Advance directives for health care among older community residents.

Advance directives (ADs) for healthcare are useful planning tools for older people. In addition, the utilization of ADs is important for health and human services planners, administrators, and policy makers to understand because whether or not people have an AD, and what types of ADs they have can dramatically influence the treatment trajectories and the well-being of older people who can longer make decisions for themselves. Using telephone survey data with a random sample of Oklahoma residents age 60 and older, we examined the prevalence of four measures of AD use.

Psychometric tests of Expectations of Filial Piety Scale in a Mexican-American population.

Aims And Objectives: This paper reports the development of the Expectations of Filial Piety Scale for use with Mexican-American parents regarding expectations they have of their adult children for care and support.

Background: Earlier work by the authors demonstrated that filial piety is a cross-cultural construct that can be used with Hispanic/Latino populations. More refined development of the construct required testing with more homogeneous subsets (i.

Length of hospice care among U.S. adults: 1992-2000.

This study examined length of service use among U.S. adult hospice patients based on data from the 1992-2000 National Home and Hospice Care Surveys.

Participant characteristics predicting voluntary early withdrawal from a multidisciplinary program providing home-delivered meals and dietitian/social work case management to homebound elders.

We examine whether baseline characteristics of participants enrolled in a multidisciplinary program providing home-delivered meals and dietitian/social work case management to homebound seniors predicted voluntary early withdrawal. Sixty-nine participants voluntarily withdrew early and 111 completed the project. Six hypotheses were based on a conceptual framework incorporating (1) agreement between project elements and needs/preferences of individuals and (2) whether participants would improve and no longer require or desire the intervention.

Factors associated with medication hassles experienced by family caregivers of older adults.

Objective: We wished to identify potential factors associated with medication administration hassles, daily irritants, among informal caregivers who provide long-term medication assistance to persons aged 55 or older.

Methods: A sample of 156 informal caregivers were recruited from seven states and several types of settings. The dependent variable was scores on the Family Caregiver Medication Administration Hassles Scale (FCMAHS).

Recruitment and retention of ethnically diverse long-term family caregivers for research.

The inclusion of ethnically diverse long-term care family caregivers is significant in research, particularly in social work research because of the importance placed on diverse populations. However, the inclusion of diverse populations poses a set of unique recruitment and retention challenges for researchers. This process can be particularly complicated when multiple long-term care recruitment partners are utilized and when the project involves a multi-phase data collection plan with different minority recruitment needs for each phase.

Recent trends in advance directives at nursing home admission and one year after admission.

Purpose: Advance directives are important planning and decision-making tools for individuals in nursing homes.

Design And Methods: By using the nursing facility Minimum Data Set, we examined the prevalence of advance directives at admission and 12 months post-admission.

Results: The prevalence of having any advance directive at admission declined slightly from 2000 to 2004, whereas the prevalence of having any advanced directive at 12 months after admission increased slightly during the same period.

National trends in adult hospice use: 1991-1992 to 1999-2000.

This study examines hospice use among adult hospice patients based on the 1992-2000 National Home and Hospice Care Surveys, the 1997-1999 National Nursing Home Surveys, and the 1991-2000 annual Underlying and Multiple Cause-of-Death Files. The total number of adult hospice patients tripled between 1991-1992 and 1999-2000. The majority of inpatient hospice patients resided in nursing homes.

Helping family members manage medication administration hassles.

Managing the medication regimens of dependent older adults in the home is a complex issue for family caregivers. The tasks involved can include helping the older adults manage their own medications or may require involvement in the purchasing, scheduling, and administering of multiple medications for serious conditions. The hassles associated with this responsibility are now known to be associated with increased caregiver strain.

Development of the Expectations of Filial Piety Scale--Spanish version.

Aims: This paper reports the development of the Expectations of Filial Piety Scale for use with Hispanic/Latino parents regarding their expectations of care and support from their adult children.

Background: Filial piety, a term used to describe a set of family values in relation to parental care and respect, has strong cultural underpinnings. To date, there have been no measures of this construct for use with Hispanic/Latino populations.

Effects of acculturation and social exchange on the expectations of filial piety among Hispanic/Latino parents of adult children.

This study explores the effects of acculturation and social exchange variables on the expectations of filial piety (values and beliefs about parents' care) among Hispanic/Latino parents of adult children. A convenience sample of 318 Hispanics/Latinos with adult children was assembled in Texas and North Carolina, USA, for face-to-face interviews in order to collect information about their families and to assess their expectations of filial piety by their adult children. The number of years in the USA, age, gender, the eldest child's age, and living with a person > or = 65 years of age had significant relationships to scores from a new Spanish version of the Expectations of Filial Piety Scale (EFPS).

Clinical indicators of treatment futility and imminent terminal decline as discussed by multidisciplinary teams in long-term care.

Focus group methodology was used to describe how members of multidisciplinary teams in long-term care facilities recognize when residents are approaching end-stage disease, document evidence that associated treatment futility has occurred, and convey this information to the residents, each other, and family members. In addition to the typical clinical indicators of treatment futility found in the literature (e.g.

Incorporating medication regimen reviews into the interdisciplinary care planning process.

Although many long-term care providers regard medication utilization reviews in terms of regulatory mandates, survey deficiencies, practice intrusion, and policy violations, not all consider these activities in such negative terms. This article describes the approach used by a large interdisciplinary team at a private continuing-care retirement community (CCRC) in North Carolina that includes medication regimen review in the larger context of resident care planning.

Analyses of nursing home residents with diabetes at admission.

Objective: The objective of this study was to profile nursing home residents with diabetes at admission to the nursing facility.

Methods: We used all admission assessments in the Minimum Data Set recorded throughout the United States during 2002 to identify 144,969 residents with diabetes, or 26.4% of all admissions.

A commitment to professional caregivers: the Rosalynn Carter Institute for Human Development.

When the term caregiver is used, one most often thinks about family caregivers and other informal providers of assistance to impaired individuals. The Rosalynn Carter Institute (RCI) is the only national institute or center to take a different approach to addressing the needs of the nation's caregivers and caregiving teams. The universal psychosocial difficulties and shared rewards associated with all types of caregiving shape the research, education, and advocacy agendas of the RCI, founded in honor of former First Lady Rosalynn Carter.

Relocation to a long-term care facility: working with patients and families before, during, and after.

Permanent relocation of a dependent older adult to a long-term care facility can occur for a number of reasons, including the need for postacute care or a higher level of care than can be provided in a less-restrictive environment, and/or the inability of family members or others to care for the individual in a noninstitutional setting. Outcomes of institutional placement may be either negative, such as the older adult experiencing relocation stress syndrome, or positive, such as improved management of chronic illnesses and reversal of functional decline. This article offers a review of the factors that predict when and where older adults will relocate for institutional long-term care, an overview of individual transitions to institutional care, and suggestions for seamless transitions during the preinstitutionalization, transitional, and postinstitutionalization phases of relocation, which are guided by a transactionist approach to stress and coping.

Advance care planning among residents in long-term care.

This study was conducted to determine whether two types of advance directives exist for individuals residing in long-term care facilities. Findings were based on data from the Medical Expenditure Panel Study-Nursing Home Component (MEPS-NHC), a survey using a two-stage stratified probability sample of nursing homes and residents to produce valid national estimates of the nursing home population in the United States. The two types of advance directives included basic, i.

Development of the family caregiver medication administration hassles scale.

Purpose: "Medication administration hassles" are the minor daily irritants that family caregivers experience when they assist a dependent family member with medication regimens. This study was designed to develop and test a multidimensional measure of the hassles in family caregiver medication administration.

Design And Method: The authors employed a multiphase process (caregiver focus groups, instrument development, pilot testing, and field testing).

Analysis of the reliability of the modified caregiver strain index.

Objectives: The Caregiver Strain Index (CSI) is a 13-item index originally developed in the early 1980s to screen for caregiver strain after hospital discharge of an elderly family member. This study examined the reliability of a modified CSI for applications with contemporary long-term family caregivers.

Methods: As part of a larger family caregiver study using focus groups, telephone interviews, and mailed surveys, test-retest procedures were included to examine the reliability of the Modified CSI.

Obstacles to palliation and end-of-life care in a long-term care facility.

Purpose: This exploratory study used a set of four obstacle constructs derived from both the existing literature and our earlier work to describe the diverse end-of-life scenarios observed for a group of residents in a long-term care facility.

Design And Methods: Data from a retrospective chart review and both quantitative and qualitative methods of data collection and analysis were used to examine in-depth the end-of-life experiences of all nursing home residents (N = 41) who died on the nursing care unit of a large continuing care retirement community during an 18-month period.

Results: A hierarchy of obstacles to palliation and end-of-life care seems to exist in long-term care settings that begins with the lack of recognition that restorative, rehabilitative, or curative treatment futility has commenced.