Elders' needs and experiences of receiving formal and informal care for their activities of daily living.

Older people living in the community or institutional settings are more likely to require help with their activities of daily living, with women more likely than men to need some help. The interviews in this qualitative study were conducted with a convenience and purposive sample of 20 elders living in Southeast Washington, USA, at home or in institutional settings, receiving informal or formal health care. Findings related to personal and instrumental activities of daily living are reported and include elders' experiences and views relating to the help and assistance they receive. The majority of elders needed help with their instrumental activities of daily living, provided by informal networks, whether living at home or in institutional settings. This help constituted social care. Formal health care with personal activities of daily living was required only by a minority of elders and constituted those with the greatest disability and dependency.

Elders' perceptions of formal and informal care: aspects of getting and receiving help for their activities of daily living.

A purposive and convenience sample of 16 women and four men receiving informal and formal care for their activities of daily living either at home or institutions in Southeast Washington, USA was interviewed. Qualitative findings related to asking for help, getting and receiving help, interpersonal aspects of receiving help, and met and unmet needs are reported. Some seniors found it more difficult to ask for and accept help and there were gender differences, with men tending to adopt a more logical and pragmatic approach while women viewed receiving help as a loss of independence and an invasion of privacy. Intimacy and nudity were also threats for women. Three styles of adjustment and acceptance were identified within the data and related to positive acceptance, resigned acceptance and passive acceptance. There appeared to be a relationship between independence and control, with elders losing some independence but retaining control through choice, payment and involvement in decision making. Reciprocity was found to bring added value to relationships between care providers and elders, with a rhythm and symmetry developing in relationships where needs were known, anticipated and met. Seniors should be encouraged to plan for their future and to find out about local help and services available to them in advance of their requiring any assistance.

Filial piety. A cross-cultural comparison and its implications for the well-being of older parents.

The purpose of this article is to compare and contrast the concept of filial piety in Chinese culture and American culture and to discuss the relationship between expectations of filial piety and the well-being of older adults. In both cultures, filial piety is a socially approved virtue and contains attributes of respecting, caring for, and loving the parents. The differences include: obedience versus confrontation of parents; limited versus unlimited responsibility to parents; and a difference in the concept of legitimate support. Based on previous literature, the relationship between the expectations of filial piety and parents' well-being was explored, and nursing implications were suggested. Nonetheless, there is no single intervention that could fit all clients from one culture. Nurses need to examine to what extent clients value their culture of origin.

Broad-spectrum group treatment for parents bereaved by the violent deaths of their 12- to 28-year-old children: a randomized controlled trial.

This study assessed the efficacy of a 10-week broad-spectrum intervention offered to bereaved parents about 4 months after the deaths of their 12--28-year-old children due to accidents, homicide, or suicide. For three outcomes of distress there was a significant interaction between treatment and baseline values for each outcome for mothers both immediately posttreatment and 6 months later. The intervention appeared to be the most beneficial for mothers most distressed at baseline. Fathers showed no immediate benefits of treatment. Further research is needed to investigate these unexpected results for fathers and to further characterize those who benefit from similar programs.

Falls: are rural elders at greater risk?

1. Advocating that elderly clients engage exclusively in behaviors that are free of risks may not always advance the goals of independence, autonomy, and a maximal level of functioning. 2. Falls in the elderly may not be primary events, but indicators of an as yet undetected decline in health, suggesting that the health care provider tailor fall prevention information to the specific lifestyle of the older adult. 3. There may be a range of safe and acceptable risk depending on the lifestyles and the demands of daily living.

Reliability, construct validity, and subscale norms of the Brief Symptom Inventory when administered to bereaved parents.

The Brief Symptom Inventory (BSI) was administered to parents (N = 260; 171 mothers and 89 fathers) whose adolescent and young adult children died unexpectedly and violently by accident, homicide, or suicide. Summary statistics and reliability coefficients (Cronbach's alpha) for the nine subscales and the Global Severity Index were calculated. A comparison of means and standard deviations confirmed the expectation that this sample is dramatically different from the normative American community standard. Raw scores for the subscales were transformed into standardized T scores and critical values for a screening heuristic presented. An attempt to obtain construct validity using factor analysis suggested that a five-factor solution provided a description of this population of bereaved parents that is more insightful than the nine standard subscales of the BSI. Implications for both clinicians and future research are discussed.

The experience of bereavement in older adults.

One of the most profound losses experienced by humans is the death of a spouse. The purposes of this report are to describe the grief experiences of older adults over the first 2 years after the death of their spouse, and to compare these experiences with those of younger bereaved spouses. Data from interviews with 12 older bereaved spouses were analysed using the universal semantic relationships described by Spradley (1979). The major categories that emerged from the data were 'feelings', 'physical symptoms', 'special hardships', 'coping' and 'support'. This report describes respondent experience related to the first four categories; the ways in which bereaved spouses received support have been described elsewhere (Rigdon et al. 1987). Important similarities and differences between experiences of older and younger bereaved spouses are discussed, and recommendations for how nurses can meet the special needs of bereaved older adults are made.

The 'Learnmore' project: information acquisition solutions for the long-term care information system.

Research and development efforts on Long Term Care (LTC) information systems are only beginning to appear in the literature. For the past two years, a small, interdisciplinary team of researchers (the Learnmore Team) have designed information solutions to information acquisition problems in LTC systems. This paper provides an overview of the Learnmore Team's proposed solutions to acquisition problems experienced by end-users (clinicians, students, and patients) and human experts. Solutions addressing information acquisition costs of integrated expert systems are also discussed. Critical issues and experiences gained during the development of these solutions are presented.

Understanding depression in bereaved older adults.

Depression is a common outcome of spousal bereavement. Concurrent life events may contribute to the intensity of depression following spousal bereavement in older adults and, if not identified, may interfere with therapeutic plans for the management of depression. Taped interviews, conducted six times over two years, were analyzed for ten subjects, five whose depression scores were low, and five whose scores were high. In addition, a detailed case comparison analysis of two subjects was done. Four recurring types of life events, reported by the bereaved spouses, were illness (of self or others), deaths of family or friends, residential relocation, and changes in interpersonal relationships. Significantly depressed spouses were more likely to report these events. Implications for nursing practice and for integrating qualitative and quantitative research methods are addressed.

Toward a theory of helpfulness for the elderly bereaved: an invitation to a new life.

The purpose of this study was to generate a theory of helpfulness for the elderly bereaved. The theory is grounded in data from responses of 30 participants concerning the advice they would give others who have lost a spouse and how others were helpful to them. Participants responded during six interviews following death of their spouses. A content analysis of responses was the basis of a dialectical theory of helpfulness: An Invitation to a New Life.