Norm O'Rourke

Functions of reminiscence and mental health in later life.

This study examines the extent to which various forms of reminiscence predict life satisfaction and psychiatric distress with and without control for the contribution of personality traits (n = 420). Among older adults, reminiscences to revive old problems and to fill a void of stimulation were associated with lower life satisfaction and greater psychiatric distress. Reminiscence to maintain connection with a departed person also predicted psychiatric distress. In contrast, reminiscences for death preparation and to foster conversation were linked with higher life satisfaction. Based on our proposed model of the functions of reminiscence, discussion focuses on adaptive and non-adaptive uses of reminiscence in later life.

Functions of reminiscence and the psychological well-being of young-old and older adults over time

Existing cross-sectional research demonstrates an association between reminiscence functions and well-being in later life. The results of this study replicate and extend previous findings in separate participant samples above and below 70 years of age. Findings suggest a link between reminiscence functions and psychological well-being, and indirectly between reminiscence and well-being 16 months thereafter. Invariance analyses reveal few differences in association between reminiscence and well-being when young-old (n = 196) and older adults (n = 215) are compared. These findings suggest a direct positive association between self-positive reminiscence functions (identity, death preparation, and problem-solving) and a direct negative association between self-negative functions (boredom reduction, bitterness revival, and intimacy maintenance) and psychological well-being (life satisfaction, depressive, and anxiety symptoms). In contrast, prosocial reminiscence functions (conversation, teach/inform others) appear to have an indirect association with well-being (i.e., via self-positive and self-negative functions). These findings are discussed relative to evolving theory and research linking cognition and health.

The Differential Influence of Culture Change Models on Long-Term Care Staff Empowerment and Provision of Individualized Care

La présente étude vise à déterminer si des différences existent entre les divers modèles de changement de culture (MCC) relativement à la perception du personnel soignant agréé à l’égard de l’accès aux structures d’habilitation et des prestations connues de soins individualisés. Nous avons embauché des employés qui travaillent dans des établissements ayant mis en œuvre les modèles sociaux de soins Eden Alternative, GentleCare ou Facility Specific ou n’ayant pas implanté de MCC. Nous avons effectué des analyses de variance multidimensionnelles de chacun des trois groupes de personnel soignant (infirmières autorisées, infirmières auxiliaires autorisées et aides-soignants) en fonction de chaque CCM. Les résultats indiquent qu’il existe des différences considérables entre le personnel soignant agréé et entre chacun des MCC. Plus le personnel soignant côtoie quotidiennement les patients, plus l’influence des MCC semble affecter l’autonomisation perçue et les prestations connues de soins individualisés. Des recherches suggèrent que les employés travaillant dans des établissements ayant mis en œuvre un des modèles sociaux de soins mentionnés ci-dessus profitent des meilleures conditions de travail. Inversement, parmi les établissements ayant implanté un de ces modèles, seul le personnel d’un établissement a fourni des réponses différentes de celles des employés travaillant dans des établissements sans MCC. With this study we set out to determine if differences exist across culture change models (CCM) in relation to formal caregivers’ perceived access to empowerment structures and reported provision of individualized care. We recruited staff working in facilities that had implemented the Eden Alternative, GentleCare, Facility Specific Social Models of Care (FSSMOC), or no CCM. Multivariate analyses of variance (MANOVA) compared these constructs by CCM for each of three caregiver groups (Registered Nurses, Licensed Practical Nurses, and care aides). Results suggest that considerable differences exist between formal caregivers and by CCM. The greater caregivers’ day-to-day contact with residents, the more CCMs appear to affect perceived empowerment and reported provision of individualized care. Findings suggest the greatest benefits existed for staff working in facilities with a FSSMOC. Conversely, in only one instance did responses from staff in Eden Alternative facilities differ from those in facilities with no CCM.

Marital Aggrandizement as a Mediator of Burden Among Spouses of Suspected Dementia Patients

Recent research suggests that the single strongest predictor of burden among dementia caregivers is a measure of marital aggrandizement (Marital Conventionalization Scale). The current study corroborates the significant inverse relation between these constructs. In addition, there appears to be little association between this response style and more standard social desirability constructs (i.e. self-deception, impression management). Furthermore, the tendency to discount negative experience in ones marital history appears distinct from emotion- and problem-focussed coping as defined within Lazarus and Folkmans cognitive phenomenological model. The propensity to idealize ones spouse and marriage is discussed relative to the reconstructionist theory of memory and social exchange theory.

Factor Structure of the Center for Epidemiologic Studies-Depression Scale (CES-D) Among Older Men and Women Who Provide Care to Persons with Dementia

The Center for Epidemiologic Studies–Depression Scale (CES–D) is among the most widely used depression screening measures. Existing research suggests a higher order factor structure of responses among older adults (factors labeled as Depressive Affect, Absence of Well-being, Somatic Symptoms, and Interpersonal Affect each loading on a 2nd-order depression factor). This study extended this research to ascertain whether this structure is equivalent (or invariant) between men and women. Findings suggest that the number and relative contribution of each factor is similar for male and female caregivers of persons with dementia. Furthermore, interpretation of CES–D items is statistically indistinguishable for 17 of 20 items across gender within this randomly identified, national sample of respondents. Results of this study support the higher order factor structure of the CES–D and provide data in support of the concurrent validity and reliability of responses within a population at elevated risk for depression.

Development and Validation of a Couples Measure of Biased Responding: The Marital Aggrandizement Scale

More than 30 years ago, Edmonds (1967) recognized the need for a couples measure of biased responding. Like other categories of self-report instruments, marital measures are believed to be highly susceptible to distortion. In this study, we describe the development of the Marital Aggrandizement Scale (MAS). For this study, item analyses were performed on a subset of responses (n = 200). A priori inclusion criteria were applied from which a set of 18 items was selected. Three phases of validation research establish the reliability and validity of responses to the MAS among an international sample of older married adults (n = 410). The concurrent and discriminant validity of responses to this scale is demonstrated vis-à-vis separate measures of biased responding, marital satisfaction, and psychological well-being. Internal consistency was calculated as α = .84. Test-retest reliability was calculated as r(200) = .80 over an average interval of 15 months. The challenge remains to identify factors associated with the etiology and maintenance of this construct. Subsequent research is required to identify correlates and antecedents of marital aggrandizement across populations over time.

Cognitive Adaptation and Women's Adjustment to Conjugal Bereavement

ABSTRACT Conjugal bereavement is experienced by the majority of older women in enduring relationships. Although most experience considerable distress in the immediate aftermath of this loss, the majority adjusts over the course of time. The current study of self-selected participants applies the theory of cognitive adaptation in an attempt to distinguish between women who have successfully adjusted to the death of their husbands versus those who exhibit prolonged distress. Results of this study suggest that positivity biases in personally relevant information processing (i.e., self-deception, marital aggrandizement, dispositional optimism) are significantly associated with life satisfaction and the absence of psychiatric distress. The contribution of cognitive adaptation is maintained over and above that provided by personality variables (i.e., neuroticism, extraversion, openness to experience). Intervention strategies to treat enduring distress among widowed women are considered on the basis of these findings.

Functions of Reminiscence in Later Life as Viewed by Young and Old Adults.

Reminiscence is the process of thinking or telling about past experiences. The goal of this study was to investigate which functions young adults attribute to their own reminiscences, and to the reminiscences of older persons. The views of young adults on the reminiscences of older adults were also compared with the self-reports of older persons on their reminiscences. We used the Reminiscence Functions Scale (Webster, 1993,1997), which measures eight functions: Boredom Reduction, Death Preparation, Identity, Problem-Solving, Conversation, Intimacy Maintenance, Bitterness Revival, and Teach/Inform. Seventy-six undergraduate students reported on their own uses of reminiscences. A few weeks later, they gave their views regarding the functions for older persons on the same scale. Eighty-three adults over the age of 65 completed the scale regarding their own uses. Age-appropriate higher uses of the functions of Boredom Reduction, Identity and Problem-Solving characterized the young adults. Older adults most characteristically used reminiscence for Teach/ Inform, i.e. for transmission of life experiences. Compared to themselves, young adults believed that older adults reminisced more for practically all functions, which reflects the stereotypical view. When these beliefs were checked against the reports of older adults, it became clear that young adults overestimated almost all uses, especially Boredom Reduction, Death Preparation, and Teach/Inform. These findings reflect the prevalence of ageist assumptions regarding the uses of reminiscence by older persons.

Caregiver Burden and Depressive Symptomatology

Abstract The current study examines the association between burden and depression symptoms among cohabiting caregivers recruited as part of a longitudinal study of dementia incidence and patterns of care (Canadian Study of Health and Aging). Patterns of change were examined among informal caregivers among those continuing to live with community dwelling care recipients (five years subsequent to initial study participation, N = 137). With control for demographic variables and patient illness features, regression analyses suggest that burden exists as a significant antecedent of depressive symptomatology (subsequent to control for baseline depressive symptoms; F[11,125] = 3.71, p < .05). The reverse association, however, was not observed (again, subsequent to control for demographic variables, patient illness features, and baseline burden; F[11,125] = 1.88, ns). These findings support the operational definition of caregiver burden in which this construct is understood as a form of negative appraisal of current and future ability to cope with care demands.

Recurrent depressive symptomatology and physical health: a 10-year study of informal caregivers of persons with dementia.

Objective: To examine the degree to which recurrent depressive symptomatology predicts the decline in the health status of a randomly derived national sample of caregivers of persons with dementia. Method: Individuals with dementia and their caregivers were recruited from each Canadian province as part of a national epidemiologic study of dementia prevalence and the health and welfare of care providers. Both patients and caregivers were assessed at 3 points over a 10-year period. Cohabiting family members who shared the same residence as care recipients were selected for the current study (n = 96 pairs). We computed a repeated measures analysis of variance to compare the health of caregivers who were consistently asymptomatic for depression, of those symptomatic at 1 of 3 points of measurement, and of those symptomatic at 2 of 3 points. Results: As hypothesized, caregivers presenting with elevated depressive symptomatology at multiple points of measurement reported poorer and worsening physical health over time. Conclusions: The results of this study support the assertion that depressive symptomatology significantly predicts the decline in health status of caregivers of persons with dementia. Concerted effort to treat depression in this population is warranted to forestall this trajectory of decline and premature patient institutionalization.