Maria Claver

Perceived Control in the Lives of Older Adults: The Influence of Langer and Rodin’s Work on Gerontological Theory, Policy, and Practice

A key concept driving the field of both clinical and applied gerontology is that of personal control. Seminal work conducted in the late 1970s to early 1980s by Ellen Langer and Judith Rodin, who examined the effect of choice and enhanced responsibility on older adults, not only contributed to the discussion of the relevance of control in contemporary theories and practices of aging but also aided in the development of todays philosophy of how to serve and care for older adults in ways that are passionate, humanistic, and empowering. In their early research, residents at a nursing home were randomly assigned to 2 groups: 1 group was told they could arrange their furniture as they wanted, go where they wanted, spend time with whom they wanted, and so forth and were given a plant to care for; the other group was told that the staff was there to take care of and help them, including watering a plant given to each of them. During this study, and 18 months later, residents who were given control and personal responsibility had improved health; among those for whom control had not changed, a greater proportion had died. Since these original studies, research has continued to support the need for personal control as we age. This paper presents a brief overview of literature informed by Langer and Rodins seminal findings, as well as the role of control to theory, policy, and practice.

Comprehensive care for vulnerable elderly veterans during disasters

Despite problematic evacuation and sheltering of nursing home residents during Hurricanes Katrina and Rita, an exploration of the experiences of Veterans Health Administration (VHA) nursing homes (VANHs) is necessary for a comprehensive examination of the healthcare communitys response to these disasters. VANH evacuations during these hurricanes have not been widely studied. This exploratory project aimed to provide information about the evacuation experiences and characteristics of vulnerable nursing home residents. Interviews with key informants from VHA facilities with nursing home staff and representatives revealed that physical harm, psychological distress, cognitive decline and increased social isolation were areas that deserved special attention for this vulnerable population. Moreover, physical, psychological and social needs were interconnected in that each influenced the others. Findings contribute to the general conversation about meeting the biopsychosocial needs of nursing home residents in an integrated healthcare delivery system and more broadly, the role of long-term care facilities in general in planning for future disasters.

Provider Stakeholders' Perceived Benefit from a Nascent Health Information Exchange: A Qualitative Analysis

We sought to better understand the perceived costs and benefits of joining a nascent health information exchange (HIE) from the perspective of potential provider organization participants. We therefore conducted semi-structured interviews with organizational representatives. Interview transcriptions were thematically coded, and coded text was subsequently aggregated to summarize the breadth and depth of responses. Although no respondents expected HIE to result in net financial benefit to their organization, all respondents recognized some potential benefits, and some respondents expected HIE to result in overall organizational benefit. Disproportionate benefit was expected for the poorest, sickest patients. Many respondents had concerns about HIE increasing the risk of data security breaches, and these concerns were most pronounced at larger organizations. We found little evidence of organizational concern regarding loss of patients to other organizations or publication of unfavorable quality data. If HIE’s greatest benefactors are indeed the poorest, sickest patients, our current health care financing environment will make it difficult to align HIE costs with benefits. To sustain HIE, state and federal governments may need to consider ongoing subsidies. Furthermore, these governments will need to ensure that policies regulating data exchange have sufficient nationwide coordination and liability limitations that the perceived organizational risks of joining HIEs do not outweigh perceived benefits. HIE founders can address organizational concerns by attempting to coordinate HIE policies with those of their largest founding organizations, particularly for data security policies. Early HIE development and promotional efforts should not only focus on potential benefits, but should also address organizational concerns.

Hurricanes Katrina and Rita and the Department of Veterans Affairs: A Conceptual Model for Understanding the Evacuation of Nursing Homes

Background: Hurricanes Katrina and Rita exposed significant flaws in US preparedness for catastrophic events and the nation’s capacity to respond to them. These flaws were especially evident in the affected disaster areas’ nursing homes, which house a particularly vulnerable population of frail older adults. Although evacuation of a healthcare facility is a key preparedness activity, there is limited research on factors that lead to effective evacuation. Objective: Our review of the literature on evacuation is focused on developing a conceptual framework to study future evacuations rather than as a comprehensive assessment of prior work. Methods: This paper summarizes what is known thus far about disaster response activities of nursing homes following natural and human-caused disasters, describes a conceptual model to guide future inquiry regarding this topic, and suggests future areas of research to further understand the decision-making process of nursing home facilitators regarding evacuating nursing home residents. To demonstrate the utility of the conceptual model and to provide guidance about effective practices and procedures, this paper focuses on the responses of Veterans Health Administration (VHA) nursing homes to the 2 hurricanes. Results: Quarantelli’s conceptual framework, as modified by Perry and Mushkatel, is useful in guiding the development of central hypotheses related to the decision-making that occurred in VA nursing homes and other healthcare facilities following Hurricanes Katrina and Rita. However, we define evacuation somewhat differently to account for the fact that evacuation may, in some instances, be permanent. Thus, we propose modifying this framework to improve its applicability beyond preventive evacuation. Conclusions: We need to better understand how disaster plans can be adapted to meet the needs of frail elders and other residents in nursing homes. Moreover, we must address identified gaps in the scientific literature with respect to health outcomes by tracking outcomes over time. Information on health outcomes would allow administrators and others to more appropriately weigh the balance of risks and benefits associated with evacuation. Without this understanding of the relationship between evacuation and health outcomes, it is not possible to develop effective response plans that are tailored to meet the needs of nursing home residents.

Organizational Challenges in Developing One of the Nationwide Health Information Network Trial Implementation Awardees

Health care in the United States is rarely delivered in a coordinated manner. Current methods to share patient information are inefficient and may lead to medical errors, higher readmission rates, and delays in the delivery of needed health services. This qualitative study describes lessons learned concerning the early implementation of one Nationwide Health Information Network (NHIN) site in Long Beach, CA during its first year of operation. The Long Beach Network for Health (LBNH) focused on an incremental effort to exchange health information. Despite a limited concentration on emergency department care, virtually all respondents noted concerns regarding the sustainability, or business case, for the exchange of health information. Nevertheless, respondents were encouraged by progress on technological challenges and user requirements during this first year. The early gains in this process may, in turn, have laid the groundwork for future efforts to expand beyond the emergency department.

Deciding to use the emergency room: a qualitative survey of older veterans.

Increasing use in the past decade has created pressure for hospital emergency rooms (ERs). Healthcare provided through an ER is expensive and is not designed to meet the complex needs of an older, chronically-ill population. ER visits are presented as the outcome of a decision-making process. Thirty veterans who had visited the ER in the previous year were asked about their decisions to use the ER. Their responses reflected four distinct approaches to ER use, which are characterized by frequency (frequent/infrequent) and risk for social isolation (low/high). Appropriate interventions by social work personnel might reduce inappropriate use of the ER and enhance the care of this vulnerable population.

Disaster Planning for Home Health Patients and Providers: A Literature Review of Best Practices

Individuals receiving care in the home are vulnerable during disasters due to high rates of chronic disease, cognitive impairment, functional limitations, and physical disabilities as well as dependence on life-saving treatments and equipment. Increasing disaster preparedness among home health care recipients decreases the likelihood of adverse health outcomes and lessens the burden on community hospitals and emergency responders. A literature review examined existing home health organization policies and procedures, lessons learned in the field, and expert recommendations for improving home-based patient disaster preparedness. This review addressed preparedness on three levels: organization, provider, and patient. The results (1) indicate gaps between established and recommended tools and policies and adopted policies, and (2) demonstrate marked differences in approaches to evaluation, classification, education, and triage between organizations.

The role of veterans affairs in emergency management: a systematic literature review.

UNLABELLED The Department of Veterans Affairs (VA) is a key player in emergency management for both veterans and civilians. Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of article characteristics include methodology, phase of emergency management addressed in the research, and study design. Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to generate suggestions for future research. KEYWORDS Veterans Affairs, veterans, disaster, emergency.The Department of Veterans Affairs (VA) is a key player in emergency management for both veterans and civilians. Unfortunately, limited evidence-based research findings exist regarding the role and experience of VA during disasters. The present study is a systematic literature review of 41 published, peer-reviewed articles regarding VA and emergency management. Trained researchers utilized a data abstraction tool and conducted a qualitative content analysis. A description of article characteristics include methodology, phase of emergency management addressed in the research, and study design. Five topic categories emerged from the review including effects of disaster on mental health status and services use, effects of disaster on general health services use, patient tracking, evacuation, and disaster planning/preparation. Findings were used to generate suggestions for future research. Keywords: Veterans Affairs, veterans, disaster, emergency

Developing a Home-Based Primary Care Disaster Preparedness Toolkit.

OBJECTIVE Health agencies working with the homebound play a vital role in bolstering a communitys resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs. METHODS We conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate). RESULTS Respondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their programs disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05). CONCLUSION This toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkits utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patients personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56-63).

Contents Vol. 56, 2010

Behavioural Science Section K.J. Anstey, Canberra L. Clare, Bangor D. Gerstorf, University Park, Pa. J.D. Henry, Sydney T. Hess, Raleigh, N.C. S.M. Hofer, Victoria I. Kryspin Exner, Wien D.C. Park, Dallas, Tex. K. Ritchie, Montpellier J. Smith, Ann Arbor, Mich. Experimental Section C. Bertoni-Freddari, Ancona R. Faragher, Brighton C. Franceschi, Bologna T. Fülöp, Sherbrooke L. Gavrilov, Chicago, Ill. L. Haynes, Saranac Lake, N.Y. K. Hirokawa, Tokyo G.J. Lithgow, Novato, Calif. M. Rose, Irvine, Calif. A. Viidik, Wien J. Vijg, Bronx, N.Y.