Deborah Messecar

How Frail Elders Evaluate Their Caregiver's Role Enactment A Scale to Measure Affection, Skill, and Attentiveness

In this validity study, using factor analysis, the authors identified three dimensions (affection, skill, and attentiveness) of the Care Receiver View of Caregiver Role Enactment Scale, a self-report measure designed to elicit an elderly care receivers evaluation of how well their family member carried out the role of caregiver. The scale is a revision of the Satisfaction With Caregiving Scale. This study was a secondary analysis of data from PREP: Family-based Care for Frail Older Persons. Care receiver mutuality was the variable most highly correlated with caregiver role enactment. Other variables related to good quality care were higher care receiver positive affect, better caregiver physical health, and lower caregiver role strain; husband caregivers were rated as giving poorer quality care.

Growing Old With Fibromyalgia: Factors That Predict Physical Function

Background:Fibromyalgia, a persistent, widespread pain condition, significantly limits physical function, threatening an older adult’s health and ability to live independently. Objectives:The aim of the study was to identify predictors of physical function in older adults living with fibromyalgia and to examine the influence of resilience on the relationship between fibromyalgia pain and physical function. Methods:This was a descriptive correlational, cross-sectional design using mailed questionnaires to analyze relationships between health-related variables and physical function in a convenience sample of community-dwelling older adults diagnosed with fibromyalgia (n = 224; age M = 62.1 years, SD = 6.75 years). Multiple regression was used to identify a priori predictors of physical function; hierarchical multiple regression was used to examine resilience as a moderator of pain and physical function. Results:The sample was predominantly women, Caucasian, married, well educated, had moderate levels of income and tangible social support, and had low levels of physical function. Three-fourths were overweight or obese. Despite impaired physical function (Late Life Function and Disability Index, M = 51.5/100, SD = 9) and moderate levels of pain (Numeric Rating Scale, M = 5.47/10, SD = 2.6), resilience was moderately high (Resilience Scale, M = 137/175, SD = 20). An eight-variable disablement-based model accounted for 48% of variance in physical function: age, income, education, depressive symptoms, body mass index, and physical activity accounted for 31%; pain added 14%; and resilience contributed an additional 3%. Resilience was not a moderator of fibromyalgia pain and physical function; resilience did contribute uniquely to physical function variance. Discussion:Resilience, a novel variable in fibromyalgia research, was a unique predictor of physical function. Further research is needed to learn more about the relationships between resilience, fibromyalgia impact, and the aging process.

Mammography Decision Making in Older Women With a Breast Cancer Family History

Purpose: This studys purpose is to describe and explain how women 55 years of age and older with a family history of breast cancer make screening mammography decisions. Design: A qualitative design based on grounded theory. This purposeful sample consisted of 23 women 55 years of age or older with one more first-degree relatives diagnosed with breast cancer. Method: Open-ended interviews were conducted with 23 women 55 years of age and older with a family history of breast cancer using a semistructured interview guide. Transcribed interview data were analyzed using constant comparative analysis to identify the conditions, actions, and consequences associated with participants screening mammography decision making. Findings: Women reported becoming aware of their breast cancer risk usually due to a triggering event such as having a family member diagnosed with breast cancer, resulting in women “guarding against cancer.” Womens actions included having mammograms, getting health check-ups, having healthy behaviors, and being optimistic. Most women reported extraordinary faith in mammography, often ignoring negative mammogram information. A negative mammogram gave women peace of mind and assurance that breast cancer was not present. Being called back for additional mammograms caused worry, especially with delayed results. Conclusions: The “guarding against cancer” theory needs to be tested in other at-risk populations and ultimately used to test strategies that promote cancer screening decision making and the adoption of screening behaviors in those at increased risk for developing cancer. Clinical Relevance: Women 55 years of age and older with a breast cancer family history need timely mammogram results, mammography reminders, and psychosocial support when undergoing a mammography recall or other follow-up tests.

Smoking Cessation Interventions for Pregnant Women to Prevent Low Birth Weight: What Does the Evidence Show?

PURPOSE To review the epidemiology of smoking cessation and low birth weight (LBW), the use of meta‐analysis and cost‐benefit analysis in analyzing this problem, and the financial considerations of institutionalizing smoking cessation interventions. Recommendations for clinicians caring for smoking pregnant women and suggestions for implementing the recommended strategies for smoking cessation programs are included. DATA SOURCES Comprehensive review of smoking and low birth weight (LBW) outcomes, cost‐effective‐ness, and tobacco use and dependence literature; clinical practice guidelines, and a widely cited meta‐analysis on smoking cessation. CONCLUSIONS Research has shown that smoking is a significant factor in LBW outcomes and that cessation is especially critical for pregnant women. IMPLICATIONS FOR PRACTICE Careful evaluation of the intervention research is required before designing local interventions to ensure the most effective measures are utilized.

Reading statistics in nursing research: a self-study CD-ROM module.

A statistics CD-ROM tutorial program was developed to replace a classroom course with several self-study modules. For the CD-ROM delivery method, students were asked to complete a Likert-type questionnaire with response options similar to those used for end-of-course evaluations at the nursing school. Ratings ranged from 1 to 5, with 1 equaling outstanding and 5 equaling completely unsatisfactory. Ratings for the CD-ROM were compared with those of a Web-based course taught the prior year. Mean satisfaction ratings of Web-based delivery of content was low due to technical problems with the Internet courseware used. Overall satisfaction with the CD-ROM for students who used all the components was improved substantially, compared to the Web-based delivery method.

Guard and Reserve Spouse Separation during the Persian Gulf War: Coming to Terms with Uncertainty

During the Persian Gulf War (1990-1991), more than 228,000 National Guard and reserve members were recalled to active duty. Little information exists about the effect of wartime military separation among the civilian spouses of guard and reserve personnel. This grounded theory study describes the effect of the Persian Gulf War separation on 14 guard and reserve spouses. Data were generated from in-depth interviews and were analyzed using the constant comparative method. Three patterns of coming to terms with the separation emerged from analysis of the intensive interviews: (a) settling in immediately, (b) struggling followed by settling in, and (c) struggling without relief. Each pattern is associated with different patterns of social support that affect the relationship between uncertainty and adjustment. These findings provide important information for nurses who work with spouses who can anticipate this type of separation.

Rural Women Veterans' Use and Perception of Mental Health Services

While the total number of veterans in the U.S. is decreasing overall, the number of women veterans is significantly increasing. There are numerous barriers which keep women veterans from accessing mental health care. One barrier which can impact receiving care is living in a rural area. Veterans in rural areas have access to fewer mental health services than do urban residing veterans, and women veterans in general have less access to mental health care than do their male colleagues. Little is known about rural women veterans and their mental health service needs. Women, who have served in the military, have unique problems related to their service compared to their male colleagues including higher rates of post-traumatic stress disorder (PTSD) and military sexual trauma (MST). This qualitative study investigated use of and barriers to receiving mental health care for rural women veterans. In-depth interviews were conducted with ten women veterans who have reported experiencing problems with either MST, PTSD, or combat trauma. All ten women had utilized mental health services during active-duty military service, and post service, in Veterans Administration (VA) community based-outpatient clinics. Several recurring themes in the womens experience were identified. For all of the women interviewed, a sentinel precipitating event led to seeking mental health services. These precipitating events included episodes of chronic sexual harassment and ridicule, traumatic sexual assaults, and difficult combat experiences. Efforts to report mistreatment were unsuccessful or met with punishment. All the women interviewed reported that they would not have sought services without the help of a supportive peer who encouraged seeking care. Barriers to seeking care included feeling like they were not really a combat veteran (in spite of serving in a combat unit in Iraq); feeling stigmatized by providers and other military personnel, being treated as crazy; and a lack of interest from those providing care in hearing their stories. This study may generate positive social change by helping providers approach women veterans in a way that is sympathetic to their experiences.

Review: several interventions reduce fear of falling in older people living in the community.

R Zijlstra Correspondence to: Ms R Zijlstra, Maastricht University, Maastricht, the Netherlands; R.Zijlstra@zw.unimaas.nl In older people in the community, which interventions reduce fear of falling? ### Data sources: Medline, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, and PsycINFO (to 2005); reference lists; and 14 experts. ### Study selection and assessment: randomised controlled trials (RCTs) that assessed fear of falling in community-dwelling people who had a mean age ⩾65 years. Studies of people with a specific medical condition were excluded. 19 RCTs met the selection criteria. Interventions included multifactorial interventions (8 RCTs), tai chi (3 RCTs), exercise interventions (4 RCTs), balance interventions (6 RCTs), hip protectors (1 RCT), and a fall risk-factor intervention (1 RCT). Some RCTs assessed ⩾1 intervention. 3 interventions had the explicit aim of reducing fear of falling. Duration of interventions ranged from 1 home visit to 1 hour/week for 1 year. Study follow-up ranged from 1.5 …

Resistance exercises or vitamin D did not improve physical health or reduce falls in frail older people.

Patients 243 people admitted to geriatric rehabilitation units (inpatient or day wards) who were ≥ 65 years of age (mean age 79 y, 53% women), considered frail ( ≥ 1 health problem or functional limitation [eg, dependency in an activity of daily living, prolonged bed rest, impaired mobility, or a recent fall]), and had no indication or contraindication for the study treatments. Exclusion criteria included poor prognosis, severe cognitive impairment, physical limitations restricting adherence to the exercise programme, unstable cardiac status, and large ulcers around the ankles. Follow up was 91%. Intervention Patients were allocated to resistance exercise (n=120) or attention control (n=123) and to vitamin D (six 1.25 mg tablets of calciferol) (n=121) or placebo (n=122). The quadriceps resistance exercise involved warm up stretches and 3 sets of 8 repetitions of knee extensions using ankle cuff weights in a seated position 3 times per week for 10 weeks. Patients were monitored weekly by a physiotherapist, with alternating telephone calls and home visits. The attention control group received frequency matched telephone calls and home visits from the physiotherapist.

Review: admission-avoidance hospital-at-home decreases mortality at 6 months but does not differ from inpatient care for readmission.

How does admission-avoidance hospital-at-home (HAH) compare with inpatient hospital care for various outcomes? Included studies compared admission-avoidance HAH (time-limited active treatment by healthcare professionals for acute conditions in patients’ homes, without which patients would be admitted to an acute care hospital ward) with acute inpatient hospital care in patients ⩾18 years of age. Studies of obstetric, paediatric, mental health, and long-term care services; services in outpatient settings or after hospital discharge; or patient self-care at home were excluded. Outcomes included mortality, hospital readmission, functional ability, cognitive ability, quality of life, and patient satisfaction. Medline, CINAHL, EMBASE/Excerpta Medica, EconLit, Cochrane Effective Practice and Organisation of Care Group register, and reference lists were searched to January 2008 for randomised …