Jing Jy Wang

Stress, loneliness, and depression in Taiwanese rural community-dwelling elders.

This study examined the stressors and stress levels, loneliness, and depression experienced by Taiwanese rural elders and determine if differences in the level of stress were associated with specific person-environmental characteristics. The relationship between stress and depression was also explored. A total of 201 older rural community residents participated in the study. Findings showed that rural elders experienced a number of stressors related to health and family issues. Differences in the degree of stressfulness of individuals differed by gender, educational level, living arrangement, and socioeconomic status (SES). Findings in this study also showed that there was a high association among stress level, depressive symptoms, and mood status. The findings of this study will assist community health policy-makers in determining the need for health-related services for rural elders experiencing these problems.

Effects of gerotranscendence support group on gerotranscendence perspective, depression, and life satisfaction of institutionalized elders

Objective: The purpose of this research was to test the clinical use of the gerotranscendence (GT) theory and its influence on GT perspective, depression, and life satisfaction among a group of institutionalized elders. Methods: An experimental study utilizing pre–post group design and random assignment of elders into intervention and control group was conducted. The intervention support group was implemented in the experimental group once a week for eight weeks for 60 min. Over the eight-week period, 35 subjects in the experimental group and 41 in the control group completed the study. Data were collected one week before and one week after the intervention for both groups. Instruments include the GT Scale, Geriatric Depression Scale short form, and Life Satisfaction scale. Data were analyzed by paired t-test, Wilcoxon, McNemar, and analysis of co-variance. Results: Pre- and post-test scores on the GT perspective and life satisfaction were significantly increased (p = 0.000) in the experimental group. The mean depression score of the experimental group showed a slight but not significant decrease (p = 0.06). However, significant post-test differences were noted between groups in GT perspective, depression, and life satisfaction (p  = 0.000, 0.01, and 0.000). Conclusion: The findings of this study suggest that after participating in a GT support group, institutionalized elders’ GT perspective and life satisfaction were enhanced, and depression reduced. The positive effects demonstrated by this study can be extended and applied to the clinical health promotion of institutionalized elders. Ongoing GT intervention is encouraged to promote mental and spiritual health among institutionalized elders.

Prevalence and related factors of do-not-resuscitate directives among nursing home residents in Taiwan.

OBJECTIVES To report the prevalence of Do-Not-Resuscitate (DNR) directives and to explore the factors associated with the presence of DNR directives among nursing home residents in Taiwan. DESIGN A cross-sectional, correlation study. SETTING Seven nursing homes in southern Taiwan. PARTICIPANTS Nursing home residents and their family surrogates. MEASUREMENTS Data were collected using chart abstraction and a questionnaire survey. We used multivariate logistic regression to analyze the associations between resident, family surrogate, and facility characteristics and the presence of DNR directives. RESULTS Among the 201 nursing home residents, 33 (16.4%) had DNR directives and 91% of the directives had been put in place by family surrogates. Our data revealed that residents age (OR = 1.06, 95% CI = 1.01-1.12), cognitive function score (OR = 0.91, 95% CI = 0.85-0.97), prior DNR discussion between physician and family surrogate (OR = 4.09, 95% CI = 1.53-10.96), and nursing home with DNR policy (OR = 17.71, 95% CI = 5.87-53.46) were independently and associated with the presence of a DNR directive. CONCLUSIONS The prevalence of DNR directives among Taiwanese nursing home residents was lower than that in other countries. Our results point out the lack of DNR policy in most Taiwanese nursing homes and highlight the need for policy makers to implement further regulations. Meanwhile, education about advance directives is warranted to increase public and professional awareness and to facilitate empowerment of the increasing number of frail elderly nursing home residents in Taiwan.

A structural model of the bio‐psycho‐socio‐spiritual factors influencing the development towards gerotranscendence in a sample of institutionalized elders

AIMS This paper is a report of a study to determine the bio-psycho-socio-spiritual factors influencing the development towards gerotranscendence in institutionalized older people. Physical ability, depressive symptoms, social network support, meaning of life and life satisfaction were examined through a structured equation modelling approach. BACKGROUND Older peoples pursuit of gerotranscendence is believed to facilitate successful ageing and late-life growth. Although a few Scandinavian studies have identified the relationship between psychosocial factors and the development of gerotranscendence, there is little trans-cultural study of the model, which limits the ability of the gerotranscendence theory to be applied worldwide. METHODS Cognitively intact older residents (N = 195) from six long-term care facilities in southern Taiwan participated in a structured interview using the Gerotranscendence scale, Barthels Index, the Geriatric Depression Scale short form, the Inventory of Socially supportive Behaviour, the Life Meaning scale, and the Life Satisfaction scale. Data were collected over a 6-month period in 2008. RESULTS The model-fit indexes of the final model (χ2)  = 32.08, d.f. = 14, P = 0.004; CMIN/d.f. = 2.29; GFI = 0.97, AGFI = 0.89, TLI = 0.94, NFI = 0.96) exceeded acceptable levels except for χ2 . In the final model, social support, life satisfaction and meaning of life had direct effects on gerotranscendence (standardized regression weight 0.54, 0.43, and 0.76). CONCLUSION The gerotranscendence model of healthy ageing is congruent in the Taiwanese population. Findings of this study can guide nursing and other health professionals in planning implementation of best practice in older peoples care.

Caregiver factors contributing to psychological elder abuse behavior in long-term care facilities: a structural equation model approach

BACKGROUND Identification of caregiver risk factors associated with psychological elder abuse is crucial for preventing and managing such abuse. The aim of this study was to test the most effective model for explaining caregiver factors contributing to caregiver psychological abuse behavior. We hypothesized that caregiver hours worked each day, years of education, age, geriatric care-giving training, gerontological care knowledge, social resources, and self-reported work stress are factors contributing to psychological abuse behavior of caregivers. METHODS A cross-sectional study design was used. The sample included a total of 183 caregivers recruited from seven long-term care facilities in southern areas of Taiwan. Instruments included the Caregiver Psychological Elder Abuse Behavior (CPEAB) scale, the Work Stressors Inventory Chinese version (WSI-C), the Personal Resources Questionnaire (PRQ-2000), and Knowledge of Gerontological Nursing Scale (KGNS). The structural equation modeling (SEM) procedure was used to analyze the data. RESULTS All the model-fit indexes (chi2 = 87.84, df = 70, p = 0.073; CMIN/DF = 1.26; GFI = 0.94, AGFI =0.91, TLI = 0.96, RMSEA = 0.037) of the final model exceeded their respective common acceptance levels except for the normed fit index (NFI) value (0.88). The study results suggest that caregivers who work fewer hours, received fewer years of education, lack social resources, and had more work stress showed higher levels of psychological abuse behavior in caring for the elderly (p = 0.000-0.037). CONCLUSIONS These findings should be incorporated into practice by intervening to reduce caregiver stress and reduce elder abuse behaviors. To help reduce elder psychological abuse, caregivers would benefit from stress management and social resource interventions provided by employers or government programs.

Cognitive function and quality of life in community-dwelling seniors with mild cognitive impairment in Taiwan

The aims of this study were to examine the relationships between overall cognitive function and the quality of life (QOL) domains, and to compare the differences in these by age, gender, and educational level in community-dwelling seniors in Taiwan. A cross-sectional study was conducted, with the participants screened and recruited from Southern Tainan. The Saint Louis University Mental Status Examination was used to screen the cognitive status of the participants. A total of 144 seniors participated in this study were assessed using the Taiwanese version of WHOQOL-BREF. The results showed that the participants performed better in the cognitive domains of “figure identification” and “orientation” while they performed poor in “delayed recall” and “immediate paragraph recall”. No significant relationship between cognitive function and overall QOL, but a positive relationship between cognitive function and the physical health domain of QOL was found. The findings of this study provide valuable information for community healthcare providers.

The Impacts of using community health volunteers to coach medication safety behaviors among rural elders with chronic illnesses

It is a challenge for rural health professionals to promote medication safety among older adults taking multiple medications. A volunteer coaching program to promote medication safety among rural elders with chronic illnesses was designed and evaluated. A community-based interventional study randomly assigned 62 rural elders with at least two chronic illnesses to routine care plus volunteer coaching or routine care alone. The volunteer coaching group received a medication safety program, including a coach and reminders by well-trained volunteers, as well as three home visits and five telephone calls over a two-month period. All the subjects received routine medication safety instructions for their chronic illnesses. The program was evaluated using pre- and post-tests of knowledge, attitude and behaviors with regard to medication safety. Results show the volunteer coaching group improved their knowledge of medication safety, but there was no change in attitude after the two-month study period. Moreover, the group demonstrated three improved medication safety behaviors compared to the routine care group. The volunteer coaching program and instructions with pictorial aids can provide a reference for community health professionals who wish to improve the medication safety of chronically ill elders.

Characteristics and underlying meaning of hoarding behavior in elders with Alzheimer's dementia: caregivers' perspective.

Background: Dementia and its associated problem behaviors remain bothersome to family and professional caregivers. Exploring characteristics and the underlying meaning of disruptive behaviors in elders with Alzheimer’s dementia can be a first step to pursuing patient-centered care. Although hoarding is relatively harmless, unattended excessive hoarding can create health and safety issues for both patients and caregivers. Purpose: This study examined the characteristics and underlying meaning of hoarding behavior among Taiwanese elders with Alzheimer’s dementia from the perspective of family caregivers. Methods: We used an exploratory research design and purposive sampling. A total of 12 family caregivers of elders with Alzheimer’s dementia received qualitative interview. We used one-on-one in-depth interviews to collect data and content analysis to analyze data. Results: Three main characteristics related to hoarding behavior emerged from the data were “influence of former and current symptoms,” “recurrence of the original personal characteristics and habits,” and “re-experiencing past economic crises.” These three characteristics reflected patients’ past social and family background and the current life situation. We elicited “a desire for security” as the underlying meaning of hoarding behavior. Conclusion: Findings of this study provide a reference for family and professional care providers to understand dementia-related problem behaviors. Improved caregiver understanding of dementia patient behaviors may help improve caregiver–patient interaction and communication and help caregivers better meet patient needs.

The Initial Development of a Checklist for Assessing Thirst in Patients With Advanced Dementia.

Background: Patients with advanced dementia (PwAD) often have difficulty expressing their needs verbally because of cognitive impairments. PwAD thus often communicate these needs through behaviors and psychological symptoms. Understanding the behavioral characteristics of certain needs is critical for caregivers and clinicians when caring for PwAD. Purpose: The purpose of this study was to develop a checklist that may be used to assess the thirst status of PwAD. Methods: A mixed method design was used. The checklist was developed using qualitative interviews and surveys. The initial items were developed through interviews with 10 professional nurses who were caring for PwAD. Four experts in dementia assessed the content validity of these items. PwAD caregivers from eight facilities were then invited to complete the checklist based on their current PwAD patient care experience. Data obtained in this study were analyzed with regard to content validity, interrater reliability, internal consistency, and exploratory factor analysis. Results: The content validity of the initial 18 items was .96, interrater reliability was −.33 to 1, and internal consistency reliability was .52. Exploratory factor analysis identified seven checklist items, including repetitive movements, squirming, restlessness or anxiety, persistent or unreasonable demands, pacing back and forth, repeating a sentence or question without purpose, and slow reaction. The factor loadings of these seven items accounted for 49.3% of the total variance. The reassessed internal consistency reliability was .66. Conclusions/Implications for Practice: Caregivers may use this checklist as an aid to identify the thirst or fluid needs of PwAD who are unable to communicate their needs effectively.

Effects of the Advanced Innovative Internet-Based Communication Education Program on Promoting Communication Between Nurses and Patients With Dementia.

Background: Effective communication between nurses and patients with dementia promotes the quality of patient care by improving the identification of patient needs and by reducing the miscommunication-related frustration of patients and nurses. Purpose: This study evaluates the effects of an advanced innovative Internet-based communication education (AIICE) program on nurses’ communication knowledge, attitudes, frequency of assessing patient communication capacity, and communication performance in the context of care for patients with dementia. In addition, this study attempts to evaluate the indirect effects of this program on outcomes for patients with dementia, including memory and behavior-related problems and depressive symptoms. Methods: A quasi-experimental research design with a one-group repeated measure was conducted. Convenience sampling was used to recruit nurses from long-term care facilities in southern Taiwan. Data were analyzed using general estimating equations to compare changes over time across three points: baseline, fourth-week posttest, and 16th-week posttest. One hundred five nurses completed the AIICE program and the posttest surveys. Results: The findings indicate that nurses’ communication knowledge, frequency in assessing patients’ communication capacity, and communication performance had improved significantly over the baseline by either the 4th- or 16th-week posttest (p < .01). However, communication attitude showed no significant improvement in the posttest survey (p = .40). Furthermore, the findings indicate that the memory and behavior-related problems and the depressive symptoms of patients had decreased significantly by the 16th-week posttest (p = .05). Conclusions/Implications for Practice: This study showed that the AIICE program improves nurses’ communication knowledge, frequency to assess patients’ communication capacity, and communication performance and alleviates the memory and behavior-related problems and depressive symptoms of patients. The continuous communication training of nurses using the AIICE program is thus recommended.