Cary S. Kart

Striving to Provide Safety Assistance for Families of Elders The SAFE House Project

We describe the process of installing a monitoring system in the homes of 19 families who were caring for a relative with dementia, and evaluating the use of the system for 24 weeks. The system is Internet-based and consists of cameras and sensors that are routed through a controller unit via a broadband-connected computer to a web site. From the web site, text messages indicating sensor activity are sent to a cell phone that alerts caregivers to activity in the home. Specifically, we discuss ‘behind the scenes’ issues associated with bundling the various technologies together and installing and maintaining the technologies in caregivers’ homes, describe the challenges that caregivers confronted while using the technology, and summarize caregivers’ experiences with the technologies over the 24-week assessment period. Results indicate that, although the use of technology is not without challenge, it has the potential to facilitate family caregiving.

Diabetes Self-care among a Multiethnic Sample of Older Adults

Type 2 diabetes constitutes a leading and increasing cause of morbidity and mortality among older adults, particularly African Americans, Native Americans, Mexican Americans, and rural dwellers. To understand diabetes self-care, an essential determinant of diabetic and overall health outcomes, 80 middle aged and older adults from these four disproportionately affected racial/ethnic/residential groups engaged in in-depth interviews, focusing on approaches to and explanations for diabetes self-care. Certain self-care activities (medication-taking, diet, foot care) were performed regularly while others (blood glucose monitoring, exercise) were practiced less frequently. Despite research suggestions to the contrary, only one in four elders used unconventional diabetes therapies, and only one-third listed someone other than a health care provider as a primary information source. Few self-care differences emerged according to race/ethnicity/residence, perhaps because of the influential and common circumstance of low income. Thematic analyses suggest that inadequate resources, perceived efficacy of medication, great respect for biomedical authority, and lack of familiarity with and concerns about unconventional therapies are influential in establishing these patterns of self-care. We discuss the similarity of self-care practices and perspectives irrespective of race/ethnicity/residence and the predominance of biomedical acceptability.

Variation in Long-Term Care Service Use by Aged Blacks Data from the Supplement on Aging

Data from the Supplement on Aging to the 1984 National Health Interview Survey were used to identify patterns of long-term care (LTC) service use among older Blacks. A subset of the SOA, including all 1,217 Blacks aged 55 and over, was the focus of the research. About 37% of all older Blacks in the sample reported difficulty in carrying out at least one activity of daily living (ADL) or instrumental activity of daily living (IADL); 27% reported receiving help with at least one of the ADLs or IADLs. Older Blacks were not significant users of community-based LTC services, with 11.9% reporting using a senior center, the highest percentage of use among a list of 10 community and social services. Five LTC factors were identified: ADL Help, Community Services, Home Health Services, Home Management Services, and Personal Services. Multiple regression analyses identify need factors as most dominant in explaining variation in LTC service use by older Blacks.

Assessing the reliability of the EORTC QLQ-C30 in a sample of older African American and Caucasian adults

The purpose of this study was to examine the structure and reliability of the EORTC QLQ-C30. This 30-item instrument has five functional scales (physical, role, cognitive, emotional, and social), three symptom scales (fatigue, pain, and nausea and vomiting) and a global health and quality of life scale. Confirmatory factor analysis and Cronbachs α estimates were used to assess the functioning of the EORTC QLQ-C30 in a sample of 489 African American (n = 255) and Caucasian (n = 234) adults aged 50 + years. Seven of the nine EORTC QLQ-C30 scales showed good reliability for both the African Americans and the Caucasians in the sample (Cronbachs > 0.75). In contrast, the cognitive functioning scale had a reliability coefficient of only 0.69 for the African Americans and 0.40 for the Caucasians, and the nausea and vomiting scale had a reliability coefficient of only 0.49 for the African Americans and 0.51 for the Caucasians. In summary, although the overall reliabilities of seven of the scales showed good fit, many of the item-to-scale correlations did not. Researchers planning to use the EORTC QLQ-C30 might first consider conducting separate analyses on the different racial or ethnic subgroups in their study populations to determine whether a common set of factors or scales is available for further analysis.

‘That’s me, the Goother’: Evaluation of a program for individuals with early-onset dementia

We conducted face-to-face, semi-structured interviews with six white men with early-onset dementia (EOD) and supplemented the interviews with a focus group with six wives of the men to document perceptions of a weekly, supervised volunteer program for the men at the local zoo. The program, ‘Get Out of the House,’ is designed to provide individuals with EOD a weekly opportunity to participate in meaningful, supervised volunteer work in the community. Interviews with participants revealed that they strongly identify with the program and are eager to share their experiences, about which they show some depth of insight. The focus group revealed that the program represents a break in the day-to-day routine for spouses and families, as well as participants, and has benefits that extend beyond the program time itself. Challenges with the development and implementation of such programs and implications for research and practice are discussed.

Food for Thought: Nourishing the Publication of Qualitative Research

In recent years, journal editors have issued loud and earnest calls for high-quality manuscripts based on qualitative methods. Yet, in reviewing the past several years of gerontological journals, including the Journal of Applied Gerontology (JAG), the authors noticed that the rate at which qualitative papers are published has held steady at modest percentages of the total number of published works. This essay explores this seemingly contradictory situation by providing insights into several key questions: Why are not more research articles published that use qualitative methods? Why is it important that qualitative researchers publish their works in applied venues like the JAG? What should authors of qualitative pieces keep in mind when developing their manuscripts?

Explaining Pathways of Care Taken by Elderly People: An Analysis of Responses to Illness Symptoms

Abstract This paper documents the pathways elderly people follow in managing illness symptoms. Illness behavior is conceptualized as a series of actions or decisions that occur over time in varying permutations or combinations. Data were collected through personal interviews completed by a sample of older people managing their health in community settings in upstate New York. Respondents also completed three weeks of health diaries. Multiple logistic regression analyses of five patterns or pathways of care over the reporting period were guided by an adaptation of the health-behavior model, supplemented with indicators of symptom experience and the availability of lay consultants. Marital status and gender, barriers to formal care, availability of lay consultants and several indicators of symptom experience differentiated self care from the other four pathways. Painful or disruptive symptoms increased the probability of lay consultation or lagged professional consultation, and uncertainty about potential s...

Assessing the Reliability of Four Standard Health Measures in a Sample of Older, Urban Adults

Increasing attention is being paid to racial and ethnic differences in the structure and measurement of physical health and mental health constructs. The objective of this study was to examine the reliability of four measures of physical health and mental health in a sample of 400 older (50+ years) African Americans and Caucasians. These measures are the instrumental activities of daily living and activities of daily living scales of the National Chronic Care Consortium Health Risk Appraisal Survey, the SF-12, the Multidimensional Health Locus of Control Scale, and the John Henryism Active Coping Scale. The measures were tested by racial group. The results of factor analyses reveal that the overall reliability of each scale, as measured by Cronbach’s alpha, was near or above .70. However, the item-to-scale correlations of many of these scales were low. This finding indicates that the measurement of the constructs may be different for older African Americans and Caucasians.

Self-Health Care among the Elderly: A Test of the Health-Behavior Model

Data from a U.S. sample of 714 respondents aged 55 years and over were used to test the efficacy of the health-behavior model for explaining self-health care practices and attitudes. Three different indicators of self-health care, including a measure of actual self-care behavior and two attitudinal indicators, normative self-care response and global self-care, were employed in this work. Hierarchical ordinary least squares regression modeling yielded R2s consistent with those reported in the extant literature on health-services utilization. A difference with this literature, however, was that the net contribution of predisposing characteristics was found to be larger than that of enabling and need characteristics combined for all three indicators of self-health care.

Predictors of adherence with self-care guidelines among persons with type 2 diabetes: results from a logistic regression tree analysis.

Type 2 diabetes is known to contribute to health disparities in the U.S. and failure to adhere to recommended self-care behaviors is a contributing factor. Intervention programs face difficulties as a result of patient diversity and limited resources. With data from the 2005 Behavioral Risk Factor Surveillance System, this study employs a logistic regression tree algorithm to identify characteristics of sub-populations with type 2 diabetes according to their reported frequency of adherence to four recommended diabetes self-care behaviors including blood glucose monitoring, foot examination, eye examination and HbA1c testing. Using Andersen’s health behavior model, need factors appear to dominate the definition of which sub-groups were at greatest risk for low as well as high adherence. Findings demonstrate the utility of easily interpreted tree diagrams to design specific culturally appropriate intervention programs targeting sub-populations of diabetes patients who need to improve their self-care behaviors. Limitations and contributions of the study are discussed.