Debra Dobbs

Symptom Experience of Dying Long-Term Care Residents

OBJECTIVES: To describe the end‐of‐life symptoms of nursing home (NH) and residential care/assisted living (RC/AL) residents, compare staff and family symptom ratings, and compare how staff assess pain and dyspnea for cognitively impaired and cognitively intact residents.

Residential Care/Assisted Living Staff May Detect Undiagnosed Dementia Using the Minimum Data Set Cognition Scale

OBJECTIVES: To estimate the sensitivity, specificity, and reliability of the Minimum Data Set Cognition Scale (MDS‐COGS) in screening for undetected dementia when completed by direct care staff in residential care/assisted living (RC/AL) facilities and secondarily to determine the prevalence of dementia in the sample.

The Adjustment to a New Home

Abstract This paper, an ethnographic study using grounded theory, explores the meanings of “home” and “care” for residents in an assisted living facility. The narratives of residents and staff in the setting are analyzed using the theoretical concepts of the abstract and concrete meanings of home as outlined by Groger (1995). This study finds that unlike in a nursing home, an assisted living setting provides the continuity of concrete meanings of home (the physical features and aesthetic appearance) but does not provide for the abstract meanings of home. The findings also reveal that residents have counter definitions of care from the definitions ofcare typically given by Staff.

Religiosity, Spirituality, and Death Attitudes in Chronically Ill Older Adults

The aim of this study was to examine the association of religiosity and spirituality with fear of death and death acceptance attitudes in chronically ill older adults. In-home interviews were conducted with 257 community-dwelling elders with chronic illness identified through an administrative database of ambulatory care clinics from an academic health center in Kansas City and through primary care practices participating in a practice-based research network in North Carolina. Hierarchical regression models were constructed for predictor variables and the outcomes of fear of death and approach acceptance of death attitudes. Self-efficacy beliefs (b = —.097, p < .001), anxiety (b = .026, p < .01), and physical functioning (b = .015, p < .01) were significantly associated with fear of death attitudes. Self-reported religiosity (b = —.389, p < .001), closeness to God (b = —.595, p < .001), and age (b = —.019, p < .001) contributed significantly to the variance in the final model and were significantly associated with approach acceptance of death attitudes.

Pain, Dyspnea, and the Quality of Dying in Long-Term Care

OBJECTIVES: To evaluate the relationship between pain, dyspnea, and family perceptions of the quality of dying in long‐term care.

Aging in Community Mobilizing a New Paradigm of Older Adults as a Core Social Resource

Dignity and independence are widely considered as core concepts to aging well, yet little research has explored how older adults perceive these issues in the context of community life. Moreover, little is known regarding the ways in which the broader public views and enhances aging with dignity and independence with their older residents. Using participatory action research, multiple methods of qualitative inquiry, and tenets of appreciative inquiry, this article reports on a community-based initiative aimed to better understand the positive aspects of aging with dignity and independence. Synthesized findings yielded 6 “actionable themes”: (1) meaningful involvement, (2) aging in place, (3) respect and inclusion, (4) communication and information, (5) transportation and mobility, and (6) health and well-being. The findings invoke a new paradigm for community aging that highlights the unique contributions of older adults as a core social resource. Implications for mobilizing community action to promote aging with dignity and independence are discussed.

An Exploratory Study of Advance Care Planning in Seriously Ill African-American Elders

INTRODUCTION The process of advance care planning (ACP) is often difficult to initiate and complete in minority populations, and African Americans are less likely to participate in ACP than non-Hispanic whites. We explored the perceptions of ACP among seriously ill African-American older adults. METHOD Qualitative semistructured interviews and editing analysis of 10 community-dwelling African-American elders in North Carolina. RESULTS Three major themes were identified. First, participants had little to no familiarity with ACP; none reported that they participated in any substantive discussions regarding ACP. Inconsistent sources of healthcare information, in which there was little congruence in the information given and discordant of sources of information, were a second theme. Finally, participants denoted a deferred autonomy, in which they postponed involvement in future care decision-making but viewed themselves as active in their day-to-day living. CONCLUSION Seriously ill African-American elders report both individual-level and health systems-level barriers to ACP. Efforts to improve ACP need to take into account the differences between the current, autonomy-based model of ACP within biomedicine and the values of minority older adults approaching the end of life.

Community-dwelling older adults' perceptions of dignity: core meanings, challenges, supports and opportunities

ABSTRACT Dignity is a universally important issue for all people, and particularly vital for older adults who face multiple losses associated with ageing. In the United States of America and beyond, the maintenance of dignity is a key aim of policy and service provision for older people. Yet surprisingly little research has been conducted into the meaning of dignity to community-based older adults in the context of everyday life. As life expectancy continues to increase worldwide, unprecedented numbers of people are living longer than ever before. The majority of older adults will face declining health and other factors that may impact dignity in the course of ageing in their communities. This paper reports on a study that explored older peoples understandings and experiences of dignity through focus groups and a survey. Three key components of dignity are identified: autonomy, relational and self-identity. In addition, the paper discusses a range of factors that can facilitate or inhibit a sense of dignity for older people, including long-term health issues, sensory deficits and resilience to life events. Finally, the implications of these findings for policy and practice are considered in the context of American social structures and values.

Setting of care modifies risk of nursing home placement for older adults with dementia

The purpose of this study was to examine risk of nursing home (NH) placement among older adults receiving publicly funded home and community‐based services (HCBS) or assisted living (AL) and to explore whether these settings of care modify the relationship between dementia and risk of NH placement.

Facility characteristics associated with the use of electronic health records in residential care facilities

The integration of electronic health records (EHRs) across care settings including residential care facilities (RCFs) promises to reduce medical errors and improve coordination of services. Using data from the 2010 National Survey of Residential Care Facilities (n=2302), this study examines the association between facility structural characteristics and the use of EHRs in RCFs. Findings indicate that in 2010, only 3% of RCFs nationwide were using an EHR. However, 55% of RCFs reported using a computerized system for one or more (but not all) of the functionalities defined by a basic EHR. Ownership, chain membership, staffing levels, and facility size were significantly associated with the use of one or more core EHR functionalities. These findings suggest that facility characteristics may play an important role in the adoption of EHRs in RCFs.