Judging outcomes in psychosocial interventions for dementia caregivers: the problem of treatment implementation.

PURPOSE: In published dementia caregiver intervention research, there is widespread failure to measure the level at which treatment was implemented as intended, thereby introducing threats to internal and external validity. The purpose of this article is to discuss the importance of inducing and assessing treatment implementation (TI) strategies in caregiving trials and to propose Lichstein's TI model as a potential guide. DESIGN AND METHODS: The efforts of a large cooperative research study of caregiving interventions, Resources for Enhancing Alzheimer's Caregiver Health (REACH), illustrates induction and assessment of the three components of TI: delivery, receipt, and enactment. RESULTS: The approaches taken in REACH vary with the intervention protocols and include using treatment manuals, training and certification of interventionists, and continuous monitoring of actual implementation. IMPLICATIONS: Investigation and description of treatment process variables allows researchers to understand which aspects of the intervention are responsible for therapeutic change, potentially resulting in development of more efficacious and efficient interventions.

Fifteen-year results of the Müller CoCrNiMo straight stem.

Between September 1980 and May 1982, 112 primary unilateral total hip arthroplasties with the original cemented M. E. Müller Straight stem (manufactured from Protasul-10, a CoCrNiMo alloy) were inserted in 109 consecutive patients, all combined with non-cemented, non-coated polyethylene RM cups. Forty-three patients (40%) died during the follow-up period, all with the implant in place. Of the 66 surviving patients, 2 (1.8%) were lost to follow-up, and 7 (6.3%) were unable to attend the 15-year clinical and radiological follow-up. Eight stems (7.3%) had to be revised for aseptic loosening and 3 stems (2.7%), for septic loosening. The 15-year survivorship of the Müller Straight stem regarding aseptic loosening is, therefore, 92.7%. Forty-six patients with 49 total hip replacements could be evaluated clinically and radiologically after 15 years. The mean duration of clinical follow-up for these 46 patients (42.2%) was 14.8 years (range 12.8-16.5 years). There were 22 women (48%) and 24 men (52%). The mean age at the time of the operation was 62 years (range 38-80 years), and 78 years (range 59-93 years) at the time of the latest follow-up. The mean Harris Hip Score at the latest follow-up evaluation of the 49 hip joints was 85 points (range 34-100 points). Of the 46 patients, 39 (85%) had a good or excellent clinical result. Radiographic follow-up was performed for 49 hips: 35 (70%) had linear or focal osteolysis in one or more zones of the stem, but only 4 (8%) had evidence of definitive loosening (linear radiolucency of over 2 mm all around the stem). Subsidence of over 2 mm was found in 20 hips (41%), 6 of them within the cement mantle. There was no correlation between subsidence and pain. The cause for the poor results is primarily the high rate of aseptic loosening of the non-coated, non-cemented all-polyethylene RM cups, with a loosening rate of 63% and a revision rate of 25% after 15 years.

[Comparative results after endoscopic synovectomy and open bursectomy in chronic bursitis olecrani]. / Vergleichende Ergebnisse nach endoskopischer Synovektomie und offener Bursektomie bei chronischer Bursitis olecrani.

UNLABELLED: The surgical treatment of choice in cases with chronic bursitis of the elbow usually consists of an open radical bursectomy. PURPOSE OF THIS STUDY: Comparison of the outcome after the endoscopic synovectomy and internal drainage with the conventional operative procedures (control). METHODS: Clinical follow-up in nine endoscopically treated patients and conventionally operated controls in the similar year that were comparable in age and number of prior surgical procedures in that region. Comparison by means of the score of Morrey et al. using Mann-Whitney-U-test and chi 2-test. DISCUSSION: All patients in both groups were highly satisfied with the results of their treatment. The analysis revealed no differences in score Morrey et al. (endoscopy: 97.11 points vs. control: 95.33 points; p = 0.564). However, the endoscopically treated patients returned significantly earlier to work (10 d vs. 18 d, p = 0.041). CONCLUSION: The endoscopical synovectomy in cases with chronic bursitis olecrani is an easy and safe method to obtain excellent results.

Structural constraints on process explanations in cognitive aging.

Much of the current research in the area of cognitive aging has been focused on investigating specific processes presumed to be responsible for the age differences observed in particular cognitive tasks. A central thesis of this article is that age-related effects on cognitive variables seldom occur in isolation, and hence, they are best interpreted in the context of the structural interrelations that exist among variables and the relations of age on that organizational structure. Results from analyses of 2 separate data sets suggest that large proportions of the age-related effects across a wide range of cognitive variables are shared and that independent, or unique, age-related effects often contribute relatively little to the age differences observed in many cognitive variables. These findings imply that it is important to consider the structure within which a variable occurs when attempting to investigate the processes responsible for age-related differences on that variable.

Family-based therapy for dementia caregivers: clinical observations.

Family caregiving for dementia patients is a major social and clinical problem. Family caregivers face major stressful emotional, social and economic burdens, and the negative consequences associated with caregiving are well documented. Given the projected increase in the number of people with dementia, there is a need to identify approaches that will help families manage the challenges of caregiving. Social support from friends and family members has consistently been found to mediate caregiver outcomes, yet many caregivers face problems with isolation and estrangement from family members. In this regard, family-based therapy is a promising intervention for increasing social support for caregivers, and enhancing their quality of life and ability to provide care.This paper will discuss how family-based therapy can be applied as an intervention for family caregivers of dementia patients.The clinical implications of specific interactional patterns will be presented via case examples from an ongoing clinical trial with white American and Cuban American caregivers of dementia patients.The intent is to demonstrate how identification of interactional patterns is a valuable tool for implementing family-based interventions.

Aging, motor control, and the performance of computer mouse tasks.

Because of the increased presence of computers in work and everyday life and the demographic "graying" of America, there is a need for interface designs that promote accessibility for older people. This study examined age differences in the performance of basic computer mouse control techniques. An additional goal of the study was to examine the influence of age-related changes in psychomotor abilities on mouse control. A total of 60 participants in 3 age groups (20-39 years, 40-59 years, and 60-75 years) performed 4 target acquisition tasks (pointing, clicking, double-clicking, and dragging) using a computer mouse. The data indicated that the older participants had more difficulty performing mouse tasks than the younger participants. Differences in performance attributable to age were found for the more complex tasks (clicking and double-clicking). Furthermore, age-related changes in psychomotor abilities were related to age differences in performance. We discuss applications to computer interface designs. Actual or potential applications of this research include specifications for computer mouse design to accommodate older populations.

Age differences in attitudes toward computers.

It is commonly believed that older adults hold more negative attitudes toward computer technology than younger people. This study examined age differences in attitudes toward computers as a function of experience with computers and computer task characteristics. A sample of 384 community-dwelling adults ranging in age from 20 to 75 years performed one of three real-world computer tasks (data entry, database inquiry, accounts balancing) for a 3-day period. A multidimensional computer attitude scale was used to assess attitudes toward computers pretask and posttask. Although there were no age differences in overall attitudes, there were age effects for the dimensions of comfort, efficacy, dehumanization, and control. In general, older people perceived less comfort, efficacy, and control over computers than did the other participants. The results also indicated that experience with computers resulted in more positive attitudes for all participants across most attitude dimensions. These effects were moderated by task and gender. Overall, the findings indicated that computer attitudes are modifiable for people of all age groups. However, the nature of computer experience has an impact on attitude change.

Furniture tipping accidents: redesign for prevention.

A large public service organization was concerned with protection of its customers against hazards associated with furniture tipping in public use concourses. Because no injury experience was available for analysis, hazard patterns for tipping accidents were developed from an observational study of public interaction with the furniture. For each hazard pattern, anthropometric models were used to find the probability of the furniture being safe from tipping, for different age and gender combinations. A safety criterion was developed from this modeling, and used to change the weights of some furniture items to resist tipping. These modifications have now been implemented and are in widespread use. Implications for broader application of these models to the development of valid tipping standards for furniture are discussed.

An assessment of falls in elderly men and women.

BACKGROUND: The assessment of falls in the elderly has moved from disease-oriented approaches, which attempt to identify single causative factors, to performance-oriented evaluations of functional deficits. This study examined the abilities of elderly fallers and nonfallers to perform various functional activities and to provide some rationale for performance differences by assessing the integrity of specific systems within the sensory, central processing control, and effector components of balance control. METHODS: Twenty-two elderly subjects, aged 69-93 years, categorized as either a faller or a nonfaller, were assessed on their ability to perform the functional activities of static balance, walking, and stair descent. In addition, the balance control components of sensory input: vision, vestibular function, and proprioception; the central processing control system components: mental status, selective attention, perceptual style, and simple and choice reaction time; and the effector system: isometric strength were assessed. RESULTS: The data indicated that fallers exhibited significantly reduced static balance, walking and stair descent performance than the nonfallers. The fallers exhibited significantly lower selective attention abilities and increased choice resisted reaction times, both measures of the central processing control system component. The nonfallers exhibited reduced proprioceptive function, suggesting that this is not a major contributor to the performance of balance and mobility skills. CONCLUSIONS: The data suggest that actual performance of mobility skills is an efficient means of identifying potential fallers. The decrements in functional activity performance appear to be related to central information processing control components, specifically selective attention and choice reaction time. The significant correlations between the sensory input, central processing control, and effector components with the functional activities suggest that the marginal declines in the sensory and effector components may have an additive effect, which may adversely affect the ability of fallers to perform the functional activities. The data suggest that selective attention and choice reaction time are the two most significant balance control components predictive of falls.

Recurrent acute hemarthrosis after anterior cruciate ligament reconstruction. Report of an unusual complication and a review of the literature.

Arthroscopic-assisted and endoscopic operative techniques have allowed for less and less restrictive postoperative rehabilitation programs after cruciate ligament reconstruction. Accelerated rehabilitation programs may, however, also provoke mechanical problems at the transplant-bone interface, as reports in the literature of loosened fixation devices and loosened or even fractured bone pegs with subsequent hemarthrosis and recurrent instability have shown. We describe the case of a patient who presented with recurrent acute hemarthrosis after anterior cruciate ligament reconstruction without additional trauma and without instability. However, the symptoms and signs were clearly related to the fixation method employed.

Employment opportunities for older adults: engineering design and research issues.

A challenge facing the engineering community is to find ways to integrate older people into the labor force. Despite laws regarding age discrimination and compulsory retirement, older people's participation in the labor force is declining. Unless strategies are developed to keep older people in the workforce, the issues of economic dependency and intergenerational equity are likely to become formidable in the near future. There are a number of areas where engineering applications can enhance older adults' employment opportunities. These include training, workplace and equipment design, and job design. An overview of current knowledge regarding aging and work is provided. Gaps in the knowledge base are identified as areas for research. Examples of how engineering can contribute to the integration of older people into work settings are presented.

Ageing, computer-based task performance, and stress: issues and challenges.

An emerging problem that encompasses both traditional ergonomic as well as macroergonomic concerns involves assessing the potential implications of computer-based tasks for older workers. An increasing older workforce and the influx of computer technology into a wide variety of work settings has motivated both a re-examination of the literature concerning ageing and work performance and research that more directly addresses the computer-interactive task domain. In this paper, we overview this literature and raise a number of crucial issues concerning potential age differences in performance and stress associated with computer-based tasks. Underlying our discussion throughout is the intention of identifying the challenges that await interested practitioners and researchers.

A human factors analysis of ADL activities: a capability-demand approach.

Older adults frequently encounter difficulties performing daily living activities. Often times these difficulties arise because environmental demands create barriers which hinder task performance. Currently, there is little empirical data that relate environmental demands to functional capabilities of older adults. The concepts and methods of Human Factors Engineering can be used to accomplish this goal. Human Factors views task performance within a systems context and maintains that successful task performance is dependent on a match between task demands and human capabilities. This article will discuss how Human Factors methodologies can be used to analyze problems encountered by older adults performing routine activities. Data from a study concerned with identifying physiological demands associated with personal and instrumental activities of daily living will be used to demonstrate the utility of using this approach.

Age differences in the performance of computer-based work.

This study investigated the extent to which age had an impact on the performance of computer-based work. Three simulated real-world computer-interactive tasks that varied in complexity and pacing requirements were evaluated. Ss included 65 women, ranging in age from 25 years to 70 years. The methodology encompassed physiological, subjective, and objective performance measures. The data indicated that previous computer experience and age had a significant impact on the performance of the 3 tasks. Increased age was associated with longer response times and a greater number of errors for all 3 tasks. Age also influenced perceptions of fatigue and task difficulty. The findings are discussed in terms of the implications for training and job design.

Older adults and daily living task profiles.

This paper describes data generated from a comprehensive study in which human factors techniques were applied to the analysis of 25 personal and instrumental activities of daily living (ADLs) performed by 60 older adults (age 55 to 93 years) living in the community. Demand profiles generated from task analysis of video-taped ADLs identify the demands inherent in task activities and the objects and environments associated with them. Examples of four different approaches to examine ADL performance using demand profiles are presented: global descriptions of demands across all ADL tasks, task component profiles, task-specific profiles, and action profiles.

The effects of grouping and cueing in the performance of location tasks.

In location tasks such as assembly of a control panel, operators respond to stimulus information by locating a given target in an extensive set of response alternatives. Arrangement of the response alternatives and the method of presenting the location information (cueing), as well as the interaction between these factors, were hypothesised to influence performance in this type of task. To test these hypotheses, a factorial experiment involving 60 subjects was performed in which five levels of grouping and four levels of cueing were investigated. Grouping appeared to affect location accuracy more than location time, whereas the effects of cueing were found to be significant for both location accuracy and time. The absence of an interaction effect between grouping and cueing suggested that the effects of these factors on performance were independent.

[Geographic distance, the measurement of socioeconomic development, and the extent of migration]. / Odleglosc geograficzna i miernik rozwoju spoleczno-ekonomicznego a wielkosc ruchow migracyjnych

PIP: A study of migration in the region of Wojewodztwo Wloclawskie, Poland, is presented for the period 1975-1979 using a gravitational model. The model includes migration variables and variables measuring the level of socioeconomic development.^ieng

[An attempt at the econometric specification of the socioeconomic determinants of migratory movements and migration balance]. / Proba ekonometrycznego okreslenia spoleczno-ekonomicznych determinant ruchow migracyjnych i salda migracji

PIP: An analysis of internal migration in Poland is presented. Models of out-migration, in-migration, and migration balance are constructed for each of the 49 voivodships for 1979. Factors affecting migration are analyzed, including per capita investment, employment, output, fixed capital, per capita retail sales, housing, social services, manufacturing payroll, school enrollment, per capita hospital beds, movie theater seats, and book publications.^ieng