Shayna Stein

Satisfaction with ambulatory care and compliance in older patients.

Predictors of satisfaction with ambulatory care and compliance in 267 older and 581 younger patients were determined. Each patient rated a 45-item satisfaction-with-care-scale. Race, SES, marital status, distance from clinic, severity of illness (as measured by physician ratings, self-health assessment, number of medications, number of diagnoses, and number of clinic visits and hospitalizations in the prior year), and physician expectations of improvement were entered as predictors into stepwise multiple regression analyses for the elderly and the young. Predictors of better satisfaction in the young were less severe conditions, being nearer to the clinic and having fewer prior clinic visits over the year. In the elderly, having fewer visits to the clinic, more expectation of improvement by the physician and less severe conditions were associated with better satisfaction. Severity and clinic visits were predictors in each age group. The young, however, were also influenced by distance from the clinic. The elderly were influenced separately by the physicians prognosis. Thus, when the more impaired elderly are seen frequently without expecting a benefit, their satisfaction with care is poor. Further, satisfaction with care was correlated significantly with compliance in the elderly but not in the young. Findings suggest that improving satisfaction with care might also improve rates of compliance with the medical regimen in older patients.

Evaluation of continuing education for long-term care personnel: impact upon attitudes and knowledge.

Nursing assistants (aides) and licensed practical nurses (LPNs) from three proprietary nursing homes participated in a continuing education program designed to enhance knowledge and attitudes about the elderly in long‐term care. The program covered six weeks for the initial 115 aides and one full‐day seminar for the 83 LPNs. The content covered knowledge about human anatomy, the physiology of normal aging, physical and psychosocial problems of the elderly and, for the nurses, problems associated with cardiovascular accidents. The final participants (29 aides and 52 LPNs) consisted of those who were tested before and after their training with respect to knowledge, life satisfaction, and attitudes toward the elderly. Results indicated overall favorable changes for both aides and LPNs, particularly in the areas of increased knowledge and more positive attitudes. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long‐term care facilities, and it should be a first step toward improving the quality of care for elderly residents.

Geriatric sweet tooth. A problem with tricyclics.

Ninety‐three consecutive outpatients receiving tricyclic antidepressants for at least one month were asked about medication side effects, including excessive appetite and craving for sweets. Prevalence of these side effects and their relationship (Pearson r) to type of medication, dosage, patient characteristics, diagnoses, weight gain, and clinical improvement were examined. More than one‐third (38%) reported excessive appetite, 34% had a craving for sweets, and about one‐half (48%) had either one or the other of these reactions. These adverse side effects were related significantly to weight gain (P < .001) and a higher dose of medication, but not to clinical improvement. Clinical improvement was in the moderate‐to‐good range but was not related to medication dose. Because increasing degrees of overweight can pose serious health risks, especially for the elderly, it is critical for future research to examine ways of maintaining therapeutic benefit while minimizing food craving side effects. Methods of dealing with these issues clinically are suggested.

Effect of Nursing Home Staff Training on Quality of Patient Survival

This study tests the effects of nursing home staff training in care for the dying on the quality of life of terminally ill patients. Ten matched community nursing homes were assigned randomly to experimental (training) or control (no training) conditions. Patients (N = 306) admitted to the homes were assessed at admission, one month, and three months concerning quality of life as measured by depression, alienation, self-esteem, and locus of control. Satisfaction with care was also measured at one and three months. Patients in trained homes had less depression and greater satisfaction with care than patients in control homes at one and three months. Training effects were similar in all of the five homes. The study shows that a favorable impact on patient care can be achieved when staff in nursing homes are trained to work with dying patients.

The Relationship of Self-help Networks to Physical and Psychosocial Functioning

One hundred fifty‐eight elderly persons living in retirement hotels and apartments were classified by being receivers or givers of help to their neighbors into four groups: givers, getters, both (GG), or neither (NGG). The aim was to determine whether the groups differed in personal characteristics, physical functioning, or psychologic adjustment at baseline and six months later. The groups did not differ in personal characteristics. The NGG group (N = 55) functioned significantly less well, both physically and psychosocially. At six months, with baseline scores adjusted, the givers had fewer illnesses and the GG group had better self‐esteem. Thus, subjects did not change significantly in other variables. Efforts to enhance the ability of the NGG group to form social networks, if applied cautiously, may help to improve their overall adjustment.

Effectiveness of a Service Workers' Action Team (SWAT) for the Elderly*

The Service Workers Action Team (SWAT) is a three‐year, community‐based demonstration project for the elderly, with the primary goal of improving or maintaining psychosocial and physical functioning. With baseline scores and selected demography data as covariates, 243 experimental SWAT recipients were compared (manova) with 158 controls after six months, with respect to: 1) Hopkins Symptom Checklist, 2) Social Participation Scale, 3) Life Satisfaction Scale, 4) Self‐Esteem Scale, 5) Activities of Daily Living, and 6) four selected health‐related questions. The frequency of responses for the experimental elderly were computed for program satisfaction at the time of follow‐up. In terms of psychosocial functioning, the experimental group fared significantly better at six months than did the control group. In terms of health, both groups declined in functional status, as evidenced by their scores on Activities of Daily Living, though the experimental subjects still were significantly better than the controls. The majority of the experimental group found the program to be helpful, with suggestions made for program expansion.

Future Concerns and Recent Life Events of Elderly Community Residents

Fifty‐eight elderly community residents completed a 37–item inventory that measured their level of concern about potentially stressful events or emotions. Afterwards, they indicated whether selected life events had actually occurred in the last six months. All data were intercorrelated to determine if there were relationships between total scores, personal characteristics, and recent life events. Results showed elderly persons in this sample to be most worried about immediate economic survival and disability. Those in poorer health who had less education, were living with their children, and had less tenure in the neighborhood evidenced greater total concern.

Sterilization among American Indian and Chicano Mothers

In a large study concerning family size and birth control among women from five cultures in the Miami, Florida, area, it was noted that 60 percent of the Miccosukee and Seminole Indians having five or more children were surgically sterile. Compared with the incidence for whites (30%) and a similar socio-economic group of Chicanos (20%), the incidence among Indian women seemed highly inflated. To examine why this should be so and whether or not there were negative effects of such sterilization, analyses examined both pre- and post-operative differences between the Indians and a comparison group of Chicanos. Though there were significant cultural differences found for the women, these differences did not interact significantly in predicting sterilization. However, sterilized women reported significantly more pregnancy complications. Factors which may have contributed to the greater incidence of tubal ligation among Indian women are explored.

Ratings of Impairment and Functional Status in Prediction of Mortality

Little attention has been given to selecting a set of variables that define the dimensions of health or illness as a totality. This could have utility, particularly in the field of aging, for better assessment of the persons residual capacity and proper selection of treatments or services. Generally, scales are assembled to measure discrete areas of physical, mental, and social functioning without regard to any overlap between scales or items in the over-all association with some dependent variable. Reducing these to the ones that uniquely contribute to outcome is a desirable research goal. Even within the area of physical health, there are dimensions such as impairment and disability (functional status). Impairment is usually defined as organic pathology judged by a physician, whereas disability or functional status can be determined through observation of the persons self-care ability in such areas as eating, dressing, toileting, bathing, and ambulation. However, some people who are quite impaired continue to function at rather high levels and some nor so organically impaired may exhibit poor functional states. Most medical research has relied on measurement of functional status (since these ratings are based on more objective observation) rather than on estimates of degree of impairment to organ systems. Yet, there seems to be justification for both types of assessment. The purpose of this study was to determine the relationship between these two areas in the prediction of mortality. Males (n = 714) averaging 67 yr. were rated by their physicians in the hospital on a 13-item impairment scale (1) and by a ward nurse on a 16-item functional status scale (2), just before their transfer to community nursing homes. Follow-up 6 mo. later showed that 221 patients (31%) had died. Both stepwise multiple regression and stepdown discriminant function analyses were used to identify the predictors in terms of unique contribution and accuracy in classification. Scales were first analysed separately and then all 29 items were combined. Although 8 functional items discriminated between living and dead at a univariate level. only 5 uniquely predicted mortality. All 16 functional scores had an accuracy in classification of 68%. Five of the 13 impairment items were statistically significant at a univariate level and also contributed significantly as predictors. All 13 impairment items had an accuracy in classification of 74%. Using the combined 29 items, 6 variables (4 impairment and 2 function) emerged as accounting significantly for 80% of the predictable variance in mortality and achieving an accuracy in classification of 77%. At the .O1 level, vascular, respiratory, and neurological impairment and need for assistance with earing were identified. Degree of mental depression and impairment ratings on hepatic system were associated with mortality (P < .05). Our data suggest that combining selected functional status ratings with estimates of impairment led to better classification of clinical condition and predictors of outcome.

The Effect of Drug Use on Social Work Students' Treatment Attitudes

Abstract Sixty first-year social work students were studied regarding their drug experiences and attitudes. A minority had experimented with drugs other than marijuana, and over half had tried marijuana. Older age was found to be associated with less drug use and more negative attitudes. Experience with drugs was also related to less negative attitudes toward users and more positive views about treatment effectiveness. Since social work is a profession concerned with helping those in trouble, particularly substance abusers, drug experiences and attitudes of social workers need to be explored further concerning their relationship to treatment outcome.