Comparative impact of hearing and vision impairment on subsequent functioning.

OBJECTIVES: The purpose of this study was to compare independent impacts of two levels of self-reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning. DESIGN: A 1-year prospective cohort study. SETTING: San Francisco Bay Area, California. PARTICIPANTS: Two thousand four hundred forty-two community-dwelling men and women age 50 to 102 from the Alameda County Study (California). MEASUREMENTS: Hearing and vision impairment were assessed in 1994. Outcomes, measured in 1995, included physical disability (activities of daily living, instrumental activities of daily living, physical performance, mobility, and lack of participation in activities), mental health (self-assessed, major depressive episode), and social functioning (feeling left out, feeling lonely, hard to feel close to others, inability to pay attention). All 1995 outcomes were adjusted for baseline 1994 values. RESULTS: Both impairments had strong independent impacts on subsequent functioning. Vision impairment exerted a more wide-ranging impact on functional status, ranging from physical disability to social functioning. However, the results also highlighted the importance of hearing impairment, even when mild. CONCLUSIONS: These impairments can be partially ameliorated through prevention, assessment, and treatment strategies. Greater attention to sensory impairments by clinicians, patients, public health advocates, and researchers is needed to enhance functioning in older adults.

Negative consequences of hearing impairment in old age: a longitudinal analysis.

To determine whether functional and psychosocial outcomes associated with hearing impairment are a direct result or stem from prevalent comorbidity, we analyzed the impact of two levels of reported hearing impairment on health and psychosocial functioning one year later with adjustments for baseline chronic conditions. Physical functioning, mental health, and social functioning decreased in a dose-response pattern for those with progressive levels of hearing impairment compared with those reporting no impairment. Our results demonstrate an independent impact of hearing impairment on functional outcomes, reveal increasing problems with higher levels of impairment, and support the importance of preventing and treating this highly prevalent condition.

New NHLBI clinical guidelines for obesity and overweight: will they promote health?

OBJECTIVES: The purpose of this study was to assess the justification, on the basis of mortality, of the new National Heart, Lung, and Blood Institute (NHLBI) guidelines on obesity and overweight and to discuss the health implications of declaring all adults with a body mass index of 25 through 29 "overweight." METHODS: The relationships between NHLBI body mass index categories and mortality for individuals older than 31 years were analyzed for 6253 Alameda County Study respondents aged 21 through 75 years. Time-dependent proportional hazards models were used to adjust for changes in risk factors and weight during follow-up. RESULTS: Adjusted relative risks of mortality for 4 NHLBI categories compared with the category "normal" indicated that only being underweight or moderately/extremely obese were associated with higher mortality. Specific risk varied significantly by sex. CONCLUSIONS: Our results are consistent with other studies and fail to justify lowering the overweight threshold on the basis of mortality. Current interpretations of the revised guidelines stigmatize too many people as overweight; fail to account for sex, race/ethnicity, age, and other differences; and ignore the serious health risks associated with low weight and efforts to maintain an unrealistically lean body mass.

Perceived control and psychosocial/physiological functioning in African American elders with type 2 diabetes.

PURPOSE: The purpose of this pilot study was to assess (1) the reliability of the revised Wallhagen Perceived Control Questionnaire (PCQ-R), derived from a person-environment perspective, in a sample of elderly African Americans > or = 60 years with Type 2 diabetes and (2) the relationship between the PCQ-R and psychosocial and physiological functioning. METHODS: A descriptive, cross-sectional, pilot project was conducted with a convenience sample of 23 African Americans with Type 2 diabetes. Variables included health status, the PCQ-R, the Medical Outcomes Survey Short Form 36, and glycosylated hemoglobin. RESULTS: The PCQ-R was reliable and significantly related to physical and social functioning, physical and emotional role involvement, mental health, vitality, and general health perception. No relationship was found with metabolic control. CONCLUSIONS: Findings support the reliability of the PCQ-R and the conceptualization of control. However, confirmation is needed in a larger sample, and questions that emerged require further exploration.

Service use by family caregivers in Japan.

This paper presents a conceptual framework for understanding how Japanese family caregivers make decisions about the use of formal services such as adult day care, short term hospital stays, and long-term institutionalization. Using grounded theory methodology, 26 Japanese daughters or daughters-in-law who were caring for an elderly demented parent or parent-in-law were interviewed. From these data, an overall process of "navigating among endorsed options" evolved. This process was set in motion when caregivers reached the limit of their tolerance, a point at which they felt they could not continue caregiving under the given arrangement. Caregivers then began to assess three issues which determined whether or not they used formal services: the availability of services; their authority level within the family; and whether or not they could justify their tolerance limit. The availability of a service was determined by the quality of the service, the distance to the service, the sanctions that would incur as a result of using the service, information about the service, and the quantity of the service. The caregivers' authority within the family varied depending on such factors as how much the caregiver was accepted by her married family or the type of family business. This authority level determined whether and how the caregivers could approach other family members in order to obtain their consent to use formal services. Finally, whether the caregivers could justify their tolerance limit depended on the internalization of the societal norm regarding family caregiving, attachment to the care recipient, and the caregiver's belief on how care should be given. Justification of their limit included re-prioritizing the needs of family members, acting in defiance of societal norm, and redefining reality. Each of the three issues was assessed in relation to the others with the final decision to use or not use formal services based on the balance of forces.

New burdens or more of the same? Comparing grandparent, spouse, and adult-child caregivers.

This study compares the health of 42 grandparent, 44 spouse, and 130 adult-child caregivers with 1,669 noncaregivers in 1994 and 1974. In 1994, all three caregiver groups had poorer mental health than the noncaregivers; grandparent caregivers also had poorer physical health and greater activity limitations. Spouse and adult-child caregivers had not differed from the noncaregivers 20 years prior, but grandparent caregivers had experienced poorer health than the noncaregivers and more stressful life events than the other caregivers. Caregiving appears to add new burdens to otherwise normal lives for spouse and adult-child caregivers, while being yet another aspect of a difficult life course for grandparent caregivers.

The continuation of family caregiving in Japan.

The purpose of this study was to develop concepts that facilitate our understanding of why family caregivers of demented elderly persons can continue caregiving despite various difficulties of care. Twenty-six Japanese daughter or daughter-in-law caregivers of elderly parents with dementia who lived at home or in long-term care facilities were recruited through various senior service organizations in Japan. The caregivers underwent unstructured interviews, and the interview data were analyzed using the constant comparative method. Three categories emerged as reasons for care continuation: value of care, maintainers of value, and reinforcers of care continuation. Value of care came from societal norms and attachment, and was the basis of caregivers' motivation to continue care. Several maintainers of value and reinforcers of care continuation also emerged from the analysis. The contents and some longitudinal changes in these categories were explained. The findings highlight the need to assess these categories separately in order to develop appropriate interventions and they have implications for future research and policy development.

A study of the psychosocial characteristics of patients in a geriatric rehabilitation unit in Israel.

This study characterizes the demographic backgrounds of patients in an Israeli geriatric rehabilitation unit, determines the factors associated with their family relationships and the instrumental support they received, and emphasizes the importance of social roles as a personal resource. The study population consisted of 336 low-income Jews, all of whom were immigrants. Virtually all of the subjects had a small, close support network composed mainly of their children and spouses. Their children were the most important source of instrumental support during their hospitalization. The subjects' sources of instrumental support prior to hospitalization varied, depending upon their age, gender, marital status, and social roles. Social exchange theory provided a framework for explaining their social roles. Factors found to be predictors of good family relationships were marital status, living arrangements, instrumental support, social roles, and educational level.

An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study.

OBJECTIVES: This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS: Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS: The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS: Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.

Perceived control and well-being in Parkinson's disease.

Sense of control in the context of an uncontrollable chronic illness is explored by analyzing the impact of the patient's perceived control over symptoms (PCS) and perceived control over disease progression (PCDP) on patient and caregiver outcomes. PCS was significantly associated with patient well-being, caregiver well-being, and less caregiver burden. No relationship was found between PCDP and patient well-being, caregiver well-being, or caregiver burden. Findings support the importance of symptom management, viewing the patient-caregiver dyad as a unit, and the need for future research on control and transition points in chronic illness.

Analgesics prescribed and administered to intensive care cardiac surgery patients: does patient age make a difference?

This study was conducted to determine the effects of patient age on the opioid prescription and administration practices of professionals in a sample of 80 cardiac surgery patients. The age categories were patients < 65 years of age and patients > or = 65 years of age. Medical records of adult cardiac surgery patients undergoing valve replacements and coronary artery bypass surgery within a single metropolitan teaching hospital were reviewed. Data were collected for up to three days or until the patient was discharged from the intensive care unit (ICU). For each of the study days, the specific types of opioids prescribed and administered were recorded. Calculations were performed to determine the maximum amounts of opioids prescribed and administered during the study period and to analyze for differences between the two age groups. Analyses revealed that all patients received small amounts of opioid analgesics during their three ICU days: mean = 9.4 mg, day of surgery; mean = 13.3 mg, postoperative day one; mean = 12.1 mg, postoperative day 2. When the total patient sample was evaluated, a significant difference in the doses of opioids prescribed versus administered was found across all three study days. Differences in amounts of opioids administered to the two age groups progressively increased across the three days, with patients > or = 65 receiving less than patients < 65. These differences approached significance on postoperative days one and two. The findings that elderly patients received less opioids than younger patients and that these differences became greater over time is intriguing. Questions remain as to whether ICU patients in pain are under-medicated and whether postsurgical pain control is effective over time.

My parent--not myself. Contrasting themes in family care.

We studied 100 adult child caregivers providing care to dependent parents and found that although the vast majority supported family care for older persons in general and their own parent in particular, 46% did not want family care for themselves if they became dependent. For many the contrast between their general statements supporting care of parents and eschewing it for themselves was quite sharp. Caregiver variables significantly associated with not wanting family care for self included age, conflict with relatives over caring, caregiving burden, number of caregiving tasks performed, poorer mental health, and number of years has provided care. Caregivers not wanting family care for self were also more likely to consider placing their parent in a nursing home. Our data reveal contrasting themes in caregiving that may affect caregiver well-being and burden, and that may have implications for the future care of dependent older persons.

Impact of internal health locus of control on health outcomes for older men and women: a longitudinal perspective.

We investigated the relationship between baseline internal health locus of control (IHLC) and 6-year change in physical functioning in 356 older adults. IHLC was strongly related to change in physical functioning for women at all levels of baseline functioning, but only affected men with lower baseline functioning. Cross-sectional analyses indicated no relationship between IHLC and health seeking activities except changing eating patterns when sick. Other findings were that IHLC was related to depression and not having childhood illness for men and to number of negative life events for women. For both genders IHLC was related to the importance placed on good health.

Perceived control and adaptation in elder caregivers: development of an explanatory model.

Perceived control has been implicated in the adaptation and well-being of older adults and may be especially relevant to elder caregivers. However, few studies have investigated perceived control within the individual's unique personal, social, and environmental context. This study tested a model representing the hypothesis that perceived control, defined as the perception that salient or valued aspects of one's life are manageable, mediates the objective and subjective aspects of caregiving and caregiver adaptation. Sixty elderly caregivers ranging in age from sixty to eighty-four (M = 69.4) were interviewed. Perceived control had a direct relationship with life satisfaction and depression, and an indirect relationship with subjective symptoms of stress. Wishful thinking coping behavior had a negative relationship with all adaptation variables. Findings are discussed in relation to further refinement and development of a theoretical approach to caregiver research and intervention studies in light of the obtained path model.

Caregiving demands: their difficulty and effects on the well-being of elderly caregivers.

Nurses assess situations involving elderly caregivers, yet data conflict on how caregivers perceive caregiving demands. To develop appropriate research-based interventions, more data are needed on specific aspects of these demands. Discussed are data from interviews with 60 elderly caregivers regarding tasks and personal demands. Results suggest that personal demands are perceived as more difficult than task demands and are associated to a greater extent with caregiver life satisfaction and depression. Issues are raised, however, regarding the measurement of expressed difficulty. Findings also support the adaptive capacity of these caregivers and their commitment to the caregiving role. Implications for nursing practice and nursing science are discussed.

Impact of family conflict on adult child caregivers.

Family conflict is an overlooked yet potentially critical component of the caregiving experience. In a study of 100 adult child caregivers, 40% were experiencing relatively serious conflict with another family member, usually a sibling. Most conflict arose because the relative failed to provide sufficient help. Path analysis revealed that caregivers experiencing family conflict had significantly higher perceived burden and poorer mental health than did caregivers without conflict, even when quality of the caregiver's relationship with the parent, extent of caregiver tasks, income, gender, and age were taken into account.