The preferences for everyday living inventory: scale development and description of psychosocial preferences responses in community-dwelling elders.

PURPOSE OF THE STUDY: Assessing preferences for daily life is the foundation for person-centered care delivery. This study tested a new measure, the Preferences for Everyday Living Inventory (PELI), with a large sample of community-dwelling older adults. We sought to evaluate the tool's convergent and divergent validity, identify the most commonly held preferences within the sample, and explore relationships between gender and race and strength of preferences. DESIGN AND METHODS: Randomly selected African American and Caucasian home health agency clients (N = 437) were interviewed using the PELI. Respondents self-reported functional ability, physical health, affect, mental health, and five domains of psychosocial preferences. The study examined correlations among descriptive variables and preference items and used logistic regression to estimate relationships between gender and race and 55 PELI items and 10 descriptive covariates. RESULTS: The study found support for the PELI's construct validity, identified seniors' most strongly held preferences across domains, and revealed significant differences in preferences by gender and race. IMPLICATIONS: The PELI captures strongly held personal preferences and shows promise as a practical tool that allows providers to document client preferences and customize care accordingly.

Symptoms, affects, and self-rated health: evidence for a subjective trajectory of health.

OBJECTIVE: Self-rated health (SRH) is known to predict mortality and other health outcomes better than objective ratings, suggesting that patients have important knowledge that physicians do not. The study assessed whether SRH reflects changes in internal states, specifically symptoms and affects. METHOD: In an event-sampling study, 54 elders completed a SRH measure, positive and negative affect scale, a symptom checklist, and a pain scale every evening for 8 weeks. Using lagged (time series) hierarchical regression, the authors modeled associations of SRH with previous symptoms, moods, and changes in symptoms and mood. RESULTS: The SRH was highest when symptoms had decreased from the previous day and lowest when symptoms had increased, suggesting that SRH reflects a sense of change. Symptoms and affects contributed independently to SRH. Self-rated health was more sensitive to positive than negative affect and also sensitive to changes of positive but not negative affect. DISCUSSION: Patients may possess a subjective trajectory of health-an awareness of changes in symptoms and affect. This trajectory may constitute an important component of SRH and help to explain its ability to predict health outcomes.

Older patients' aversion to antidepressants. A qualitative study.

BACKGROUND: Depression is common among older patients yet is often inadequately treated. Patient beliefs about antidepressants are known to affect treatment initiation and adherence, but are often not expressed in clinical settings. OBJECTIVE: To explore attitudes toward antidepressants in a sample of depressed, community-dwelling elders who were offered treatment. DESIGN. Cross-sectional, qualitative study utilizing semi-structured interviews. PARTICIPANTS: Primary care patients age 60 years and over with depression, from academic and community primary care practices of the University of Pennsylvania Health System and the Philadelphia Department of Veterans Affairs. Patients participated in either the Prevention of Suicide in Primary Care Elderly: Collaborative Trial or the Primary Care Research in Substance Abuse and Mental Health for the Elderly Trial. Sixty-eight patients were interviewed and responses from 42 participants with negative attitudes toward medication for depression were analyzed. MEASUREMENTS: Interviews were audiotaped, transcribed, and entered into a qualitative software program for coding and analysis. A multidisciplinary team of investigators coded the transcripts and identified key features of narratives expressing aversion to antidepressants. RESULTS: Four themes characterized resistance to antidepressants: (1) fear of dependence; (2) resistance to viewing depressive symptoms as a medical illness; (3) concern that antidepressants will prevent natural sadness; (4) prior negative experiences with medications for depression. CONCLUSIONS: Many elders resisted the use of antidepressants. Patients expressed concerns that seem to reflect their concept of depression as well as their specific concerns regarding antidepressants. These findings may enhance patient-provider communication about depression treatment in elders.

Using the minimum data set 2.0 mood disturbance items as a self-report screening instrument for depression in nursing home residents.

OBJECTIVE: Seeking to enhance nursing home residents' involvement in their care, the authors examined whether the Minimum Data Set, Version 2.0 (MDS) Mood Disturbance items could be administered by self-report. They compared the MDS to the Geriatric Depression Scale (GDS) in terms of its association with depression diagnosis. METHODS: Subjects (N=204) were nursing home residents who were interviewed with a psychiatric diagnostic instrument, the GDS, and a self-report version of the MDS mood disturbance items. RESULTS: Analyses of variance and receiver operating characteristics analyses demonstrated that MDS items distinguished subjects with any versus no depression about as well as did the GDS. This pattern held within cognitive, gender, and ethnicity subgroups. CONCLUSION: The MDS Mood Disturbance items can be reliably and validly administered via self-report to persons scoring at least 12 on the Mini-Mental State Exam.

A workshop for nursing home staff: recognizing and responding to their own and resident's emotions.

An appreciation for the emotion work required of nursing home staff suggests that caregiver education should address the skills of emotional intelligence. Although the number of training efforts geared toward paraprofessionals is growing, few programs address caregivers' emotional skills, and fewer still have their roots in research. After providing background on resident-centered care, caring for the caregiver, and emotions in dementia, this paper describes a research-based workshop that promotes nursing home staff's skills in emotional intelligence. The first segment of the workshop introduces the importance of being aware of one's feelings and controlling impulses, and discusses how to manage one's own emotions. The second segment focuses on recognizing residents' emotions and helping residents manage their emotions.

Preferences for prolonging life: a prospect theory approach.

Kahneman and Tversky's (1979) Prospect theory was tested as a model of preferences for prolonging life under various hypothetical health statuses. A sample of 384 elderly people living in congregate housing (263 healthy, 131 frail) indicated how long (if at all) they would want to live under each of nine hypothetical health conditions (e.g., limited to bed or chair in a nursing home). Prospect theory, a decision model which takes into account the individual's point of reference, would predict that frail people would view prospective poorer health conditions as more tolerable and express preferences to live longer in worse health than would currently healthy people. In separate analyses of covariance, we evaluated preferences for continued life under four conditions of functional ability, four conditions of cognitive impairment, and three pain conditions--each as a function of participant's current health status (frail vs. healthy). The predicted interaction between frailty and declining prospective health status was obtained. Frail participants expressed preferences for longer life under more compromised health conditions than did healthy participants. The results imply that such preferences are malleable, changing as health deteriorates. They also help explain disparities between proxy decision-makers' and patients' own preferences as expressed in advance directives.