Tracy Chippendale

Testing a family-centered intervention to promote functional and cognitive recovery in hospitalized older adults.

A comparative trial using a repeated‐measures design was designed to evaluate the feasibility and outcomes of the Family‐Centered Function‐Focused‐Care (Fam‐FFC) intervention, which is intended to promote functional recovery in hospitalized older adults. A family‐centered resource nurse and a facility champion implemented a three‐component intervention (environmental assessment and modification, staff education, individual and family education and partnership in care planning with follow‐up after hospitalization for an acute illness). Control units were exposed to function‐focused‐care education only. Ninety‐seven dyads of medical patients aged 65 and older and family caregivers (FCGs) were recruited from three medical units of a community teaching hospital. Fifty‐three percent of patients were female, 89% were white, 51% were married, and 40% were widowed, and they had a mean age of 80.8 ± 7.5. Seventy‐eight percent of FCGs were married, 34% were daughters, 31% were female spouses or partners, and 38% were aged 46 to 65. Patient outcomes included functional outcomes (activities of daily living (ADLs), walking performance, gait, balance) and delirium severity and duration. FCG outcomes included preparedness for caregiving, anxiety, depression, role strain, and mutuality. The intervention group demonstrated less severity and shorter duration of delirium and better ADL and walking performance but not better gait and balance performance than the control group. FCGs who participated in Fam‐FFC showed a significant increase in preparedness for caregiving and a decrease in anxiety and depression from admission to 2 months after discharge but no significant differences in strain or quality of the relationship with the care recipient from FCGs in the control group. Fam‐FFC is feasible and has the potential to improve outcomes for hospitalized older adults and their caregivers.

Effect of life review writing on depressive symptoms in older adults: a randomized controlled trial.

OBJECTIVE We examined the effects of engaging in the occupation-based intervention of life review through writing on expressed depressive symptoms as measured with the Geriatric Depression Scale in older adults residing in senior residences. METHOD The study design was a randomized controlled trial that took place in four senior residences in New York City. Forty-five participants (23 treatment, 22 wait-list control) ≥ 65 yr old participated in the 8-wk, once-weekly autobiographical writing workshop, Share Your Life Story (Sierpina, 2002). RESULTS Depressive symptoms were significantly less prevalent for the treatment group than for the control group after the 8-wk life review program (repeated-measures analysis of variance p = .03). CONCLUSION The results suggest that the Share Your Life Story writing workshop is an effective occupation-based intervention for occupational therapists to use with older adults who reside in senior residences.

Enabling "aging in place" for urban dwelling seniors: An adaptive or remedial approach

ABSTRACT Given that the majority of older adults prefer to remain in their homes as they age, rather than relocate to an institution or live with family members, “aging in place” is critical to life satisfaction and quality of life for the older adult. To address this issue, the authors define place and discuss the aspects of place that could contribute to an individuals ability to “age in place.” Factors addressed include social capital and the physical environment (including the home and neighborhood environments). The authors present an argument for consideration to facilitate successful “aging in place,” and suggest an adaptive rather than remedial occupational therapy approach. This approach is contrary to the usual way of thinking in occupational therapy practice, where compensation or adaptation is usually not considered until remediation is complete. Finally, plans for the future in occupational therapy practice are discussed with emphasis on embracing the clients needs from a social capital perspective.

The Neighborhood Environment: Perceived Fall Risk, Resources, and Strategies for Fall Prevention

PURPOSE OF THE STUDY To explore the experience of older adults in their neighborhood in relation to perceived fall risk, fear of falling (FOF), and resources/strategies for fall prevention. DESIGN AND METHODS Fourteen older adults, 65 years of age and older from 3 urban senior centers, participated in this qualitative study. The semistructured interview guidelines and background questionnaire were developed by the researchers based on the literature and an existing measure of walkability. Both tools were refined based on pilot interviews with seniors. Collaizzis phenomenological method was used for data analysis. RESULTS Five themes emerged from the data: (a) The built environment contributes to perceived fall risk and FOF, (b) personal strategies used to adapt to perceived neighborhood fall risks-behavioral approaches, (c) resources for physical activity and safety, (d) barriers to physical activity and exercise, and (e) neighborhood features as a motivator. IMPLICATIONS Urban-dwelling seniors perceive that neighborhood features contribute to or mitigate fall risk and FOF. Behavioral strategies are used by seniors to prevent outdoor falls. The findings can help clinicians develop targeted fall prevention interventions for well elders and help urban planners to design and retrofit urban environments to reduce fall risk.

Testing family-centered, function-focused care in hospitalized persons with dementia

AIM Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. MATERIALS & METHODS A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). RESULTS The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. CONCLUSION Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.

Anxiety in family caregivers of hospitalized persons with dementia: contributing factors and responses.

Background:Baseline health and functional vulnerabilities increase the risk for complications in persons with dementia and predispose family caregivers (FCGs) to increased stress. Methods:This secondary analysis used a combined quantitative and qualitative approach. Regression analyses examined the contribution of patient and FCG characteristics to FCG anxiety. Interviews with FCGs explored the experiences and responses of FCGs during hospitalization of their family member with dementia. Results:Lower patient physical function and higher caregiver strain were associated with higher FCG anxiety. FCGs described the following themes related to the hospitalization: (1) added strain, (2) care-related worries, (3) keeping vigil, (4) need to be heard, and (5) enablers of FCGs. Conclusions:Routine evaluation of caregiver strain and baseline patient function is integral to informing the transitional planning for persons with dementia. The FCG responses suggest that a multifactorial approach (family-centered policies of partnership in care, staff education addressing the specialized needs of patients and family members, and attention to promoting functional recovery) may benefit both hospitalized patients with dementia as well as FCGs and warrants future research.

Factors Associated With Depressive Symptoms Among Elders in Senior Residences: The Importance of Feeling Valued by Others

This study investigated (a) whether feeling valued and important is a significant predictor of depressive symptoms in elders residing in senior residences and (b) whether feeling valued and important is a more important predictor of depressive symptoms than self-rated health in this population. The sample consisted of older adults (N = 47) from four senior residences in New York City. The Geriatric Depression Scale was used to assess depressive symptoms and a multiple regression analysis was employed for the analysis. Self-rated health, education level, and feeling valued and important were significant predictors of depressive symptoms. Further, the unique contribution of feeling valued and important accounted for an equal amount of the variance in depressive symptoms as compared to the well established predictor of self-rated health. Therefore, given the importance of feeling valued and important, interventions that provide the opportunity for elders in senior residences to provide meaningful contributions to family and society should be considered.

Indoor and outdoor falls among older adult trauma patients: A comparison of patient characteristics, associated factors and outcomes

The aim of the present study was to examine significant differences in patient characteristics, associated factors and outcomes for indoor versus outdoor falls among trauma patients.

Development and validity of the Outdoor Falls Questionnaire.

The aim of this study was to develop and examine the content and face validity of the Outdoor Falls Questionnaire. The initial questionnaire was developed by the primary investigator on the basis of the existing literature on outdoor falls. A rating scale was used to obtain feedback from content experts to ascertain the validity of each question and the questionnaire as a whole. Cognitive interviewing of community-dwelling seniors was performed to ensure accurate interpretation of each question. An expert in questionnaire design reviewed the questions for language and structure. Content experts rated the questionnaire as a whole as ‘quite relevant’ or ‘very relevant’ to outdoor falls. The majority of individual questions (22 of 32) were rated by experts as either quite relevant or very relevant. Feedback from reviewers and older adults on specific questions were incorporated into the revised questionnaire. Preliminary testing demonstrates that the Outdoor Falls Questionnaire has good content and face validity. Further testing is needed to examine factor structure, to establish reliability, internal consistency, and interclass correlations.

Life Satisfaction Among Elders in Senior Residences: A Pilot Study

ABSTRACT Objective: This pilot study investigated predictors of life satisfaction among elders residing in senior residences with a focus on feeling valued and important (FVI), a seldom-studied predictor that has the potential for late-life changes through occupational therapy intervention. Method: Using existing data from an intervention study (N = 47), simultaneous multiple regression analysis was employed. Results: The regression model, which included predictors of self-rated health, education level, and FVI, was significant F(3,43) = 21.16, p < 0.001. Further, FVI was a stronger predictor of life satisfaction than the well-established predictor of self-rated health. Conclusion: FVI is a significant predictor of life satisfaction in older adults residing in senior residences. Practice implications include promoting participation in occupations that provide the opportunity for meaningful contributions to family and society.