John F. Watkins

Conceptualizing Self-care in Heart Failure A Life Course Model of Patient Characteristics

Self-care is fundamental to achieving optimal outcomes in patients with heart failure. Unfortunately, self-care among patients with heart failure is commonly poor, and patients have considerable difficulties performing self-care skills. Elderly patients, in particular, face a number of challenges trying to engage in adequate self-care. Heart failure self-care is an intricate process that is the result of decisions made on many levels by patients. Little is known about self-care decision making in patients with heart failure, and the existing literature does not take into account the complexity of interrelated factors that affect self-care decision making. In this article, a model of factors affecting self-care decision making that include aging status, psychosocial status, health literacy, current symptom status, and prior experiences is proposed.

‘It could be worse … lot's worse!’ Why health-related quality of life is better in older compared with younger individuals with heart failure

BACKGROUND health-related quality of life (HRQOL) is markedly impaired in patients with heart failure (HF). Despite worse prognosis and physical status, older patients have better HRQOL than younger patients. OBJECTIVE to determine reasons for differences in HRQOL in older compared with younger HF patients. METHODS a mixed methods approach was used. HRQOL was assessed using the Minnesota Living with HF Questionnaire and compared among HF patients (n = 603) in four age groups (≤ 53, 54-62, 63-70 and ≥ 71 years). Socio-demographic/clinical and psychological factors related to HRQOL were determined in four groups using multiple regressions. Patients (n = 20) described their views of HRQOL during semi-structured interviews. RESULTS HRQOL was worse in the youngest group, and best in the two oldest groups. The youngest group reported higher levels of depression and anxiety than the oldest group. Anxiety, depression and functional capacity predicted HRQOL in all age groups. Qualitatively, patients in all age groups acknowledged the negative impact of HF on HRQOL; nonetheless older patients reported that their HRQOL exceeded their expectations for their age. Younger patients bemoaned the loss of activities and roles, and reported their HRQOL as poor. CONCLUSIONS better HRQOL among older HF patients is the result, in part, of better psychosocial status. The major factor driving better HRQOL among older patients is a change with advancing age in expectations about what constitutes good HRQOL.

The Malleability of Possible Selves and Expectations Regarding Aging

Many people are apprehensive about old age and their future years. This pilot study sought to improve participants’ sense of possibility in, and expectations for, old age. Students and middle-aged volunteers completed a survey including the Expectations Regarding Aging 38-item questionnaire (ERA-38) and a possible-selves questionnaire before and after a positive-aging-intervention presentation. While there were no significant possible-selves changes, respondents demonstrated an improvement in expectations about aging. This study demonstrates the potential for a brief positive aging intervention to impact expectations for the future. Implications for decision making and health choices are discussed.

Gender and Race Differentials in Elderly Migration

A number of studies have provided evidence that elderly migration in the United States is strongly selective in terms of the characteristics of the migrants. Such characteristics as age, gender, and race are commonly used in examinations of migrant selectivity, but the differences in spatial behavior of these subpopulations are still poorly understood. This article uses state-to-state migration data, categorized by age, gender, and race, to explore the comparative patterns of origins, destinations, and migration propensities, with a focus on the southeastern states of the country.

Appalachian Elderly Migration Patterns and Implications

This article seeks to explore the patterns of population aging and elderly migration in Appalachia, with a focus on two distinct and different subregions: eastern Kentucky and western North Carolina. Although the framework of the study is demographic, the foundation is more related to overarching concerns of the implications of migration, particularly with respect to local economies and services, and the potential use of elderly migration as a development strategy.

The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure

Background More than 22% of individuals with diabetes mellitus have concomitant heart failure (HF), and the prevalence of diabetes in those with HF is nearly triple that of individuals without HF. Comorbid depressive symptoms are common in diabetes and HF. Depressive symptoms are an independent predictor of mortality in individuals with diabetes alone, as well as those with HF alone and are a predictor of rehospitalization in those with HF. However, the association of comorbid HF, diabetes and depressive symptoms with all-cause mortality and rehospitalization for cardiac causes has not been determined. Objective The purpose of this study was to evaluate the association of comorbid HF, diabetes and depression with all-cause mortality and rehospitalization for cardiac cause. Method Patients provided data at baseline about demographic and clinical variables and depressive symptoms; patients were followed for at least 2 years. Participants were divided into four groups based on the presence and absence of diabetes and depressive symptoms. Cox regression analysis was used to determine whether comorbid diabetes and depressive symptoms independently predicted all-cause mortality and cardiac rehospitalization in these patients with HF. Results Patients (n=663) were primarily male (69%), white (76%), and aged 61±13 years. All-cause mortality was independently predicted by the presence of concomitant diabetes and depressive symptoms (HR 3.71; 95% CI 1.49 to 9.25; p=0.005), and depressive symptoms alone (HR 2.29; 95% CI 0.94 to 5.40; p=0.05). The presence of comorbid diabetes and depressive symptoms was also an independent predictor of cardiac rehospitalization (HR 2.36; 95% CI 1.27 to 4.39; p=0.007). Conclusions Comorbid diabetes and depressive symptoms are associated with poorer survival and rehospitalization in patients with HF; effective strategies to regularly evaluate and effectively manage these comorbid conditions are necessary to improve survival and reduce rehospitalization rates.

Professional and Personal Development in Contemporary Gerontology Doctoral Education

This article reports on the Gerontology Doctoral Student Assessment Model (GDSAM), a comprehensive web-based system premised on developing an evaluation mechanism attuned to the special requirements of advanced graduate education at the doctoral level. The system focuses on longitudinal tracking of selected dimensions of intellectual, professional, and personal progress. This involves interlocking elements of online personal dossier development, student self-rating assessment, faculty assessment of student progress, and a means of communicating interactive and iterative feedback among students and faculty. Preliminary findings from initial data collection using the assessment system indicate that students who have completed and passed their qualifying examinations are more confident in their ability to articulate diverse ideas in professional settings, work in direct contact with research participants, present research findings to scientific audiences, and adjust to the rigors of doctoral education. Additional feedback from participants in the system suggests that, although important ethical issues of confidentiality and appropriate use must be recognized and monitored, the GDSAM has strong potential to provide an appropriate assessment tool at the doctoral level. Implementation of such a system throughout doctoral education in gerontology provides a unique opportunity for tracking the impact and effectiveness of doctoral education in an emergent field as additional programs come on line.

Migration and regional population aging in the Philippines.

There is a growing realization that developing countries will be affected in the future by the problems associated with population aging. Although internal migration could exacerbate the problems of aging at subnational levels, there remains a paucity of research on the role of migration in elderly population change for the developing countries of the world. This study uses 1980 census data for the Philippines to explore the spatial and temporal dynamics of the countrys elderly population. Through examination of internal migration patterns among the thirteen regions of the country and population projections, this paper demonstrates the potentially large role that migration plays in determining local patterns of aging.The National Capital Region, which is a primary destination of labor force migrants, exhibits the greatest projected increase in the share of the nations elderly population, while the centrally located Visayas regions show rapid reductions in the future. The Visayas regions, however, may be expected to have the highest concentrations of elderly in their populations. Such findings suggest that labor force migration patterns, with subsequent aging-in-place, will most strongly influence near future distributions and concentrations of the elderly, and that national planning for the futures elderly population should incorporate regional examinations as a means of appropriately distributing financial and service related support.

A Qualitative Approach to Increasing HIV Prevention in Primary Care Settings for Older Adults Perspectives From Primary Care Providers

The purpose of this research was to explore primary care providers’ willingness and ability to increase HIV prevention efforts among older adults and to gain recommendations for improving HIV prevention in primary care settings. Data were collected through 24 semistructured interviews with primary care providers. The results of the study reveal that the majority of providers find it necessary to increase HIV prevention efforts in primary care settings and are willing to do so; however, they cannot do so without assistance. Providers suggested strategies to increase HIV prevention in primary care, for instance, expanding the use of electronic reminders to include HIV prevention and increasing collaboration among providers of different specialties. As a result of the interviews, additional recommendations for increasing HIV prevention have been identified. These findings will aid in improving the quality of care provided to individuals older than 50 in primary care settings.