M. Powell Lawton

Annual review of gerontology and geriatrics

The contributors to this volume provide an overview of each component of the acute and long-term care service continuum, including managed health care, subacute care, nursing homes, community care case management, and private case management. This volume is one of the first efforts to place these varied approaches side-by-side, highlighting the gaps and areas of duplication in the services delivery system. In addition, chapters address the emerging practices in long-term care financing and assisted living as well as the conceptual issues that need to be resolved to achieve acute and chronic care integration. This volume is of primary importance to professionals involved in long-term care, including administration, community nursing, social work, case management, discharge planning and policy.

Psychometric Characteristics of the Minimum Data Set II: Validity

OBJECTIVE: To determine the validity of the Minimum Data Set (MDS).

The varieties of wellbeing

Well-being in older people may be represented in the sectors of behavioral competence, perceived quality of life, psychological well-being, and objective environment. Research findings are presented, which show that two dimensions of psychological well-being, negative affect and positive affect, are among the important domains in this sector. Negative affect was more strongly related to inner aspects of the person while positive affect was more strongly related to external, interactive aspects of the persons world. Bradburns two-factor theory is thus supported. These two aspects of well-being are discussed in relation to life events, personal causation, neuroticism, and introversion-extra-version.

The relationships among anxiety, depression, and pain in a geriatric institutionalized sample

&NA; This study sought to determine if depression and/or anxiety is uniquely related to pain after controlling for the strong association between anxiety and depression. Both depression and anxiety were assessed in an elderly institutionalized sample using: (1) research‐based diagnoses based on Diagnostic and Statistical Manual‐revised 3rd edition (DSM‐IIIR) criteria, and (2) evaluations of ones recent affective states using the Profile of Moods States (POMS). Pain was assessed by pain intensity and number of pain complaints. A series of path models indicated that: (1) both research‐based anxiety and depression share unique variance with pain, and (2) only POMS anxiety is uniquely related to pain. A path model using both measures of anxiety and depression indicated that only the anxiety measures are significantly related to pain. However, POMS anxiety sustained a significantly greater relationship with pain than did research‐based anxiety.

Psychometric Characteristics of the Minimum Data Set I: Confirmatory Factor Analysis

OBJECTIVE: To determine the structure and statistical reliability of the federally mandated Minimum Data Set (MDS).

Depression and medical illness in late life: Report of a symposium.

Clinically significant depression in older people is an important public health problem. Medical illness is the most consistently identified factor associated with the presence of late‐life depression and is the most powerful predictor of poor depressive outcome. Closer examination of these associations holds promise for revealing insights into depressive pathogenesis at biological, psychological, and social levels of organization.

Affect and quality of life: objective and subjective.

Objectives:The objective of this article is to determine direct and indirect contributions of objective and subjective quality of life (QOL) to positive and negative indicators of mental health. Specifically, the dual-channel hypothesis predicted that objective and subjective social engagement would enhance positive affect (PA) but be unrelated to depression. Methods:Older people from senior centers and several housing environments volunteered to complete a questionnaire or interview about a number of aspects of their everyday lives (N= 602). Objective and subjective were related to one another. Results:Objective activity participation and subjective time use and friend quality were associated with PA. Only time use was related to depression. Discussion:The importance of assessing both amount of behavior (objective) and its quality (subjective) when measuring QOL was demonstrated. Although external engagement bears a closer relationship to PA than to negative, the dual-channel model relating locus of stimulation differentially to PA and depression requires modification.

Elderly People and the Environment

1 Dimensions of Environment-Behavior Research: Orientations to Place, Design, Process, and Policy.- 2 Housing Older America.- 3 Retirement Communities.- 4 Alternative Modes of Living for the Elderly: A Critical Review.- 5 Aging in Rural Environments.- 6 Supportive Residential Settings for Older People.- 7 Human Factors Research and Functional Environments for the Aged.- 8 The Effects of Residential and Activity Behaviors on Old Peoples Environmental Experiences.- 9 A Complementary/Congruence Model of Well-Being or Mental Health for the Community Elderly.

Quality of Life and Affect in Later Life

Publisher Summary This chapter addresses the research literature on psychological well-being, quality of life (QOL), and affect, as they apply to older people and suggests a new way of accounting for their interrelationships. The literature on affect experience examines the relation to Helsons adaptation level (AL) theory. QOL is asserted to represent a subjective processing of the overall duration and intensity of affect states over a self-chosen period of time augmented by stable personality characteristics and cognitive affective schemata built up over variable periods of time. The person tends to select the reference time period in such a way as to optimize the excess of positive over negative affect. The connection between events and QOL is clearly mediated by affect and the hedonic integral of these states. Events may be protracted in time, as in the case where the event of residential location in turn creates, or allows the person to form, an ongoing set of new daily events. In contexts that are ongoing and relatively stable, the persons familiarity and sense of personal competence in living in that context contribute to the mild sense of positive affect (PA) that constitutes most peoples baseline level of QOL. Intrusions of negative events are more likely as personal competence decreases and as contexts become imposed rather than chosen. Internally focused affect management processes, such as adaptation and cognitive control come into play at that point. Thus, the continuing motivation to remain proactive, together with the use of reactive affect management mechanisms, accounts for the surplus of PA over negative affect (NA) states.

Objective and Subjective Uses of Time by Older People.

The time allocations of 525 older people from two independent community-resident and two types of service-agency populations were studied. The strongest determinant of time allocation, beyond basic demographic characteristics, was functional health, which was better among people spending time in most obligatory activities, both alone and outside the home. Cognitive competence was associated with media use, being alone, less rest, time with family, and time in the home. More time was spent in most-liked discretionary, but not obligatory activities. Specifically, the more time one spent interacting with friends, with household family, reading, watching television, engaging in recreation, and being in the yard, the more each of these activities was liked. While there was a strong relationship between degree of liking for most activities and personal adjustment, the actual distribution of time among the activities was quite independent of personal adjustment, with the exception of time alone, which showed a slight negative association with personal adjustment.