Cognitive status and relocation stress: a test of the vulnerability hypothesis.

PURPOSE: This study investigated whether cognitively impaired nursing home residents are at particular risk of experiencing harmful effects during a mass, intra-institutional, interbuilding relocation. DESIGN AND METHODS: A pretest-post-test experimental-comparison group design was used. Data on cognitive status, functional capacity, psychosocial health status, physical health status, and mortality were abstracted from the Minimum Data Set Plus and were analyzed using continuous and discrete survival analyses, controlling for covariates as well as baseline status of outcome variables. RESULTS: None of the Relocation x Cognitive Status interaction effects were significant. Relocation main effects indicated that movers in general were more likely than nonmovers to decline in physical health status. Evidence also emerged for a positive long-term effect of moving on psychosocial health status. IMPLICATIONS: These findings suggest cognitively impaired residents are not at unusual risk of harmful effects as a consequence of mass, interbuilding transfer. Given the significant relocation main effects, though, caution must be taken in moving cognitively impaired residents, as it should be in moving any residents.

Using the health belief model to explain clinic appointment-keeping for the management of a chronic disease condition.

Broken appointments have untoward repercussions for patients' health and well-being. Although the literature on missed appointments has been largely atheoretical, several studies have tested the Health Belief Model (HBM) in this context. Those studies have found HBM dimensions are not predictive of keeping appointments for the management of a chronic condition. Given several limitations that characterize these studies, questions can be raised about the validity of this conclusion. This study investigated the utility of HBM for explaining appointment-keeping for Systemic Lupus Erythematosus (SLE), a potentially fatal chronic disease. A questionnaire, operationalizing HBM dimensions and exhibiting acceptable psychometric properties, was developed for this research and administered to 153 SLE patients enrolled at an outpatient clinic of a major teaching hospital. In addition to measuring intention to keep appointments, data were abstracted from medical records regarding actual appointment-keeping during 12 months prior to and 6 months following questionnaire completion. Regression analysis indicated that general health motivation and perceived severity of SLE were uniquely associated in the theoretically predicted direction with, respectively, intent and the percentage of scheduled appointments kept (PSAK) during the 12 month retrospective period. Perceived costs was associated in the expected direction with intent, 12 month retrospective and 6 month prospective PSAK. Typical of HBM research the effect sizes uncovered were modest in magnitude. Questions for future investigation are discussed.

The health belief model and adherence with a community center-based, supervised coronary heart disease exercise program.

Some investigators have concluded that health beliefs do not influence the maintenance of coronary heart disease (CHD) exercise adherence. However, the beliefs tested have not been specific to CHD nor exercise. In addition, much of the research has been atheoretical. We conducted a retrospective study to explore the possible utility of the Health Belief Model (HBM) for explaining attendance at a supervised CHD exercise program, based in a community center. Two dimensions of the model, general health motivation and perceived severity of CHD, were associated with attendance in the theoretically predicted direction, while a third dimension, perceived benefits of exercise, was associated in a direction opposite that predicted by the model. The model as a whole accounted for 29% (adjusted R2) of the variance. This study provides some initial evidence that health beliefs are associated with CHD exercise adherence.

Responses of noninterviewable long-term care patients before and after interinstitutional relocation.

This study investigated the health consequences of an interinstitutional relocation on a sample of 103 noninterviewable, cognitively impaired patients in long-term care. Relocated patients functioned as their own controls. Specifically, data were abstracted from the patients' medical records on 16 health indicators for the 6 months prior to and following relocation as well as for the same months in the year before. Multivariate analysis indicated patients in general exhibited good health pretransfer but worse health posttransfer. In addition, less impaired patients were somewhat more affected by relocation.

The impact of intrainstitutional relocation on morbidity in an acute care setting.

This study investigated the effects on morbidity of intrainstitutional room changes among stabilized male patients in an acute care setting. Controlling for potential confounders, patients who underwent room changes did not differ post-transfer from control patients in vital sign parameters. Younger movers, however, were found to be taking fewer medications post-transfer and were more likely to be independently ambulatory at discharge than younger controls, while older movers were found to be taking more medications and were less likely to be independently ambulatory at discharge in comparison to older controls. A parallel trend appeared with regard to physician evaluation of patient improvement. These findings suggest that age moderates the impact of intramural relocation on patients' health status; while younger patients experience a room change as beneficial, older patients may find it deleterious. Suggestions are offered for future research.

The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided?

Recent research has assigned a prominent role to labeling and stigma as factors that impair the social and psychological functioning of people officially labeled mentally ill. But can the effects of labeling and stigma be overcome by adopting a few simple approaches to coping with these problems? If so, the stigma-induced problems of social awkwardness, demoralization and unemployment emphasized by recent research may not be as severe as claimed. Using a sample of psychiatric patients, we examine this issue by assessing whether patients can ameliorate labeling effects by keeping their history of treatment a secret, educating others about their situation, or avoiding situations in which rejection might occur. None of these coping orientations were effective in diminishing negative labeling effects on unemployment or on psychological distress/demoralization. In fact, the three coping strategies show consistent effects in the direction of producing more harm than good, and with respect to withdrawal-avoidance this effect is significant. Based on these results we argue that stigma is powerfully reinforced by culture and that its effects are not easily overcome by the coping actions of individuals. Using C. Wright Mills's (1967) distinction we conclude that labeling and stigma are "social problems" not "individual troubles."

Characterizing life events as risk factors for depression: the role of fateful loss events.

Empirical associations between life events and health are often weak, in part because event exposure measures may group together very different kinds of experiences within a single event category. Attempts to refine the measures (by using respondents' subjective appraisals of event stressfulness or by taking into consideration situational and personal factors that influence the contextual threat of the events) may strengthen the association, but they cloud the clarity of any causal inference by confounding the measure with extraneous variation. Instead, the use of descriptive information about what actually happened before, during, and after each event is recommended to define exposure to potent, fateful life events. In a comparison of 96 patients with major depression and 404 community residents with no apparent depression, the odds that a person would have experienced one or more events meeting criteria for fatefulness and disruptiveness was 2.5 times greater in the depressed group.

Cardiovascular fitness program: factors associated with participation and adherence.

Despite the proliferation in the last 10 to 15 years of cardiovascular fitness programs, little is known about who uses them. Who joins such a program and who adheres after enrollment were examined in this study. The first issue was addressed by comparing clients who came to the Coronary Detection and Intervention Center of the 92nd Street YM-YWHA in New York City to obtain a CHD risk assessment with those who, after being evaluated for coronary heart disease, enrolled in the center's fitness program. Joiners were found to be in poorer physical condition than nonjoiners. In addition, they were more concerned about their health and more likely to see improved health as being beneficial to other areas of their lives. The issue of adherence was investigated by comparing the joiners who attended less than 50 percent of the exercise sessions with those who attended 50 percent or more of the sessions. Those who adhered to the program were found to be more fit than those who did not adhere. These results, in conjunction with those of other researchers, have several useful implications for the administration of cardiovascular fitness programs.