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Mental Health, Adaptation and Caretaking of Aged
Funded by the National Institute on Aging, 1985-1988
In this study, the physical health-mental health interface was investigated focusing on elderly heart patients and their caregivers. More than one-fourth of the activity limitation of persons 65 and over is related to heart problems, and mental health consequences such as depression are frequent correlates of myocardial infarction (MI). Furthermore, the ailing aged require assistance and care and major caregivers are often elderly. The study provides better understanding of predictors of recovery among older heart patients. A one-year longitudinal study was conducted of 200 patients and their prime caregivers. Elderly persons and their major caregivers were individually interviewed six weeks following discharge from hospitalization for a first heart attack and again one year later. Data were collected on their personal and social resources including general coping style, illness- specific coping efforts, social support, and medical-economic variables. The study provides better understanding of predictors of recovery among older persons. Older adults who possessed adequate personal and social resources exhibited positive illness adaptation outcomes. This study documented both the value of support from caregivers to the older patient and the costs of caregiving as impacting physical and mental health of elderly caregivers.
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Attitudes Toward Alzheimer's Patients and their Care
Funded by the Alzheimer Center of University Hospitals, 1987-1988
This research project focused on determinants of staff attitudes and behavioral intentions toward demented elderly patients suffering from Alzheimer’s disease, and also explored the relationship between attitudes and behavioral intentions. Because professional staff is responsible for providing care to large numbers of institutionalized AD patients, their attitudes and orientation play an important role in the quality of life for these elderly. The aims of this investigation were to document nursing home employees’ attitudes toward well elderly, physically impaired, and cognitively impaired elderly. A total of 143 staff members from four Cleveland area nursing homes completed questionnaires. These staff members included nurses’ aides, LPN’s, RN’s, administrators and other employees. Results indicate that staff demonstrated the most negative evaluations for the AD patients, and rated them the lowest on most variables. Staff showed a wide range of beliefs about the well elderly and AD patients, indicating that stereotyping was not pervasive. Although the staff members reported greater feelings of usefulness in working with well or physically ill elderly, almost half still reported a sense of efficacy in working with Alzheimer’s patients.
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Adaptation to Frailty Among Dispersed Elders
Funded by the National Institute on Aging as MERIT Award, 1989-1994
This research aimed to gain a better understanding of adaptation of elderly living in retirement communities as they approach old-old age and face increasing frailty. The study sought an in-depth understanding of personal, environmental, and social resources, and service needs of old-old residents of a Florida retirement community. The sample was comprised of 1,000 old-old (age 72+) residents of three Florida retirement communities. Only respondents who were initially in good functional health and free of major mental impairments were included in this longitudinal study. The study provided detailed information on respondents’ social support networks, documented the types of resources exchanged, the directionality of exchanges, and satisfaction with the relationships for both formal and informal supports. Our study revealed that older adults living in retirement communities engaged in meaningful leisure oriented and health promoting life styles. They developed close social ties with neighbors and found meaningful new social roles in volunteering. Most elders maintained good health and psychological well-being. Positive quality of life was facilitated by helping others and by maintaining future orientation and healthy life styles.
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Buffers of the Impairment Disability Cascade
Funded by the National Institute on Aging as MERIT Award, 1994-1999
This study examined proactive adaptations undertaken by older adults to limit the adverse impact of physical impairment on their ability to function and to maximize the quality of their lives. Aims included: (1) providing a test of our proactivity-based model of health maintenance and successful aging (Kahana & Kahana, 1996; 2000); (2) generalize the model across social (demographic and community) contexts. We conducted annual longitudinal follow-ups with a representative sample of 1,250 participants recruited from two study communities (On Top of the World Retirement Community in Clearwater, Florida and Cleveland, Ohio). We also added respondents from two additional communities (Celebration, Florida and Miami, Florida). Findings of this study offer support for the proactivity model of successful aging. Those older adults who engaged in proactive adaptations, such as health promotion, planning ahead, and marshaling support were more likely to maintain good quality of life over time, both in terms of psychological well-being and social activities.
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Health Care Partnership & Self-Care of Older Adults
Funded by the National Institute on Aging, 1999-2004
With this grant, we examined how responsiveness of Health Care Partners (Primary Care Physicians and Health Significant Others) lessens the adverse impact of chronic illness on older adults’ ability to function and help maximize the quality of their lives. Physicians, patients, and Health Significant Others are seen as partners in care, with responsiveness of Health Care Partners enhancing preventive and corrective self-care by patients. A major innovative focus of the study deals with mutual influences between patients and physicians. We collected four annual waves of data based on in-home interviews with 350 respondents in Florida and 350 respondents in Cleveland. These elderly constitute committed cohorts in two probability samples of community-based elders. We conducted telephone surveys with Primary Care Physicians and Health Significant Others of respondents to ascertain responsiveness in terms of provider’s knowledge of patients, involvement, and communication. Findings revealed closer communication between elders and health significant others than those between elders and their doctors.
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Health Care Partnership in Cancer Communication
Funded by the National Cancer Institute, 2004-2008
This study was designed to test a “Health Care Partnership” (HCP) model of doctor-patient health communication related to cancer prevention and care among elderly persons. We considered not only doctor-patient communication, but also proactive roles played by consumers and their family members in information gathering and communication concerning health. We examined how communication among health care partners influences health care experiences of the aged (N= 900). We also conducted in-depth qualitative interviews with older adults who had been diagnosed with cancer. Among cancer patients, consumer initiatives or self-care were seldom reported as personal coping strategies, but emerged as important coping approaches in advice given to others (6% vs 29%, and 5% vs 12%, respectively). The findings of the current study suggest that a transition may be occurring, from a passive to a more-active or even activist orientation to the illness experience.
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Elders Marshalling Responsive Care & Enhancing Quality of Life in the Final Years
Funded by the National Institute of Nursing Research, 2007-2013
As more people are living to old-old age, maintenance of quality of life, particularly in the final years of life, assumes increasing importance. This study tests a model of maintenance of quality of life during the final years of life. Most research on end of life has focused on advance directives or quality of life of the terminally ill during their last days. This study examines a longer period prior to the end of life in order to identify changes in health and quality of life (i.e. physical frailty, dependency moves, and psychological well-being), as well as the predictors of quality of life outcomes during this period. Our model explores the buffering role of ameliorative resources (proactive adaptations, social supports, and congruence between patient and caregiver preferences) in counteracting the adverse effects of stressors on quality of life. We focus on decision-making about care during this little understood final phase of life. Beyond the actual experience of health problems and events among study participants, over one-third (36.0%) expressed significant worry about their existing health conditions, and almost one-third noting concerns about the prospects of a future serious illness (31.8%). Findings of our study point to a paradox of elders reporting health events and worries along with limited planning for care. Minority respondents and the less educated were particularly limited in their orientation to planning for care needs. Our findings reveal that elderly respondents in our study desire close connections to family during the final years of life. At the same time, respondents also want to protect family members from burdens of caregiving. Lack of planning, especially among disadvantaged elders, indicates that interventions are called for.
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Intervention to Promote Health Communication by Consumers About Cancer Prevention and Screening
Funded by the National Cancer Institute, 2011-2017
This study implements a novel, community based educational program to inform and motivate underserved older adults to forge partnerships with their doctors, targeting cancer prevention as a shared goal. Using a randomized controlled trial (RCT), we evaluate the efficacy of our social learning theory based intervention that promotes patient participation in order to enhance patient centered medical care. This educational intervention (“Speak Up” program) aims to improve patient initiative, competence, and confidence in communication with physicians. Based on foundations of social learning theory the intervention is expected to result in increased discussion about cancer prevention and screening between older adults and their primary care physicians. Participants in the intervention are also expected to receive more age and risk specific preventive advice from their doctors and report greater satisfaction with their health care. Participants in the “Speak Up” facilitated discussion groups (N=250) will be compared to participants in “Connect” attention control groups (N=250). The latter program addresses important goals of enhancing civic and social engagement. The study is being conducted among community based older adults who attend Senior Center programs, sponsored by Area Agencies on Aging (AAA).
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Future Care Planning - Interventions
Pending with the National Institute of Nursing Research, 2013-2018
Based on findings of our NINR funded study, “Elders Marshaling Responsive Care,” we plan to implement a novel, community-based educational program that will promote future care planning (FCP) for underserved older adults. Participants will learn how to enlist support from family and from health care providers (HCP) and identify community resources for dealing with adverse health events. Using a randomized controlled trial (RCT), we will evaluate the efficacy of the FCP intervention, “Be Prepared,” (N=400) relative to an attention control program, “Dollar Wise,” (N=400) that offers education about managing finances. In response to these findings, we aim to empower elders to obtain responsive care. Our intervention addresses the care needs of elders who may experience serious illness, falls, emergency room visits, or hospitalization. Our multi-modal “Be Prepared” training program aims to improve patient self-advocacy. Based on social learning theory, the intervention is expected to result in increased discussion between older adults, family members, and HCPs about future care planning. Participants are also expected to implement FCP and have increased knowledge about community resources for meeting care needs. Self-advocacy and FCP are expected to lead to greater satisfaction with social supports and trust in responsiveness of future care.
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