Gloria Gutman

Randomized Trial of a Health Promotion Program For Frail Elders

This study evaluates a local health promotion project that may be widely adaptable to assist frail elderly persons to live longer at home. Subjects, enrolled in New Westminster, B.C., were men and women aged 65 and over living in their own homes but assessed and newly admitted to “personal care at home” by the Long Term Care (LTC) program of the B.C. Ministry of Health. About 90 per cent of eligible clients consented to participate. Randomized to Treatment or Control, they were followed for three years. Controls ( n = 86) received standard LTC services, which included screening and pre-admission assessment, arrangement/purchase of needed services and review at three months and at least yearly thereafter. The Treatment group ( n = 81) received standard LTC services plus visits from the project nurse who helped each subject to devise a personal health plan based on his or her needs in the areas of health care, substance use, exercise, nutrition, stress management, emotional functioning, social support and participation, housing, finances and transportation. The visits concentrated on setting goals and developing personal health skills, with referral to appropriate community services. An additional group of LTC clients ( n = 81) from the adjacent community of Coquitlam was also followed. Success or “survival” was defined as “alive and still assessed for care at home”. After three years the “survival rate” for the Treatment group was 75.3 per cent, compared with 59.3 per cent for the Control group and 58.0 per cent for the Coquitlam group. Standard Kaplan-Meier “survival” graphs show that Treatment subjects were more likely to be alive and living at home at every time point during the three years. Differences between the Treatment and Control groups were statistically significant ( p ≤ 0.05) both for simple cross-tabulations of care status at 24 and 36 months and in tests comparing “survival” curves. The results are especially striking because Control subjects received LTC services in a geographic area that offers universal access to health care and community resources and because the Control data were concurrent, not historical.

Unanticipated Consequences: A Comparison of Expected and Actual Retirement Timing Among Older Women

ABSTRACT The present study adds to the growing body of literature on women and retirement by means of a comparative analysis of the factors associated with anticipated retirement timing (among pre-retirees) and actual retirement timing (among retirees). Adopting a political economy of aging perspective, we argue that socially-structured patterns of gender inequality related to womens multiple roles across the life course affect patterns of retirement timing. Specifically, we hypothesize that the gendered nature of womens work-retirement decision-making is unanticipated during pre-retirement years. Logistic regression analyses are performed on data drawn from a sample of 275 women aged 45 and older living in the Vancouver area of British Columbia. A central finding is that while actual timing of retirement is affected by family caregiving responsibilities and by health/stress factors, pre-retirees do not perceive these to be important in their own expected retirement timing. Implications for social policy, education, and womens financial and psychological well-being in old age are elaborated.

Communication between individuals with dementia and their caregivers during activities of daily living

Much previous research has focused on linguistic factors that can lead to communication breakdown in caregiver-patient interactions. However, the impact of such linguistic deficits on communication may vary depending on the context, goals, and complexity of the interaction. As a result, the likelihood of experiencing communication problems is expected to differ across different activities. In the present study, family caregivers of persons with dementia were asked to discuss communication challenges that they have experienced in a range of daily activities in the home. Four focus groups, involving a total of 22 caregivers, were conducted in community settings. The main goal of the focus groups was to identify specific daily activities in the home in which caregivers most often experience communication problems. The content of the focus groups was audio recorded and transcribed, and then coded and analyzed using qualitative and quantitative analytic techniques. The analyses focused on identifying trends across caregivers in which particular activities were noted as being prone to communication breakdown at different stages of the disease. Information about which activities are most communicatively challenging should assist caregivers in preparing for and adapting to these changes.

The Differential Influence of Culture Change Models on Long-Term Care Staff Empowerment and Provision of Individualized Care

La présente étude vise à déterminer si des différences existent entre les divers modèles de changement de culture (MCC) relativement à la perception du personnel soignant agréé à l’égard de l’accès aux structures d’habilitation et des prestations connues de soins individualisés. Nous avons embauché des employés qui travaillent dans des établissements ayant mis en œuvre les modèles sociaux de soins Eden Alternative, GentleCare ou Facility Specific ou n’ayant pas implanté de MCC. Nous avons effectué des analyses de variance multidimensionnelles de chacun des trois groupes de personnel soignant (infirmières autorisées, infirmières auxiliaires autorisées et aides-soignants) en fonction de chaque CCM. Les résultats indiquent qu’il existe des différences considérables entre le personnel soignant agréé et entre chacun des MCC. Plus le personnel soignant côtoie quotidiennement les patients, plus l’influence des MCC semble affecter l’autonomisation perçue et les prestations connues de soins individualisés. Des recherches suggèrent que les employés travaillant dans des établissements ayant mis en œuvre un des modèles sociaux de soins mentionnés ci-dessus profitent des meilleures conditions de travail. Inversement, parmi les établissements ayant implanté un de ces modèles, seul le personnel d’un établissement a fourni des réponses différentes de celles des employés travaillant dans des établissements sans MCC. With this study we set out to determine if differences exist across culture change models (CCM) in relation to formal caregivers’ perceived access to empowerment structures and reported provision of individualized care. We recruited staff working in facilities that had implemented the Eden Alternative, GentleCare, Facility Specific Social Models of Care (FSSMOC), or no CCM. Multivariate analyses of variance (MANOVA) compared these constructs by CCM for each of three caregiver groups (Registered Nurses, Licensed Practical Nurses, and care aides). Results suggest that considerable differences exist between formal caregivers and by CCM. The greater caregivers’ day-to-day contact with residents, the more CCMs appear to affect perceived empowerment and reported provision of individualized care. Findings suggest the greatest benefits existed for staff working in facilities with a FSSMOC. Conversely, in only one instance did responses from staff in Eden Alternative facilities differ from those in facilities with no CCM.

Self-Care among Older Adults An Analysis of the Objective and Subjective Illness Contexts

Objectives: The authors hypothesize that older adults diagnosed with arthritis showa greater reliance on objective factors in their self-care behaviors, whereas those diagnosed with heart problems or hypertension demonstrate a greater reliance on more general belief-laden factors. Methods: A total of 794 older adults (mean age = 69.3) who were professionally diagnosed with arthritis, heart problems, or hypertension completed a telephone survey about a number of aspects of their illness condition and their general well-being. Results: The results from the hierarchical regression analyses indicate that objective factors and illness-specific beliefs are better predictors of self-care behavior in the arthritis group, whereas general beliefs (e.g., self-efficacy and general well-being) are better predictors of such behavior in the heart problems and hypertension groups. Discussion: The analyses support the authors’ hypothesis. The results are discussed in the context of expanding the Health Belief Model of self-care.

Technologies for Active Aging

The challenge of population aging requires innovative approaches to meet the needs of increasing numbers of older people. Emerging information and communication technologies (ICTs), such as pervasive computing and ambient assistive technology, have considerable potential for enhancing the quality of life of many older people by providing additional safety and security while also supporting mobility, independent living, and social participation. The proposed book will be a landmark publication in the area of technology and aging that will serve as a statement of the current state-of-the-art and as a pointer to directions for future research and emerging technologies, products, and services.

Client transfers in long-term care: five years' experience.

This paper reports the home-facility and level of care changes, discharges, and deaths over a five-year period for 1,653 clients newly admitted in 1978 to a long-term care program in British Columbia, Canada. Five years after admission, of clients initially admitted to care at home (N = 1241), 34.3 per cent were still in the program (14.5 per cent unchanged; 6.7 per cent at home but at a higher level of care, and 11.7 per cent in facilities). Of the remainder, 38.9 per cent had died and 26.8 per cent had been discharged. Findings for those initially admitted to care in facilities (N = 412) are remarkably similar. After five years, 28.4 per cent of these clients were still in the program; 39.3 per cent had died. Moves from facility to home care were few (2.4 per cent). Despite their advanced age at admission (mean = 74.7, S.D. 14.6), one-third were still in the program five years later, some with status virtually unchanged.

Placement changes in long-term care: three years' experience.

This paper describes the place and level of care of an urban and a semi-rural health unit for which 1,653 clients began their experience in British Columbias Long-Term Care (LTC) program and where they were one and three years later. Three years after admission, 54 per cent of 759 clients initially admitted at home to the lowest level of care were still active clients: 25.8 per cent unchanged, 11.3 per cent at home but at a higher level of care, 16.9 per cent had moved to facilities, 25.4 per cent had died; the remainder of this group had been discharged from LTC. A similar proportion of the 184 clients admitted to the lowest level of care in facilities were still in the program at the end of three years. In contrast, 25 per cent of those admitted to the highest level of care at home (N = 60) and 14.1 per cent of those admitted to the highest level in facilities (N = 64) remained in the program after three years. The potential of the study data for planning purposes is suggested.

Does Cognitive Ability Explain Inaccuracy in Older Adults’ Self-Reported Medication Adherence?

This study examines the accuracy of younger-old and older-old adults’ self-reported adherence over a 3-month period and the potential interactive relationship between self-report accuracy and cognitive abilities. For 3 months, 71 younger-old (M = 68.10, range = 57 to 74) and 62 older-old (M = 80.31, range = 75 to 89) adults had their actual and self-reported adherence monitored. Cognitive tests assessing episodic and prospective memory were given at the beginning of the study. Multilevel models indicate that 32% of the variability in objective adherence was from between-person differences whereas 68% was from within-person fluctuations. There were age differences in the coupling of actual and self-reported adherence over time, such that younger-old adults’ self-reports less accurately reflected their actual adherence. Subsequent models indicate that age differences in the coupled relationship were further moderated by cognitive abilities. Results suggest that the relationships among age, cognitive abilities, and accuracy of self-reported adherence are far from simple.

Naturally Occurring Retirement Communities: Untapped Resources to Enable Optimal Aging at Home

Staying healthy, independent and happy in ones own home is one of the greatest challenges of aging. Naturally occurring retirement communities (NORCs) are untapped and underutilized resources that have the potential to optimize health, independence, and quality of life for older individuals in an economical way. This conceptual article describes the evolution (1996–2010) of the Cherryhill NORC (13 apartment buildings; total population = 2,925; mean age ± standard deviation = 76 ± 8.08 years; 77% female, 23% male) from an ordinary neighborhood to a sustainable shared learning partnership model that enables optimal aging at home for seniors. The process of development, accomplishments, and lessons learned are outlined in detail.