Louis J. Medvene

Promoting signing of advance directives in faith communities

AbstractOBJECTIVE: To develop a participatory educational program implemented in faith communities that would increase discussion and signing of two types of advance directives—living will and durable power of attorney for health care decisions. DESIGN: Longitudinal study with four annual cycles of program implementation, evaluation, and revision incorporating a program that fostered the discussion, signing, and/or revision of advance directives. The program involved an educational workbook and ongoing support by parish nurses. SETTING: Seventeen faith communities in Wichita, Kansas. Faith communities included several predominantly white congregations, as well as several primarily African-American and Hispanic congregations. PARTICIPANTS: Seventeen faith communities, their pastors, and 25 parish nurses worked with 361 self-selected residents, living in community settings, to participate in the program as members of their faith communities. Congregations were recruited by the executive director of a local interfaith ministries organization and parish nurses. MAIN RESULTS: Two hundred forty-eight (69%) of the congregants who started the program completed it. Of the program completers, 83 (33%) had a directive prior to the program and 140 (56%) had a directive after completion. One hundred eighty-six of the completers discussed directives with family members. Overall, 89 (36%) of the 248 program completers revised an existing directive or signed one for the first time. Age was positively related to having signed/revised a directive prior to the program. Fear that advance directives would be used to deny medical care was negatively related to signing both prior to the program and after program completion, and contributed to participants’ reluctance to sign directives. CONCLUSIONS: Educational programs implemented by parish nurses in faith communities can be effective in increasing rates of discussion, revision, and/or signing of advance directives.

Social networks and links to isolation and loneliness among elderly HCBS clients.

Objectives: The purpose of this study was to explore the network types of HCBS clients based on the structural characteristics of their social networks. We also examined how the network types were associated with social isolation, relationship quality and loneliness. Method: Forty personal interviews were carried out with HCBS clients to assess the structure of their social networks as indicated by frequency of contact with children, friends, family and participation in religious and community organizations. Hierarchical cluster analysis was conducted to identify network types. Results: Four network types were found including: family (n = 16), diverse (n = 8), restricted (n = 8) and religious (n = 7). Family members comprised almost half of participants’ social networks, and friends comprised less than one-third. Clients embedded in family, diverse and religious networks had significantly more positive relationships than clients embedded in restricted networks. Clients embedded in restricted networks had significantly higher social isolation scores and were lonelier than clients in diverse and family networks. Discussion: The findings suggest that HCBS clients’ isolation and loneliness are linked to the types of social networks in which they are embedded. The findings also suggest that clients embedded in restricted networks are at high risk for negative outcomes.

Exploring the Potential of Computers to Enrich Home and Community-Based Services Clients' Social Networks

Older persons receiving services in community settings, rather than Nursing Homes, are at risk of social isolation. Computer mediated communication offers technological resources that recipients of Home and Community-Based Services (HCBS) might use to reduce their social isolation. The present study involved personal interviews with 40 HCBS clients regarding their interest in communicating with members of their social networks and using computers. At the time of the interview, 30 of the 40 participants did not use computers and reported cost, lack of training, physical limitations, lack of interest and access, and fraud as the reasons for not using computers. After watching a videotape illustrating an easy-to-use computer interface that allows older persons to communicate with families and friends, 90% reported that it would be helpful for people like them. Participants said such a computer would be helpful because it would make communication with friends and family easy, it could accommodate visual and manual disabilities, and would be interesting. Eighty-five percent said they would use a system like the one they were shown if it were available to them.

The social convoys of affordable senior housing residents: Fellow residents and “Time Left”

ABSTRACT Living in an affordable senior housing site is a viable option for older adults who want to age in a community setting. Affordable senior housing is subsidized housing provided in the United States by the federal government’s Department of Housing and Urban Development (HUD). Such housing is available to people 62-years-of-age and older whose income level is low enough to merit federal assistance. The current study assessed the social convoys of 32 residents of one affordable senior housing site, with interest in the number of co-residents included in participants’ social convoys, as well as participants’ levels of social isolation and loneliness. In the present study, family relationships made up the largest proportion of residents’ social convoys (38.6%); however, co-residents made up 26% of participants’ social convoys. There was a positive correlation between the number of years that participants had lived at the affordable senior housing site and the percent of co-residents in their social convoys r = .39, p = .03. These findings suggest that under certain conditions older adults are willing to invest in creating new relationships with co-residents in congregate settings. The implications of these findings are explored.

Computer use and loneliness among older persons across settings

The objective of the EVIDEM-EXERCISE study was to evaluatethe effectiveness of an exercise regime as a therapy for the behaviouraland psychological symptoms of dementia (BPSD). A pragmatic, ran-domized, controlled, single-blind, parallel-group trial of a dyadic exer-cise regime (tailored walking) for community-dwelling individuals withBPSD and their carers was undertaken. The primary outcome wasBehavioural and Psychological Symptoms as measured by the Neuro-Psychiatric Inventory at week 12. Results show no significant differ-ence of NPI score at week 12 between the group receiving the dyadicexercise regime and those that did not. Secondary outcome measure ofcaregiver’s burden was significantly improved; caregiver burden dou-bled by week 12 for the control group participants, but decreased forthose receiving the exercise intervention. In conclusion, this study foundthat regular simple exercise does not improve BPSD but did seem toattenuate changes of caregiver burden.Studies about intimacy in old age have mostly focused on institutionalized life-long marriages. Little research has focused on re-partnering in later life and the impact these relationships have on life satisfaction. Framed by Giddens’ Transformation of intimacy and Laslett’s Third age, as well as changing social and demographical conditions, this paper focuses on how different forms of new intimate relationships impact on life satisfaction in later life. Qualitative interviews were conducted with a strategic sample of 28 Swedes, 63–91 years, who were married, cohabiting and living apart together in new intimate heterosexual relationships initiated after the age of 60 or who were currently dating. The results showed the significance of new intimate relations the experience of life satisfaction in later life: The importance of being needed and confirmed by one’s partner, for intimacy and sexuality, for unloading children’s care responsibility, for sharing experiences in everyday life and for safety. The results also showed the importance of the partner as a resource for new experiences and a healthier life style. In conclusion, the results will be theorized in a time frame: First, in the light of new post (re)productive free time in the third age. Second, in the light of the finite remaining life-time. The results from the qualitative study will be contextualized by results from a representative survey on intimate relations among 3 000 60-90 year old Swedes (data collection has just finished).It is often argued that in late modernity sex has escaped its reproductive cage and people form pure relationships, based on mutual satisfaction. Ironically, although older people are per definitio ...

Elderly home and community-based service customers: computers, social networks and quality of life

The objective of the EVIDEM-EXERCISE study was to evaluatethe effectiveness of an exercise regime as a therapy for the behaviouraland psychological symptoms of dementia (BPSD). A pragmatic, ran-domized, controlled, single-blind, parallel-group trial of a dyadic exer-cise regime (tailored walking) for community-dwelling individuals withBPSD and their carers was undertaken. The primary outcome wasBehavioural and Psychological Symptoms as measured by the Neuro-Psychiatric Inventory at week 12. Results show no significant differ-ence of NPI score at week 12 between the group receiving the dyadicexercise regime and those that did not. Secondary outcome measure ofcaregiver’s burden was significantly improved; caregiver burden dou-bled by week 12 for the control group participants, but decreased forthose receiving the exercise intervention. In conclusion, this study foundthat regular simple exercise does not improve BPSD but did seem toattenuate changes of caregiver burden.Studies about intimacy in old age have mostly focused on institutionalized life-long marriages. Little research has focused on re-partnering in later life and the impact these relationships have on life satisfaction. Framed by Giddens’ Transformation of intimacy and Laslett’s Third age, as well as changing social and demographical conditions, this paper focuses on how different forms of new intimate relationships impact on life satisfaction in later life. Qualitative interviews were conducted with a strategic sample of 28 Swedes, 63–91 years, who were married, cohabiting and living apart together in new intimate heterosexual relationships initiated after the age of 60 or who were currently dating. The results showed the significance of new intimate relations the experience of life satisfaction in later life: The importance of being needed and confirmed by one’s partner, for intimacy and sexuality, for unloading children’s care responsibility, for sharing experiences in everyday life and for safety. The results also showed the importance of the partner as a resource for new experiences and a healthier life style. In conclusion, the results will be theorized in a time frame: First, in the light of new post (re)productive free time in the third age. Second, in the light of the finite remaining life-time. The results from the qualitative study will be contextualized by results from a representative survey on intimate relations among 3 000 60-90 year old Swedes (data collection has just finished).It is often argued that in late modernity sex has escaped its reproductive cage and people form pure relationships, based on mutual satisfaction. Ironically, although older people are per definitio ...

Applying interdependence theory to geriatric nursing assistant/resident relationships

Globalization is challenging social gerontologists’ notions of who older migrants are and how to cater to their needs. This presentation aims to show that there are specific risks for social exclus ...Narrative foreclosure is a new sensitizing concept for studying stagnation of identity development in later life. It is defined as the conviction that no new interpretations of one’s past, nor new commitments and experiences in one’s future are possible that can substantially change one’s life story. The Narrative Foreclosure Scale (NFS) was developed to study this concept empirically. The NFS comprises two subscales: Past and Future. The psychometric properties were studied in two samples of older adults (n=247 and n = 220). Confirmatory factor analyses confirm that the scale consists of two distinct factors. Internal consistencies are sufficient to good. The validity is further confirmed by the relationship with demographics and other psychological constructs, such as personality, hope, reminiscence, ego-integrity, balanced time perspective, wisdom, depression, and positive mental health. It is discussed that diminishing narrative foreclosure may be an important process factor in life-review and narrative therapy with older adults.

Chapter 6. Mexican American and Anglo American parents of the mentally Ill: Attitudes and participation in family support groups

Summary Mexican American parents (N = 32) and Ango American parents (N = 34) of an adult son/daughter with serious mental illness were interviewed in order to identify factors related to their interest in attending a family support group. Parents were interviewed regarding their caregiving burden (level of distress), their causal attributions regarding their son/daughters problems, and level of satisfaction with their social support network. Additionally, Mexican American parents were invited to participate in one of two Spanish‐speaking support groups facilitated by a bilingual Hispanic mental health professional. There was some support for the hypotheses that interest in attending a meeting would be greater among parents who attributed their son/daughters problems to an illness rather than to a moral weakness, and that interest would be greater among parents who were less satisfied with their social support networks. Additionally, 44% of the Mexican American parents attended at least one group meeting...