Willingness to Use Pain Medication to Treat Pain.

OBJECTIVE: Despite the growth of the economic impact of pain and pain management, there remains a lack of knowledge about disparities, especially, evidence regarding individual attitudes and beliefs about accepting pain treatments. This study provides preliminary information on the prevalence of public concerns about pain management and a better understanding of factors that may ultimately lead to improved pain management and treatment adherence. METHODS: Using a cross-sectional survey of community-dwelling adults 18+ in the US, 123 randomly selected respondents were telephone-interviewed in 2012. Principal components factor analysis (PCA) was used to detect statistical groupings of attitudes and beliefs about pain and pain management. The modified Protection Motivation Theory was applied to examine the willingness to use pain medicine. RESULTS: The five most important components pertained to threat appraisal, coping appraisal, attitudes, subjective norms, and perceived control. Threat appraisal was the most common factor, and subjective norms was the least common factor. Lower income, more awareness of hospice, and less misconceptions about threat appraisal and attitudes toward pain and pain management were associated with more willingness to use pain medicine in hierarchical regression. CONCLUSIONS: These components are useful for future research on the willingness to use pain medicine and may have implications for assessing cognitive barriers toward pain and pain management among the general public.

Quality of death among hospice decedents: Proxy observations from a survey of community-dwelling adults in the contiguous United States.

This study examines hospice service experience and quality of death. A survey of 123 community-dwelling adults in the United States found that physical comfort, pain-free, and spiritual peace were more important to respondents reporting a personal experience with hospice. A "good death" was associated with older patients who died at home, and respondent satisfaction with hospice service. A "good death" was mapped as 29 nodes and 79 links using semantic network analysis. Three subjects (patient, family, hospice), three timeframes (end-of-life, moment of dying, death), and four central causes (home, peaceful, pain-free, and expected) were identified.

Veteran's Attitudes and Knowledge of End-of-Life Care: A Pilot Study Using a Mixed Methods Approach.

Veterans make up a quarter of the deaths in the United States (US). However, little is known about their knowledge and preferences about end-of-life care and pain management. Given this, we were interested in how veterans' military experiences impact their end-of-life experiences and attitudes. Our exploratory study addressed the knowledge and perceptions of hospice and pain management at the end of life. The quantitative aspect was a survey using descriptive statistics that used a small (n = 14) subgroup from a randomly selected sample in the continental US. A small population-based sample (N = 123) used a blended sampling frame of randomly selected validated cell phone and landline numbers. The qualitative aspect examined eight targeted interviews of urban dwelling older veterans over age 60 residing in Northeast Ohio to get a deeper understanding of their knowledge and attitudes toward end-of-life care. Our findings suggest that veterans did not understand the difference between hospice and palliative care and expressed concerns regarding pain medication use at the end of life. Future research examining the concept of stoicism at the end of life among veterans and educational interventions are needed.

Accreditation of gerontology programs: a look from inside.

For over three decades, there has been considerable discussion about the development of gerontology education in the United States. A debate about accreditation is a logical outgrowth in this evolution. The dialogue about accreditation raises some important questions and gives gerontology an opportunity to further define itself. Accreditation poses opportunities and challenges that must be addressed to have a valid and meaningful discussion about the future of gerontological education. This article examines the advantages and disadvantages of accreditation for gerontology using the lens of faculty members from these three different academic programs. The authors ask: Is accreditation a good idea for each program? What are the advantages and disadvantages? Is this the right time?

Hospitalization in High Fracture Risk Older Adults with Osteoporosis Using the Safe Functional Motion Test: A Longitudinal Analysis.

The Safe Functional Motion Test (SFM-5) is a five item performance based clinical assessment tool quantifying habitual daily movement that may increase the risk of osteoporosis and fractures. Fractures are a major cause of hospitalization and contributor to increased health care utilization costs. A sample of 1,700 adults, aged 40 and older, from an osteoporosis specialty clinic were evaluated to determine if the initial SFM-5 score had predictive utility for determining inpatient hospitalization at 12, 24, and 36 months post fracture. When adjusted for sex, age, and prior hospitalization, logistic regression analyses indicated that the SFM-5 score significantly predicted inpatient hospitalization within 12 months, 24 months, and 36 months. For every 10 point decrease in the SFM-5 score, the 1 year risk of hospitalization increased by 24%. The SFM-5 is a tool to use when assessing habitual functional movements and hospitalization risk among high-fracture risk adults.

Measuring Attitudes About End-of-Life Care: Evaluation of a Modified Version of the Hospice Philosophy Scale.

The Hospice Philosophy Scale (HPS) is the only scaled instrument that measures health professionals' attitudes about end-of-life care consistent with the hospice philosophy. This study tested the properties of a modified version of the HPS to provide preliminary validation data on internal consistency, convergent validity, and factorability in a broad population of adults. A cross-sectional telephone survey designed to assess the general population's attitudes regarding hospice use was administered. exploratory factor analysis elicited an eight-item instrument (HPS-8). The HPS-8 produced a Cronbach's alpha of .73 and demonstrated sufficient convergent validity, including positive associations with a scale measuring the importance of relevant end-of-life issues (r = .41, p < .001), a personal preference for hospice (ρ = .36, p < .001), and, among those who had experienced hospice care, satisfaction with hospice care (ρ = .28, p < .01). Our evidence suggests the HPS-8 is a reliable and valid instrument for use with a general adult population.

Gender and informal caregiving in CCRCs: primary caregivers or support networks?

Relatively little research has been conducted on caregiving or kin support patterns among residents of newer forms of senior housing. The current research investigates variation in reported current or potential supporters by gender, age, and marital status among 687 residents of four continuing care retirement communities. Women and men tended to identify different configurations of social support, with the gender difference partially attributable to marital status (i.e., higher rates of widowhood among women). Age 75-84 was nonlinearly associated with more reported supporters, suggesting a shift in types of supporters by age. Unmarried persons more often identified friends and "others" in terms of support, in lieu of spousal support.

Functional risk for fracture by safe functional motion testing: a short version of the safe functional motion test.

BACKGROUND: 'Unsafe' movement strategies used to perform everyday activities were quantified using scores for tasks included in the Short Form Safe Functional Motion test series (SSFM). Baseline scores were independently associated with incident fractures after adjusting for factors known to effect fracture risk. The purpose of the present study is to determine whether the SSFM, a series of tests of habitual motion, is associated with incident fragility fracture at any skeletal sites. METHODS: An osteoporosis clinic database was queried for adults with baseline SSFM scores and corresponding data for prevalent fractures, femoral neck bone mineral density (fnBMD), osteoporosis medication use, and incident fractures at 1-year and 3-year follow ups [n = 1700 (118 incident fractures) and n = 1058 (202 incident fractures), respectively]. Multiple logistic regressions, adjusted for sex, age, fnBMD, osteoporosis medication use, and any prevalent fractures at baseline, were used to determine whether baseline SSFM scores were associated with incident fragility fractures. RESULTS: An Sfm-3 score was a significant independent predictor of any fracture at 1 year [adjusted odds ratio (95% CI) = 1.118 (1.025, 1.219) for each 10-point decrease in Sfm-3; p = 0.012], and 3-year follow up [adjusted odds ratio (95% CI) = 1.183 (1.098, 1.274) for each 10-point decrease in Sfm-3; p < 0.0001]. CONCLUSIONS: Scores on the SSFM predict fracture risk such that for each 10-point drop in score the odds of fracture are increased by up to 18% independent of risk associated with age, bone mineral density, use of bone-sparing medications, and history of a fracture.

Work organization, economic inequality, and depression among nursing assistants: a multilevel modeling approach.

To investigate the relationships among the nursing home work environment, emotional strain, and depression in Nursing Assistants in Ohio and West Virginia, this cross-sectional study was conducted with 395 Nurse Assistants in 49 nursing homes in Ohio and West Virginia. Organizational attributes were measured independently at the individual and organizational levels. Multilevel modeling techniques were used to analyze the data. Our methods examined nursing home organizational structure (ownership type, managerial style), and work organization (emotional strain) was examined in relation to the prevalence of depression among nursing assistants. Our findings suggest workplace emotional strain and age are associated with increased odds of depression. Implications of our work include that work in nursing homes for the environment it fosters has a strong effect on emotional strain and depression among Nursing Assistants.

Knowledge About Hospice: Exploring Misconceptions, Attitudes, and Preferences for Care.

CONTEXT: Poor knowledge and misperceptions about hospice are believed to be common, but there is scant evidence about the public's understanding of hospice. OBJECTIVES: To examine hospice knowledge among geographically diverse adults; and describe linkages between knowledge, attitudes and beliefs about hospice care, and demographics. METHODS: A small cross-sectional telephone survey of adults living in the contiguous US was conducted using randomly selected numbers (cell phone and landline) and over-sampling of minorities. Measures assessed knowledge (23-item test), attitudes (8-item scale), experiences and preferences related to hospice. RESULTS: 123 participants completed surveys (response rate 46%). 106 (86%) had heard about hospice, 65 (54%) of whom had a personal experience with hospice. Participants had an average hospice knowledge test score of 18 (SD = 3.4) indicating moderate knowledge of hospice. A majority of respondents (62%) did not know that hospice cannot provide concurrent cure-oriented care. Misperceptions about eligibility, coverage of hospice, the provision of hospice in nursing homes or to persons who live alone were not uncommon (missed by >20%). Greater knowledge of hospice was associated with more favorable attitudes about the hospice philosophy of care (r = .22, p = .023) and a greater preference for hospice (p = .049). Respondents who were more educated, worked in the medical field, were non-Hispanic White, and had direct experience with hospice were also more likely to be more knowledgeable about hospice. CONCLUSION: Despite relatively high hospice awareness and favorability, myths and misperceptions about hospice still abound--and may drive ethnic disparities in end-of-life care. Educational interventions and future study are needed.

Longitudinal analysis of the reciprocal effects of self-assessed global health and depressive symptoms.

This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.

Knowledge About Hospice Care and Beliefs About Pain Management: Exploring Differences Between Hispanics and Non-Hispanics.

CONTEXT: Among Hispanics, incomplete knowledge about hospice care may explain low rates of utilization and culturally-specific beliefs about pain and pain treatments may contribute to disparities in pain management. OBJECTIVES: To compare (1) knowledge and attitudes regarding hospice, (2) and beliefs about pain and pain medication between Hispanics and non-Hispanics. METHODS: A cross-sectional phone-based survey of adults living in the contiguous United States was conducted using randomly selected phone numbers with over-sampling for diversity. Measures assessed knowledge (a 23-item test), attitudes (an 8-item scale), experiences, preferences related to hospice and beliefs regarding pain and pain management. RESULTS: 123 individuals participated in the survey, 13% of whom were Hispanic. Hispanics were less likely to have heard of hospice are (p <. 001) and, among those who had, more likely to have inaccurate information about it (p = .05). Specifically, Hispanics were more likely to report that only individuals over age 65 are eligible for hospice services, which is incorrect (44% vs. 93% of non-Hispanics; p=.001). Only 67% of Hispanics knew that hospice helps family members as well as the dying person. More Hispanics (43%) than non-Hispanics (9.3%) reported that admitting pain is a sign of weakness (p < .001). A greater proportion of Hispanic respondents agreed that a good patient does not talk about pain (p = .07): 38% vs. 18% from non-Hispanics. CONCLUSION: Despite the increasing knowledge of hospice care among Hispanics, specific information about the scope of services remains limited. Cultural beliefs about pain management, along with inadequate knowledge of the role of pain management at end of life, persist.