Rebecca S. Allen

Conversational coherence: discourse analysis of older adults with and without dementia

Abstract The purpose of this study was to compare the discourse profiles of 30 nursing home residents with dementia and of 30 healthy older adults. A total of 60 transcripts of interview style conversations were analyzed using a discourse analysis schema. The results revealed a higher frequency of discourse building features, such as coherence and cohesion, for healthy adults compared to adults with dementia. Conversely, discourse-impairing features, such as disruptive topic shifts and empty phrases, were found more often in conversations of adults with dementia compared to healthy adults. Conversational partners deviated from their conversation protocol when talking to adults with dementia by including facilitative strategies in the conversation. Discourse features in interview style conversations in adults with dementia reflect declines in their memory.

Rey-Osterrieth Complex Figure : Psychometric characteristics in a geriatric sample

Abstract We studied the psychometric characteristics of the Rey-Osterrieth Complex Figure (ROCF) in an aged sample. One hundred and seven healthy white males and females, 50 to 79 years of age, received the ROCF and Taylor Complex Figure (TCF) as well as a screening battery of neuropsychological tests. Interrater, alternate form, test-retest, and internal consistency reliability were adequate to good for recall trials of the ROCF, with the copy trial generally lower in reliability. Validity procedures confirmed the sensitivity of the ROCF to Alzheimers Disease, while factor analysis suggested that the ROCF loaded on a visuospatial perceptual/memory dimension. ROCF scores were significantly correlated with age and years of education, although not with sex. These results are generally supportive of the psychometric quality of the ROCF in an elderly sample. Once adequate normative data become available, the ROCF should prove a useful tool for clinicians in assessing elderly patients.

Vulnerability of Older Latino and Asian Immigrants with Limited English Proficiency

OBJECTIVES: To explore the implications of limited English proficiency (LEP) for disparities in health status and healthcare service use of older Latino and Asian immigrants.

Testing a Theoretical Model of the Stress Process in Alzheimer's Caregivers With Race as a Moderator

PURPOSE The primary aim of this study was to test the stress process model (SPM; Pearlin, Mullan, Semple, & Skaff, 1990) in a racially diverse sample of Alzheimers caregivers (CGs) using structural equation modeling (SEM) and regression techniques. A secondary aim was to examine race or ethnicity as a moderator of the relation between latent constructs (e.g., subjective stressors and role strain) in the SPM. SAMPLE Participants included White or Caucasian (n = 212), Black or African American (n = 201), and Hispanic or Latino (n = 196) Alzheimers CGs from the Resources for Enhancing Alzheimers Caregiver Health (REACH) II clinical trial. RESULTS SEM revealed that the Pearlin model obtains a satisfactory fit across race or ethnicity in the REACH II data, despite significant racial differences in each of the latent constructs. Race or ethnicity moderated the impact of resources on intrapsychic strain, such that CGs reported similar intrapsychic strain across race at lower levels of resources, but White or Caucasian CGs reported more intrapsychic strain than Black or African American or Hispanic or Latino CGs when resources are higher. IMPLICATIONS Strengths and weaknesses for each race or ethnicity vary considerably, suggesting that interventions must target different aspects of the stress process to provide optimal benefit for individuals of different cultural or ethnic backgrounds.

Legacy Activities as Interventions Approaching the End of Life

We examined the efficacy of an innovative family-based intervention designed to decrease caregiving stress and increase family communication among individuals with chronic, life-limiting illnesses and their family caregivers in a randomized, contact control group design. The intervention group received three home visits in which the interventionist actively worked with the family to construct a personal Legacy, usually a scrapbook with photographs or audiotaped stories. Control group families received three supportive telephone calls. Of the 42 families that entered the project, 31 families completed follow-up assessments within 9 to 10 weeks (14 control; 17 intervention; 72% African American) for a retention rate of 74%. Intervention caregivers showed reduced caregiving stress in comparison with control group caregivers, who showed increases in stress. Intervention patients reported decreased breathing difficulty and increased religious meaning. Caregivers and patients reported greater social interaction on the part of the patient. All participants in the intervention group initiated a Legacy activity and reported that Legacy improved family communication. Legacy interventions hold promise and are simple to implement.

Family Issues in End-of-life Decision Making and End-of-life Care

Family members are involved in every aspect of end-of-life decision making and care. The present article reviews family involvement in providing care during chronic and terminal illness, in discussions and plans for advance directives, in decision making during chronic illness, in executing advance directives and making critical decisions near the end of life, and the long-lasting effects of caregiving and difficult decisions on the family member during bereavement. Although legal standards and much of the research on end of life emphasize individual decision making and the value of autonomy, end-of-life care and decisions should be increasingly understood within a family context. There is also increasing need to study how issues of race, ethnicity, and culture affect end-of-life care and decisions within families.

Widowhood and Spirituality: Coping Responses to Bereavement

SUMMARY Nearly half of women age 65 or older are widows and nearly 70% of these women live alone. Because older women are three times more likely than their male counterparts to be widowed, widowhood has been labeled a primarily female phenomenon. This review article has two aims: (a) to discuss the impact of widowhood on the lives of older women and (b) to discuss how religion and spirituality may be used as coping methods for conjugal loss. After reviewing the literature the authors conclude that older women use religious coping as well as religious and spiritual beliefs and behaviors to facilitate positive adjustment to the loss of a spouse.

Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making

PURPOSE We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient-proxy agreement. DESIGN AND METHODS Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adults preferences for cardiopulmonary resuscitation, artificial feeding and fluids, and palliative care in hypothetical illness scenarios. The responses of 34 Caucasian dyads and 30 African American dyads were compared to determine the extent to which family members could accurately predict the treatment preferences of their older relative. RESULTS We found higher treatment preference agreement among African American dyads compared with Caucasian dyads when considering overall raw difference scores (i.e., overtreatment errors can compensate for undertreatment errors). Prior advance care planning moderated the effect such that lower levels of advance care planning predicted undertreatment errors among African American proxies and overtreatment errors among Caucasian proxies. In contrast, no racial/ethnic differences in treatment preference agreement were found within absolute difference scores (i.e., total error, regardless of the direction of error). IMPLICATIONS This project is one of the first to examine the mediators and moderators of dyadic racial/cultural differences in treatment preference agreement for end-of-life care in hypothetical illness scenarios. Future studies should use mixed method approaches to explore underlying factors for racial differences in patient-proxy agreement as a basis for developing culturally sensitive interventions to reduce racial disparities in end-of-life care options.

Perceived Income Inadequacy as a Predictor of Psychological Distress in Alzheimer's Caregivers

The authors examined perceived income inadequacy as a predictor of self-reported depressive symptomatology and anxiety in the original sites of the Resources for Enhancing Alzheimers Caregiver Health I project. Perceived income inadequacy, self-reported household income, and control factors (e.g., subjective health) were entered into hierarchical regression analyses predicting psychological distress. Findings suggest that perceived income inadequacy and not household income significantly predicted more self-reported depressive symptomatology and greater self-reported anxiety. This supports previous findings that objective income measures alone are not adequate indicators of socioeconomic status in older adults.

Staff Knowledge and Perceptions of Sexuality and Dementia of Older Adults in Nursing Homes

Objectives: Adults hold negative attitudes toward sexual expression in late life. We investigated knowledge and attitudes about older adult sexuality and dementia among staff in nursing homes (NHs). Method: We acquired staff demographics, knowledge of dementia and sexuality, and attitudes of sexuality. Staff participated in focus groups and received continuing education credit. Results: The three NHs had an average census of 178 beds. Participants’ (N = 100) mean age was 38.53. The most common type of sexual contact reported was nondemented male with nondemented female (67.5%), followed by demented male with demented female (53.6%). Participants endorsed neutral attitudes about late-life sexuality. Focus groups revealed a need for more training and effective interventions to balance resident safety and autonomy. Discussion: Staffs’ knowledge of sexuality and dementia, desire for guidance in “managing” sexual expression, and neutral attitudes toward late-life sexuality supports the need for educational interventions on sexuality and dementia in NH.