Resident-to-Resident Abuse: A Scoping Review.

Resident-to-resident abuse involves aggression and violence that occurs between long-term care (LTC) home residents and can have serious consequences for both aggressors and victims. To date, there has been no attempt to systematically assess the breadth of the problem in Canada. To address this gap, we undertook a scoping review to enhance understanding of resident-to-resident abuse in LTC homes. A redacted Canadian data set on resident-to-resident abuse is also reported on. Nine electronic literature databases were searched; a total of 784 abstracts were identified, but only 32 satisfied the inclusion criteria. The majority of records (75%) were retrospective case studies, qualitative studies, and reviews/commentaries. Of these, only 14 focused exclusively on resident-to-resident abuse. The redacted Canadian data set suggests resident-to-resident abuse makes up approximately one-third of reported abuse cases. Recommendations for future research, clinical practice, and policy are provided to raise awareness of this phenomenon to help decrease its incidence.

Age-related and death-related differences in emotional complexity.

The present study aimed to examine an aspect of emotional complexity as seen in covariation between retrospective judgments of positive and negative affects. We assume that individuals can experience positive affect independently of negative affect. Theories argue that emotional complexity increases in old age, but research shows mixed evidence. Additionally, emotional complexity has been shown to decrease in situations prevalent in old age, such as physical illness and disability. Integrating distinct effects of age and distance to death, we propose that emotional complexity may remain intact or even increase in old age, and yet it decreases in light of functional deterioration shortly before death. The current research examined whether emotional complexity decreases as a function of subjective perception of closeness to death (subjective survival probability) or actual closeness to death. We used 3 large-scale databases: 2 cross-sectional (SHARE, N = 17,437, mean age = 64; HRS, N = 6,032, mean age = 67) and 1 longitudinal (CALAS, N = 1,310, mean age at baseline = 83). Hierarchical multiple regressions and multilevel models showed that respondents who perceived themselves as closer to death or were actually closer to death showed lower emotional complexity (a stronger negative correlation between positive and negative affects). Age and emotional complexity were unrelated or positively related, depending on the sample. Findings remained the same after controlling for demographic characteristics, as well as physical and cognitive functioning. The results indicate that both subjective and objective closeness to death are associated with lower emotional complexity. This death-related decrease in emotional complexity is discussed within current theories of aging.

Improvements and decline in the physical functioning of Israeli older adults.

PURPOSE OF THE STUDY: The current study depicts improvement and decline in functioning among 3 population groups of Israeli older adults: Jews and veteran immigrants, former Soviet Union immigrants, and Arabs. METHODS: Using longitudinal data from 2005 and 2010 Survey of Health and Retirement (SHARE) in Israel (n = 982), we examined 4 functional changes in late life in mobility, movement, activities of daily living (ADL), and instrumental ADL, as a function of sociodemographic, health, and social variables RESULTS: The findings reveal that physical functioning among older adults can decline as well as improve over time. Older age, higher number of diseases and comorbidity, living with others (not the spouse) compared with living alone, receiving informal help and formal help with homemaking, and declined mental health and cognitive status predict deterioration in physical functioning. Also, Arab older adults are at higher risk of deterioration over time compared with Jewish older adults. IMPLICATIONS: Findings imply that noncompatible assistance to older adults may "save them the hassle" of doing things by themselves and thus, weakens a potential functional rehabilitation process. There is a need to guide not only professional personnel but also nonprofessional home care workers and family members on how to encourage and retain older adults' functions as much as possible in order to improve their quality of life. Another implication of investing in rehabilitation is that it might reduce the disability rate among older adults and thus save health expenditures on long-term care at the macrosocial level.

Identifying frail older people using predictive modeling.

OBJECTIVES: To determine whether a designation of frailty using the Adjusted Clinical Groups-diagnoses based computerized predictive model (ACG Dx-PM) can identify an elderly population who (1) have the clinical characteristics of frailty and (2) are frail as determined by the validated Vulnerable Elders Survey (VES), and to determine the ability of these tools to predict adverse outcomes. STUDY DESIGN: Secondary analysis of administrative and survey data. METHODS: Participants over age 65 years (n = 195) in an outpatient comprehensive geriatric assessment study at an Israeli health maintenance organization (HMO) were screened for frailty using the ACG Dx-PM and VES. Administrative and demographic data were also gathered. RESULTS: Compared with ACG nonfrail patients, ACG frail patients were older and less likely to be married; had a higher rate of falls, incontinence, and need for personal care; and had a poorer quality of life consistent with a clinical picture of frailty. The ACG frailty tag identified a frail population using the VES frailty determination as the accepted standard with moderate success (area under the curve 0.62). Adjusting for sex and functional status in backward logistic regression, the ACG frailty tag predicted hospitalizations (P <.032) and the VES frailty tool predicted emergency department visits (P <.016). CONCLUSIONS: The ACG frailty tag identified an elderly population with clinical characteristics of frailty and performed with moderate success compared with the VES. Both tools predicted adverse outcomes in older HMO members. A combined screening approach for frailty using predictive modeling with a function-based survey deserves further study.

[Comprehensive geriatric assessments: what are their place and how do they contribute to care for elderly patients in Israel's health care system?].

INTRODUCTION AND BACKGROUND: Comprehensive geriatric assessment (CGA) is considered a good method for diagnosing frail older people, deferring disability and providing adequate care. Since it is more expensive than a regular clinic, it should be used efficiently. STUDY GOALS: To ascertain whether CGA is provided to the appropriate population and identify changes pre- and six months post-CGA in intervention and control groups. STUDY DESIGN: Two surveys--one retrospective including atd 580 older people receiving CGA in Maccabi Healthcare Services in 2007 (data from Maccabi's database), the other a prospective semi-experimental survey, with a representative sample of 211 older people, receiving CGA in 2008, and 166 matching patients who had not received CGA (both groups interviewed twice within a six-month intervaL). FINDINGS: A total of 59% of CGA people were women, average age 79 years. Geriatric symptoms: 42% with functional disability, 63% Limited in out-of-home functions (e.g., shopping), 52%--cognitive decline, 33%--suspected depression, 41%--repeated falls, 35%--urinary incontinence. Morbidity data included: 55% suffered from heart disease, 29% diabetes, 18% malignancies, taking 7.8 medications on average. There was an improvement in health-related quality-of-life and use of services by patients receiving CGA, while this remained unchanged in the control group, with no change in the geriatric symptoms of both groups. IMPLICATIONS FOR POLICY: CGA clinics receive referrals with multiple geriatric symptoms. It is important to expand them and to formulate structured criteria to identify target populations and disseminate the criteria to physicians, in order to increase referral of suitable patients.

Formal education level versus self-rated literacy as predictors of cognitive aging.

OBJECTIVES: To compare the prediction of cognitive functioning by formal education and self-rated literacy and the differences in prediction across younger and older cohorts. METHOD: Data on 28,535 respondents were drawn from a cross-sectional representative sample of community-dwelling older individuals (≥50), participating in the Survey of Health, Ageing, and Retirement in Europe. Education level was classified according to the International Standard Classification of Education 1997 (ISCED-1997) self-rated literacy was determined by having respondents rate their reading and writing on 1-5 scales. Cognitive functioning was measured by verbal recall, word fluency, and arithmetic ability. RESULTS: Structural equation modeling demonstrated that self-rated literacy was more strongly associated with cognitive functioning than was education level, with or without additional exogenous variables (age, sex, household income, medical conditions, activities of daily living, reading eyesight, and country). The association between education level and cognitive functioning was weaker in older than in younger age groups, whereas the association between self-rated literacy and cognitive functioning showed the opposite trend. DISCUSSION: Self-rated literacy was found to be a better predictor of late-life cognitive functioning than was the level of formal education. The results have implications for studies of age-related differences in which education level is taken into account.

For better and for worse: the relationship between future expectations and functioning in the second half of life.

OBJECTIVES: To examine age group differences in the relationship between future expectations about standards of living and physical, mental, and cognitive functioning in the second half of life. METHOD: Data from the Survey of Health, Ageing, and Retirement in Europe (N=27,687, mean age=64.44). RESULTS: First, with increasing age, the expectation to improve (ETI) and the expectation to worsen (ETW) in standards of living became more independent of each other. Second, with increasing age, ETI was less strongly correlated with functioning whereas ETW was more strongly correlated with it. Third, with increasing age, the relationship between ETI and functioning was more strongly moderated by ETW, so that adaptive functioning was associated with expectations that no major change is to occur and with expectations for both growth and decline. DISCUSSION: Late-life positive and negative expectancies are less interdependent than they are in younger age, probably due to their stronger interaction when associating with functioning. Expectancies interact either to reflect an attempt to preserve the functional status quo (low expectancy to improve and to decline) or may signal a highly complex mental organization (high expectancy to improve and to decline).

Delineating terminal change in subjective well-being and subjective health.

The present study investigated whether several evaluative indicators of subjective well-being (SWB) and subjective health decline as death approaches and which of them shows a stronger decline. Using three-wave longitudinal data from deceased participants of the Cross-Sectional and Longitudinal Aging Study (N = 1,360; age range 75-94 at T1= Time 1), we found a stronger decline in most evaluative indicators when plotted by distance-to-death relative to distance from birth. After controlling for background characteristics and physical and cognitive functioning, death-related decline was still found for SWB but not for subjective health. Implications are discussed regarding the well-being paradox and the yet unclear mechanisms that link evaluative indicators to the dying process.