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1.
Aging Ment Health ; 24(1): 8-14, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30380912

RESUMEN

This study utilized experience sampling methodology (ESM) to examine the relationship of social interactions with daily pain and mood symptoms in people with osteoarthritis (OA) of the knee. Two hundred sixty-eight adults with physician-diagnosed OA of the knee underwent a baseline in-person interview and subsequent week-long ESM protocol to assess their daily activity patterns, pain, and mood via phone interview four times a day. A coding system was developed to assess presence and type of social interactions based on subject self-report of activity patterns. Multilevel modeling was used to examine between- and within-subject variation in outcomes based on both global and momentary measures of social activities, pain, and mood, while controlling for key demographic and potentially confounding variables. Positive associations were demonstrated between the ratio of positive to negative affect and both global (ß = 0.49, p < .001) and momentary, especially positive (ß = 0.24, p < .05), social activity patterns. Additionally, the association between negative affect and pain (ß = -0.07, p < .01) was attenuated in those with more baseline social interactions. Social interaction has the potential to influence mood in adults with OA of the knee, both on a global scale, and through daily variations in interactions. These interactions seem to be directly related to mood, as well as the apparently attenuating the relationship between pain and depression. Daily social interactions showed a robust positive association with contemporaneous positive affect.

2.
Aging Ment Health ; : 1-6, 2019 Oct 17.
Artículo en Inglés | MEDLINE | ID: mdl-31621378

RESUMEN

Objective: The current study explored whether the three-factor structure of an emotional intelligence measure (attention to emotions, clarity in understanding emotions, and emotion regulation) developed in a sample of college students would replicate in a sample of older adults with chronic pain. Method: Confirmatory and exploratory factor analyses were conducted to examine the factor structure of the 30-item Trait Meta-Mood Scale among 340 older adults with knee osteoarthritis. Results: Confirmatory factor analyses indicated that the original three-factor model of emotional intelligence did not fit well with the data for older adults. Exploratory factor analyses revealed a four-factor model of emotional intelligence: (1) confusion, (2) acceptance, (3) rejection, and (4) insight. Correlations between the original and new subscales were explored. Conclusion: While the newly derived emotional intelligence scales resembled the original conceptualization of emotional intelligence proposed by Salovey, Mayer, Goldman, Turvey, and Palfai ( 1995 ), the current study highlights the differences in emotional intelligence likely representative of older adults with chronic pain.

3.
Aging Ment Health ; : 1-7, 2019 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-31468988

RESUMEN

Objectives: The current aims were to explore the effects of relocation stress on depression and anxiety in long-term care residents and to investigate the moderating effect of cognitive status. Methods: The study used existing data from nursing home and congregate apartment residents. Self-reported measures of relocation stress, cognitive status, depression, and anxiety were examined. Exploratory analyses examined group differences in depression and anxiety within the full sample (n = 568) and the sample of first-year residents (n = 347). Main analyses were conducted in a subsample of 107 first-year residents who completed the measure of relocation stress. Results: Residents who had moved in the past year reported more anxiety but not depression than longer-term residents. Relocation stress significantly predicted depression but not anxiety in the subsample of first-year residents. There was no significant effect of cognitive status or the interaction of cognitive status and relocation stress on depression and anxiety. Conclusion: Findings suggest that cognitively impaired older adults are no more vulnerable to the negative effects of relocation stress than cognitively unimpaired older adults. Relocation stress should be regarded as a risk factor for depression in long-term care residents, regardless of cognitive status, in the first year after relocation.

4.
J Aging Health ; : 898264319863609, 2019 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-31319748

RESUMEN

OBJECTIVE: Fatigue is commonly reported by persons with osteoarthritis (OA) and predicts worse functioning and decreased activity. The current research used a combination of wrist and waist accelerometry along with experience sampling methodology to examine the relationship between reports of fatigue and subsequent physical activity among older adults with knee OA. METHOD: Two hundred one participants completed an interview followed by a 1-week period during which their activity was monitored and they reported symptoms of pain and fatigue. Multilevel models examined within-subjects versus between-subjects patterns of symptoms and their association with physical activity. RESULTS: Fatigue was the most consistent predictor of lowered physical activity (ß = -20.83, p < .001). Although wrist-worn actigraphs produced higher averaged activity counts than did waist actigraphs (t = 34.68, p < .001), multilevel models showed consistent results regardless of placement. DISCUSSION: Fatigue was a consistent predictor of lowered activity regardless of actigraph location.

5.
Geriatr Nurs ; 40(2): 129-137, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30122402

RESUMEN

Maximizing nursing home (NH) resident autonomy is a person-centered care (PCC) best practice. The purpose of this study was to identify and describe specific autonomy-supportive techniques used by nursing assistants (NAs) in three NH neighborhoods at one Veterans Affairs medical center. Thirteen interviews and approximately 80 h of behavioral observation of NAs were conducted across the three NH neighborhoods. Data were analyzed using thematic analysis. Ten autonomy-supportive tactics were identified: assisting, monitoring, encouraging, bargaining, informing, providing instructions, persuading, asking, providing options, and redirecting. Although all tactics honored some degree of resident autonomy, some were more restrictive than others. Results from the study elucidate specific actions NAs can take to promote resident autonomy, even when cognitive or physical limitations are present or there is potential concern for safety, and thereby support PCC best practice.


Asunto(s)
Cuidados a Largo Plazo , Asistentes de Enfermería/psicología , Autonomía Personal , Femenino , Hospitales de Veteranos , Humanos , Masculino , Casas de Salud , Atención Dirigida al Paciente/métodos
6.
Ann Behav Med ; 52(8): 713-723, 2018 07 13.
Artículo en Inglés | MEDLINE | ID: mdl-30010708

RESUMEN

Background: Pain and emotional well-being are complexly associated both globally and in the moment. Emotional regulation strategies may contribute to that complexity by shaping the pain-well-being association. Purpose: Using emotional intelligence (EI) as an integrative conceptual framework, this study probed the role of emotional regulation in the associations of osteoarthritis pain with emotional well-being in varying time frames. Perceived attention to, clarity, and regulation of emotions were examined as predictors of well-being, and as moderators of the well-being-pain association, at global and momentary (within-day) levels. Methods: In a microlongitudinal study, 218 older adults with physician-diagnosed knee osteoarthritis self-reported global pain, depressive symptoms, and EI (mood attention, clarity, and repair). Momentary pain and positive and negative affect were then assessed four times daily for 7 days. EI subscales were examined as moderators of the pain-well-being association at global and momentary levels, controlling demographics and general health. Results: Global and momentary pain were positively associated with mood clarity and negatively with attention, but not with repair. Clarity and repair negatively predicted depression, and buffered effects of pain on depression. Momentary negative affect was negatively predicted by mood clarity and repair; again, clarity and mood repair buffered effects of momentary pain on negative affect. Only mood repair predicted positive affect, with no interactions emerging. Conclusions: Attention to mood states exacerbates the experience of pain in both short and long terms. In contrast, both mood clarity and ability to repair moods appear important to both momentary and longer-term emotional well-being.


Asunto(s)
Afecto , Inteligencia Emocional , Osteoartritis de la Rodilla/psicología , Dolor/psicología , Anciano , Anciano de 80 o más Años , Depresión/complicaciones , Depresión/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dolor/complicaciones
7.
Gerontologist ; 58(2): e15-e24, 2018 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-28499032

RESUMEN

Purpose of Study: To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions. Design and Methods: In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification. Results: The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review. Implications: The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.


Asunto(s)
Envejecimiento/psicología , Actitud del Personal de Salud , Técnicas de Observación Conductual/métodos , Hogares para Ancianos , Casas de Salud , Participación del Paciente , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Participación del Paciente/métodos , Participación del Paciente/psicología , Relaciones Profesional-Paciente , Psicometría/métodos , Reproducibilidad de los Resultados
8.
Gerontologist ; 58(5): 913-922, 2018 09 14.
Artículo en Inglés | MEDLINE | ID: mdl-28977383

RESUMEN

Purpose of the Study: We examined the effect of daily stress, affect, and adult day service (ADS) use on the daily pain experience among caregivers of individuals with dementia (IWD). Participants were interviewed for 8 consecutive days. Caregivers utilized an ADS program on some days and provided care at home on other days. We hypothesized ADS use, care-related and noncare-related subjective stress, and affect would significantly influence and interact in ways to exacerbate or buffer the experience of daily pain. Design: Participants were 173 family caregivers of IWDs using ADS more than 2 days per week. Participants with IWDs diagnosed with "mild cognitive impairment" were excluded. Daily telephone interviews assessed stress, affect, and pain. Methods: Multilevel models were used to examine the relation between daily stress and daily pain and interaction effects of other daily experiences within the context of ADS use. Results: Multilevel models revealed a significant relation between care-related subjective stress and daily bodily pain as well as an interaction between noncare-related subjective stress and daily bodily pain. ADS use and affect did not predict daily pain. Lagged effects revealed a significant interaction between yesterday's ADS use and today's positive affect on today's bodily pain. Implications: Findings suggest that further studies are warranted for understanding and controlling pain among caregivers. Addressing the physical health needs through pain management interventions, positive affect maximization, and ADS use may improve the overall wellbeing of caregiving dyads.


Asunto(s)
Centros de Día para Mayores , Cuidadores/psicología , Demencia , Dolor/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estrés Psicológico
9.
J Appl Gerontol ; 37(3): 349-370, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-27091880

RESUMEN

The purpose of this study was to identify structural, market, and administrator factors of nursing homes that are related to the implementation of person-centered care. Administrators of Medicare/Medicaid-certified nursing homes in the Deep South were invited to complete a standardized survey about their facility and their perceptions and attitudes regarding person-centered care practices (PCCPs). Nursing home structural and market factors were obtained from public websites, and these data were matched with administrator data. Consistent with the resource-based theory of competitive advantage, nursing homes with greater resources and more competition were more likely to implement PCCPs. Implementation of person-centered care was also higher in nursing homes with administrators who perceived culture change implementation to be feasible in their facilities. Given that there is a link between resource availability and adoption of person-centered care, future research should investigate the cost of such innovations.


Asunto(s)
Personal Administrativo , Actitud , Hogares para Ancianos/organización & administración , Cuidados a Largo Plazo/organización & administración , Casas de Salud/organización & administración , Atención Dirigida al Paciente/organización & administración , Adulto , Competencia Económica , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Cultura Organizacional , Innovación Organizacional , Sudeste de Estados Unidos , Encuestas y Cuestionarios
10.
Sleep Health ; 3(3): 163-169, 2017 06.
Artículo en Inglés | MEDLINE | ID: mdl-28526253

RESUMEN

OBJECTIVE: To examine racial/ethnic differences in sleep quality and the pain-sleep association among older adults with osteoarthritis of the knee. DESIGN: Baseline interview followed by a 7-day microlongitudinal study using accelerometry and self-reports. SETTING: Participants were community residents in western Alabama and Long Island, NY. PARTICIPANTS: Ninety-six African Americans (AAs) and 128 non-Hispanic whites (NHWs) with physician-diagnosed knee osteoarthritis, recruited from a variety of clinical and community settings. MEASUREMENTS: Self-reports yielded demographics, body mass index, physical health problems, and depressive symptoms. Sleep quality was measured for 3 to 7 nights using wrist-worn accelerometers; pain was self-reported daily over the same period. RESULTS: With demographics and health controlled, AAs displayed poorer sleep efficiency, greater time awake after sleep onset and sleep fragmentation, and marginally more awakenings during the night, but no differences in total sleep time. AAs also showed greater night-to-night variability in number of awakenings and sleep fragmentation, and marginally greater variability in total sleep time and sleep efficiency. Sleep quality was not associated with pain either the day before sleep or the day after. Average daily pain interacted with race, whereas AAs displayed no effect of pain on sleep efficiency, NHWs exhibited better sleep efficiency at higher levels of average pain. CONCLUSIONS: These data corroborate previous studies documenting poorer sleep among AAs vs NHWs. The findings of greater night-to-night variability in sleep among AAs, as well as a negative association of pain with sleep quality among NHWs, are unique. Further study is needed to elucidate these findings.


Asunto(s)
Grupos de Población Continentales , Grupos Étnicos/estadística & datos numéricos , Osteoartritis de la Rodilla/etnología , Sueño/fisiología , Acelerometría/instrumentación , Acelerometría/métodos , Alabama , Femenino , Humanos , Masculino , Persona de Mediana Edad , New York , Dolor/etnología , Autoinforme , Trastornos del Inicio y del Mantenimiento del Sueño/etnología
11.
J Aging Health ; 29(5): 826-841, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-27107005

RESUMEN

OBJECTIVE: To investigate associations of perceived usefulness to other people with active versus passive coping strategies among adults with knee osteoarthritis (OA). Additional aims explored contributions of personality variables to this dynamic. METHOD: 199 persons (70.3 years ± 10.4) with knee OA reported personality, coping, and psychosocial data using the Big Five Inventory, subscales from the Social Provisions Scale, and the Coping With Illness measure. Regression analyses identified predictors of perceived usefulness and its independent and interactive associations with active versus passive coping and personality variables. RESULTS: Better subjective health predicted perceived usefulness. Older adults with higher reported perceived usefulness employed more active than passive pain coping strategies. Passive coping was associated with neuroticism and greater functional disability. DISCUSSION: Usefulness predicted active OA pain coping, suggesting that it may promote well-being among persons with chronic pain. Further study investigating perceived usefulness in promoting positive health behaviors is needed.


Asunto(s)
Adaptación Psicológica , Osteoartritis de la Rodilla/fisiopatología , Dolor/psicología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
Gerontologist ; 56(2): 357-67, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26035882

RESUMEN

PURPOSE OF THE STUDY: To describe the experience of recruiting, training, and retaining retired senior volunteers (RSVs) as interventionists delivering a successful reminiscence and creative activity intervention to community-dwelling palliative care patients and their caregivers. DESIGN AND METHODS: A community-based participatory research framework involved Senior Corps RSV programs. Recruitment meetings and feedback groups yielded interested volunteers, who were trained in a 4-hr session using role plays and real-time feedback. Qualitative descriptive analysis identified themes arising from: (a) recruitment/feedback groups with potential RSV interventionists; and (b) individual interviews with RSVs who delivered the intervention. RESULTS: Themes identified within recruitment/feedback groups include questions about intervention process, concerns about patient health, positive perceptions of the intervention, and potential characteristics of successful interventionists. Twelve RSVs achieved 89.8% performance criterion in treatment delivery. Six volunteers worked with at least one family and 100% chose to work with additional families. Salient themes identified from exit interviews included positive and negative aspects of the experience, process recommendations, reactions to the Interventionist Manual, feelings arising during work with patient/caregiver participants, and personal reflections. Volunteers reported a strong desire to recommend the intervention to others as a meaningful volunteer opportunity. IMPLICATIONS: RSVs reported having a positive impact on palliative care dyads and experiencing personal benefit via increased meaning in life. Two issues require further research attention: (a) further translation of this cost-effective mode of treatment delivery for palliative dyads and (b) further characterization of successful RSVs and the long-term impact on their own physical, cognitive, and emotional functioning.


Asunto(s)
Cuidadores/psicología , Investigación Participativa Basada en la Comunidad , Memoria , Cuidados Paliativos/psicología , Investigación Cualitativa , Calidad de Vida , Voluntarios/psicología , Anciano , Femenino , Humanos , Masculino , Motivación , Estudios Retrospectivos
13.
Arthritis Care Res (Hoboken) ; 68(1): 115-22, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26315851

RESUMEN

OBJECTIVE: Fatigue is common among persons with osteoarthritis (OA), but little is known about racial/ethnic differences in the prevalence, correlates, or dynamics of fatigue in OA. This research therefore used experience sampling methodology (ESM) to examine fatigue and pain at global and momentary levels among African Americans and non-Hispanic whites with OA. METHODS: Thirty-nine African Americans and 81 non-Hispanic whites with physician-diagnosed knee OA completed a baseline interview and an ESM protocol assessing fatigue, pain, and mood 4 times daily for 7 days. In addition to analyzing basic group differences, multilevel modeling examined within- versus between-subject patterns and correlates of variability in momentary fatigue, controlling for demographics and other potential confounders. RESULTS: Both racial groups experienced moderate levels of fatigue; however, there were clear individual differences in both mean fatigue level and variability across momentary assessments. Mean fatigue levels were associated with global pain and depression. Increase in fatigue over the course of the day was much stronger among non-Hispanic whites than African Americans. Momentary fatigue and pain were closely correlated. Mean fatigue predicted variability in mood; at the momentary level, both fatigue and pain were independently associated with mood. CONCLUSION: Fatigue is a significant factor for both African Americans and non-Hispanic whites with OA, and is negatively related to quality of life. Pain symptoms, at both the momentary level and across individuals, were robust predictors of fatigue. Although overall levels of reported symptoms were similar across these 2 groups, the pattern of fatigue symptoms across the day differed.


Asunto(s)
Afroamericanos , Artralgia/etnología , Grupo de Ascendencia Continental Europea , Fatiga/etnología , Osteoartritis de la Rodilla/etnología , Afecto , Afroamericanos/psicología , Anciano , Anciano de 80 o más Años , Alabama/epidemiología , Artralgia/diagnóstico , Artralgia/psicología , Emociones , Grupo de Ascendencia Continental Europea/psicología , Fatiga/diagnóstico , Fatiga/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/psicología , Dimensión del Dolor , Prevalencia , Factores de Tiempo
14.
Aging Ment Health ; 19(12): 1113-22, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25658300

RESUMEN

OBJECTIVES: Given the chronically painful, incurable nature of osteoarthritis, effective cognitive and behavioral coping strategies may be critical for older adults with the disease. Little is known about how and why coping changes over time, nor about stability of coping strategies in persons with osteoarthritis. The aims of this work were to examine the structure of coping in older adults with osteoarthritis, the association of coping strategies with well-being, the stability of coping over time, and its association with changes in well-being over the same period. METHOD: In a cross-sectional study, 199 older adults with osteoarthritis of the knee were assessed at baseline and two-years' follow-up. Items from two coping scales were factor analyzed, and Pearson's correlations and paired-samples t-tests assessed relative and absolute stability of the resultant coping strategies. CFA assessed the stability of the factor structure itself. Ordinary least-squares regression analyses examined the impact of change in coping on well-being. RESULTS: A five-factor coping solution emerged: stoicism, refocusing, problem-solving, wishful-thinking, and emotion-focused coping. The factor structure showed stability over the two-year period. Absolute stability of strategies varied, indicating that change in coping styles was possible. CONCLUSION: Changes in coping style predicts future well-being; however, coping remains malleable with age and maladaptive strategies can be effectively targeted. Greater knowledge of the utility or maladaptive nature of a given strategy may help guide decisions about interventions for patients with osteoarthritis and encourage more adaptive coping styles.


Asunto(s)
Adaptación Psicológica , Dolor Crónico/psicología , Depresión/complicaciones , Personas con Discapacidad/psicología , Osteoartritis/psicología , Adulto , Anciano , Estudios Transversales , Depresión/psicología , Evaluación de la Discapacidad , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Osteoartritis/fisiopatología , Perfil de Impacto de Enfermedad , Encuestas y Cuestionarios
15.
Arthritis Care Res (Hoboken) ; 67(3): 358-65, 2015 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25283955

RESUMEN

OBJECTIVE: It is known that osteoarthritis (OA) increases the risk of sleep disturbance, and that both pain and sleep problems may trigger functional disability and depression. However, studies examining all 4 variables simultaneously are rare. The aim of this study was to examine cross-sectional and longitudinal associations of self-reported sleep disturbance with OA-related pain and disability and depressive symptoms. METHODS: At baseline, 367 persons with physician-diagnosed knee OA reported sleep disturbances, pain, functional limitations, and depressive symptoms. At 1-year followup, all measures were repeated in 288 of the subjects. Baseline analyses examined the independent and interactive associations of sleep disturbance with pain, disability, and depression, net of demographics and general health. Longitudinal analyses used baseline sleep disturbance to predict the 1-year change in pain, disability, and depression. RESULTS: At baseline, sleep was independently associated with pain and depression but not disability. The sleep-pain relationship was mediated by depressive symptoms; sleep interacted with pain to exacerbate depression among persons with high levels of pain. Baseline sleep disturbance predicted increased depression and disability, but not pain, at followup. CONCLUSION: These data confirm known cross-sectional relationships between sleep disturbance and pain and depression and provide new insights regarding longitudinal associations among those variables. Depression appears to play a strong role in the sleep-pain linkage, particularly when pain is severe. The unique predictive role of sleep in the progression of disability requires further study but may be an important point of intervention to prevent OA-related functional decline among persons whose sleep is disrupted by OA-related pain.


Asunto(s)
Artralgia/etiología , Depresión/etiología , Evaluación de la Discapacidad , Osteoartritis de la Rodilla/complicaciones , Trastornos del Sueño-Vigilia/etiología , Anciano , Anciano de 80 o más Años , Artralgia/diagnóstico , Artralgia/fisiopatología , Artralgia/psicología , Estudios Transversales , Depresión/diagnóstico , Depresión/fisiopatología , Depresión/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/diagnóstico , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/psicología , Dimensión del Dolor , Valor Predictivo de las Pruebas , Factores de Riesgo , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/fisiopatología , Trastornos del Sueño-Vigilia/psicología , Factores de Tiempo
16.
Psychiatr Q ; 86(2): 243-51, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25355603

RESUMEN

This paper examined predictors of length of stay in a freestanding geriatric psychiatry hospital. Data on patient and treatment characteristics of geriatric inpatients (N = 1,593) were extracted from an archival administrative tracking database from Mary Starke Geriatric Harper Center. Five independent variables (length of time between last discharge and most recent admission, number of previous admissions, number of assaults, co-morbid medical condition, and admitting psychiatric diagnosis) were entered into a hierarchical regression model as potential predictors of length of stay in a geriatric psychiatry hospital. Number of assaults committed by the patient was the only significant predictor of length of stay, such that patients that had a greater number of assaults were more likely to have longer lengths of stay than those with fewer assaults. These findings highlight the importance of identifying patients at risk for assaultive behavior and developing effective interventions for aggression in geriatric psychiatry hospitals.


Asunto(s)
Agresión/fisiología , Servicios de Salud para Ancianos/estadística & datos numéricos , Hospitales Psiquiátricos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Pronóstico
17.
J Aging Health ; 25(8): 1329-39, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24122353

RESUMEN

OBJECTIVES: The purpose of this secondary data analysis is to determine whether depression, cognition, functional status, health, and pain severity are predictors of day-to-day pain variability in older adults in long-term care settings. METHODS: Seventy-seven adults aged 68 years and older were included in the multiple linear regression analyses. Pain severity mean and variability were measured over 30 days of daily self-reported pain levels. The Geriatric Depression Scale (GDS), Blessed Memory-Information-Concentration test, Physical Self-Maintenance Scale (PSMS), baseline pain severity, mean of daily health, and mean of daily pain severity were used as predictors. Pain variability was measured by examining intra-individual standard deviations of daily pain scores. RESULTS: Results show that global depression and pain severity are predictors of pain variability in that greater baseline depression and pain severity predicted higher pain variability. Daily mean pain and health were also found to be predictors of pain variability. DISCUSSION: Pain variability is an important characteristic that is not given enough emphasis in current literature. Understanding pain variability may give insight into older adults' experiences with both pain and depression, and may essentially improve quality of care and quality of life.


Asunto(s)
Actividades Cotidianas , Cognición/fisiología , Depresión/diagnóstico , Estado de Salud , Dolor/fisiopatología , Dolor/psicología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Escalas de Valoración Psiquiátrica , Autoinforme , Índice de Severidad de la Enfermedad
18.
Geriatr Nurs ; 34(5): 388-94, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23850129

RESUMEN

This article describes the development and particulars of a new, comprehensive model of nursing home culture change, the Nursing Home Integrated Model for Producing and Assessing Cultural Transformation (Nursing Home IMPACT). This model is structured into four categories, "meta constructs," "care practices," "workplace practices," and "environment of care," with multiple domains under each. It includes detailed, triangulated assessment methods capturing various stakeholder perspectives for each of the model's domains. It is hoped that this model will serve two functions: first, to help practitioners guide improvements in resident care by identifying particular areas in which culture change is having positive effects, as well as areas that could benefit from modification; and second, to emphasize the importance in culture change of the innumerable perspectives of residents, family members, staff, management, and leadership.


Asunto(s)
Modelos Organizacionales , Casas de Salud/organización & administración , Cultura Organizacional , Innovación Organizacional , Humanos , Pacientes Internos/psicología , Admisión y Programación de Personal , Calidad de Vida , Administración de la Seguridad , Lugar de Trabajo
19.
Int J Geriatr Psychiatry ; 28(4): 393-401, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22653754

RESUMEN

OBJECTIVE: To examine the structure of symptoms of affective disorder among older adults with a chronic health problem (osteoarthritis) and to explore cross-sectional and longitudinal associations of obtained affective symptom clusters with key health outcomes (pain, functional disability, perceived health). METHODS: One-year longitudinal study of older adults with diagnosed osteoarthritis of the knee. Symptoms of DSM depression and anxiety were assessed in a research diagnostic interview by using a DSM-IV symptom checklist; self-reports captured demographic characteristics, objective health, pain, disability, and perceived health. Confirmatory factor analysis tested comparability of affective symptom structure in this sample to findings of previous research; ordinary least squares regression examined cross-sectional and longitudinal associations of affective symptoms with health outcomes, controlling for demographics and objective health. RESULTS: The current sample displayed an affective symptom structure comparable with that observed in previous research, with symptoms clustering into depressed mood (DM), somatic symptoms (SS), and psychic anxiety (PA) factors. DM was cross-sectionally associated with pain and disability and marginally with perceived health; SS predicted current pain and perceived health. Only DM predicted 1 year change in disability and perceived health (but not pain). CONCLUSIONS: This research confirms the role of SS of distress in fueling disability and perceived ill health among older adults who are chronically ill. However, it is DM that drives changes in perceived health and functional ability.


Asunto(s)
Trastornos del Humor/psicología , Osteoartritis de la Rodilla/psicología , Trastornos Somatomorfos/psicología , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Dolor/psicología , Análisis de Regresión , Estrés Psicológico/psicología
20.
Gerontologist ; 53(4): 618-26, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22859437

RESUMEN

PURPOSE: Given the paucity of research on the role of geography in mental health care, this study examined whether racial differences in mental health service use varied across geographic regions among older adults. DESIGN AND METHODS: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), blacks (n = 1,008) and whites (n = 1,870) aged 60 and older were selected for analysis. Logistic regression analyses were conducted. RESULTS: Results showed significant racial disparities in mental health service use in the overall sample, as well as significant variation by region. Although no racial differences were observed in the Northeast, West, or Midwest regions, black elders in the South were significantly less likely than whites to use mental health services (odds ratios [OR], 2.08; 95% confidence interval [CI], 1.34-3.23). IMPLICATIONS: The findings suggest that improving the access to mental health care in certain regions, the South in particular, may be essential to reduce racial disparities at the national level. Policy implications are discussed.


Asunto(s)
Actitud Frente a la Salud , Grupos Étnicos/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Trastornos Mentales/psicología , Servicios de Salud Mental/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Geografía , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/etnología , Trastornos Mentales/terapia , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Estados Unidos/epidemiología
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