Self-esteem in later life: a nursing perspective.

Self-esteem provides a measure for the quality of life of the elderly in long-term care. This article defines self-esteem in relation to self-concept and identifies the antecedents that affect its development. Elements of labeling theory, activity theory, and social exchange theory are explored to account for a potential decline in self-esteem among the elderly. According to this electric theoretical framework, stigmatization, decreased social interaction, and loss of control over the environment are all negatively correlated with self-esteem. Institutionalization intensifies the effect of these forces. Nursing is in a unique position to promote self-esteem by combating ageism, promoting social interaction, and maximizing the control and participation of elderly residents.

Drug abuse? Use and misuse of psychotropic drugs in Alzheimer's care.

Although psychotropic drugs are widely used to control symptoms related to dementia, concerns are raised by the potential for adverse effects and misuse. Antidepressants may be useful when depression and dementia coexist in the early stages of Alzheimer's disease. In later stages, anxiety and agitation are often treated with antianxiety or antipsychotic agents. Concerns escalate about the use of antipsychotic agents as chemical restraints. Nursing home reform provisions of OBRA '87 mandate dose reductions of antipsychotics in an effort to discontinue their use. The role of the nurse is to establish and monitor therapeutic goals, to assess the incidence and severity of predictable side effects, and to provide a safe, supportive environment that reduces the need for pharmacological intervention.

Dementia care creating a therapeutic milieu.

1. In dementia care, the full spectrum of interventions in a therapeutic milieu provides for safety, structure, support, involvement, and validation. 2. A safe environment accommodates wandering and compensates for physical and cognitive impairments. A therapeutic milieu provides for both physical and psychologic safety. 3. Two components of structure include the design of the physical environment and the schedule of activities. 4. The central element that defines quality in a therapeutic milieu is the dimension of interpersonal relationships.

Remembering and sharing through poetry writing.

Reminiscing may have therapeutic outcomes for the elderly. In this article, the author describes how nursing students used poetry writing to stimulate reminiscence in group work with the elderly. The outcomes included reciprocal benefits for both the students and the elderly participants.

Osteoporosis: a disease management opportunity.

Advances in the ability to detect and effectively treat osteoporosis lead to questions about when testing and treatment should be initiated. Disease management provides answers with the promise of both cost-effective use of resources and improved health outcomes. Applying the characteristics and principles of disease management to osteoporosis provides a powerful rationale for a population-based approach to this disease. Disease management makes it possible to systematically identify persons at risk, intervene with prevention and treatment programs, and measure clinical, quality of life, and economic outcomes. Clinical guidelines are a critical element in disease management. This article presents clinical guidelines developed recently by national medical and public health experts based on a review of available research and clinical evidence.

Computer-assisted qualitative research.

The use of computer technology has emerged as a significant component in qualitative research methodology. This article differentiates between mechanical and conceptual activities in qualitative analysis and discusses the interplay between them. Advantages of computer technology in the mechanical activities of data management and concerns about the use of computer programs in conceptual/analytic activities are discussed. Guidelines for the judicious application of computers in qualitative research are outlined.

Conceptual analysis of agitation in the confused elderly.

Agitation is a significant behavior problem for many elderly nursing-home residents with dementia. Lack of conceptual clarity constrains effective management of agitated behaviors. This conceptual analysis examines the meaning of agitation and attempts to disentangle its antecedents, critical attributes, and consequences. Measurement and management implications are examined.

Behavioral symptoms in dementia: an update.

A descriptive literature review was done to identify research conducted in both community and institutional settings and published from 1986 to 1993 on the correlates of behavioral symptoms associated with dementia. Critical appraisal and synthesis of the 40 studies revealed theoretical and methodological problems that tempered conclusions about the relationships between behavioral symptoms and the correlates under study. While direct relationships were found in studies in which relationships between behavioral symptoms and cognitive impairment and contextual factors were examined, contradictory results were found in studies of demographic and functional variables. Recommendations for research-based practice are advanced, including the development and testing of alternatives to physical and chemical restraints in the care of persons with dementia.

Reminiscence, life review, and ego integrity in nursing home residents.

The purpose of this study was to explore the relationship between dimensions of reminiscence and ego integrity in elderly nursing-home residents. Although frequency of reminiscence was not significantly correlated with ego integrity, using reminiscence for the purpose of life review was positively correlated with high ego-integrity scores in this sample of elderly individuals. This significant, positive relationship supports Butler's life-review theory and provides a link between the life review type of reminiscence and the resolution of Erikson's eighth and final developmental stage--a yardstick of successful aging.

A psychosocial model of dementia care: theoretical and empirical support.

In this article, a psychosocial model of dementia care is presented from a social constructionist perspective, contrasted to the medical model, and illustrated with data from a qualitative study. In findings reported in this article, family and professional caregivers described social and psychological approaches that portray elements of specialized dementia care provided within a therapeutic social environment.