Elders Health Empowerment Scale. Spanish adaptation and psychometric analysis / Escala de Empoderamiento sobre la Salud para Adultos Mayores. Adaptación al español y análisis psicométrico

Introduction: Empowerment refers to patient skills that allow them to become primary decision-makers in control of daily self-management of health problems. As important the concept as it is, particularly for elders with chronic diseases, few available instruments have been validated for use with Spanish speaking people. Objective: Translate and adapt the Health Empowerment Scale (HES) for a Spanish-speaking older adults sample and perform its psychometric validation. Methods: The HES was adapted based on the Diabetes Empowerment Scale-Short Form. Where "diabetes" was mentioned in the original tool, it was replaced with "health" terms to cover all kinds of conditions that could affect health empowerment. Statistical and Psychometric Analyses were conducted on 648 urban-dwelling seniors. Results: The HES had an acceptable internal consistency with a Cronbach's α of 0.89. The convergent validity was supported by significant Pearson's Coefficient correlations between the HES total and item scores and the General Self Efficacy Scale (r= 0.77), Swedish Rheumatic Disease Empowerment Scale (r= 0.69) and Making Decisions Empowerment Scale (r= 0.70). Construct validity was evaluated using item analysis, half-split test and corrected item to total correlation coefficients; with good internal consistency (α> 0.8). The content validity was supported by Scale and Item Content Validity Index of 0.98 and 1.0, respectively. Conclusions: HES had acceptable face validity and reliability coefficients; which added to its ease administration and users' unbiased comprehension, could set it as a suitable tool in evaluating elder's outpatient empowerment-based medical education programs.

Introducción: Empoderamiento se refiere a las habilidades que le permiten al paciente convertirse en responsable de tomar las decisiones para el control diario de sus problemas de salud. A pesar de ser un concepto tan importante, particularmente para adultos mayores con problemas crónicos de salud, hay pocos instrumentos accesibles que hayan sido validados para su uso en hispano-hablantes. Objetivo: Traducir y adaptar la Escala de Empoderamiento sobre la Salud (EES) para una muestra de adultos mayores hispano-hablantes y llevar a cabo su validación psicométrica. Métodos: La EES se adaptó basándose en la Escala de Empoderamiento de la Diabetes versión corta. Donde se mencionaba "diabetes" en el instrumento original, se reemplazó con el término "salud" para cubrir todos los tipos de condiciones que podrían afectar el Empoderamiento sobre la salud. Se realizaron análisis estadísticos y psicométricos sobre 648 adultos mayores residentes urbanos. Resultados: La EES tuvo una consistencia interna aceptable con un α de Cronbach de 0.89. la validez convergente se apoyó en un coeficiente de correlación de Pearson significativo entre la EES total y por ítems y la Escala General de Auto-eficacia (r= 0.77), la Escala de Empoderamiento para la Enfermedad Reumática versión Sueca (r= 0.69) y la Escala de Empoderamiento Tomando Decisiones (r= 0.70). La validez de Constructo se evaluó mediante análisis de ítem, test de las dos mitades y coeficiente de correlación ítem corregido total (α >0.8). La validez de contenido se apoyó por los Índices de Validez de Contenido para la Escala y para los ítems de 0.98 y 1.0, respectivamente. Conclusiones: La EES tuvo una validez y confiabilidad aceptables, que sumados a su facilidad de administración y comprensión simple y sin sesgos podría constituirse en una herramienta confiable para evaluar programas educativos médicos basados en el Empoderamiento de pacientes mayores ambulatorios.

A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease: a randomized controlled trial / Intervenção com um programa de reminiscência para melhorar qualidade de vida de residentes com Alzheimer com cuidados prolongados: ensaio controlado randomizado

OBJECTIVE: A single-blinded, parallel-groups (intervention, active and passive control groups) randomized controlled trial (RCT) was chosen to investigate whether a specific reminiscence program is associated with higher levels of quality of life in nursing home residents with dementia. METHODS: The intervention used a life-story approach, while the control groups participated in casual discussions. The Social Engagement Scale (SES) and Self Reported Quality of Life Scale (SRQoL) were used as the outcome measures, which were examined at baseline (T0), 12 weeks (T1), and six months (T2) after the intervention. The final sample had 135 subjects (active control group = 45; passive control group = 45; intervention group = 45). RESULTS: The Wilcoxon test showed significant differences in the intervention group between T2 and T0, and between T1 and T0 in the SES, and there were significant differences between T0 and T1 (intervention effect size = 0.267) and T1 and T2 (intervention effect size = 0.450) in the SRQoL. The univariate logistic regression scores showed that predictors of change in the SRQoL were associated with fewer baseline anxiety symptoms and lower depression scores. CONCLUSIONS: The intervention led to significant differences between the three groups over time, showing a significant improvement in the quality of life and engagement of the residents in the intervention group.

OBJETIVO: Elegeu-se um ensaio randomizado controlado simples cego, com grupos paralelos (intervenção, comparação e controle) para pesquisar se um programa específico de reminiscência associa-se com maiores níveis de qualidade de vida em residentes com demência com cuidados prolongados. MÉTODO: No grupo de intervenção usou-se o enfoque da história de vida, enquanto o grupo controle recebeu conversas amistosas. A Escala de Compromisso Social (SES) e a escala auto-referida de qualidade de vida (SRQoL) foram as medidas de resultados, examinados na linha de base, doze semanas, e seis meses após a intervenção. A mostra final teve 135 sujeitos (controle n = 45; comparação n = 45; intervenção n = 45). RESULTADOS: Wilcoxon test no grupo intervencional comparando os resultados entre T1 e T0, T2 e T1, e T2 e T0 mostraram diferenças significativas entre T2 e T0 (tamanho do efeito de intervenção = 0,460) e T1 e T0 (tamanho do efeito de intervenção = 0,486) em o SES; e entre T0 e T1 (tamanho do efeito de intervenção = 0,267) e T1 e T2 (tamanho do efeito de intervenção = 0,450) em o SRQoL no grupo de intervenção. As pontuações de regressão logística univariada mostraram que os predictores de mudança estavam associados com menores níveis de ansiedade basal e menores níveis de depresión. CONCLUSÕES: A intervenção produziu diferenças significativas entre os três grupos ao longo do tempo, mostrando uma melhoria significativa na qualidade de vida e compromisso dos residentes no grupo de intervenção.

Disociación entre atribución de discapacidad explícita e implícita hacia adultos mayores en estudiantes de psicología / Dissociation between psychology student's implicit and explicit disability atribution to elders

Los adultos mayores son objeto de estereotipos negativos que pueden explorarse por medidas explícitas e implícitas. Dado que existen discrepancias entre ambas, es conveniente combinarlas. Son escasos los estudios sobre atribución de discapacidad hacia adultos mayores por parte de jóvenes en el ámbito educativo. El objetivo del estudio que se informa fue evaluar si existe una disociación entre las medidas implícitas y explícitas de atribución de discapacidad hacia adultos mayores en una cohorte de estudiantes de la Carrera de Psicología. Las actitudes explícitas se estudiaron con el Test de Evaluación de Actitudes hacia Adultos Mayores (EVAAM) y las implícitas, con un test de asociación implícita (TAI) en relación con categorías de capacidad / discapacidad, en combinaciones congruentes e incongruentes. Se correlacionaron ambas pruebas para verificar el grado de disociación entre ellos. Como resultado se observó que en el TAI, la combinación incongruente (capacidad + vejez) tuvo mayor tamaño de efecto implícito que la congruente (capacidad + juventud), demostrando la existencia de una atribución automática de discapacidad hacia adultos mayores. Los valores para la escala explícita fueron mejores y no correlacionaron con el TAI. Así se concluye que los adultos mayores reciben una atribución automática de discapacidad por parte de los estudiantes de Psicología, que no coincide con su preferencia explícita. Esto podría deberse a la intención de agradabilidad de los jóvenes, a la falta de introspección sobre representaciones implícitas o a una independencia de las representaciones explícitas e implícitas. Queda por considerar si las atribuciones implícitas y explícitas forman diferentes constructos, o son parte de uno solo, con valores positivos en el polo voluntario y negativos en el involuntario.

Negative attributions toward elders are a paramount feature creating an unfavorable trait which manifests itself as stereotypes and discriminatory behaviors. This turns to be more critical when those misattributions are covertly distributed in the general population. Negative attributions toward elders are greater than younger when comparing both groups, and are dependent on several factors such as amount of information provided, coherence of the data, age and even the year when the search was carried on, as recent studies show less differences between elders and young attributions compared with older ones, particularly on explicit measures. Probably this reflects the more acceptability and tolerance exhibited by new cohorts toward different social groups in such areas as ethnics, religion or sexuality. It is obvious that elders stereotypes must be explored using not only explicit but also implicit measures, which reveal more clearly automatic associations and attributions toward key social groups. As there are sound differences between both kinds of assessments, combination is highly recommended. There are few studies that have accomplished the investigation of disability attribution toward elders by young subjects in the field of Education using Implicit Association Tests (IAT). This may prove useful as ageism exists in the Psychology Career Programs, being studies about elders under-represented in the programs contents. Objectives: To evaluate whether dissociation between implicit and explicit disability attribution measures exists in a cohort of young university psychology students. Methods and instruments: 210 subjects were included in the study (121 female and 89 men), who were recruited from students attending regular courses at the Faculty of Psychology on the city of Rosario (Argentina), aged from 24 to 29-year-old. Implicit attributions were assessed with the IAT that measures automatic association's strength between two core concepts (in the present study abilities /disabilities) and the two poles of an evaluative dimension (elderhood / youth). Stimulus are displayed on a computer screen and the subject has to associate core concept and attribute dimension faster when both are of equal valence (shorter latency). Subjects holding strong association between disability and elderhood have faster responses when those share the same key that has to be pressed to accomplish a valid answer. Latency spread between congruent (ability / youth) and incongruent (ability / elderhood) associations is accounted for the automatic strength of the implicit effect. Explicit attitudes were studied with the Attitudes toward Elders Evaluation Test and implicit ones using the Implicit Association Test with ability / disability categories in congruent and incongruent combinations. Both tests were correlated to disclose any dissociation between them. Dependent variable to measure implicit attitudes was the value of d which represents the size of the implicit effect between congruent and incongruent condition. A 2 (cate gories) x 2 (attributes) x 2 (dimensions) matrix was used, and independent variables were rotated between participants. Valence of attributes ranged from positive to negative and were associated with categories using as control factor the order of task congruence (block 3 congruent and block 6 incongruent). Dependent variable for explicit attitudes was the overall mean answers of the EVAAM (Adult Evaluation Scale). Results: In the IAT, the incongruent combination (ability old age) had a greater implicit size effect than the congruent one (ability youth), showing the existence of an automatic disability attribution toward elders. Results in the explicit scale were better and didn't correlate with IAT. Conclusions: Elders receive a Psychology student's automatic disability attribution, which doesn't match their explicit preference. This may be due to young students' agreeability intention, lack of introspection on implicit representations, or explicit and implicit representations independence. It remains to be investigated whether explicit and implicit attributions belong to different constructs or to only one, with positive values in the voluntary pole and negative values in the involuntary pole.