Psychological Distress and Help-Seeking by Residents of a Neighborhood Naturally Occurring Retirement Community (NNORC).

This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.

Threading the needle in health-risk communication: increasing vulnerability salience while promoting self-worth.

Health interventions often draw attention to the risks associated with unhealthy choice but in the process produce a boomerang effect such that those targeted become more committed to risky behavior. In 2 studies designed to promote condom use among sexually active college students, the authors document strategies for highlighting risk while promoting healthy choices. Study 1 demonstrated that optimistic perceptions regarding the likelihood of contracting sexually transmitted diseases (STDs) can be counteracted by drawing attention to the emotional consequences of contracting STDs, instead of its likelihood. Rather than promoting condom use, however, this procedure generated a boomerang effect: It decreased commitment to using condoms, especially among high self-esteem individuals. Study 2 showed that this unwanted effect could be reversed when emotional vulnerability was paired with a self-affirmation. This finding suggests that there can be benefits to adding threatening content to health interventions, provided that the message also contains elements designed to protect feelings of self-worth.

Anxiety and related symptoms in older persons with dementia: directions for practice.

Anxiety disorders and related symptoms commonly occur in older people with cognitive impairment or dementia, significantly worsening functioning and reducing quality of life. This review of the literature outlines the extent of the problem, and focuses on current best practices in psychosocial interventions anxiety in persons with dementia. Discussion follows on promising nonpharmacological interventions that are recommended for further consideration and future research.

Effects of a program for coordinated care of advanced illness on patients, surrogates, and healthcare costs: a randomized trial.

OBJECTIVE: To evaluate the Advanced Illness Coordinated Care Program (AICCP), delivered by allied health personnel to improve care for patients coping with advanced illness and in need of preparation for end-of-life (EOL) care. STUDY DESIGN: Clinical trial involving 275 patients and 143 surrogates in 6 settings who were randomly assigned to the AICCP or usual care (UC). METHODS: The AICCP participants met with a care coordinator for assistance with provider communication, care coordination, and support. The AICCP was evaluated for effects on satisfaction with care, advance planning, consistency of care with patient preferences, and healthcare costs. RESULTS: The AICCP increased patient satisfaction with care and communication (P = .03), and AICCP surrogates reported fewer problems with provider support (P = .03). More AICCP than UC participants completed an advance directive (AD) (69.4% vs 48.4%; P = .006), and the AICCP group completed more ADs per participant (P = .01). Median time to AD documentation was 46 days for AICCP and 238 days for UC (P = .02). There was no difference in survival (AICCP 43% vs UC 42%). Six-month costs were lower with AICCP than with UC (12,123 US dollars vs 16,295 US dollars); however, the difference did not reach statistical significance. CONCLUSIONS: The AICCP improved satisfaction with care and helped patients develop and revise more ADs, sooner, without affecting mortality. This program may be delivered in a range of managed care, fee-for-service, and group-model settings.