Rural Areas: An Ecological Systems Approach

Sanders, G. F., Fitzgerald, M. A., Bratteli, M. — 2008-05-06

Groups of North Dakota professionals from health and aging services participated in a focus group study of mental health needs and barriers to service among older adults. Data were collected from 13 focus groups that included human service providers, public health nurses, out-reach workers, and advisory groups who discuss mental health and aging issues in a number of ecological systems contexts. Lack of knowledgeable care providers, funding cutbacks, accessibility of services, and ageism were frequently cited barriers to mental health services for older adults in rural areas. Focus groups also discussed the needs of older adults including information on services, how to access services, the need for service providers in rural areas, and routine assessments by physicians. Participants suggested that the main needs of providers were education, more services, and changes or flexibility in the types of services.

Issues in Recruitment, Retention, and Data Collection in a Longitudinal Nutrition Study of Community-Dwelling Older Adults With Early-Stage Alzheimer's Dementia

Shatenstein, B., Kergoat, M.-J., Reid, I. — 2008-05-06

The Nutrition-Memory Study (NMS) followed evolution of nutrition status among elderly community-dwelling individuals with Alzheimer's disease (AD). Participants, age-matched to cognitively intact controls, were recruited from three university hospital memory clinics. Incentives encouraged retention; flexible procedures and caregiver collaboration permitted collection of nutrition information from AD patients. Of 71 patients referred by the clinics, 55 (77.5%) were eligible, 42 (76.4% of eligible) were recruited with their caregivers, and 40 (72.7%) completed the baseline. Thirty-two patient—caregiver dyads completed the first three interviews (58.1% of eligible; 80% of recruited); 26 of the 32 dyads (81.3% of recruited) completed four of the five interviews, and 14 (43.8% of recruited) were seen at all five study visits. Ensuring successful recruitment and retention in this clientele requires strong links between the research team and target community, ensuring relevance of the study to participants, and being mindful of the burden levied on patient—caregiver dyads.

Caregivers' Aspirations, Realities, and Expectations: The CARE Tool

Keefe, J., Guberman, N., Fancey, P., Barylak, L., Nahmiash, D. — 2008-05-06

Caregivers to family and friends are increasingly recognized as essential players in the continued shift of care of dependent populations to the community. Currently, Canadian provincial home care programs have neither a comprehensive policy nor an assessment regarding caregivers' needs. This article describes an assessment tool that takes into account caregivers' reality and conditions and that situates them as essential partners with the formal system and reports on the validation and reliability testing of this tool. Seven sites in Quebec and Nova Scotia involving 40 assessors tested the tool with 168 caregivers. Results suggest that this comprehensive tool enables practitioners to understand caregivers' needs and situations. Focus groups with assessors and interviews with home care administrators revealed that the tool increased worker understanding and awareness of what it means to be a caregiver, ascertained the key caregiver concerns, and identified these needs in rapid succession.

Caregiving Burden, Community Services, and Quality of Life of Primary Caregivers of Frail Elderly Persons

Iecovich, E. — 2008-05-06

Caregiving burden was found to be affected by a multiplicity of factors and to affect the quality of life of family caregivers. The present study is aimed at examining the extent to which various supportive services help to alleviate caregivers' burden and the extent to which caregivers' burden affects various domains of the quality of life of primary caregivers and also to investigate the factors that best explain quality of life. The sample includes 114 primary caregivers who provided care to physically disabled elderly family members. Data were collected through face-to-face interviews. The findings show that various domains of the quality of life of primary caregivers were affected by the level of the caregivers' burden and the types of services provided to the elderly person, by caregivers' characteristics, as well as their health and economic status.

Daily Physical Activity: Relation to Everyday Memory in Adulthood

Whitbourne, S. B., Neupert, S. D., Lachman, M. E. — 2008-05-06

This article examines the relationship between daily physical activity and everyday memory using an 8-day diary design with young, middle-aged, and older adults. Contrary to expectations, age differences were not reported in the frequency of memory failures and daily physical activity at the between-person level. Multilevel modeling, however, indicated that on days when adults engaged in leisure exercise (physical activity performed during leisure or free time), they reported fewer memory failures, and this was most apparent for older adults. Lagged analyses indicated that when leisure activity was reported on one day, fewer memory failures were reported the next day, and this was especially true for older adults. Thus, findings demonstrate that the benefits of physical activity for memory in later life are observable on a short-term daily basis.

Antecedents of Physical Activity Among Family Caregivers

Etkin, C. D., Prohaska, T. R., Connell, C. M, Edelman, P., Hughes, S. L. — 2008-05-06

The authors examined exercise behaviors among family caregivers and the degree to which aspects of the caregiving role influenced exercise behaviors. Understanding factors associated with caregiver physical activity provides practitioners the means to design and tailor interventions to be effective for caregivers. Caregivers (N = 208) participating in a self-care intervention to promote caregiving skills were surveyed at baseline, prior to training. Measures included caregiver characteristics, care recipient characteristics, attitudes and intentions toward exercise, and levels of physical activity. Mental health variables and self-efficacy for exercise were significantly related to exercise levels in bivariate analyses. Regression analyses revealed that caregiver and care recipient characteristics accounted for a small percentage of the variance in exercise behavior. Caregiver vitality and self-efficacy for exercise were key variables most significantly related to exercise behaviors. Findings suggest that mental health factors and attitudes about exercise may be more important predictors of exercise than caregiving factors.

Episodic Crises in the Provision of Care to Elderly Relatives

Sims-Gould, J., Martin-Matthews, A., Gignac, M. A. M. — 2008-03-19

An extensive body of research explores caring for older relatives. However, relatively little is known about crisis episodes in the provision of care to older adults. The purpose of this research is to explore the nature of crises in employed caregivers' lives by examining the type, frequency, and impact associated with crises. Data come from the Canadian Aging Research Network's (CARNET) survey of 5,496 employed Canadians. The analyses focus on open- and close-ended data collected from 250 respondents (108 men and 142 women) with caregiving responsibilities. Nearly half the participants (47%) reported a crisis in the previous 6 months. Crises are predictable and unpredictable events in the lives of the caregiver and the older person receiving care. They are primarily health related but could also be social, emotional, financial, and idiosyncratic to a family. Findings from this research contribute to a more comprehensive understanding of the trajectories in caregiving.

Cultural Influences in the Patterns of Long-Term Care Use Among Mexican American Family Caregivers

Herrera, A. P., Lee, J., Palos, G., Torres-Vigil, I. — 2008-03-19

This study sought to explore cultural attitudes toward caregiving and long-term care and their influence on patterns of long-term care use among Mexican American family caregivers of relatives aged 50 and older. Using a cross-sectional design, the researchers used mixed methods and conducted interviews with 66 Mexican American family caregivers in San Diego, California. They applied the Andersen behavioral model of health service utilization to examine familism, gender roles, acculturation, religiosity, and knowledge and perceptions of long-term care as factors in usage. Caregivers with greater long-term care use displayed lower levels of familism, were knowledgeable about services, had a care recipient with health insurance, shared caregiving responsibilities, and were less acculturated. Medicaid coverage for low-income care recipients was associated with higher long-term care use. Although familism may deter service use, caregivers empowered with resources and knowledge or Medicaid coverage are inclined to use long-term care services.

Death and Dying in Nursing Homes: A Burden for the Staff?

Jenull, B., Brunner, E. — 2008-03-19

Changes in our society increasingly place the old and impaired in institutions, where they spend their last remaining days. The authors explore the burden of being confronted with death and dying on nursing home staff using mixed methodology. Findings from open-ended interviews with 17 representatives of different occupational groups inform the design of a questionnaire used to conduct a survey in 52 nursing homes of the Federal Province of Carinthia (Austria). In total, 894 questionnaires were returned, yielding a response rate of 49%. Results indicate that it is more difficult to talk about death with family members of terminally ill residents than with the dying themselves. The need for end-of-life training is not only essential for nursing staff but is also needed for nonnursing staff, who are found to be substantially strained by aspects of death and dying in their workplace.

Unobtrusive In-Home Monitoring of Cognitive and Physical Health: Reactions and Perceptions of Older Adults

Wild, K., Boise, L., Lundell, J., Foucek, A. — 2008-03-19

Although the potential benefits of unobtrusive in-home sensing technologies for maintaining health and independence of older adults have been highlighted in recent research, little is known about their views toward such technology. The aims of this project were to identify monitoring needs and expectations of community-residing elderly and their family members. Focus groups were presented with examples of in-home monitoring devices and data output; participants were asked to consider whether the data showed information that was meaningful to them, and how and to whom they would like to have such data disseminated. Content analysis of transcripts revealed four dominant themes: maintaining independence, detecting cognitive decline, sharing of information, and the trade-off between privacy and usefulness of monitoring. The acceptance by elderly of unobtrusive in-home monitoring was closely tied to perceived utility of data generated by such systems. Privacy concerns appeared to be less of an issue than anticipated in this sample.

What Is the Optimal Duration of Participation in a Community-Based Health Promotion Program for Older Adults?

2008-03-19

Optimizing duration of participation in health promotion programs has important implications for program reach and costs. We examine data from 355 participants in EnhanceWellness to determine whether improvements in disability risk factors (depression, physical inactivity) occurred early or late in the enrollment period. Participants had a mean age of 74 years; 76% were women, and 16% were non-White. The percentage depressed declined from enrollment to 6 months (35% to 28%, p = .001) and from 6 to 12 months (28% to 22%, p = .03). The percentage physically inactive declined over the first 6 months, without substantial change thereafter (47%, 29%, and 29%). Those remaining inactive at 6 months had worse self-rated health and more depressive symptoms initially; a subset of those increased their physical activity by 12 months. These data suggest that enrollment could be reduced from 12 to 6 months without compromising favorable effects of EW participation, although additional benefits may accrue beyond 6 months.

Comparison of Caregiver and Occupational Therapist Ratings of Dementia Patients' Performance of Activities of Daily Living

Cotter, E. M., Burgio, L. D., Roth, D. L., Gerstle, J., Richardson, P. — 2008-03-19

Although proxy reports of activities of daily living (ADLs) are commonly used, especially when the care recipient has dementia, how well these caregiver reports correspond to professionals' ratings is not always clear. In this study, dementia caregivers completed an orally administered version of the Self-Care subscale of the Functional Independence Measure (FIM). ADL interactions were videotaped in the home, and independent raters assigned a FIM score to these interactions. An occupational therapist later viewed the videotaped ADLs and assigned FIM scores to those interactions. These three sets of scores were then compared. All possible correlations were significant (n = 21; p ≤ .005; r_s = .620 to .933; Mdn = .862), and there were no significant differences among ratings obtained from the different sources. These results support earlier conclusions regarding the validity and clinical utility of caregiver proxy ratings of functional ability in elders with dementia.

The Many Faces of Applied Gerontology

Cutchin, M. P. — 2008-02-06

Addressing Fidelity in Evidence-Based Health Promotion Programs for Older Adults

Frank, J. C., Coviak, C. P., Healy, T. C., Belza, B., Casado, B. L. — 2008-02-06

This article addresses health behavior change program fidelity using the five components of fidelity from the National Institute of Aging's Behavior Change Consortia: fidelity in design, training, delivery, receipt, and enactment. Fidelity is a key issue in successful translational research projects into community settings. The authors examine four programs sponsored by the Administration on Aging that target health behavior change in physical activity (EnhanceFitness), chronic disease self-management (Partners on the PATH [Personal Action Toward Health]), fear of falling and falls prevention (Matter of Balance), and depression management (Healthy IDEAS). This article (a) describes the tools and strategies used by these projects to track and enhance fidelity to the core elements of the original intervention studies, (b) compares and contrasts each project's mechanisms of fidelity, (c) provides examples of fidelity outcomes, and (d) discusses themes and lessons learned that may be useful to others in developing the "next generation" of program translation.

The Feasibility and Effectiveness of Translating a Matter of Balance Into a Volunteer Lay Leader Model

Healy, T. C., Peng, C., Haynes, M. S., McMahon, E. M., Botler, J. L., Gross, L. — 2008-02-06

The purpose of this study is to examine whether A Matter of Balance, a cognitive-behavioral program previously found to be efficacious in a randomized clinical trial (RCT), could be translated into a community-based volunteer lay leader model and achieve outcomes comparable to those found in the RCT. A repeated measures, single-group design is employed. Participants experience significant increases in falls efficacy, falls management, and falls control at 6 weeks, 6 months, and 12 months, thus achieving comparable outcomes with those of participants in the RCT. This successful translation of a professionally led health promotion program into a volunteer lay leader model enables embedding the program in community-based organizations, thus making it more broadly available to older adults in diverse settings. The findings also suggest that other evidence-based programs currently requiring professional staff can be adapted for facilitation by volunteers.

Determinants of Exercise Among Older Female Heart Attack Survivors

Traywick, L. S., Schoenberg, N. E. — 2008-02-06

Despite the well-known health benefits associated with regular daily physical activity, most Americans do not engage in sufficient exercise. Of particular concern are the low levels of exercise among older women, who have a heightened risk of adverse cardiovascular events. To improve our understanding of the determinants of exercise among this particularly vulnerable population, the authors undertook face-to-face interviews with 45 women who had survived a heart attack (age range = 48-88, M = 73). Upon completion of standard qualitative analytic procedures, several themes emerged as influential in shaping exercise behavior. There were multiple and connected determinants of exercise, including cognitive factors (competing demands, perceived health maintenance), life course issues (exercise as inappropriate given traditional gender expectations, positive lifelong experiences with exercise), and social and ecological environment determinants (social support, weather-related barriers). Enhancing exercise requires addressing these multifaceted and complex barriers faced by older women. Specific recommendations are provided.

Outcomes of Adult Day Services for Participants: A Conceptual Model

Dabelko, H. I., Zimmerman, J. A. — 2008-02-06

Adult day programs provide nutritional, health, social, and recreational services for older adults during daytime hours. The heterogeneity of programs, participants, and funding sources creates challenges in defining and measuring participant outcomes of adult day services. There appear to be two main domains of influence that adult day programs can have on participants: physical health functioning and psychosocial well-being. The study of the psychosocial benefits of adult day services to participants has been neglected. The purpose of this article is to review current empirical literature and to propose a new conceptual model for examining the participant outcomes in adult day services programs, taking into consideration the variability in participant needs and program design and delivery. The model includes service elements that are related to psychosocial well-being and physical functioning, and these elements relate to specific physical and psychosocial proximal and distal outcomes. Further areas for research are suggested.

Factors Associated With Advance Care Planning Among Older Adults in Southwest Florida

Black, K., Reynolds, S. L., Osman, H. — 2008-02-06

As the nation's population continues to age, many older adults will face care needs that can be anticipated in advance. However, little is known about older adults' advance care plans and the characteristics of those who plan. This study used a stratified random sampling design to survey older adults (n = 203) in the state of Florida regarding their attitudes toward future care and planning behavior in social-environmental, health, and financial domains. Regression analyses were conducted to determine factors most predictive of older adults' attitudes toward future care and planning behavior by domain. Results suggests that gender, age, and functional status predict greater planning behavior and more accepting attitudes toward long-term care, whereas living alone and poor health status are associated with less advance care planning behavior and greater nonaccepting attitudes. Factors associated with a greater likelihood to have advance care planning documents and concrete plans for future care include increased age, higher educational attainment, and female gender.

Willingness to Use a Nursing Home: A Study of Korean American Elders

Jang, Y., Kim, G., Chiriboga, D. A., Cho, S. — 2008-02-06

This study explored predictors of willingness to use a nursing home in Korean American elders. Andersen's behavioral health model was adapted with predisposing factors (age, gender, education, length of residence in the United States), potential health needs (chronic condition, functional disability, self-perceived health), and network-related enabling factors (marital status and living arrangement, family network, having someone close living in a nursing home). Among 427 participants, 45% reported their willingness to use a nursing home. Logistic regression analysis showed that the likelihood of willingness increased when individuals had poorer perceived health and had a close other living in a nursing home. Findings indicate that (a) self-perceived health serves as a proxy for future needs for long-term care services, and (b) indirect exposure to formal care is an important enabler for more acceptance of nursing home use. Implications of the findings and further directions for research are discussed.