The Role of Communication Perceptions in the Mental Health of Older Adults: Views From Thailand and the United States.

This study examines age ingroup and outgroup communication perceptions of older Thai and American adults to assess whether communication perceptions of self and others are associated with mental health outcomes such as personal self-esteem, collective self-esteem, and life satisfaction. Results suggest that more accommodation by same-age older others leads to greater personal self-esteem, greater group esteem, and greater life satisfaction, while more nonaccommodation by younger others leads to less life satisfaction for the Thais and Americans. More overaccommodation by younger others was found to lead to less personal self-esteem and less life satisfaction for the sample as a whole. Discriminant loadings show life satisfaction was the most important variable in distinguishing between the prototypical older Thai and American respondent. The overall profile shows the typical Thai older adult participants as perceiving members of their own age ingroup as communicatively avoidant and overaccommodating while also experiencing lower collective self-esteem and life satisfaction. Typical older Americans tended to be associated with higher collective self-esteem and life satisfaction.

Palliative and end-of-life care in stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association.

BACKGROUND AND PURPOSE: The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke. METHODS: Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were chosen to reflect the diversity and expertise of professional roles in delivering optimal palliative care. Writing group members were assigned topics relevant to their areas of expertise, reviewed the appropriate literature, and drafted manuscript content and recommendations in accordance with the American Heart Association's framework for defining classes and level of evidence and recommendations. RESULTS: The palliative care needs of patients with serious or life-threatening stroke and their families are enormous: complex decision making, aligning treatment with goals, and symptom control. Primary palliative care should be available to all patients with serious or life-threatening stroke and their families throughout the entire course of illness. To optimally deliver primary palliative care, stroke systems of care and provider teams should (1) promote and practice patient- and family-centered care; (2) effectively estimate prognosis; (3) develop appropriate goals of care; (4) be familiar with the evidence for common stroke decisions with end-of-life implications; (5) assess and effectively manage emerging stroke symptoms; (6) possess experience with palliative treatments at the end of life; (7) assist with care coordination, including referral to a palliative care specialist or hospice if necessary; (8) provide the patient and family the opportunity for personal growth and make bereavement resources available if death is anticipated; and (9) actively participate in continuous quality improvement and research. CONCLUSIONS: Addressing the palliative care needs of patients and families throughout the course of illness can complement existing practices and improve the quality of life of stroke patients, their families, and their care providers. There is an urgent need for further research in this area.

Hospital to home: a geriatric educational program on effective discharge planning.

There has been increased attention on the needs of the burgeoning older adult population, with focus on the limited education and training experiences available in geriatric care. Older adults transitioning between levels of care often require increased attention, and the American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has encouraged greater training opportunities be provided to better understand the needs of this population. The Hospital to Home Program is one model of geriatric training emphasizing many of the AGS recommendations. Through qualitative analyses of 51 internal medicine residents' reflections, the authors report how this educational program is meeting the above need and share how Hospital to Home is enhancing residents' skills in creating a safe discharge for geriatric patients and their families.

"Geriatricizing" hospitalists: identifying educational opportunities.

The objective of this study was to identify differences between geriatricians and hospitalists in caring for hospitalized older adults, so as to inform faculty development programs that have the goal of improving older patient care. Eleven hospitalists and 13 geriatricians were surveyed regarding knowledge, confidence, and practice patterns in caring for hospitalized older adults, targeting areas previously defined as central to taking care of older hospitalized patients. Overall, geriatricians had more confidence and more knowledge in caring for older hospitalized adults. The areas in which hospitalists expressed the least confidence were in caring for patients with dementia, self-care issues, and care planning. Geriatricians reported more routine medication reviews, functional and cognitive assessments, and fall evaluations. Geriatricians and hospitalists differ in their approach to older adults. Where these differences reflect lack of knowledge or experience, they set the stage for developing curricula to help narrow these gaps.

Hazards of hospitalization: residence prior to admission predicts outcomes.

PURPOSE: Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during hospitalization, so that interventions can be developed to reduce risk. METHODS: This is a prospective, observational study of 212 sequential patients admitted during a 1-month period in 2006 to a 38-bed Acute Care for Elders unit in Rochester, New York and followed until discharge. We categorized the patients by residence prior to admission (i.e., community, assisted living, and nursing home). Our outcome categories were: worsening function, delirium, depression, falls, pressure sores, and nursing home admission. RESULTS: After adjusting for multiple characteristics, we found that patients admitted from assisted living facilities were at substantially higher risk than those admitted from the community for functional decline and falls. Patients from nursing homes had a trend toward increased risk for these outcomes, but the trend did not reach statistical significance. More than three fourths of assisted living facility residents were discharged to a nursing home after hospitalization, with a relative risk of 9.41 (p <.001) versus community-dwellers for this outcome. IMPLICATIONS: People who are admitted to the hospital from assisted living facilities are at high risk for falls and functional decline during hospitalization. Assisted living residents are at a particularly high risk of nursing home admission following hospitalization. Targeted preventive programs should be developed with a goal of reducing risk in this vulnerable population.

Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population.

Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a "geriatric, rather than orthopedic disease." Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co-management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co-managed Geriatric Fracture Center program that has resulted in lower-than-predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co-management, protocol-driven geriatric-focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition.

Communication ambivalence toward elders: data from North Vietnam, South Vietnam, and the U.S.A.

This study investigated young adults' beliefs about their intra- and intergenerational communications in South Vietnam, North Vietnam, and the U.S.A. Respondents perceived their interactions with older people as simultaneously more problematic (e.g., older people seen as more nonaccommodative) and more pleasing (e.g., older adults seen as more accommodative) than their interactions with other young adults. Young adults also strongly felt more of an obligation to be respectful, and to a lesser degree avoidant, in their communication with older adults than to those in their peer age group. Large-scale linguistic, historical, political, and cultural differences notwithstanding, a similar intergenerational communication profile emerged among the North Vietnamese, South Vietnamese, and American respondents in their reports of their communication with people of different ages. Intergroup, cultural, identity, and modernity issues were invoked to account for these findings.

Perceptions of intergenerational communication across cultures: an Italian case.

406 Anglo-American, Italian-American, and Italian (Northern and Southern Italy) students were asked to evaluate past conversations with same-age peers, i.e., 17 to 30 years, and older adults, i.e., 65 years and older. While according older adults more deference, all cultural groups perceived older adults as more rigid and nonaccommodating than younger adults. Exchanges with older adults were reported as having more negative affect than were those with other young adults, and were also more likely to he avoided.