Being in Place: Toward a Situational Perspective on Care.

An optimum focus in any care situation is creating and sustaining environments that facilitate an ongoing sense of "being in place" for all involved. Using this rationale, we propose a Situational Model of Care for exploring dynamic relationships among aging persons receiving care, the convoy of persons offering this care and support, and the place where this occurs, as evolving situations throughout the course of a disease. The model is grounded in extant literature and illustrated through a case study derived from in-home observations and interviews. Emphasizing an underlying goal of fostering a sense of being in place as a desirable outcome facilitates situationally nuanced directions in research and clinical care.

Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study.

Mild cognitive impairment (MCI) or dementia often leads to behavioral and psychiatric symptoms of dementia (BPSD). Sensory processing abnormalities may be associated with BPSD. The purpose of this study was to explore relationships among sensory processing, behavior, and environmental features within the homes of people with MCI or dementia. This project used mixed methods to assess participants' sensory processing, care partner perspectives on behaviors, and in situ observations of the home environment. Nine participants with cognitive impairment (MCI n = 8, early dementia = 1) and their care partners were included. Seven participants with cognitive impairment were reported to have abnormal sensory processing. Findings suggest that unique environmental adaptations, tailored to personal and sensory preferences for each participant, were associated with a decreased level of behavioral disruption during the observation periods. Implementing sensory-based approaches to maximize environment adaptation may be beneficial in reducing disruptive behaviors for adults with cognitive impairment.

Toward a Regional Gerontological Agenda: The Use of Empowerment Evaluation.

This article describes the application of an empowerment evaluation approach to nurturing the growth and priority setting of a regional organization. A model is provided of the processes whereby the Southern Gerontological Society (SGS) identified research and service priorities by conducting a survey of stakeholder perceptions of regional needs. The survey goal was to identify important issues faced by older adults in the South as a prelude to refining SGS research and service priorities and developing its contemporary regional gerontological agenda. We trace how the survey findings were translated into actions including shaping the annual meeting program, creating new standing committees, and developing service activities. Underlying the process of developing and refining this agenda are a set of key principles that have come to characterize the operation of SGS. These principles are discussed and provide a model for comparable organizations seeking to develop agendas consistent with their mission and identity.

Exploring college students' attitudes toward older adults: A description of methods used by the gerontological literacy network.

Recognizing the pervasiveness of negative societal attitudes toward aging and older adults is critical, as research indicates how older adults are viewed subsequently influences how they are treated. The Gerontological Literacy Network (GLN) is a multi-university collaboration established to address ingrained beliefs that underlie ageism and gerontophobia. The GLN developed a data-gathering protocol that uses drawing as a foundation to assess the gerontological literacy of college students. The protocol includes drawing what aging means, writing a paragraph describing the drawing, indicating the age at which someone is "old," and writing words associated with "old person" and "grandma/grandpa." Results from 1,609 protocols confirm that college students have negative views of aging as depicted in drawings of negative emotional states, illness, physical decline, and death. The presence of positive representations of aging (e.g., smiling) reveals the heterogeneity of perceptions and suggests the potential to achieve more accurate perceptions through educational interventions. This article provides an overview of the protocols and suggestions for future efforts related to gerontophobia and ageism.

Positive Psychological Change Following a Cancer Diagnosis in Old Age: A Mixed-Methods Study.

BACKGROUND: Despite the stress inherent in a cancer diagnosis, many cancer survivors report benefits, including perceptions of personal growth and well-being. Among adults 60 years or older, for whom cancer diagnoses are most prevalent, there is a notable lack of research on positive psychological change. OBJECTIVE: This mixed-methods study was designed to advance current understanding of positive psychology (ie, posttraumatic growth, well-being) in older adults with cancer. METHODS: Fifty-six older adult cancer survivors were recruited through a statewide cancer registry and the community. Participants completed questionnaires on posttraumatic growth, well-being, coping, and quality of life, as well as a series of open-ended questions via mail. RESULTS: Participants reported high posttraumatic growth and well-being and primarily adaptive and emotion-focused coping strategies. They also reported better mental quality of life (P = .0001) but not physical quality of life (P = .31) compared with age-adjusted population norms. Older age was associated with less posttraumatic growth (r = -0.32, P = .02) but not well-being (P = .34). Qualitative responses emphasized appreciation and acceptance and a reliance on faith and social support and provided context for quantitative results. CONCLUSIONS: This mixed-methods study suggests that older adults report positive psychological change and adaptive coping with cancer, demonstrating their high level of emotional resilience. IMPLICATIONS FOR PRACTICE: Mental health screenings should be provided as appropriate, but oncology nurses should also consider the potential for positive psychological change postdiagnosis. The provision of care and social support may need to be modified to accommodate older cancer survivors' needs.

Clinical geography: A proposal to embrace space, place and wellbeing through person-centered practice.

This essay envisions how geography can operationalize nuanced understandings of space and place to enrich the lives of individuals across the lifespan. We propose a focused integration of geography into person-centered practice: a clinical geography dedicated to working directly with people to promote optimal physical and mental health outcomes and wellbeing. Our proposal integrates spatial modifications to facilitate access and utility, behavioral interventions to maximize effectiveness in using space, and therapeutic engagement to nurture a deeper sense of 'being in place' that enhances wellbeing and quality of life. This focus is timely given societal instability and precariousness resulting from incongruous person-environment situations. In addition to investigating, explaining, and critiquing hazardous and inappropriate conditions, geographers might also directly and more immediately intervene with people who find themselves in such situations.

Behaviors Characteristic of Autism Spectrum Disorder in a Geriatric Cohort With Mild Cognitive Impairment or Early Dementia.

INTRODUCTION: Autism spectrum disorder (ASD) represents a heterogenous cluster of clinical phenotypes that are classically diagnosed by the time of adolescence. The possibility of late-life emergence of ASD has been poorly explored. METHODS: To more fully characterize the possibility of late-life emergence of behaviors characteristic of ASD in mild cognitive impairment and AD, we surveyed caregivers of 142 older persons with cognitive impairment from the University of Kentucky Alzheimer's Disease Center Longitudinal Cohort using the Gilliam Autism Rating Scale-2. RESULTS: Participants with high autism index ratings (autism "possible/very likely," n=23) reported significantly (statistically and clinically) younger age at the onset of cognitive impairment than those who scored in the autism "unlikely" range (n=119): 71.14±10.9 vs. 76.65±8.25 (P=0.034). In addition, those in the autism "possible/very likely" group demonstrated advanced severity of cognitive impairment, indicated by the Clinical Dementia Rating Scale Sum of Boxes scores. DISCUSSION: Data demonstrate that ASD behaviors may seem de novo of degenerative dementia and such behaviors are more prevalent in those with early onset dementia. Further work elucidating a connection between ASD and dementia could shed light on subclinical forms of ASD, identify areas of shared neuroanatomic involvement between ASD and dementias, and provide valuable insights that might hasten the development of therapeutic strategies.

"It Doesn't Require Much Effort Once You Get to Know Them": Certified Nursing Assistants' Views of Communication in Long-Term Care.

Certified nursing assistants (CNAs) provide the majority of hands-on care and become highly sensitive to residents' communication behaviors. Yet, CNAs feel disempowered when communicating residents' concerns to higher levels of authority. A grounded theory approach using focus group interviews with 23 CNAs was used to describe the communication environment in long-term care (LTC) and explore CNAs' perceptions of the acceptability of communication plans, a recent Canadian intervention to facilitate resident-staff communication. Findings suggest the communication environment in LTC relates to three overlapping constructs: (a) CNA and resident communication style; (b) paradox of context; and (c) dedication to residents. Although CNAs frequently interact with residents, a division between "top and bottom staff" communication was apparent in the findings. The current study suggested that communication plans may improve the communication environment in LTC settings. [Journal of Gerontological Nursing, 42(4), 42-51.].

Patient's perception of quality patient--provider communication.

PURPOSE: To develop a model of patients' perception of quality patient-healthcare provider communication. METHODS/SAMPLE: Fifteen patients with rheumatoid arthritis participated in in-depth, audiorecorded interviews. Following transcription verification, interviews were analyzed using constant comparative analysis to identify primary themes and develop a model of patients' perception of quality patient-healthcare provider communication. FINDINGS: The participants described a multifaceted, dynamic process of quality patient-healthcare provider communication involving the interrelationship between appropriate time and 4 key communication exchanges: patient honesty when explaining symptoms, patients asking questions and offering opinions, healthcare providers asking questions and offering opinions, and healthcare providers disseminating information. CONCLUSION: By understanding patient-healthcare provider communication from the patient perspective within the rubric of this model, healthcare providers can adapt interactions with patients with rheumatoid arthritis to incorporate dimensions of the exchange that their patients feel create effective communication.

Geriatric education in the health professions: are we making progress?

PURPOSE: Relative to the overall population, older adults consume a disproportionally large percentage of health care resources. Despite advocacy and efforts initiated more than 30 years ago, the number of providers with specialized training in geriatrics is still not commensurate with the growing population of older adults. This contribution provides a contemporary update on the status of geriatric education and explores how geriatric coverage is valued, how geriatric competence is defined, and how students are evaluated for geriatric competencies. DESIGN AND METHODS: Semi-structured interviews were conducted with curriculum representatives from 7 health profession disciplines in a case study of one academic medical center. FINDINGS: Geriatric training varies across health professions' disciplines. Although participants recognized the unique needs of older patients and valued geriatric coverage, they identified shortage of time in packed curricula, lack of geriatrics-trained educators, absence of financial incentive, and low student demand (resulting from limited exposure to older adults and gerontological stereotyping) as barriers to improving geriatric training. IMPLICATIONS: Progress in including geriatric training within curricula across the health professions continues to lag behind need as a result of the continuing presence of barriers identified several decades ago. There remains an urgent need for institutional commitment to enhance geriatric education as a component of health professions curricula.

Toward a physical environmental continuum for occupational intervention in a rehabilitation hospital.

ABSTRACT A study was conducted to explore occupational therapists' perceptions of rehabilitation environments and the influence of these perceptions on practice and occupational interventions. Traditionally, inpatient occupational therapists have a choice of intervention environments, ranging from a gym-like to a more home-like setting. Choosing to provide interventions in these different environments can have an impact on occupational performance. In this qualitative exploration, 21 occupational therapists participated in focus groups designed to explore their perceptions of practice environments. Analysis of the transcribed data revealed that therapists felt rehabilitation environments should offer choices and be flexible, that environments influenced intervention strategies, and that the practice environment had an impact on professional identity. On the basis of this data, a conceptual matrix of the intersection of environmental setting and occupation-based interventions is presented to highlight the importance of these two aspects of therapy. Future research in this understudied area is needed to transform this matrix into a clinically useful model.

Patient-provider communication: understanding diabetes management among adult females.

OBJECTIVE: The purpose of this study was to explore how adult women manage their diabetes. Recommendations for improving adherence and opportunities to maximize communication between the healthcare provider and individuals who have type 2 diabetes also were described. METHODS: An exploratory qualitative descriptive design was used to describe the experience of living with type 2 diabetes in adult females. Data were obtained via individual in-depth interviews with five women over age 50 with type 2 diabetes. Participants were interviewed individually and participated in a focus group. RESULTS: Participants clearly identified three major themes affecting adherence to treatment regimens: communication with the healthcare provider, knowledge of diabetes, and the consequences of poor glycemic control. For these participants, patient-provider communication was the most important factor affecting diabetes adherence. CONCLUSION: Individual autonomy asserted in day-to-day management is often perceived as non-compliance by the healthcare provider; while provider's descriptions of potential severe complications are viewed as scare tactics by the patients. PRACTICE IMPLICATIONS: Improved communication offers the clinician the opportunity to develop a partnership with patients to build mutually acceptable treatment plans and reach mutually agreed upon goals. Empowering the individual with skills needed to negotiate treatment regimens will encourage positive health decisions and improved outcomes.