Julie Robison

Caregiving and Women's Well-being: A Life Course Approach

This study demonstrates the utility of incorporating a life course, role context approach in investigations of the ties between particular roles and psychological well-being, using the links between womens caregiving and well-being as a case in point. We draw on panel data from a random sample of 293 women interviewed in 1956 and 1986, considering both current role occupancy and the duration of caregiving as well as a number of factors that may moderate the effects of caregiving on well-being. We find, using ordinary least squares regression, that the effects of caregiving on womens emotional health are moderated by their previous psychological well-being, with caregivers with high prior well-being reporting high subsequent well-being. Other moderators are previous social integration (in the form of religiosity and multiple-role involvements) and other nonfamily roles (worker and volunteer) currently occupied. What women bring to caregiving (in terms of their previous social integration and psychological well-being) shapes its significance for their emotional health. Moreover, the duration and timing of caregiving in womens lives also relate to its effects on their well-being. These findings point to the importance of examining the impacts of particular social roles, such as caregiving, in the context of other roles and resources.

Predictors of recovery in activities of daily living among disabled older persons living in the community

ObjectiveTo identify the factors that predict recovery in activities of daily living (ADLs) among disabled older persons living in the community.DesignProspective cohort study with 2-year follow-up.SettingGeneral community.Participants213 men and women 72 years or older, who reported dependence in one or more ADLs.Measurements and Main ResultsAll participants underwent a comprehensive home assessment and were followed for recovery of ADL function, defined as requiring no personal assistance in any of the ADLs within 2 years. Fifty-nine participants (28%) recovered independent ADL function. Compared with those older than 85 years, participants aged 85 years or younger were more than 8 times as likely to recover their ADL function (relative risk [RR] 8.4; 95% confidence interval [CI] 2.7. 26). Several factors besides age were associated with ADL recovery in bivariate analysis, including disability in only one ADL, self-efficacy score greater than 75, Folstein Mini-Mental State Examination (MMSE) score of 28 or better, high mobility, score in the best third of timed physical performance, fewer than five medications, and good nutritional status. In multivariable analysis, four factors were independently associated with ADL recovery—age 85 years or younger (adjusted RR 4.1; 95% CI 1.3, 13), MMSE score of 28 or better (RR 1.7; 95% CI 1.2, 2.3), high mobility (RR 1.7; 95% CI 1.0, 2.9), and good nutritional status (RR 1.6; 95% CI 1.0, 2.5).ConclusionsOnce disabled, few persons older than 85 years recover independent ADL function. Intact cognitive function, high mobility, and good nutritional status each improve the likelihood of ADL recovery and may serve as markers of resilliency in this population.

A population-based study of environmental hazards in the homes of older persons.

OBJECTIVES This study sought to estimate the population-based prevalence of environmental hazards in the homes of older persons and to determine whether the prevalence of these hazards differs by housing type or by level of disability in terms of activities of daily living (ADLs). METHODS An environmental assessment was completed in the homes of 1000 persons 72 years and older. Weighted prevalence rates were calculated for each of the potential hazards and subsequently compared among subgroups of participants characterized by housing type and level of ADL disability. RESULTS Overall, the prevalence of most environmental hazards was high. Two or more hazards were found in 59% of bathrooms and in 23% to 42% of the other rooms. Nearly all homes had at least 2 potential hazards. Although age-restricted housing was less hazardous than community housing, older persons who were disabled were no less likely to be exposed to environmental hazards than older persons who were nondisabled. CONCLUSIONS Environmental hazards are common in the homes of community-living older persons.

A Life-Course Perspective on Housing Expectations and Shifts in Late Midlife

This study applies a life-course approach and retirement migration theory to develop a model of future housing expectations and actual moves for a random sample of men and women in late midlife. Results suggest that late-midlife workers and retirees expect to age in place; expectations to live in highly supportive environments are uniformly low. Older, nonmetropolitan respondents with less education and more years in their homes express the strongest expectations that they will age in place. Those people who rent their homes, have weaker ties to their communities, and have more symptoms of depression tend to foresee a move in the future. However, physical health of respondents and their spouses do not predict future housing expectations. Prior expectations about aging in place, residential history, and life-course changes in marriage and retirement predict actual moves within the next two years, with differing patterns for men and women.

Mismatches between the home environment and physical capabilities among community-living older persons

OBJECTIVE: To determine whether environmental hazards related to transfers, balance, and gait are any less prevalent in the homes of older persons with specific deficits in physical capabilities than they are in the homes of older persons without the same deficits.

Screening for Dementia in the Outpatient Setting: The Time and Change Test

OBJECTIVE: To develop and validate the Time and Change (T&C) test, a simple, standardized method for detecting dementia in a diverse older outpatient population with varying levels of education.

Life‐Sustaining Treatment and Assisted Death Choices in Depressed Older Patients

OBJECTIVES: The major purpose of this study was to examine the effect of depressed mood in older, medically ill, hospitalized patients on their preferences regarding life‐sustaining treatments, physician‐assisted suicide (PAS), and euthanasia and to determine the degree to which financial constraints affected their choices.

Should I Stay or Should I Go?: Moving Plans of Older Adults

Abstract Data from a longitudinal study of older adults in an upstate New York county (N = 333) show that poor housing “fit” increases the likelihood that older adults are currently considering a move, as does lower residential satisfaction. Those adults who said only that they “might consider moving” focused on health transitions that might signal a need for a new housing situation. Residential satisfaction predicts actual moves even when controlling for moving plans. Older adults may be “pushed” to make a move by a crisis, but those older adults planning moves tend to be “pulled” into housing arrangements with desirable features.

Anxiety Disorders in Older Puerto Rican Primary Care Patients

OBJECTIVE Authors examined the frequency and comorbidity of anxiety disorders among aging Puerto Ricans seen in primary care. METHODS A group of 303 middle-aged and older low-socioeconomic-status Puerto Ricans attending primary-care clinics were surveyed, using a Spanish-language diagnostic interview. RESULTS Twenty-four percent of participants met probable DSM criteria for at least one anxiety disorder in the previous year, especially generalized anxiety disorder, specific phobia, and panic attacks. Psychiatric comorbidity was common; the occurrence of most anxiety disorders increased the conditional risk of a comorbid disorder from 5- to 30-fold. CONCLUSIONS The present results suggest a need to screen at-risk patients in primary care settings serving this population.

Efficacy of a Geriatrics Team Intervention for Residents in Dementia-Specific Assisted Living Facilities: Effect on Unanticipated Transitions

OBJECTIVES: To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia.