Emotional impact of retirement on physicians.

The current study sought to identify the factors underlying physicians' decision to retire, describe the emotional impact of retirement on physicians, measure quality of life in retirement, and identify coping strategies used by retired physicians. A questionnaire was sent to all 689 retired members of the Harris County Medical Society, and 323 (47%) responded. Data were analyzed using SPSS. Physicians overwhelmingly indicated positive reasons for retirement, although one third said that loss of autonomy and control in medical practice were factors. Participants were satisfied with retirement and enjoyed low levels of stress and depression. Spousal and personal health had the largest negative impact on retirement. Being prepared emotionally significantly affected physicians' attitudes. Longitudinal studies and research on the impact of managed care on the retirement experience are needed. Younger physicians need to be prepared for the emotional impact of retirement.

Dementia family caregiver training: affecting beliefs about caregiving and caregiver outcomes.

OBJECTIVES: Family caregiving is an integral part of the care system for persons with dementing disorders, such as Alzheimer's disease. This study tested role-training intervention as a way to help family caregivers appreciate and assume a more clinical belief set about caregiving and thereby ameliorate the adverse outcomes associated with caregiving. DESIGN: Training effectiveness was tested in a trial in which family care receiver dyads were randomly assigned to training beginning immediately or were placed in a wait-list control group and assigned to receive training in 5 to 6 months, following completion of data collection. SETTING: A community-based 14-hour training program provided in seven weekly 2-hour sessions. The training program curriculum was built on a stress and coping theory base. Recruitment and randomization were ongoing. Programs were begun every 2 months over a two and one half-year period for a total of 16 programs. PARTICIPANTS: Community health and social service agencies referred primary caregivers and at least one other family member of community-dwelling persons with dementia to participate. MEASUREMENTS: Data reported in this paper were gathered from each participating family at entry to the study and 5 months later. Standard measures of beliefs about caregiving, burden, depression, and reaction to care receiver behavior were administered to caregivers. A standard measure of mental status was administered to the person with dementia and standardized instruments were used to gather information from caregivers concerning care receivers' behavior and abilities to perform activities of daily living (ADLs). RESULTS: Data were analyzed from 94 caregiver/care receiver dyads with complete sets of data. Treatment and control caregivers and care receivers were similar at baseline, and care receivers in both groups declined similarly over the 5-month period. Significant within-group improvements occurred with treatment group caregivers on measures of beliefs about caregiving (P = .044) and reaction to behavior (P = .001). When outcomes were compared, treatment group caregivers were significantly different (in the expected direction) from those in the control group on measures of the stress mediator, beliefs (P = .025), and key outcomes, response to behavior (P = .019), depression (P = .040), and burden (P = .051). There was a significant positive association between the strengthened mediator, the caregivers' having less-emotionally enmeshed beliefs about caregiving roles and responsibilities, and the outcome, namely improvements in burden (P = .019) and depression (P = .007). CONCLUSION: A caregiver training intervention focused on the work of caregiving and targeted at knowledge, skills, and beliefs benefits caregivers in important outcome dimensions. The results suggest the benefits of providing information, linkage, and role coaching to dementia family caregivers.

Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia.

This 3-year randomized clinical trial tested the effectiveness of an interdisciplinary psychoeducational family group intervention in decreasing the caregivers' perceptions of the frequency and severity of behavioral problems in persons with dementia and their reactions to those problems, and in decreasing caregiver burden and depression. The intervention consisted of seven weekly, 2-hour multimedia training sessions that included education, family support, and skills training for 94 primary caregivers and their families. Repeated measures ANOVA was used to test for significant differences between the intervention and waiting list control groups over a 5-month period. The intervention was successful in reducing caregivers' negative reactions to disruptive behaviors and in reducing caregiver burden over time.

Caregiver exhaustion: caring for the hidden patients.

Family caregivers, the backbone of the health care system, are frequently themselves the hidden patients. Their commitment to care for frail older relatives may lead to exhaustion, with negative consequences for themselves and their loved ones. In this study of 245 family caregivers, 56.4% of caregiver exhaustion was predicted by three factors: lack of personal time, employed in a paid job outside the home, and frequent behavioral problems in the care recipient. Advanced practice nurses must recognize the needs and limitations of these hidden patients and advocate on their behalf in the health care system.

The Family Stories Workshop: stories for those who cannot remember.

The Family Stories Workshop (FSW) is a process through which family members and friends of persons with dementing disorders living in nursing homes develop stories of these residents' lives. The stories are meant to help staff members to develop a better, more deeply felt understanding of the lives of the residents, persons who can no longer tell their own stories. The workshop is product-oriented and is not meant as a support group and works best in organizations emphasizing individualized care. This article describes the process of the FSW as well as outcomes from preliminary implementation. It suggests ways of using elements of the process to more broadly accomplish the FSW purposes.

Caregivers of frail elderly and medically fragile children: perceptions of ability to continue to provide home health care.

The purposes of this study were to compare the characteristics and support systems of caregivers of frail elderly and medically fragile children and to determine what factors discriminated between caregivers who could (and could not) continue to provide home health care. Caregivers of children were significantly more likely (chi 2 = 52.30)2), p = < .0000) to report that they were managing OK than caregivers of frail elderly. They also reported receiving more support and assistance from formal and informal sources, although in general, less than 30% of the caregivers received any help. Five variables (Mental impairment of the elder, poor physical and mental health of the caregiver, high monthly caregiving-related expenses, and use of paid in-home assistance) explained 35% of the variance between caregivers of frail elderly who were managing OK and those who were unable to continue to manage. Six variables (physical and mental impairment of the child, physical health of the caregiver, feeling like there were no alternative providers, time demand and lack of assistance from others) explained 26.57% of the variance between caregivers of children who were managing OK and those who were unable to continue to manage. The findings suggest that a strong objective stressor, combined with a lack of personal and social resources are associated with caregivers' perceptions that they cannot continue to manage home health care.

Videotape dietary assessment: validity, reliability, and comparison of results with 24-hour dietary recalls from elderly women in a retirement home.

The validity and reliability of a videotape method for quantifying food intake were tested, and results of the method were compared with results obtained from 24-hour dietary recalls. Participants were 37 elderly Catholic nuns (aged 81.8 +/- 4.1 years) who were ambulatory and living in a retirement home. The videotape method of dietary assessment consisted of videotaping food trays of each participant for three meals during 1 day and the subsequent identification of food types and amounts from the videotapes. Estimates of food amounts obtained were used in the calculation of energy and nutrient intake. Correlation coefficients between values for energy and 14 nutrients obtained by direct measurement of food and estimates from the videotape method were high (r = 0.86 to 1.0). Compared with measured food amounts, the videotape method underestimated food quantities by an average of 6%. The reliability test indicated that mean nutrient values obtained from the videotape method by two research assistants differed by an average of 3.7% and were highly correlated (r = 0.84 to 0.98). Comparison of the videotape method with 24-hour dietary recalls revealed differences between mean values that were greater than 10% for energy and 6 of the 14 nutrients and correlations that ranged from 0.09 to 0.82. These results suggest that use of 24-hour dietary recalls among the elderly may result in a high percentage of error.

Temporomandibular joint dysfunction and selected health parameters in the elderly.

Little research has focused on temporomandibular joint dysfunction (TMJD) in the elderly. The present study describes relationships between TMJD and selected health parameters in a population of 75- to 94-year-old Roman Catholic sisters (nuns). Mental, physical, and oral assessments made on 117 sisters identified 26 with TMJD. Among all sisters, TMJD was not associated with age, education, mental impairments, hand coordination, handgrip strength, mobility, or use of walking aids. In 75- to 84-year-old sisters, TMJD was positively associated with self-reported arthritis (p = 0.12), edentulism (p = 0.09), and the presence of complete dentures (p = 0.05), and negatively associated with the number of teeth present (p = 0.05), especially the posterior teeth. These associations were weaker in 85- to 94-year-old sisters. This study suggests that TMJD is associated with the presence of complete dentures and a low number of teeth, especially the posterior teeth.

The impact of health education on health status: an experimental program for elderly women in the community.

Until recently, little research has been conducted on the effect of health education and promotion programs on older adults. As the number of older adults increase and costs for health care skyrocket, educational efforts aimed at delaying the negative effects of chronic illness will become increasingly important. In this study, a pretest-posttest design was used with a 3-month follow-up assessment to determine whether participation in a teacher-directed or learner-paced health education program was related to changes in health-risk status, cholesterol levels, blood pressure readings, or life satisfaction. The program, sponsored by a community health department, enrolled 78 women with a mean age of 71 living in the suburban areas of a large metropolitan county. Women who were randomly assigned to one of the intervention groups were more likely to reduce their stress levels, decrease salt consumption, and decrease their systolic blood pressure.

Education, survival, and independence in elderly Catholic sisters, 1936-1988.

Mortality among 306 Roman Catholic sisters (nuns) from Mankato, Minnesota, was assessed during the period 1936-1988; daily use of nursing services by survivors was determined in 1986; and the ability of survivors to eat, dress, and perform other self-care activities was evaluated in 1987. The median age at death was 89.4 years for sisters with educational attainment of a bachelor's degree or higher, 82.2 years for sisters with some high school or college education, and 82.0 years for sisters with only a grade school education. Odds ratios were calculated for "survival and independence" (i.e., sisters survived to 1986 (ages 75-94 years) and did not use daily nursing services at that time). These odds ratios were 2.67 (95% confidence interval (CI) 1.16-6.16) for sisters with a bachelor's degree or higher, 1.00 for the reference group with some high school or college, and 0.94 (95% CI 0.32-2.73) for sisters with only grade school. Sisters with a bachelor's degree or higher were also more likely than others to survive to old age while maintaining their ability to perform self-care activities. These findings suggest that college graduates lived longer and maintained their ability to care for themselves longer than other persons.

Manual dexterity as a correlate of dependency in the elderly.

Physical and mental correlates of dependent living were determined in 128 Catholic sisters (nuns), aged 75 to 94 years, who had similar social support systems and lifestyles. The primary a priori hypothesis was that poor manual dexterity would correlate strongly with living in the nursing home. Stepwise discriminant analysis indicated that manual dexterity explained 51% of the variance in the sisters' residential living site (ie, nursing home, retirement home, or living in community). The discriminant analysis equation using manual dexterity predicted living site correctly for 63% of the sisters in the nursing home with a specificity of 99%, a positive predictive value of 96% and negative predictive value of 84%. The addition of age and mental status to the equation improved the prediction only slightly.

Changing employees' dietary and exercise practices: an experimental study in a small company.

The purpose of this study was to determine the effect of educational and environmental strategies on the employees' dietary and exercise practices, their satisfaction with their health practices, and their perception of organizational support for good health practices. Employees from the treatment company were randomly assigned to three intervention groups with varying levels of potency. A control company was tested to observe societal changes occurring during the program. All three intervention groups made significant changes in their health status. Except for the need to target employees with high cholesterol readings for individual counseling, the findings suggested that providing employees with feedback about their health status, persuasive information about risk reduction, and a supportive environment can result in significant changes with a minimum of professional involvement.

Years of life with good and poor mental and physical function in the elderly.

A population of Roman Catholic sisters (nuns) were divided into a high education group (i.e. at least a Bachelor's degree) and a low education group (i.e. less than a Bachelor's degree). Prevalence data on 132, 75-94 year old, sisters indicated that the high-educated had better mobility and hand coordination, stronger handgrip, better distant and near visual acuity, and fewer mental impairments than the low-educated group. Life table analyses on 154 sisters indicated that the high-educated lived an average of 3.28 years longer after age 75 than the low-educated. Years of life with relatively good and poor mental and physical function after age 75 were estimated by a mathematical model that used mortality and prevalence data. According to the model, high-educated sisters lived an average of 3.57 years longer with good function and 0.29 of a year less with poor function than low-educated sisters.

Adult day care programs: maintaining a therapeutic triad.

Adult day care programs are rapidly becoming an alternative long term care service offered by nursing homes, community hospitals, and community agencies. For an adult day care program to be most effective a therapeutic triad needs to exist between formal caregivers, the elderly client and the informal family caregivers. The purpose of this descriptive study was to identify the profile of Minnesota adult day care programs and to explore family involvement patterns. Data were analyzed from 87 percent of the operating programs (n = 48). Seventy-five percent of the programs operated from a social/health center model. About 75 percent of the programs had a staff of less than five persons and over 60 percent of them enrolled less than 20 clients. Programs reported that families were usually involved in activities such as initiating client placement, participating in the admission assessment, visiting the day care center and participating in client evaluation. Day care programs frequently sponsored social activities, counseling sessions and support groups for family members. There was a significant positive relationship between the composition of the day care staff, the number of family and client services and the family involvement patterns.