Psychosocial benefits of solitary reminiscence writing: an exploratory study.

Claims have been made that reminiscence has benefits for older people's psychological well-being, and that writing memories may be a therapeutic process. This paper describes an exploratory study in which five nursing home residents engaged in a process of writing their memories by themselves, in a series of booklets containing memory prompts and photographs, over a period of four weeks. Each completed booklet was typed up by researchers and returned to participants the following week, with a bound copy provided to participants at the end of the study period. Analysis focuses on two sets of data: an in-depth case study of one participant, and a thematic analysis of field notes, researcher reflections, and the written material produced by the other study participants. The case study revealed three main themes: views on the past; sharing the past; and confidence in writing about the past. The field note analysis indicated the presence of four themes: proof and maintenance of skills; psychological or internal processes; social contact; and pleasure in reminiscence. The writing was seen as cathartic and provided a meaningful purpose, an opportunity to exercise writing skills and memory, and a focus for participants to share key stories with others. This exploratory study suggests that there is potential in using solitary writing within a reminiscence framework to improve psychological well-being in older people. However, caution should be exercised when encouraging older people to write their stories. Issues of confidentiality, audience, support, and appropriateness of the activity for the individual need consideration.

The COPE index--a first stage assessment of negative impact, positive value and quality of support of caregiving in informal carers of older people.

Data was collected in five countries from informal carers of older people (n = 577) via a common protocol. Carers completed: (1) a 17-item version of the Carers of Older People in Europe (COPE) Index, an assessment of carers' perceptions of their role : (2) a questionnaire on demographic and caregiving circumstances : and (3) three instruments included for the criterion validation of the COPE Index (the General Health Questionnaire, the Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life-BREF). Principal Component Analysis of the COPE Index was followed by internal consistency analysis of emergent components. Scales derived by summing items loading on the components were analyzed for their association with the criterion measures. Two components, negative impact and positive value, emerged consistently across countries. A third component, quality of support was less consistent across countries. Scales derived from the negative impact and positive value components were internally consistent and significantly associated with the criterion validity measures. These two scales and four items drawn from the quality of support component were retained in the final COPE Index. While further testing is required, the COPE Index has current utility in increasing understanding of the role perceptions of carers of older people.

Fear of falling, falls efficacy, and health outcomes in older people following hip fracture.

PURPOSE: This study sought to determine whether fear of falling and falls efficacy independently contribute to the prediction of health outcomes after a fall, controlling for length of stay in hospital, prefall activity problems, and history of falls. METHOD: Eighty-two older people (> or = 65 years) admitted to hospital as a result of a fall, with proximal femoral fracture, were interviewed to assess variables of interest. At two months after initial interview, participants (n = 57) were re-interviewed in their own home, and their functional limitation and further fall events were assessed. Regression analyses were carried out to determine the ability of the variables assessed in hospital to predict functional limitation and further falls post discharge. RESULTS: Perceived risk of falling and falls efficacy did not explain variance in functional limitation when added to a model containing biomedical factors. In the prediction of further falls, addition of falls efficacy and worry over further falls to a model containing biomedical factors resulted in a statistically reliable improvement, although falls efficacy was not independently associated with outcome. CONCLUSIONS: Assessing worry over further falls in hospital may help to identify older people with hip fracture at risk of poor health outcomes.

Geriatric assessment in primary care: formulating best practice.

Comprehensive geriatric assessment (CGA) is a structured approach to measuring physical, mental and social functioning of older people to identify needs and to plan care. Meta-analysis of trials of CGA suggest that it is cost-effective, but there is no agreed approach to its implementation in primary care. Our aim was to develop a best-practice model for geriatric assessment in primary care. We took an iterative approach to development, combining expert and local stakeholder opinion, and using semi-structured interviews to assess patient and practitioner experience in nine general practices in Sheffield. Patients were aged 75 and over, living at home. The best-practice model was the use of a standardized instrument (EASY-Care) to unselected patients aged 75 years and over living at home or in residential care, administered by a practice nurse in the context of an over-75s health check. There was high patient and practitioner acceptability, and significant cost savings were noted. Key beneficial features were the assessment of mental health and sources of support; goal-setting; generation of a disability score; and high patient satisfaction from contact with nursing staff. We conclude that geriatric assessment in primary care is feasible, economical and beneficial to patients and practitioners. Nursing staff are central to successful implementation of geriatric assessment in primary care.

Health, fear of crime and psychosocial functioning in older people.

Fear of crime is thought to limit social activity in older people. Sixty older people, recruited via day centres, were given questionnaire-based interviews. A series of questions produced two scales of crime awareness and a scale of perceived crime prevalence. Fear of crime was operationalized through a catastrophizing technique, and by a single-item measure of perceived safety. Physical health, mental health and psychosocial limitation were assessed. Physical health was found to moderate a relationship between crime awareness and fear of crime. In multivariate models, fear of crime was not a significant predictor of psychosocial limitation, which was predicted by physical and mental health. Implications of the findings for models of fear of crime and health psychology are discussed.

Predicting perceived recovered activity in older people after a fall.

PURPOSE: Fall injury represents a common cause of disability in older people. Much research in this area ignores the importance of psycho-social factors in recovery from a fall. METHOD: Data were collected from a sample of 40 people (> or = 65 years) admitted to hospital as a result of a fall. Details included: the fall event; causal beliefs; psychological impact; history of falls; pre-fall activity; general health; and beliefs concerning recovery, including efficacy and affective beliefs. After 2 months, participants were recontacted by letter and completed a questionnaire assessing perceived residual levels of disability (65% response). RESULTS: Results indicated that beliefs that the fall was due to external causes and was preventable were each associated with higher perceived recovered activity, even when controlling for pre-fall activity, health status and fall injury. CONCLUSION: The implications of these findings are discussed with regard to promoting recovery after a fall in older people.

Coping in family supporters of elderly people with dementia.

Research into supporters of elderly people with dementia has a brief but significant history. Initially, research sought to establish the nature and extent of the distress that supporters endured in the fulfilment of their caring role. More recently, researchers have turned their attention towards the identification of coping techniques used by supporters in the community. The Dundee Study of Supporters and Dementia is concerned with factors associated with the maintenance and care of the demented elderly in the community, and with the impact of dementia on family supporters. A total of 228 family supporters of community-resident elderly (50 per cent of elders with dementia, 50 per cent without) were interviewed. Part of the interview focused on self-reported coping, and identified coping strategies using open-ended questions and a revised, 31-items Ways of Coping checklist. Findings indicated that the majority of supporters of community-resident elderly relatives reported coping well. Supporters predominantly used emotion-focused coping strategies as their main way of coping. However, those supporters who reported using a problem-focused strategy were found to score better on measures of coping than those supporters using an emotion-focused strategy. The supporters' main coping strategy was not associated with characteristics of the elder-supporter dyad. Factors derived from the Ways of Coping checklist produced a pattern of associations with characteristics of the elder-supporter dyad, but the same factors were largely not associated with other measures of coping. The implications of the findings are discussed with regard to coping research, and for interventions to improve the well-being of supporters of an elderly relative with dementia in the community.

Community care for demented and non-demented elderly people: a comparison study of financial burden, service use, and unmet needs in family supporters.

OBJECTIVE: To measure and compare perceived financial burden, use of services, and perceived unmet service needs of supporters of demented and non-demented elderly people. DESIGN: Comparison study of age and sex matched demented and non-demented elderly people and their supporters. SETTING: 25 primary health care teams in Dundee. SUBJECTS: 114 community resident elderly (age over 65) people with dementia, 114 age and sex matched comparators, and the main informal supporter of each elderly person. MAIN OUTCOME MEASURES: Carers' perceptions of financial impact of looking after an old person, service use (from a list of locally available services), unmet service needs, and needs for three types of generic service (help with supervision, housework, or personal care). RESULTS: Financial impact was low, except for extra household expense in the dementia group. There was significantly greater use of mainstream domiciliary and day care services in the dementia group. Dementia was nevertheless associated with a high level of unmet need, mainly for more mainstream support and help with supervision of the elderly person. CONCLUSION: Supervisory care for demented elderly people should be further developed within an expanded domiciliary service to meet supporters needs.

Concern, perceived risk and attitudes towards HIV/AIDS in Scottish prisons.

Four hundred and eighty male prisoners and 500 male staff from 7 Scottish prisons took part in a study assessing perception of risk and attitudes towards HIV/AIDS. Prison staff were found to perceive prison as a higher-risk environment for HIV/AIDS than outside prison, whereas prisoners perceived the opposite. Prisoners perceived less personal risk of HIV/AIDS inside prison than staff. Staff and prisoner concern towards HIV/AIDS was greater than perceived risk of HIV/AIDS, and concern was found to be associated with a number of demographic variables, whereas perceived risk was less influenced by such variables. These findings suggest that the process of risk perception may operate on more than one level. Factor analysis of attitudes towards HIV/AIDS produced four factors for both staff and prisoners: 'Interacting with people with HIV/AIDS'; 'Social control of HIV/AIDS'; 'HIV/AIDS prevention for high-risk groups'; and 'Response to HIV/AIDS high-risk behaviour'. For both staff and prisoners, greater concern and perceived risk towards HIV/AIDS was associated with a lower tolerance for interacting with people with HIV/AIDS and more support for strict social control measures against people with HIV/AIDS.

Risk factors associated with vasovagal reactions during colonoscopy.

To define the syndrome of vasovagal reactions that occur during colonoscopy and to identify those risk factors associated with this development, we prospectively evaluated patients undergoing colonoscopy with monitored sedation. A total of 223 consecutive patients were evaluated during the 60-day study period. A vasovagal reaction was defined as the occurrence of one or more of the following: diaphoresis, sustained bradycardia of less than 60 beats/min or a decrease in heart rate of 10%, or hypotension (systolic blood pressure less than 90 mm Hg, diastolic blood pressure less than 60 mm Hg, or a reduction in blood pressure of more than 10% below a baseline measurement before colonoscopy and after sedation). Thirty-seven (16.5%) of the 223 patients experienced a vasovagal reaction by our criteria. The remaining 186 patients did not; 100 of these patients were randomly selected by computer to form a control group. No statistically significant differences were observed between the vasovagal and control groups with regard to demographics, cardiopulmonary disease, cardiac medications, procedure success, the endoscopist, patient procedure tolerance, colon preparation, or procedure difficulty. A significant difference was seen in the mean dose of midazolam used in the vasovagal group as compared with that used in the control group (4.6 mg versus 3.9 mg, p < 0.04), and moderate to severe diverticulosis was more commonly seen in the vasovagal group as compared with the control group (43% versus 16%, p < 0.02). Thirteen (35%) of the 37 patients who had a vasovagal reaction required medical intervention (5.8% of the 223 patients).(ABSTRACT TRUNCATED AT 250 WORDS)

Intravenous drug use and HIV transmission amongst inmates in Scottish prisons.

The intravenous drug use behaviour and HIV risk reduction strategies used by a group of Scottish inmates prior to prison, during imprisonment and as expected after release was investigated. From a sample of 559 inmates (480 males and 79 females) 27.5% were involved in IVDU prior to imprisonment, 7.7% on at least one occasion during a period of imprisonment and 14.7% expected to do so after release. Prior to imprisonment 17.3% had shared needles, 5.7% at some time during imprisonment and 4.3% expected to do so after release. Some form of HIV risk reduction strategies were practised by the majority of IVDU inmates prior to imprisonment, during imprisonment and were expected to continue after release. The most at risk inmates were those who continued to share injecting equipment without reduction and without sterilizing. The reduction in IVDU and needle sharing during imprisonment in comparison to prior to imprisonment was paralleled by a self-perceived reduction of personal risk from HIV during imprisonment.

Comparison of sexual behaviour and risk of HIV transmission of Scottish inmates, with or without a history of intravenous drug use.

The sexual behaviour and intravenous drug use (IVDU) of a sample of 559 inmates (480 males and 79 females) was investigated. Sexual behaviour and IVDU prior to imprisonment, during imprisonment, and that expected after release, was assessed. Alterations in sexual behaviour as a means of HIV risk reduction was also assessed in relation to IVDU status. Prior to imprisonment most IVDUs and non-IVDUs engaged in unprotected intercourse. Sexual behaviour during imprisonment, as reported by inmates, was almost negligible for both groups. Expected sexual behaviour after imprisonment differed little from that before imprisonment for both IVDUs and non-IVDUs. Selecting partners more carefully and reducing their number was the most common method of HIV risk reduction for both IVDUs and non-IVDUs prior to imprisonment and was expected to be increasingly so after release. There was little difference in the sexual behaviour of IVDUs and non-IVDUs prior to imprisonment, during imprisonment, and as expected after release. However, IVDU inmates were more likely to have had an IVDU sexual partner than did non-IVDU inmates. Those IVDU inmates who had an HIV test, and those who had an IVDU sexual partner, were more likely to expect to continue IVDU after imprisonment. IVDU inmates, who had an IVDU sexual partner, were also more likely to have shared injected equipment but no more likely to have sterilized injecting equipment than did IVDU inmates whose sexual partner was not involved with IVDU. Results are discussed in relation to risk of HIV transmission for IVDUs and their sexual partners.