Margaret I. Wallhagen

Comparative Impact of Hearing and Vision Impairment On Subsequent Functioning

OBJECTIVES: The purpose of this study was to compare independent impacts of two levels of self‐reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning.

Differences in patients' and family caregivers' perceptions of the pain experience influence patient and caregiver outcomes

Abstract The purposes of this study were to determine if there were differences in pain intensity scores, pain duration scores, mood states, and quality of life of oncology outpatients whose pain intensity scores were congruent with their family caregivers compared to patients whose pain intensity scores were non‐congruent and to determine if there were differences in mood states, health status, and caregiver strain between family caregivers whose pain intensity scores were congruent with their family members and those family caregivers whose pain intensity scores were non‐congruent. A total of 78 patient‐caregiver dyads participated in the study. Patients completed a Demographic Questionnaire, a Cancer Pain Questionnaire, the Profile of Mood States, and the Multidimensional Quality of Life Scale‐Cancer 2. Family caregivers completed a demographic questionnaire, the Profile of Mood States, the Caregiver Strain Index, and the Medical Outcome Study Short‐Form Health Survey. Both patients and family caregivers rated the patients pain intensity using a visual analogue scale (VAS). Patients in the non‐congruent dyads (i.e. difference of >10 on the VAS score) had significantly more mood disturbance and a poorer quality of life than patients in the congruent dyads. Family caregivers in the non‐congruent dyads had significantly higher caregiver strain score than caregivers in the congruent dyads. These findings suggest that differences in the perception of the pain experience between patients and their family caregivers is associated with deleterious outcomes for the patient and their family caregivers.

The Stigma of Hearing Loss

PURPOSE To explore dimensions of stigma experienced by older adults with hearing loss and those with whom they frequently communicate to target interventions promoting engagement and positive aging. DESIGN AND METHODS This longitudinal qualitative study conducted interviews over 1 year with dyads where one partner had hearing loss. Participants were naive to or had not worn hearing aids in the past year. Data were analyzed using grounded theory, constant comparative methodology. RESULTS Perceived stigma emerged as influencing decision-making processes at multiple points along the experiential continuum of hearing loss, such as initial acceptance of hearing loss, whether to be tested, type of hearing aid selected, and when and where hearing aids were worn. Stigma was related to 3 interrelated experiences, alterations in self-perception, ageism, and vanity and was influenced by dyadic relationships and external societal forces, such as health and hearing professionals and media. IMPLICATIONS Findings are discussed in relation to theoretical perspectives regarding stigma and ageism and suggest the need to destigmatize hearing loss by promoting its assessment and treatment as well as emphasizing the importance of remaining actively engaged to support positive physical and cognitive functioning.

Differences in mood states, health status, and caregiver strain between family caregivers of oncology outpatients with and without cancer-related pain

The purpose of this study were to determine if there are differences in the mood states, health status, and caregiver strain between family caregivers of oncology outpatients with and without cancer-related pain. A convenience sample of 86 family caregivers of patients with cancer-related pain and 42 caregivers of pain-free patients participated in this study. Family caregivers of patients with cancer-related pain scored significantly higher on the tension and depression subscales of the Profile of Mood States and had a significantly higher total mood disturbance score than did caregivers of pain-free patients. Although family caregivers of patients with pain had lower health status scores and higher caregiver strain scores than caregivers of pain-free patients, these differences were not statistically significant. The results of this study suggest that the presence of pain in a cancer patient adversely affect the mood states of family caregivers, particularly their level of depression and anxiety, and that health care professionals need to assess the psychological needs of family members caring for cancer patients experiencing pain.

Self-Rated Health and Mortality Over Three Decades Results from a Time-Dependent Covariate Analysis

Previous longitudinal studies assessing relative mortality risks associated with fair or poor self-rated health have differed in the extent to which observed relative risks are explained by disease burden and health risk factors. Gender and ethnic differences have rarely been assessed. The authors used proportional hazards models with time-dependent covariates to examine associations between fair or poor self-rated health and mortality over 28 years for 5,976 Alameda County Study respondents age 21 to 94 at baseline. Adjustments for a number of demographic variables, chronic conditions, mobility impairment, and health risk factors accounted for about half of the unadjusted relative risk. No gender or ethnicity differences in relative risk comparisons were found, but consistent with other studies, lower relative risks associated with increasing age were found. The authors conclude that self-rated health is a deceptively simple variable that likely measures a great deal more than disease burden.

An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study.

OBJECTIVES This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.

Alzheimer's disease and family caregiving: critical synthesis of the literature and research agenda.

This paper is a synthesis of knowledge about Alzheimers disease (AD) and AD family caregiving published over the last decade (approximately 1979–1990). While there has been an increase in the volume of scientific work in this area, methodological difficulties, unclear findings, and gaps, particularly with regard to inclusion of ethnic minority populations, persist. The current research priority on evaluating intervention programs represents a worthy direction, yet such a focus may be premature until basic knowledge builds on, extends, and transcends the foundation established in the past decade.

Hearing Loss in an Aging American Population: Extent, Impact, and Management

Despite contributing substantially to disability in the United States, age-related hearing loss is an underappreciated public health concern. Loss of hearing sensitivity has been documented in two-thirds of adults aged 70 years and older and has been associated with communication difficulties, lower health-related quality of life, and decreased physical and cognitive function. Management strategies for age-related hearing loss are costly, yet the indirect costs due to lost productivity among people with communication difficulties are also substantial and likely to grow. Hearing aids can improve health-related quality of life, but the majority of people with documented hearing loss do not report using them. Uncovering effective means to improve the utilization of hearing health care services is essential for meeting the hearing health care demands of our aging population. The importance of hearing for general well-being warrants an effort to enhance awareness among the general population of the indications of hearing loss and options for assistance.

The Meaning of Family Caregiving in Japan and the United States: A Qualitative Comparative Study

This study explores how cultural values affect the meaning and experiences of daughter (or daughter-in-law) caregivers of elderly persons with dementia by comparing caregivers in the United States and Japan. Nine American and seven Japanese caregivers were interviewed twice at 6-month intervals. Interviews were audiotaped and analyzed using constant-comparative techniques. Data suggest that moral obligation to care and intense loss are two universal themes of caregiving. However the experiences and perceptions of the role of caregivers from these two cultures differed in select ways that were captured within three categories: reasons for caregiving, caregiving as a career, and caregiving as a life phase or detour. Findings suggest that American caregivers may need greater anticipatory socialization regarding the caregiving role, whereas Japanese caregivers may benefit from assistance in accepting needed services.

Cognitive impairment in persons with rheumatoid arthritis.

To explore the prevalence and possible predictors of cognitive impairment in persons with rheumatoid arthritis (RA).