Analysis of key decision-making incidents in the life of a nursing home resident.

PURPOSE: This study examined change in the decision-making autonomy of a single nursing facility resident. DESIGN AND METHODS: This case analysis was part of a larger 3-year ethnographic investigation of decision-making events in four nursing facilities. In this case analysis, the resident, her daughter, and three staff members closely associated with the resident's care were each interviewed five times over a 15-month period. RESULTS: Analysis of interview transcripts revealed four themes in decision making. Temporal change was evident in a complex scenario regarding room changes. Spatial context reflected the need for predictability and adaptability in decisions using space. Interdependence of decisions and decision makers was most evident with medical treatment and health care decisions. Awareness, being informed, and knowing what was going on was the final theme. IMPLICATIONS: Despite having the best interests of the resident in mind, the process of decision making in nursing facilities may contribute to a pattern of gradual withdrawal of decisional autonomy from residents regardless of their ability to make decisions.

Effects of the quality of dyadic relationships on the psychological well-being of elderly care-recipients.

The purpose of this study was to examine the association of the quality of caregiver relationships with the psychological well-being of elderly care-recipients. Sociodemographic variables and characteristics of the care-recipient situation (e.g., self-rated physical health, amount of instrumental support needed) were explored as potential predictors of the psychological well-being of elderly individuals. A secondary analysis of data collected during in-home interviews with 37 community-dwelling older adults revealed no significant correlations between the quality of the primary intimate relationship and any dimension of psychological well-being. However, better self-rated health was associated with fewer depressive symptoms, higher morale, greater life satisfaction, and better quality of life. The more instrumental support needed by an individual, the greater their depressive symptoms and the lower their morale. The findings also revealed that the older the individual was, the greater the depressive symptoms were and the lower life satisfaction became. Self-rated physical health predicted each dimension of psychological well-being. The findings suggest that age, the amount of instrumental support needed, and perceptions of physical health are important indicators of the psychological well-being of elderly care-recipients.

Individualizing care: family roles in nursing home decision-making.

l. Family members remain fully involved in nursing home decision-making after their relative has been admitted to a facility. 2. Family involvement in nursing home decision-making serves to individualize care and provide a continuing link to the resident's personal history and preferences. 3. Family members assume an array of decision-making roles in nursing homes, including: caregiving, pampering, comforting, engaging, educating, monitoring, mediating, colluding and controlling.

Nursing home room changes: toward a decision-making model.

Although nursing home relocation has been extensively studied, very little research has investigated the more commonly occurring phenomenon of room changes within nursing homes. Room changes were monitored in four nursing homes over a one-year period. Participant observation; repeated interviews with residents, family members and nursing home staff; and event analyses were used in developing detailed case studies of the room change decision-making process. A model of the room change process and factors influencing this process is offered, involving five distinctive phases--precursors, initiation, decision, action, and outcomes.

Elderly migration and development in small communities.

"This paper develops a conceptual model of the process of community change [in the United States] in response to elderly inmigration. Analysis of intra-regional variation in elderly migration patterns in Appalachia, and synthesis of an emergent literature on the benefits and costs of attracting elderly migrants, serve as a backdrop for case studies, based on field observations and interviews, of three contrasting Appalachian communities at different stages of development as retirement destinations."

Community elders: prevalence and correlates of depressive symptoms.

This pilot study examined the prevalence and correlates of depressive symptoms among community-dwelling elders 75 years of age and older. Forty subjects were recruited from a research volunteer pool. Cross-sectional data were collected during structured in-home interviews. High depressive symptoms were reported by 10 (25%) of the elders; of these, 8 were males. Depressive symptoms were positively related to the need for instrumental support. Higher depressive symptoms were associated with poorer functional health status and self-rated health and with lower morale, life satisfaction, and quality of life. Nurses working with community-dwelling elders 75 years of age or older should be alert for depressive symptoms among those with indications of poor physical and functional health, and instrumental support needs should be assessed. Further investigation into the age/gender issue as it relates to the development of depressive symptoms is warranted.

Beyond performance: being in place as a component of occupational therapy.

Emphasis on knowing and doing as focal concerns of occupational therapy has tended to overshadow being as an essential ingredient of human experience. This article advocates greater concern with understanding our clients' being in place--that is, their immersion within a lifeworld that provides the culturally defined spatiotemporal setting or horizon of their everyday lives. It is suggested that naturalistic and qualitative research strategies are appropriate for the exploration of this realm of experience. Illustration is provided from an ethnographic study of aging in a rural Appalachian community. The time-space rhythms of taken-for-granted behavior, the significance of the surveillance zone (space within the visual field of the dwelling), and the way in which the environment may come to be a component of the self, are identified as themes within being in place that have significant implications for enhancing occupational therapy practice.

The significance of elderly migration to changes in elderly population concentration in the United States: 1960-1980.

Analysis of county level elderly and nonelderly net migration data revealed that, overall, migration was of less importance in explaining changes in elderly population concentration between 1970 and 1980 than it had been in the previous decade. However, because of the spatial restructuring of both elderly and nonelderly migration, the contribution of elderly migration relative to nonelderly migration increased from 1960 to 1980. Recognizable regional variations were apparent. Elderly migration not only remained significant in explaining changes in elderly population concentrations in "traditional" Sunbelt retirement states but also showed increased importance in newly emergent southern retirement states and in several northern states, including a group in New England.

Between worlds: a relocation dilemma for the Appalachian elderly.

An historically based spatial separation of old people from their children has generated a critical relocation dilemma for the present generation of Appalachian elderly--reconciling the physical, social, and emotional support of a familiar environment with the desire to be close to family. This article, based on a four-year participant observation study of a panel of elderly persons in a rural northern Appalachian community, explores the tension between factors that reinforce inertia and those that encourage relocation to the homes of children living outside Appalachian. The article traces and illustrates a normative trajectory involving several phases--departure of children, accommodation, seasonal migration, crisis, relocation, holding on, and severance--that characterize the decision process whereby, over a period of years, the dilemma is gradually resolved.