Women's perceptions of their social roles after heart surgery and coronary angioplasty.

OBJECTIVE: The goal of this study was to describe the influence of physical health on social role perceptions, role performance, and role balance in women after heart surgery and coronary angioplasty. DESIGN: A cross-sectional descriptive survey was used. SETTING: The study was undertaken at a Midwestern community hospital. SAMPLE: The study considered 58 midlife and older women who had received heart surgery or coronary angioplasty. OUTCOME MEASURES: The following measures were used: Inventory of Adult Role Behavior, Role Discrepancy Measure, Role Balance Measure, and Salient Social Roles Measure. RESULTS: Women in poorer health had lower role performance and more negative role perceptions. In general, the balance of rewards and concerns in roles rated most important were not affected by health status. CONCLUSION: Dimensions of women's social roles are related to physical health after heart surgery and angioplasty. Knowledge about the effect of physical health on women's social role experiences is important information for clinicians who care for women with heart disease. If a woman can be helped to achieve better functional health to perform role and daily living tasks, she may feel more positive about her current and future health states.

Sense of coherence and illness appraisal in older women's quality of life.

The purpose of this descriptive, correlational study was to test a conceptual model of proposed relationships between physical health limitation, the sense of coherence, illness appraisal, and quality of life in a sample of 137 older women. The typical respondent was 76, widowed, with an income less than $12,000, and several health problems. Hierarchical multiple regression analysis indicated that physical health limitation, particularly symptom bother and functional health, had a significant negative influence on quality of life. However this effect was mediated by sense of coherence and illness appraisal. Regardless of the level of symptoms or functional health, women with higher sense of coherence and more positive illness appraisals had higher levels of quality of life. The findings support the proposed model and further our understandings regarding the protective role of personality resources in perceived quality of life in older women with chronic illnesses.

Health promotion in old age.

The empirical literature on health promotion in old age was reviewed. A developmental perspective was used to examine 42 studies: studies relating health behaviors to health outcomes, descriptive studies of health promotion in old age, studies of the outcomes of health promotion programs in old age, and studies of factors related to older adults' participation in health promotion activities. In general, elderly adults perceived health promotion activities as beneficial, engaged in health behaviors more frequently than younger adults, and participated in community-based and other health promotion programs. There is little definitive evidence that health promotion activities result in better health outcomes for older adults, however. Identifying appropriate outcomes related to health promotion in old age is a critical need.

Older women's lives through time.

This 6-year longitudinal study of 103 community-dwelling older women examined changes in physical and mental health and self conceptions and the relationships among self conceptions, physical health, and depression. Over time, physical health, personal growth, and purpose in life declined; depression increased; and positive relations and autonomy were stable. Regression analyses indicated declines in physical health rarely affected the self; increase in depression was related only to concurrent physical health; and prior depression did not predict subsequent physical health. Thus, positive self conceptions and physical health appear to be independent in elderly women, but declines in physical health are associated with depression.

Effect of a postdischarge education class on coronary artery disease knowledge and self-reported health-promoting behaviors.

OBJECTIVE: To determine the effect of a single 2-hour postdischarge education class on knowledge and health-promoting behaviors of patients undergoing cardiac catheterization. DESIGN: Descriptive, two-group, posttest survey. SETTING: Midwestern community hospital. SUBJECTS: One hundred fourteen patients who had experienced a cardiac catheterization, 53 patients who had attended a postdischarge coronary artery disease education class, and 61 patients who had not attended the class. OUTCOME MEASURES: Knowledge of coronary artery disease and coronary artery disease risk factor, and health-promoting behaviors. RESULTS: Those who attended the postdischarge class scored significantly higher on both knowledge and health-promoting behaviors. CONCLUSION: Patients who attended a single 2-hour postdischarge education class had significantly higher knowledge of coronary artery disease and coronary artery disease risk factors. Knowledge may better prepare people to increase health-promoting behaviors.

Mechanisms related to psychological well-being in older women with chronic illnesses: age and disease comparisons.

The influence of type of illness (breast cancer versus osteoarthritis) and age on physical health and functioning, self-system interpretive mechanisms, and women's psychological well-being were examined. Self-system interpretive mechanisms are considered mediators of the effects of physical health on psychological well-being and include social comparisons, social integration, and illness perceptions. Young-old (aged 60-74) and old-old (75 +) women, diagnosed with osteoarthritis (N = 102) or breast cancer (N = 86), who volunteered for the study were interviewed using structured self-report scales. Young-old and old-old women did not differ in terms of health status, interpretive mechanisms, or on three of five indices of psychological well-being. On the other hand, women with arthritis, regardless of age, reported more functional health problems, more symptoms, and perceived their illness as more severe, more chronic, and less controllable than women with breast cancer. Although women with arthritis and breast cancer differed significantly in terms of physical health, they did not differ on multiple measures of psychological well-being. For both groups, women who made more positive social comparisons and who had more extensive social networks had higher levels of psychological well-being, regardless of physical health problems.

Interventions for aged family members.

Is Mrs. B's family unusual? Is this a hypothetical situation made too dramatic? The answer is no, to both questions. This situation is real, the family is real, and a typical, elderly spouse was driven to feel helpless and out of control, experiencing what no person should ever go through, and needing to reevaluate and rethink her whole future. Hospitalization for a critical injury can disrupt even the most highly organized and functional family. Family-focused care may mitigate family stress by providing support based on the unique needs of each family. As Mrs. B's family illustrates, the family members may have suffered as much pain as the patient. They, too, deserve special attention and consideration. Their reactions are typical and manageable, and professionals who are interested in the welfare and functioning of the family must ensure that the family of the patient receives adequate and appropriate care, no matter what their age.

Psychological adjustment in adults with cancer: the self as mediator.

The role of the self in adjustment to cancer has been noted but is not well understood. Research and theory on the self suggest that discrepancies between actual and ideal self-conceptions influence adjustment and mediate the effects of disease-related health problems on psychological well-being. This relationship was investigated in a cross-sectional study of 108 persons with cancer. Cancer patients who had more symptoms and worse functional health and perceived their cancer as a chronic rather than an acute disease had higher levels of self-discrepancies and poorer adjustment. Self-discrepancy was a significant mediator of the effects of perceived health status on purpose in life, positive relations with others, and depression.

Does social problem solving differ from other types of problem solving during the adult years?

One hundred thirteen individuals, ages 18-81, were presented with a test of social problem solving, a test of practical problem solving, the Twenty Questions task (a test of traditional problem solving), the Wechsler Adult Intelligence Scale--Revised Vocabulary subtest (a measure of crystallized intelligence), and Raven's Progressive Matrices (a measure of fluid intelligence). The effects of age, sex, education, and intellectual abilities on problem-solving performance were examined. Social problem solving was positively related to higher education and higher Vocabulary scores, but it was not related to age. Social problem solving and practical problem solving were significantly related to each other and to scores on the Vocabulary subtest, whereas traditional problem solving was significantly related to scores on Raven's Progressive Matrices. These results suggest that different types of problem solving are differentially related to other intellectual abilities and to age.

Physical and mental health in later life: the self-system as mediator.

The purpose of this research was to investigate how the self-system mediates the relationship between physical health and mental health in elderly women. Three theoretical perspectives were examined: social integration (self in relationship to the social structure), social comparisons (self in relationship to others), and self-discrepancies (internal self-evaluations). Community-dwelling elderly women (N = 243) completed self-report instruments measuring the various self-assessments, physical health, and 3 mental health outcomes: psychological distress, well-being, and developmental outcomes. Social integration and social comparisons mediated the effects of physical health on all 3 outcomes.

The role of social comparisons processes in the psychological adaptation of elderly adults.

Social comparison processes were investigated as mechanisms by which elderly women maintain or enhance their psychological well-being in the face of health-related threats or loss. In Study 1, a measure of social comparisons was tested, and a preliminary model of the effects of health and social comparisons on depression was examined (N = 42). In Study 2, a separate sample of elderly women (N = 243) completed self-report measures concerning physical health, upward and downward social comparison processes, and positive and negative aspects of psychological adaptation. As predicted, worse physical health status was linked to more frequent social comparisons; however, more positive social comparisons were related to better mental health outcomes, even for women in poor health. In fact, the effects of social comparisons were strongest for women in the poorest health, resulting in psychological outcomes similar to women in good health. Thus, social comparisons appear to play a significant role in psychological well-being in old age. The findings also point to the importance of distinguishing between frequency and consequences of social comparison processes.

The relationship between physical health and psychological well-being in elderly women: a developmental perspective.

Little is known about the physical health and psychological well-being of very old women, although they are one of the fastest growing segments of the population. The relationships among physical health, psychological well-being, and age were investigated using a developmental perspective and a multidimensional approach to the assessment of psychological well-being. Two hundred and forty-three elderly women completed multiple self-report measures of physical health status and psychological well-being. Multiple regression analyses indicated that older age was related to lower levels of purpose in life, personal growth, and positive relationships. Poor health, regardless of age, was associated with more depression and anxiety and lower levels of positive relationships and autonomy. Implications for the nursing care of elderly women are discussed.

Physical and mental health relationships in the very old.

A descriptive, correlational study was conducted to examine the physical and mental health status of 80-year-olds. Thirty-seven community-dwelling adults, aged 80 and over, were interviewed about their physical health, psychological well-being, and demographic characteristics. Both descriptive and correlational data indicated that overall these older adults were positive about both their physical health and psychological well-being. However, depression emerged as a significant problem for 24% of the sample and was strongly related to physical health problems. Results are discussed in relation to both health needs and stereotypic beliefs about the very old.

The role of the self in adjustment to cancer in elderly women.

One way that people may adjust to illness is through a redefinition of the self, especially with respect to the relationship between ideal self and actual self. To investigate psychological adjustment in community-dwelling elderly women, women with cancer (n = 17) were compared to women with other health problems (n = 30) based on measures of psychological distress and well-being, actual self, ideal self, and the discrepancy between actual self and ideal self. Women with cancer scored no differently than other women on measures of psychological well-being, psychological distress, and actual self, but their ideal-self ratings were lower. The positive adjustment of women with cancer may be the result of their ability to lower their ideal-self expectations, thereby reducing self-discrepancies that can result in psychological distress.

How elderly women cope: concerns and strategies.

Forty-two elderly women were asked to describe the problems they faced with aging, and how they coped with both real-life and hypothetical problems in seven areas. Content analysis indicated that their spontaneously reported ongoing strategies were consistent with current theoretical formulations, the strategies differed by area of concern and for real-life versus hypothetical problems, and direct action strategies were related to lower levels of psychologic distress. These results have implications for nursing research and practice.

Training effects on Raven's progressive matrices in young, middle-aged, and elderly adults.

Previous training studies of fluid intellectual abilities have involved training on either figural relations or induction tasks. In the present study, young, middle-aged, and elderly adults were given training on another measure of fluid ability--Raven's Progressive Matrices. The training involved a strategy-modeling technique that lasted no more than a few minutes. The results indicated that (a) performance on the Raven decreased with increasing age, (b) training significantly improved performance, and (c) the effect of training did not differ as a function of the age or sex of the subjects. Thus, the results indicate that performance on the Raven can be significantly improved in a single, brief training session.

Effect of fetal movement, ultrasound scans, and amniocentesis on maternal-fetal attachment.

The effects of fetal movement, ultrasound scans, and amniocentesis on maternal-fetal attachment and perception of fetal development in normal pregnancy were examined in 91 women during the second trimester. Women who reported feeling fetal movement early in pregnancy had higher maternal-fetal attachment scores and higher perception of fetal development scores. Ultrasound scans had no effect on either variable. Women who had genetic amniocentesis had lower attachment scores before the procedure, but one month later the attachment scores were not significantly different from those of other women. Both maternal-fetal attachment and perceptions of fetal development increased significantly from 16 to 20 weeks of gestation. There was a small but significant correlation between attachment scores and perception of fetal development.