Twyla J. Hill

Prescription for trouble: Medicare Part D and patterns of computer and internet access among the elderly

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 specifically encourages Medicare enrollees to use the Internet to obtain information regarding the new prescription drug insurance plans and to enroll in a plan. This reliance on computer technology and the Internet leads to practical questions regarding implementation of the insurance coverage. For example, it seems unlikely that all Medicare enrollees have access to computers and the Internet or that they are all computer literate. This study uses the 2003 Current Population Survey to examine the effects of disability and income on computer access and Internet use among the elderly. Internet access declines with age and is exacerbated by disabilities. Also, decreases in income lead to decreases in computer ownership and use. Therefore, providing prescription drug coverage primarily through the Internet seems likely to maintain or increase stratification of access to health care, especially for low-income, disabled elderly, who are also a group most in need of health care access.

Legally Extending the Family An Event History Analysis of Grandparent Visitation Rights Laws

This article examines the structural forces influencing the enactment of grandparent visitation rights statutes. Cox regression is used to analyze demographic changes, social change, state litigiousness, and regional proximity as factors affecting timing of first enactment. States with higher proportions of people of grandparent age, of minor grandchild age, and higher levels of urban residence were more likely to enact than were other states. States with higher divorce rates and higher numbers of neighboring states that previously had enacted or enacted during the same year were less likely to enact than were other states. This project illustrates the need for more empirical testing of the influence of structural variables on the enactment of family policy.

What's a Grandparent to Do? The Legal Status of Grandparents in the Extended Family

Grandparents have recently been the subject of much research; however, there has been little discussion of how they are affected by social institutions outside the extended family. This article focuses on government expectations of family relationships by describing state legislation regarding grandparents. These statutes are spread throughout all areas of law, not only family code. Some evidence exists for the importance of state interests and class issues in legislation. Grandparents are mentioned in statutes and are included in definitions of family more often than grandchildren, implying that children are defined in relation to their parents, whereas grandparents are defined in relation to the children. Grandparents appear to have more legal rights than responsibilities to grandchildren, but both privileges and obligations seem to be limited to situations of disruption in the middle generation.

Sexual self-perception and adjustment of cardiac patients: a psychometric analysis

The psychological impact of a cardiac event includes anxiety and depression, poor sexual quality, and diminished sexual satisfaction. Few measures capture psychosexual recovery following a cardiac event. This study evaluated the reliability and validity of the Sexual Self-Perception and Adjustment Questionnaire (SSPAQ) among cardiac patients (N = 128), measuring sexual anxiety, depression, self-efficacy, and satisfaction. Scale-level content validity was 0.97. After item analysis, 28 items were retained; Cronbach’s alpha is >0.90, indicating item appropriateness for the combined scale (0.97). A four-factor model was supported with each of the subscale items accounting for at least 64% of the variance. Construct validity comparing sexually active to inactive showed those inactive had significantly lower sexual self-perception. The SSPAQ is a cohesive measure of sexual self-perception, and findings suggest each subscale can be used independently for measures of sexual anxiety, sexual depression, sexual self-efficacy, and sexual satisfaction, and may be useful in research and clinical settings.

Medication use and predictors of sexual activity in men and women with CVD

Purpose:To examine the influence of cardiac and noncardiac medications on sexual activity by drug classification and generation of the drug, among men and women with cardiovascular disease. Data sources:This study was a subanalysis (n = 224) of survey data from a cross‐sectional sample of 336 cardiac patients. Self‐reported medications were categorized by generic drug name, classification, and subclass and/or generation of the drug. Sexual activity was the presence or absence of current sexual activity in the last 2 months. Conclusions:Patients taking generation one beta blockers, particularly men; diuretics as a class; and loop diuretics, were significantly less likely to be sexually active, with diuretics negatively influencing sexual activity in women, but not men. Certain antidepressant medications positively influenced sexual function, particularly for women. Nearly 20% of the variances in sexual activity were explained by younger age, fewer number of medications, higher education, and having a sexual partner. Implications for practice:A new finding meriting further study was that loop diuretics negatively impacted sexual activity, particularly for women; and further studies of women overall are clearly needed. Advance practice nurses play an important role in evaluating medications, proactively choosing drugs within a class or subclass less likely to cause sexual problems, and in promoting sexual quality of life of cardiac patients.

Sexual concerns of cardiac patients: Predictors and the influence of specific sexual activities

Background: Addressing sexual concerns of cardiac patients is integral to comprehensive patient-centered nursing care, and instruments for use across cardiac populations are needed to promote this activity. Knowing the factors that contribute to sexual concerns provides insights that help to promote inclusion of assessment of relevant sexual activity and provide sexual counseling as a standard of care. Aim: This study examined demographic factors, comorbid conditions, and sexual activities as predictive of sexual concerns. Specific sexual activities and demographic variables were also examined for their relation to sexual concerns. Methods: This study was a sub-analysis of a cross-sectional observational study testing a regression model of factors that predicted sexual concerns in a broad sample of cardiac patients in the United States, using a self-report survey method. Results: More comorbidities and types of sexual activities contributed to greater sexual concerns reported by respondents. Sexual activities resulting in overall sexual concerns included hugging/kissing, oral sex, and finger penetration. Non-Whites reported more sexual concerns, sexual fears, and symptoms related to sexual activity. Those who were not working/retired from employment reported significantly more sexual concerns and dysfunction, whereas, those who had a smoking/tobacco use history reported more sexual concerns, symptoms, and dysfunction. Conclusion: This study underscores that cardiac patients across a variety of diagnoses and comorbidities often experience sexual concerns, fears, symptoms, and dysfunction. The strongest predictors of sexual concerns were the number of cardiac and noncardiac comorbidities, thus illustrating the importance of a thorough assessment of these factors when examining sexual concerns of cardiac patients.

Grandparents in law: investigating the institutionalization of extended family roles.

Previous research on grandparents has focused on the individual and familial level and has characterized grandparent roles as ambiguous and contingent. Emphasizing instead structural phenomena, this theoretical paper argues that grandmother and grandfather roles are being institutionalized through state and federal legislation. This phenomenon provides an opportunity to investigate the process of institutionalization as it happens. Grandparenthood is evaluated as a potential site for institutionalization and law as a source of institutionalization is discussed. Preliminary evidence of the legal institutionalization of grandparenthood is presented and implications and directions for further research are suggested.

Family caregiving in aging populations

1. Preface: Family Caregiving in Aging Populations 2. Acknowledgments 3. Social Context of Family Caregiving 4. Spousal and Intimate Partner Caregiving 5. Adult Child Caregiving 6. Caregiving by Other Relatives, Secondary Caregivers, and Members of Minority Groups 7. Current Policy Regarding Caregiving and Policy Implications

Cardiac comorbidities and sexual activity predict sexual self-perception and adjustment.

Background:Changes in sexual satisfaction and sexual activity are often reported by cardiac patients, although factors influencing sexual adjustment are not well established. Knowledge of risk and protective factors can guide nurses in addressing physical and psychological needs of patients. Objectives:We examined predictors of sexual self-perception and adjustment in a cross section of cardiac patients. Methods:A nonexperimental, descriptive survey design was used to examine overall sexual self-perception and adjustment, sexual anxiety, sexual depression, sexual satisfaction, sexual self-efficacy, sexual activity, selected demographic factors, and 20 cardiac and noncardiac comorbidities using a mailed survey with a broad sampling of cardiac patients (n = 128). Data were analyzed with descriptive statistics, t tests, and regression analysis. Results:Fewer cardiac conditions and being sexually active were significant predictors of sexual self-perception and adjustment. Participants with hypertension reported more sexual depression; those with myocardial infarction had higher scores for both sexual anxiety and depression, and greater sexual anxiety occurred for those with peripheral artery leg bypass. Discussion:Positive sexual self-perception and adjustment are linked to sexual activity and fewer cardiac problems. This finding can be used to inform decisions about initiating sexual counseling.

Grandchild, grandparent, and parent coresidence from 1970 to 1990 : Structural factors affecting state patterns

This study analyzes structural forces affecting state patterns of parental presence within grandparent-grandchild coresidence by testing demographic, social change, policy environment, and social problems models. The project combines published state-level data with the 1970, 1980, and 1990 Census Public Use Microdata Samples. While factors differentially affect the proportion of children living in each household structure, coresidence seems to be encouraged by social contexts in which people are poor, the middle generation is likely to die, and which have higher rates of births to teens. State policy environment only affects proportions of children living in three generation households for 1980 and 1990. Structural variables other than social problems matter more for percent of children living in three generation households than for proportion of children living only with grandparents. Structural variables explain more variation in proportion of children living in skipped generation households than in proportion of children living with both parents and grandparents.