A comparison of life satisfaction and mood in nursing home residents and community-dwelling elders.

This study compared life satisfaction and mood in a sample of 138 cognitively intact and ambulatory elders, including 70 who lived in nursing homes and 68 who lived independently in the community. Community-dwelling elders reported greater life satisfaction, and scored higher on the Vigor-Activity subscale of the Profile of Mood States (POMS) than those who lived in a nursing home. Nursing home residents scored higher on the Depression-Dejection, Tension-Anxiety, and Confusion-Bewilderment subscales of the POMS. No between group differences were shown on the Anger-Hostility and Fatigue-Inertia subscales of the POMS. The diminished life satisfaction and high depression found in the nursing home residents hold immediate implications for professionals who work in this area.

Health motivation: a determinant of older adults' attendance at health promotion programs.

The primary purpose of conducting this study was to determine if there is a significant relation between health motivation and participation in health promotion programs in a sample of community-dwelling older adults (n = 106). Health motivation was measured using Cox's (1985) Health Self-Determinism Index, and participation in health promotion programs was measured by tallying the self-reported number of programs attended within the past year by each individual. The effects of selected demographic variables on these two variables were also examined. The conceptual framework guiding the study was the Health-Promoting Self-Care System Model (Simmons, 1990). Intrinsically motivated older persons attended fewer programs (p < .01) than those who were more extrinsically motivated. Higher educational level (p < .001) and fewer health problems (p < .01) emerged as significant predictor variables for intrinsic health motivation, and those with less formal education attended more health promotion programs (p < .05).

The oldest-old: how do they differ from the old-old?

This article reviews findings from the Berkeley Older Generation Study, a long-term longitudinal study of aging. The findings show many important differences between the oldest-old age group and other, younger-old individuals. Marked variation is demonstrated in the verbal scale of intelligence. More than half of oldest-old individuals did not decline, and some actually increased in verbal IQ. Four personality traits (i.e., agreeableness, satisfaction, intellect, extroversion) are stable. The fifth trait, energetic, may reflect responses to external circumstances, including physical health. As for social relationships, most individuals--including the oldest-old--still retain ties with important family members and friends. Individual differences are great, stressing the danger of accepting stereotypes about old individuals.

Patterns of telephone use among nursing home residents.

There is convincing evidence that nursing home residents who have more visitors fare better than those who have fewer visitors. However, as many as one third of all individuals living in nursing homes have virtually no visitors. The purpose of this study was to address this concern by examining telephone use in older adults living in nursing homes, and evaluating the potential of telephone communications as a means of social support for this at-risk group. Using a recording device activated each time the receiver was picked up, the research team "listened in" on the telephone conversations of three nursing home residents (aged 76, 79, and 92) for a period of 1 week. The transcripts revealed 56 minutes of actual conversation during the week (10, 21, and 25 minutes, respectively), most often with family or longtime friends living out of town. Each resident laughed aloud more than once per minute. The telephone conversations provided the residents with vivid glimpses of life outside the walls of their facility and appeared to help them stay connected with their family and friends. The findings support further study of the telephone as a way to sustain authentic social support in long-term care populations.

Ethical and policy considerations for centenarians--the oldest old.

PURPOSE: To illustrate the incongruence of ethical standards and fiscal and policy constraints on quality care for the oldest old. As the fastest growing demographic segment in the United States, care needs of the oldest old are a special challenge to the health care system. DESIGN: Narrative analysis of interviews with centenarians who used nursing home services. The sample was three participants of the Georgia Centenarian Study who had been community dwelling and cognitively intact at the onset of participation (between 1988 and 1997). Interviews were conducted in nursing homes or after discharge. METHODS: Case histories were constructed from interviews in 1997 to improve understanding of quality of care. FINDINGS: Less-than-optimal care was provided for these elders, and little consideration was given to their input to care decisions and prospects for medical improvement. Appropriate consideration was not given to providing least-restrictive environments, appropriate restraint use, and options for community care. CONCLUSIONS: Six policy reforms are suggested for meeting the needs of the oldest-old before and after institutionalization. These include: integration of resident involvement in care decisions; development of alternate models of care; greater input from nurses concerning nursing care of special populations; more effective family and community involvement in the caring of elderly populations; increased research to promote function and independence; and increased education of personnel and nursing students to allow for more accurate assessment of cognitive and physical status.

Long-term exercise patterns and immune function in healthy older women. A report of preliminary findings.

The purpose of this study was to examine the relationship between active versus inactive lifestyle and immunocompetence in older women. A sample of 46 independently dwelling, ambulatory and mentally alert women 60-98 years was examined, 25 who rated themselves as 'active' and 21 who rated themselves as 'inactive'. Lymphocyte subpopulations were analyzed by flow cytometry using selected monoclonal antibodies. The self-reported active subjects (also validated by their current unsolicited participation in a formal exercise class) demonstrated significantly higher percent change in CD25 mitogen stimulated lymphocytes (P = 0.0335) than those who reported themselves to be sedentary.

Sharing the quest for knowledge through interdisciplinary research.

Faced with increasingly complex health care issues and diminishing resources for research, nurse scientists must collaborate with each other and with scientists from other disciplines in the search for innovative and cost-effective health care solutions. The article traces nursing's 20-year struggle to become a credible partner in interdisciplinary research and highlights advantages and challenges characteristic of such collaboration. The authors describe their respective experiences as members of interdisciplinary research teams, one in a private medical practice affiliated with a for-profit hospital and the other in an academic setting. Recommendations that nurture successful collaborations are proposed.

A profile of mood in ambulatory nursing home residents.

This study examined mood in 54 ambulatory nursing home residents. Female subjects reported significantly lower scores on the Anger-Hostility subscale than either men or normative subjects. Women also scored lower than normative subjects on the Vigor-Activity and Confusion-Bewilderment subscales, whereas men scored lower on the Fatigue-Inertia subscale. Both men and women reported below norm scores for the Tension-Anxiety subscale. Further study is needed to identify sociological factors that may explain diminished expression of mood in this vulnerable population, and to compare these findings with the mood profile of community dwelling elders.

Methodological considerations in the study of frail elderly people.

The purpose of this paper is to increase the awareness of gerontological nurse researchers about methodological, theoretical and ethical issues that are unique and critical to the study of frail elderly people. Discussion focuses on: (a) sampling, recruitment, informed consent and retention of subjects; (b) selection and adaptation of measurement instruments; (c) implementation of treatment modalities and data collection protocols; (d) theoretical shortcomings; and (e) ethical concerns. Such issues must be resolved if answers are to be found for multiple health problems that pose such a heavy burden for many frail elderly people. As the number in this highly vulnerable group increases, gerontological nurse scientists, like all health care researchers, must better understand their needs and discover their strengths. We must design innovative research protocols to capture that information.

The undergraduate student as research assistant: promoting scientific inquiry.

As nurse scientists, we must find a way to excite our undergraduate students about research so that they will value it and include it as an integral part of their practice. The ambience surrounding scientific inquiry cannot be captured from readings and classroom activities alone, but must be modelled by enthusiastic faculty who are actively involved in research. Two exemplary cases involving the use of undergraduate students as integral members of faculty-directed research teams are described.

Pilot study of the relationship between heart rate and ectopy and unrestricted vs restricted visiting hours in the coronary care unit.

OBJECTIVE: To determine the relationship between cardiac performance (as measured by heart rate and ectopy) and unrestricted vs restricted visiting hours in the coronary care unit. DESIGN: Patients were from two coronary care units. Group A had unrestricted visiting hours, and group B had restricted visiting hours. Heart rate and ectopy were measured three times both in patients with unrestricted visiting hours and in those with restricted visiting hours: (1) before visitors arrived, (2) 5 minutes after visitors arrived and (3) 1 to 5 minutes after the visitors left. A total of 25 visits were analyzed. FINDINGS: There were no significant differences in rates of premature ventricular contractions and premature atrial contractions between the two groups. Patients with unrestricted visiting hours had a significantly lower heart rate after visits than patients with restricted visits. CONCLUSION: Consideration should be given to development of unrestricted visiting policies that promote the continuing presence and natural support of the family and significant others for patients in coronary care units.

Reminiscence: a viable option to enhance power in elders.

The purpose of this study was to investigate the usefulness of reminiscent storytelling as a therapeutic modality to enhance the sense of power in well elders (ages 60-86). The study was conceptualized within Rogers' (1986) Science of Unitary Human Beings and focused on Barrett's theory of power. A pre- and posttest design with experimental and control groups was used with Barrett's Power as Knowing Participation in Change Test, Version II as the measure of power (personal control). Experimental group subjects were pretested and then participated in three reminiscence sessions during a 1-week period. Subjects were then posttested both at the end of the reminiscence sessions and again after a 5-week interval. Control group subjects were tested on a schedule identical to that of the experimental group, but participated in no reminiscence sessions. Although an overall significant difference (p = 0.003) in scores was found over the testing period, no differences were found between experimental and control groups. Both experimental (n = 34) and control (n = 41) groups demonstrated a small but insignificant decrease in power between the pretest and posttest 1. Both groups then experienced a significant increase in power between posttest 1 and posttest 2. It is recommended that research energies continue to be directed toward the investigation of this topic. In our contemporary high tech world which often allows minimal human contact and diminishing quality of life for the aged, novel modalities such as reminiscence offer a human to human exchange, which may hold the key to this modern-day challenge.

Impact of case management on hospital charges of PWAs in Georgia.

To determine the effects of case management in controlling hospital based costs for persons with AIDS (PWAs), a retrospective review of records of deceased PWAs was performed. The study compared diagnosis-to-death hospital charges for PWAs who received care under a care management model (n = 60) with PWAs receiving care within a non-case managed approach (n = 60). Hospital charges were adjusted for inflation. PWAs receiving care within the case managed model had significantly lower hospital-based changes than the non-case managed group. Additionally, PWAs in the case managed group lived significantly longer between HIV diagnosis and death, and lived longer between their first AIDS-related hospital admission and death.