Nature as nurture: Rural older women's perspectives on the natural environment.

Rural older women are surrounded by nature, a dynamic context for human development. Informed by place attachment and attention restoration theory, and guided by a life course perspective, this qualitative study focused on the perceived influence of nature in the lives of 34 rural older women. Using grounded theory techniques to analyze in-depth interviews, two primary findings emerged: (a) nature was integral to the women's identity; and (b) interactions with nature were motivated by prior positive spiritual and psychological outcomes. Findings revealed the power of the natural environment as a resource for coping with the challenges associated with aging.

Abandonment fears of persons with Alzheimer's disease attending adult day care.

By using participant observation and staff interviews, we examined the phenomenon of abandonment fears in persons with Alzheimer's disease who were frequent attendees of an adult day care center. Two women, who most frequently expressed fears of abandonment, were the primary participants of the study. Their fears stemmed from two sources: contextual confusion, centered on their inability to grasp the concept of attending an adult day care center, and imagined barriers between them and their caregivers. One of the women tended to "recruit" the other woman into her world of insecurity, and hence their friendship actually may have had a detrimental effect on each other's days at the center. Staff members discussed the issue with reluctance and indicated that methods to attempt to change the behavior would be futile.

The meaning of osteoporosis in the lives of rural older women.

Twenty-one older women living in three rural communities participated in focus groups to explore the functional and psychosocial consequences of living with osteoporosis. The increased risk of fracture and daily pain associated with the disease frequently precluded or interfered with the completion of daily activities for these women. Those living on farms faced the additional challenge of avoiding the risk of falls while continuing to do the physical labor necessary to maintain their rural lifestyle. Many of the women turned to their spouses or other family members for assistance with daily tasks, forcing the women to relinquish their own caregiver roles. The disease caused many of the women to reassess their own self-concept and decrease their participation in valued social activities. Maintaining independence was an ongoing concern.

Correlates and consequences of chronic pain in older adults.

Chronic pain is a frequent challenge to older adults' coping skills. Despite the widespread occurrence of chronic geriatric pain, no comprehensive body of literature on this topic exists. Instead, research on chronic pain is scattered across disciplines and is perceived as inaccessible by scientists. We completed a comprehensive review and qualitative analysis of the geriatric chronic pain literature since 1990 and found 314 articles on this topic that reported. North American research. Physical, social, and psychologic variables associated with chronic pain and the elderly were mentioned in just over half (53%) of the articles. However, both psychosocial causes and consequences of chronic pain were understudied. Only 16% of the articles had social variables (gender, race, and age) as their primary interest; 27% focused on psychologic or psychiatric issues, with half including depression as the variable of interest. An analysis of the articles' content suggests that research on chronic pain in later life would be substantially improved if a more structured and comprehensive approach were used that combined the study of psychosocial issues with that of physical pain. Researchers and clinicians with a global understanding of chronic pain might help improve quality of life for older adults.

Older women, their children, and grandchildren: a feminist perspective on family relationships.

Using gerontological and feminist frameworks, we explored the relationships older women have with their children and grandchildren. In-depth, qualitative interviews were conducted with 34 women, ranging in age from 55 to 88. From our analyses of the women's perceptions of their family relationships, two themes were prevalent: the centrality of children and the peripherality of grandchildren in their everyday lives. The women had varying degrees of involvement with their children and grandchildren, and these relationships contributed to their sense of self and family. Their relationships were not stagnant, but were continually reshaped as both the women and their family members proceeded through the life course.

Communication patterns between caregivers and their spouses with Alzheimer's disease: a case study.

The purpose of this study was to examine the style of communication that takes place between couples in their home environment in relationship to the abilities to the spouse with Alzheimer's disease (AD) and the amount of stress and burden experienced by the caregiver. Three styles of communication emerged: parallel, questioning, and direct. Caregivers engaging in parallel communications reported greater stress and time burden than any other caregivers. Nurses need to be observant of the communication patterns that exist between caregivers and their spouses with AD and help caregivers develop successful communicative strategies that enhance interactions with their spouses.

The vitreous protein concentration is increased prior to neovascularization in experimental ROP.

PURPOSE: To test the hypothesis that the vitreous protein content is altered prior to the development of neovascularization in an experimental model of retinopathy of prematurity (ROP). METHODS: Newborn rats underwent either a variable oxygen exposure or room air exposure following birth. On day 13 or 14, two days prior to neovascularization, the steady state vitreous and plasma total protein levels in room-air controls or variable-oxygen-exposed newborn rats were determined; similar measurements were also made for control adult rats. RESULTS: There was a significant difference (P < 0.05, 2-tailed t-test) in the vitreous protein concentration between the age-matched control and experimental newborn rats. The protein level in the ROP rat plasma was not significantly (P > 0.05) different from that in the age-matched control animals. The vitreous-to-plasma-protein ratios of both the control and ROP newborn animals were significantly greater (P < 0.05) than that in the adults. CONCLUSIONS: The results of this study demonstrate, for the first time, increased vitreous protein levels prior to the development of neovascularization in the newborn rat model of ROP. In addition, developmental changes in vitreous protein levels were identified. The role of developmental and pathologic alterations in the blood-ocular barriers in this study is discussed.

Chronic pain in the lives of older women.

Despite the prevalence of chronic pain among the elderly and older women in particular, the geriatric literature has given very little attention to it. Older women experience a range of undesirable functional, psychological, and social consequences as a result of living with chronic pain. This paper focuses on chronic pain in the lives of older adults. Age, gender, social history, and cultural expectations may influence individual responses to chronic pain, thus necessitating a multidimensional approach to its assessment and treatment. Strategies for effectively managing chronic pain experienced by the elderly include both pharmacologic and nonpharmacologic regimes. To illustrate the biopsychosocial nature of chronic pain, specific attention is given to osteoporosis, a prevalent disease among older women in which pain plays a major role.

Qualities of older women's friendships: stable or volatile?

The purpose of this study was to identify changes and stability in the qualities older women attribute to their close friendships. Seventy-four older women responded to eleven structured statements describing qualities of their relationships with ninety-one close friends. Change was found for seven of the eleven qualities examined. Differences in the women's responses were observed according to which close friend they were discussing and changes in the women's marital, work, and health status. The findings provide insight into the character of women's close friendships in later life.

Detection of vascular endothelial growth factor (VEGF) protein in vascular and non-vascular cells of the normal and oxygen-injured rat retina.

Vascular endothelial growth factor (VEGF) is a potent and specific endothelial cell cytokine that can be up-regulated by hypoxia. There is evidence that VEGF is a significant mediator in retinal neovascular diseases and other disorders in which hypoxia is believed to influence the pathogenesis. Here we demonstrate the spatial relationships among areas of retinal non-perfusion, VEGF protein and vascular endothelial cells throughout the retina, and relate these results to cellular distribution of VEGF in cross section. Newborn albino rats were oxygen-injured by cycles of alternating 50% and 10% oxygen for 14 days and then placed in room air. On days 16, 21 and 26, oxygen-injured and control (raised in room air) rats were sacrificed, enucleated and retinas were dissected and fixed for whole mount immunostaining for VEGF or embedding in glycol methacrylate for VEGF immunohistochemistry. Intact eyes taken on days 16 and 20 were processed similarly. Vascular endothelial cells were demonstrated by staining whole-mounted retinas for adenosine diphosphatase (ADPase) activity. Preretinal neovascular growths (i.e., abnormal vessels extending from the retina into the vitreous) were VEGF-positive. There was also a pan-retinal distribution of non-endothelial cells that were VEGF-positive in both room air and oxygen-injured rats, with stronger immunostaining in day 16 oxygen-injured retinas. In cross-section, VEGF staining was confirmed in preretinal growths, normal retinal vessels, cells in the inner nuclear layer (primarily Müller cells) and ganglion cells. Retinas which had been incubated with nonimmune IgG or absorbed anti-VEGF antibody showed little or no staining. In conclusion, we have identified cells of the inner retina which express VEGF. The production of VEGF by these cells--in particular, Müller cells--may promote preretinal neovascularization in oxygen-injured eyes. We have found, moreover, that the combination of immunohistochemistry and ADPase staining of whole mount preparations is a unique and powerful tool for evaluating relationships between presumed areas of retinal ischemia, VEGF (and other cytokines) and retinal blood vessels, within an entire retina. This approach can be used to study any proliferative retinal disorders in which VEGF is a potential component of the pathogenesis.

Resident rights. Knowledge of and implementation by nursing staff in long-term care facilities.

In this study, we assessed the differences between certified nursing assistants' (CNAs) and nurses' (RNs and LPNs) level of knowledge and perceived implementation of resident rights. The CNAs and nurses responded to a series of 11 scenarios representing rights such as privacy, choice, and respect. Their responses suggested that although they knew what the appropriate response to the situation was, it was not the typical response to that type of situation within their facilities. Implications for teaching and applying resident rights are discussed.

Long-term retinal vascular abnormalities in an animal model of retinopathy of prematurity.

PURPOSE: A conventional criticism of animal models of retinopathy of prematurity (ROP) concerns the common occurrence of rapid spontaneous resolution of retinal vascular sequelae. The purpose of this study was to determine whether animals subjected to a novel variable oxygen exposure protocol would undergo the rapid spontaneous resolution of retinal vascular pathology that is typical of past models. METHODS: Newborn rats were exposed to an oxygen environment that alternated between 50% and 10% every 24 h for 14 days and then removed to room air, or were raised from birth in room air as controls. To determine early retinal vascular growth rate, both exposed and non-exposed rats were sacrificed between 3 and 28 days of age, after which eyes were enucleated and retinas dissected and stained for adenosine diphosphatase (ADPase) activity to demonstrate the vasculature. Rats were maintained in room air for 2 to 18 weeks after the variable oxygen exposure period for assessment of long-term retinal vascular abnormalities by ADPase histochemistry. RESULTS: The retinal vasculature of oxygen-exposed rats was significantly different from that of room air-raised rats with respect to capillary density, branching frequency, and bifurcation angle. These differences were restricted to the area that was vascularized after removal to room air (the peripheral-most 25% of the retinal area), and they persisted for the duration of the study. CONCLUSIONS: We have developed a rat model of ROP using an exposure protocol designed to create systemic oxygen levels that approximate those of premature infants. This model does not demonstrate the complete resolution of vessel abnormalities that historically has limited animal models of ROP.

Comparison of factors influencing mothers' perceptions about the futures of their adolescent children with and without disabilities.

A qualitative methodology was used to compare specific experiences and ecological factors that 40 mothers perceived as influencing their expectations for their adolescents (20 with severe disabilities and 20 vocational education students with no documented disabilities). Analyses of all responses revealed that mothers identified many of the same factors as influencing perceptions about their adolescents' futures. Children's personalities and school- and community-provided supports were mentioned as important to children's success. Mothers of adolescents with disabilities described their children more positively. Mothers of vocational education students were concerned about their children's job prospects, whereas mothers of students with disabilities tended to emphasize limitations of support by the adult service system. Social relationships were more of a concern for mothers of youth with disabilities.

Interactions with grandparents and great-grandparents: a comparison of activities, influences, and relationships.

This study explored the relationships between young adults and their grandparents and great-grandparents. A convenience sample of fifty-two college students, who had at least one living grandparent and great-grandparent, completed a questionnaire that assessed their interactions with their grandparents and great-grandparents. The respondents engaged in more frequent contact and activities with their grandparents than with their great-grandparents. They also perceived their grandparents as having a more defined role and being more influential in their lives than great-grandparents. Discussion centers on potential personal and demographic factors that may have influenced the respondents' perceptions of and interactions with their great-grandparents.

Knowledge and attitudes of hospital personell toward older adults.

The Facts on Aging Quiz was given to 693 hospital personnel to examine their knowledge of and attitudes toward older adults. Respondents 40 years of age and over had better knowledge scores than respondents 16-29 years old. Individuals with associate, baccalaureate or graduate degrees had higher knowledge scores than respondents with a high school education. Clinical employees and volunteers had higher knowledge scores than non-clinical employees. Approximately 25% of the hospital personnel exhibited a negative bias (i.e., attitude) toward older adults. Considering the health care utilization of older adults, it is important that all individuals working within a hospital environment exhibit knowledge of and appropriate attitudes toward them. Implications for gerontological education programs based on adult-learning techniques are noted.

Communicating with persons with Alzheimer's disease: experiences of family and formal caregivers.

The purpose of this exploratory study was to examine and compare communication processes used by family members and formal caregivers to manage behavioral problems such as fearfulness, agitation, and wandering, that commonly occur when caring for persons with Alzheimer's Disease (AD). Two groups of caregivers of persons with AD (formal and family) comprised the sample for the study. Two themes emerged from the focus group interviews: environmental adjustments and reassurance. Results suggest that interventions must be individualized. Enhancing the caregiver's skills to manage disruptive behavior may prolong his or her ability to provide in-home care for the family member with AD.

Factors related to older women's recovery from hip fractures: physical ability, locus of control, and social support.

Our purpose in conducting this study was to identify the nature of care provided by the informal support network available to older women with hip fractures and to examine the relationships among prior functional ability, locus of control, and reliance on social supports in predicting recovery from hip fractures. One hundred one women who had recently sustained a hip fracture participated in a structured interview process. Overall, the women received more frequent help from their spouse, children, and friends at the time of the interview than during the month before their hip fractures. Women who had higher activities of daily living capabilities prior to the fracture, had a greater internal orientation, and used fewer formal services reported higher levels of current physical functioning.

Osteoporosis and older women:.

Osteoporosis, a metabolic bone disorder, affects four times as many women as men. Each year 1.3 million fractures, primarily of the vertebra, hip, and wrist can be attributed to osteoporosis. Risk factors for the development of this disease include age, sex, body build, family history, race, loss of estrogen, calcium deficiency, sedentary lifestyle, smoking, and the excessive use of alcohol. Three common approaches used in the treatment and prevention of osteoporosis are hormone replacement therapies, nutrition interventions. and exercise programs. These strategies are aimed at maintaining or stabilizing bone mass and preventing further loss. Living with osteoporosis presents older women with a variety of physical, psychological, and social challenges. To maintain a productive and healthy lifestyle, older women must recognize their physical limitations and make adjustments in their daily lives to cope successfully with these changes.

The role of social supports in older women's recovery from hip fractures.

Interviews were conducted with 101 women, ranging in age from 65 to 94, to determine the types of assistance that family members, friends, and formal services provide older women recovering from hip fractures, and the influence of social support variables on their recovery. More women were receiving help from members of their informal network in such areas as meal preparation, shopping, and running errands. More women were also using physical therapy and housekeeping services as a result of their fractures. The strongest predictors of recovery were the women's physical abilities prior to their fracture and the progression they had made at the time of the first interview. Results suggest that social support variables may have a more indirect than direct association with older women's recovery from hip fractures.

Provider/client views: health-care needs of the rural elderly.

Health-care providers perceived the following issues as influencing service use among rural elderly: financial restraints, eligibility requirements, values, geographic location, coordination of services, transportation, knowledge of normal aging, and family education. The elderly cited the following as influencing their acceptance of services: self-perceptions, fear of dependence, lifetime skills, finances, and maintaining dignity. More research is necessary to determine the "true" needs of older adults in rural areas so that service provision can effectively be modified to meet existing and future needs.