Psychological correlates of survival in nursing home cancer patients.

Demographic, cancer, physical functioning, and psychological data were collected for 90 late-stage cancer, newly admitted nursing home patients. Those who died within 3 months (28%) more often acknowledged their condition as terminal, anticipated greater environmental stress and adjustment problems, and had poorer self-esteem. For cancer patients undergoing the stress of nursing home placement, feelings of hopelessness and helplessness are associated with earlier death.

Elderly patients' satisfaction with care under HMO versus private systems.

In one community, 100 elderly persons (25 HMO and 75 private patients) completed a 20-item scale that measured satisfaction with medical care. Data on demographics, health care utilization, and self-assessed health status also were collected to determine whether these variables would relate to HMO membership. Satisfaction scores were compared between HMO and private care groups by multivariate analysis of variance. Satisfaction with the doctor-patient relationship and convenience of care was higher in the private care group, whereas satisfaction with cost was higher in the HMO group. Interestingly, the HMO group evaluated private care and HMO care similarly. The private group rated HMO care less favorably. Additional comments reveal specific areas of satisfaction/dissatisfaction.

Effect of nursing home staff training on quality of patient survival.

This study tests the effects of nursing home staff training in care for the dying on the quality of life of terminally ill patients. Ten matched community nursing homes were assigned randomly to experimental (training) or control (no training) conditions Patients (N = 306) admitted to the homes were assessed at admission, one month, and three months concerning quality of life as measured by depression, alienation, self-esteem, and locus of control. Satisfaction with care was also measured at one and three months. Patients in trained homes had less depression and greater satisfaction with care than patients in control homes at one and three months. Training effects were similar in all of the five homes. The study shows that a favorable impact on patient care can be achieved when staff in nursing homes are trained to work with dying patients.

Effects of psychophysical stress on surgical outcome.

The aim was to determine the effects of stress on immune status and surgical outcome in 24 healthy men undergoing hernia repair. Stressful life events over the prior 6 mo and social support was assessed at time of admission. Physiological response to a cold pressor test was measured the day before surgery. Lymphocyte blastogenesis and neutrophil chemotaxis were measured before and 3 and 30 days after surgery in patients and controls. Surgical outcomes were assessed by length of stay, narcotics used, and complications. Data were analyzed in 2 x 2 factorial designs for multivariate analysis of covariance where one factor was life stress and the other was response to the cold pressor. Age and social support were covaried in comparing immune responses before surgery. High responders to life stress had significantly less response to PHA, and high responders to cold pressor stress had lower PWM responses. With preoperative immune status covaried, high responders to cold pressor stress had significantly lower PWM response after surgery, indicating some T-B cell interaction defect and more narcotics and complications. Data suggest that high psychological and physiological stress responses before surgery (that is itself an additional psychophysiologic stressor) lead to poorer outcomes even in otherwise healthy men undergoing relatively simple elective surgical procedures.

Health and hassles in older and younger men.

This study compared hassles and uplifts in older and younger chronically ill men in regard to whether they perceived their health as good or poor (N = 50). Hassles are irritating and frustrating demands (minor stress) that characterize everyday transaction with the environment, such as losing things or being in traffic jams. Uplifts are positive events that could help counteract the effects of stress. Men in the study rated 40 potential hassles and 40 uplifts on 1 to 4 scales for the preceding month. These were compared by multivariate analysis of variance between older (age 65 and over) and younger (ages 45 through 64) men and between good vs. poor perceptions of health. Uplifts did not discriminate significantly between ages or health perceptions. In addition, hassles were similar between old and young; however, they differed significantly by good and poor assessments of health. Those who viewed their health as poor reported more hassles, mostly from events that were related to their physical health care. Because of the confounding effects with health in individuals who are already ill, hassles may not be good predictors of future health status, but they can help health professionals understand the kinds of demands that produce stress in management of diseases.

Patients and staff assess social climate of different quality nursing homes.

Three hundred and one patients and 231 nursing staff from 10 community nursing homes (categories from good to poor by independent judges) rated a 63-item scale assessing social climate along seven dimensions: cohesion, conflict, independence, self-exploration, organization, resident influence, and physical comfort. Regardless of quality of homes, mean ratings by staff were more favorable (p less than 0.001 using multivariate analysis of variance) than patient ratings on four of the seven factors. When staff attitudes were compared by quality of homes, less favorable staff ratings were found for cohesion, independence, and self-exploration in poorer quality homes. Patient responses were significantly less favorable on five of seven dimensions in poorer quality homes. In summary, nursing home patients react more negatively to their institutional environments than do staff, and though poorer institutional quality does correspond to less favorable ratings by staff and patients, it is still the patient group that reacts in a more negative manner.

Geriatric sweet tooth. A problem with tricyclics.

Ninety-three consecutive outpatients receiving tricyclic antidepressants for at least one month were asked about medication side effects, including excessive appetite and craving for sweets. Prevalence of these side effects and their relationship (Pearson r) to type of medication, dosage, patient characteristics, diagnoses, weight gain, and clinical improvement were examined. More than one-third (38%) reported excessive appetite, 34% had a craving for sweets, and about one-half (48%) had either one or the other of these reactions. These adverse side effects were related significantly to weight gain (P less than .001) and a higher dose of medication, but not to clinical improvement. Clinical improvement was in the moderate-to-good range but was not related to medication dose. Because increasing degrees of overweight can pose serious health risks, especially for the elderly, it is critical for future research to examine ways of maintaining therapeutic benefit while minimizing food craving side effects. Methods of dealing with these issues clinically are suggested.

Nursing home care as an alternative to psychiatric hospitalization. A Veterans Administration cooperative study.

Nursing homes have played a major role in deinstitutionalization, and their increased use for the mentally ill has been questioned. We performed a controlled study of nursing homes as an alternative to continued psychiatric hospitalization. Men (N = 403) referred for nursing home placement from eight Veterans Administration medical centers were randomly assigned to community nursing homes (CNHs), Veterans Administration nursing care units, continued care on the same ward, or transfer to another psychiatric ward. Patients met defined criteria for schizophrenia or organic brain disease. Data were collected before random assignment and six and 12 months later, covering physical and mental function, psychopathology, mood, social adjustment, satisfaction with care, as well as drug use, characteristics of settings, and movement in and out of settings. Significant differences between settings were found in self-care, behavioral deterioration, mental confusion, depression, and satisfaction with care. Results were strikingly consistent, showing the group transferred to another ward doing better and the CNH group doing worse. Drug use did not differ from six months before entering the study or later between the settings. Cost showed a marked advantage for the CNH group. Thus, the less costly community nursing home alternative must be viewed in the context of the nonmonetary costs of less favorable patient outcome.

Effects of unemployment on mental and physical health.

From a prospective study of the impact of stress on health in 300 men assessed every six months, men who became unemployed after entering the study were compared with an equal number, matched for age and race, who continued to work. Psychological and health data after unemployment were compared between the two groups by multivariate analysis of variance and covariance. After unemployment, symptoms of somatization, depression, and anxiety were significantly greater in the unemployed than employed. Large standard deviations on self-esteem scores in the unemployed group suggested that some men coped better than others with job-loss stress. Further analysis showed those with higher esteem had more support from family and friends than did those with low self-esteem. Furthermore, unemployed men made significantly more visits to their physicians, took more medications, and spent more days in bed sick than did employed individuals even though the number of diagnoses in the two groups were similar.

Health beliefs, compliance, and control of diabetes mellitus.

The problem of compliance and control in the treatment of diabetic patients is widely recognized. However, compliance research is contradictory and impractical as a basis for intervention to improve the patient's adherence to his medical regimen. Health beliefs may provide an opportunity to intervene to improve compliance and control of the disease. In this study we examined the health beliefs of 93 male diabetic patients and correlated their beliefs with behavioral and physiologic measures of compliance gathered at a follow-up interview. The belief in severity of illness related to compliance. Health beliefs were better predictors of metabolic control than compliance itself. The study suggests that improving attitudes about care may be a means of directly influencing control of the disease.