Catherine L. Lysack

A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.

Safe passage of goods and self during residential relocation in later life

ABSTRACT Techniques of possession research among older people tend to accentuate their prizing of things and their use of special dispositions to achieve the protection or ‘safe passage’ of things as they transfer to a new owner. Such efforts on behalf of possessions may also be undertaken to perpetuate the self. To study the care of things and self in a wider context, we examined older peoples repertoire of disposition strategies during episodes of household relocation and downsizing. We analysed the narratives of persons in 75 households in the Midwestern United States of America. People indeed told stories about the safe passage of cherished possessions – their initiative to place things, appreciation by new owners, and attempts to project the values or memory of the giver. Such accounts of special placements, however, dotted rather than dominated recollections of the move. More commonly, large quantities of items were passed via non-specific offers of possessions to others who may volunteer to take them. This allowed people to nonetheless express satisfaction that their possessions had found appreciative owners. Even though our interviews did not disclose extensive attempts at self-transmission, whole-house downsizing may affirm the self in another way: as conscientious about the care of things. Such affirmation of the present self as accomplished and responsible can be seen as a positive adaptation to the narrowing life world.

Predicting Discharge and Long-Term Outcome Patterns for Frail Elders

Objectives: Using the framework of environmental press theory to examine the predictive value of medical rehabilitation team assessments for both functional abilities and long-term living arrangements of early return home and late return home elders. Participants: One hundred thirty-five older adults (72% women, 84% African American; mean age 73 years) who lived alone prior to hospitalization for medical rehabilitation. Methods: Competency measures were collected during the hospitalization. Living arrangements were determined by phone follow-up at 3, 6, and 18 months after discharge. Multivariate analysis of variance identified early return and late return patient groups. Logistic regression analyses then determined the clinical utility of the prediction model. Chi-square analyses addressed group differences in stability of living arrangements. Results: Medical burden, functional abilities, and cognition were significant predictors of group membership. Among late return patients, 27% continued to live alone at the 18-month follow-up; 59% of the early return patients did so. Conclusions: Interdisciplinary assessments (including psychological measures) completed in the hospital provide valuable data for discharge planning for older medical rehabilitation patients and are clearly related to successful long-term adjustment. A 78-year-old widowed African American woman, who was living alone prior to hospitalization, comes to medical rehabilitation because of problems walking after knee replacement surgery. Her hospital roommate, a 74-year-old never-married African American woman, was also living alone prior to falling and breaking her hip. Both patients are adamant that their primary goal is to return to living alone, despite the fact that the widowed woman’s three children live in the same city and want her to move in with them. The 78-year-old woman scores well on cognitive testing, has no depression, and has few chronic illnesses. Functionally, she is at an independent or modified independence level by discharge. The treatment team, including the patient, all agrees that discharge home is an optimal outcome. By contrast, the 74-year-old woman

A home-based individualized information communication technology training program for older adults: a demonstration of effectiveness and value

Abstract Purpose: To demonstrate the effectiveness and value of a home-based information communication technology (ICT) training program for older adults. Methods: Thirteen older adults were provided in-home ICT training by graduate occupational therapy students using an iPad. The breadth and frequency of ICT use, perspectives on technology, and perceived independence were recorded at baseline, during the 3-month training and at follow-up, along with an end-of-study questionnaire. Non-parametric Friedman analysis was conducted to verify trends in the outcome measures. The qualitative data were examined by content analysis. Results: Participants’ breadth of ICT activities showed a significant trend across 6 months. Leisure accounted for the significant increase, while health management and social connections activities increased modestly. A positive trend in participants’ perspectives on technology was evident along with a marginal increase in perceived independence. Participants’ perspectives were thematically categorized as technology experiences, interactions with coach, training approach, and specific activities. As reflection of the training program’s value, 12 of the 13 participants took ownership of the iPad at the end of the study. Conclusion: Building capacity of older adults to utilize the multifaceted potential of ICT is critical in addressing declines in health, impending disabilities, and social isolation. Implications for Rehabilitation A one-on-one home-based individualized information communication technology (ICT) training program for older adults could result in a progressive increase in the breadth of online activities carried out by them. Specifically, the increase in their usage of ICT could be expected in leisure-based online activities. Individualized training programs designed based on needs, priorities, and learning style of older adults could have a positive impact on their technological perspectives and intrinsic motivation to adopt ICT.

Elderly Inner City Women Who Return Home to Live Alone

This study examined the status of 107 elderly inner city women who returned to their home after being in a geriatric rehabilitation unit at a large urban medical center. Prior to admission, all women had been living at home alone. After rehabilitation, 50 of the women were discharged directly to their homes, 26 followed within 3 months, 11 were back home alone by 6 months, and 20 additional women were still not home by 6 months. Results showed that, as measured by standardized assessments of physical functioning and cognition, the women who were most functionally independent returned home alone more quickly. Furthermore, those who achieved live-alone status some time after discharge (but not at discharge) did not report the same level of self-care and home maintenance task independence as women who were discharged home alone immediately at discharge. The findings raise questions about the minimum level of functional performance required to return home alone and the interaction of functional ability, assistance from others, and a variety of social and environmental factors on live-alone status.

Diabetes self-management among Arab Americans: patient and provider perspectives.

BackgroundArab Americans have a high burden of diabetes and poor outcomes compared to the general U.S. population. Diabetes self-management (DSM) requires a partnership between patients and providers that fosters mutual understanding and shared decision-making. Cultural factors influence this process; however, little is known regarding the cultural impact on DSM or if perceptions differ between patients and providers.MethodsQualitative content analysis was used to analyze five focus groups–two groups with Arab American providers (n = 8) and three groups with adult Arab Americans with diabetes (n = 23). Focus groups examined patient and provider perspectives on the meaning of DSM and cultural barriers and facilitators among Arab American patients.ResultsFour distinct themes included limited resources for DSM education and support, stigma as a barrier to ongoing support, family support as an opportunity and challenge, and Arab American patient-provider relationships.ConclusionsFindings indicate several domains should be considered for clinical practice including a need to develop linguistically and culturally reliant educational materials and relevant supports for use in the Arab American population. Findings highlight differing views among providers and patients on the familial role in supporting DSM efforts and why some patients feel dissatisfied with clinical encounters.

Living Arrangement Decisions at Discharge and Later: Differences in Criteria and Outcomes

ABSTRACT This study examined the pattern of post rehabilitation living arrangements over 18 months of 172 adults discharged from a geriatric rehabilitation unit at a large urban medical center, all of whom were living alone prior to admission. Results showed the diminishing importance of physical function and cognition as factors in decisions to return home as the length of time after hospital discharge increased. Patients who returned home to live alone after a period of time living in more supported environments had significantly lower assessment scores on physical function (p < 0.001) and cognition (p < 0.001) compared to patients who went home to live alone immediately upon discharge. As well, patients who returned home to live alone later than three months post discharge were significantly more likely to move to more supported environments by 18 months after discharge (p = 0.043) and to experience re-hospitalizations (p = 0.008), which raises questions about the appropriateness of these later decisions.

The Impact of Arab American Culture on Diabetes Self-management Education

Purpose The purpose of this study was to better understand barriers and facilitators of diabetes self-management education (DSME) among Arab American patients with diabetes. Little is known about the impact of Arab culture on DSME. Methods Arab American adults (N = 23) with medically managed diabetes participated in 1 of 3 focus groups. An Arabic-speaking, trained moderator conducted video-recorded sessions. Verbatim Arabic transcripts were translated into English. Transcripts underwent a qualitative content analysis approach. Results Arab American cultural traditions such as food sharing, religious beliefs, and gender roles both facilitated and at times impeded DSME. Patients also held conflicting views about their interactions with their providers; some participants praised the authoritative patient-physician relationship style while others perceived the gaps in communication to be a product of Arab culture. Participants expressed that lack of available educational and supportive resources are key barriers to DSME. Conclusion Arab American culture affects DSM activities, and culturally sensitive educational resources are lacking. Development of DSME programs tailored to address relevant aspects of Arab culture might improve DSME outcomes in Arab American population.

Diabetes Is Devastating, and Insulin Is a Death Sentence: Provider Perspectives of Diabetes Self-Management in Arab-American Patients

IN BRIEF The purpose of this qualitative study was to examine providers’ perspectives on cultural barriers and facilitators to diabetes self-management (DSM) in Arab Americans to identify factors to enhance DSM education in the Arab-American community. The main barriers to DSM from the providers’ perspective were the disease itself and patients’ denial or refusal to recognize it, reflecting the stigma of the disease. Cultural aspects also included overlapping themes that both facilitated and presented barriers to DSM. These results suggest that DSM education for Arab Americans will be most effective if developed and delivered in a manner consistent with the cultural facilitators and barriers noted by providers.

‘My Doctor Told Me I Can Still Have Children But …’: Contradictions in Women’s Reproductive Health Experiences after Spinal Cord Injury

Women who have sustained a traumatic spinal cord injury (SCI) are sexually active, menstruate, become pregnant, carry healthy babies to term, have a range of childbirth experiences, use birth control, experience menopause, and have the same risks for reproductive diseases, illnesses, and conditions as able-bodied women. In other words, disabled women can have full reproductive lives. Yet we know relatively little about how women with SCI think about and experience ‘normal’ reproductive processes within the context of a permanently impaired body. Using data from 20 in-depth interviews with US women with SCI, this chapter describes the impairment-related contexts and social barriers that women with SCI confront in relation to their reproductive capacities. As the data show, knowing only that disabled women are diagnosed as ‘capable of getting pregnant’ or that they have unique health conditions after SCI tells us little of their lived experiences of reproduction. Our data reveal that the everyday experience of reproduction for a woman with an SCI is much more complex and uncertain than her ‘normal’ reproductive capacity might suggest.