"Being careful": How much caution is enough? The relational context of fear of older adult falling in older adult-family caregiver dyads.

Family caregivers play an important role in coping with older adult falls; however, their perspectives on fear of older adult falling are lacking from the falls prevention literature. A mixed-method design (N=25 dyads) with interview and survey data examined linguistic characteristics and coping strategies used by older adult and family caregiver dyads to manage fear of older adult falling. Fear of older adult falling consisted of both affective (e.g., worry) and cognitive (e.g., cautious) properties. Family caregivers more frequently used affective words and first-person plural pronouns ("we" language) when talking about fear of older adult falling, while older adults more frequently used cognitive and first-and-second person singular pronouns ("I", "you"). The concept of "being careful" was shared within dyads. However, dyad partners differed in their perspectives of what constituted "being careful" and the possibilities of future falling. Findings suggest that the need for family-centered interventions to prevent falls are needed.

The Effect of Screen Viewing Duration and Self-Efficacy in Limiting Screen Viewing on Loneliness in Adolescent-Parent Dyads: An Application of the Actor-Partner Interdependence Model.

PURPOSE: To examine the influence of parents' screen viewing (SV) duration and self-efficacy in limiting SV on their adolescents' loneliness, and to explore the influence of adolescents' SV duration and self-efficacy in limiting SV on parents' loneliness. DESIGN AND METHODS: A cross-sectional survey with 1573 adolescent-parent dyads from the Family Life, Activity, Sun, Health, and Eating Study were included in this study. The actor-partner interdependence models were used to examine the effect of each dyadic partner's SV duration and self-efficacy in limiting SV on their own and their dyadic partner's loneliness within adolescent-parent dyads. RESULTS: There were no significant actor and partner effects of SV duration on loneliness for both parents and adolescents (all ps > 0.05). Adolescents' self-efficacy in limiting SV was associated with less loneliness of their own (adolescents' actor effect: ß = -0.35, SE = 0.04, p < .01) and that of their parents (adolescents' partner effect: ß = -0.15, SE = 0.04, p = .001). Parents' self-efficacy in limiting SV was negatively associated with their own loneliness (parents' actor effect: ß = -0.25, SE = 0.05, p < .01), but not with their adolescents' loneliness (parents' partner effect: ß = -0.06, SE = 0.05, p = .189). CONCLUSIONS: Adolescents' own self-efficacy in limiting SV has a significant impact on their parents' loneliness. Parents' self-efficacy in limiting SV, however, did not influence their adolescents' loneliness. PRACTICE IMPLICATIONS: Our results highlight the importance of providers screening for loneliness as part of the plan of care for adolescents and parents who might have excessive SV, with close attention given to those who possess less self-efficacy in controlling their SV.

Social Model Hospice: Providing Hospice and Palliative Care for a Homeless Population in Salt Lake City, Utah.

Health care for the homeless population is a complex challenge and represents a significant gap in care, particularly for those at the end of life. Hospice care may be desired but is rarely an option for people without residences, social support, and payment sources. Social model hospice is a unique paradigm of care delivery that offers a viable solution to make hospice and palliative care possible for this population. In this historical report from interviews with early organizers, prior and current leadership (n = 6), the evolution of The INN Between in Salt Lake City, Utah, is described. In 2010, The INN Between was conceptualized as a nonprofit community effort addressing this need to provide an alternative to people dying unsheltered. After 5 years of planning, it opened in 2015 and has grown to become a comprehensive community resource for homeless medically frail and terminally ill individuals. Recommendations for establishing social model hospices are made: key strategies include identifying stakeholders dedicated to alleviating end-of-life homelessness needs, doing a formal needs assessment to identify community resource deficits, and forming mentoring relationships with established programs. Social model hospice is a viable way of meeting the end-of-life needs of many communities' most vulnerable residents.

Experiences of Homeless Recipients of Social Model Hospice Care: A Photovoice Exploration.

Homelessness and caregiver insecurity are barriers to accessing hospice for end-of-life care. Some communities have implemented a community-based social model of hospice care, and reports of its characteristics and outcomes are growing in hospice and homeless literature. This case report explored the experiences of social model hospice recipients using photovoice, a community-based participatory method to photograph meaningful aspects of care. Participants (n = 3) took photos (n = 93), journaled, and participated in semistructured interviews as co-analyzers. Through deductive codes from the literature and inductive analysis of data, 6 themes were identified: having a physical location to receive care, involving the community, having spiritual needs attended to, acknowledging family/family of choice, connecting with animals, and feeling cared for. Participants offered few suggestions to improve care. Social model hospice provided a location for care, funding, and social support to address housing and caregiver insecurity. Results corroborated the social model hospice concept (antecedents, attributes, consequences). Findings add to the growing literature with implications for communities and leaders looking to start or improve care. Results suggest that photovoice may be a feasible method for eliciting firsthand experiences of residents. Findings may guide discussions about patient-reported aspects of care for a more accurate understanding of meaningful social model hospice care.