Older women's beliefs about physical activity

Physical activity may contribute to important health and well-being outcomes among older adults. Efforts to understand determinants of physical activity are necessary to plan effective interventions. The theory of planned behavior has been successfully applied to a variety of health behaviors. Previous research using the theory of planned behavior has not addressed beliefs about overall physical activity among community-dwelling older women. Qualitative interviews were conducted with 30 older women to identify behavioral beliefs, perceived control beliefs, and normative beliefs, which influence physical activity decisions. Content analyses of responses revealed three major themes: social influences on physical activity, psychosocial benefits of activity, and joint problems and fatigue as factors that interfere with activity. These findings about physical activity were compared with published findings about episodic exercise among 30 similar women who took part in an episodic exercise study. The result was the discovery that the women in this study talked about physical activity as embedded in their social lives while the women in the episodic exercise study viewed exercise as separate from their daily lives. These findings of beliefs about overall physical activity suggest a social model may be useful in planning public health interventions to increase activity among older women.     

Medication adherence in rheumatoid arthritis patients: older is wiser

OBJECTIVES: To create a profile of individuals nonadherent to their medications in an age-stratified sample (ages 34-84) of community-dwelling rheumatoid arthritis patients. The relative contributions of age, cognitive function, disability, emotional state, lifestyle, and beliefs about illness to nonadherence were assessed. DESIGN: A direct observation approach was used in conjunction with structural equation modeling. All participants were administered a preliminary assessment battery. Medications were then transferred to vials with microelectronic caps that recorded medication events for all medications for the next 4 weeks. PARTICIPANTS AND SETTING: A volunteer sample of 121 community-dwelling rheumatoid arthritis (RA) patients were recruited from newspaper ads, posters, and via informal physician contact from private rheumatology practices in Atlanta and Athens, Georgia. Written verification of the RA diagnosis and a disease severity rating were obtained from personal physicians before patients were enrolled in the study. Patients were tested in a private physician's office, and their medication adherence was monitored electronically for a month in their every-day work and home settings. MEASUREMENTS AND RESULTS: Structural equation modeling techniques were used to develop a model of adherence behavior. Cognitive and psychosocial measures were used to construct latent variables to predict adherence errors. The model of medication adherence explained 39% of the variance in adherence errors. The model demonstrated that older adults made the fewest adherence errors, and middle-aged adults made the most. A busy lifestyle, age, and cognitive deficits predicted nonadherence, whereas coping with arthritis-related moods predicted adherence. Illness severity, medication load, and physical function did not predict adherence errors. Omission of medication accounted for nearly all errors. CONCLUSION: Despite strong evidence for normal, age-related cognitive decline in this sample, older adults had sufficient cognitive function to manage medications. A busy lifestyle and middle age were more determinant of who was at risk of nonadherence than beliefs about medication or illness. Thus, practicing physicians should not assume that older adults have insufficient cognitive resources to manage medications and that they will be the most likely to make adherence errors. Very busy middle-aged adults seem to be at the greatest risk of managing medications improperly.     

Changes in functional health, changes in medication beliefs, and medication adherence.

Objective: Medication adherence often lies below recommendations although it is crucial for effective therapies, particularly in older adults with multiple illnesses. Medication beliefs are important factors for individual adherence, but little is known about their origin. We examine whether changes in functional health predict changes in medication beliefs, and whether such changes in beliefs predict subsequent medication adherence. Design: At three points in time over a 6-month period, 309 older adults (65–85 years) with multiple illnesses were assessed. Latent true change modeling was used to explore changes in functional health and medication beliefs. Adherence was regressed on changes in beliefs. Main Outcome Measures: Medication beliefs were measured by the Beliefs About Medicines Questionnaire; medication adherence by the Reported Adherence to Medication Scale. Results: Functional health and medication beliefs changed over time. Increasing physical limitations predicted increases in specific necessity and specific concern beliefs, but not in general beliefs. Changes in specific necessity beliefs predicted intentional adherence lapses, changes in general overuse beliefs predicted unintentional adherence lapses. Conclusions: Medication beliefs partly depend on health-related changes, and changes in beliefs affect individual adherence, suggesting to target such beliefs in interventions and to support older adults in interpreting health changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptions of prenatal care among Somali women in San Diego

Studies have shown that culturally sensitive prenatal care improves access to and utilization of that care. Focus groups were used to explore the beliefs and attitudes toward prenatal care among Somali women in San Diego, particularly in regard to their perinatal experiences following immigration. The women were very well informed about healthy prenatal practices, including nutrition and exercise, and very compliant in following such practices, having found ways and means to accommodate these practices into their new American lifestyle. The women were generally pleased with the care that they have received in San Diego and tolerant of most diagnostic and therapeutic interventions. The women preferred to be seen by a female doctor/health care practitioner who is informed about the female circumcision practiced in Somalia and who is conservative in the decision to perform cesarean section deliveries.     

Efficacy beliefs in geriatric rehabilitation

Motivation is an important variable in older adults' ability to recover from any disabling event. The theory of self-efficacy states that efficacy beliefs affect behavior, motivational level, thought patterns, and emotional reactions in response to any situation. This study explored the impact of efficacy beliefs on older adults in a rehabilitation program and tested interventions to strengthen efficacy beliefs related to participation in rehabilitation and functional performance. An experimental pretest-posttest design was used. Participants were randomly assigned to: the usual care control group or the treatment group. The study was completed on an inpatient geriatric rehabilitation unit. The sample consisted of 77 participants, 55 women and 22 men with a mean age of 78 +/- 7.2. Individuals in the treatment group received three efficacy enhancing interventions: role modeling, verbal persuasion, and physiological feedback. Baseline data were collected within 48 hours of admission and included four investigator-developed efficacy measures: Functional Inventory Measure, Participation Index, Numeric Rating Scale for pain, amount of analgesic used for pain, and Health Status. With the exception of Health Status, these measures were again completed within 48 hours of discharge. Admission performance was the only statistically significant predictor of efficacy beliefs. All efficacy beliefs increased over time and were significantly correlated with performance behaviors and length of stay. The treatment group had stronger efficacy beliefs regarding participation, higher participation at discharge, and less pain than the control group. Efficacy beliefs, both self-efficacy and outcome expectations, are related to participation, functional performance, and length of stay. Interventions to strengthen these beliefs improved participation in rehabilitation and decreased pain. Consideration of motivation can facilitate rehabilitation and help older adults obtain and maintain their highest functional level.     

Spirituality in aging: spiritual need or spiritual journey?

1. The current approach to spiritual assessment often makes the older client uncomfortable discussing his or her spiritual and religious orientation. 2. To provide therapeutic interventions, nurses must first become aware of themselves and their clients as spiritual beings. 3. A spiritual journey perspective views the nurse as one who can enhance the unique journey and growth of the individual client.     

Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes

Spirituality is a neglected area of study and research in the treatment of addictions. The role of spirituality in the treatment of the dually diagnosed has received particularly scant attention. One hundred and one patients on an in-patient dual-diagnosis unit, as well as the 31 members of the nursing staff who treat them were surveyed. Patients and staff were questioned about their spiritual beliefs and what was the role of spirituality in the patients' recovery from addiction. Staff were questioned about their own spirituality and what they think the patients' level of spirituality is. In addition the staff were asked what they think the patients' view of spiritually is. Results indicate that the patients and staff are equally spiritually oriented. The patients view spirituality as essential to their recovery and value spiritual programming in their treatment more than some concrete items. The nursing staff underestimated both the patients' level of spirituality and this importance placed on spiritual issues. The authors suggest that more attention should be given by staff to spirituality in the treatment of this population.     

Spiritual nursing interventions

Oncology, parish, and hospice nurses in the Midwest were surveyed to explore what nursing interventions they implement to enhance the spirituality of clients and how they learned about these interventions. Some 95 spiritual nursing interventions were identified and ranked according to frequency of implementation. The most frequently identified nursing interventions were referral, prayer, active listening, facilitation and validation of clients' feelings and thoughts, conveying acceptance, and instilling hope. The most frequently ranked implemented interventions were communication and religious nursing interventions. Only 15% of the participants indicated that they learned the most about spirituality and spiritual nursing interventions from basic and advanced nursing education combined. Findings support the need for increased emphasis of theoretical and clinical spiritual knowledge in nursing education and the development of a typology of spiritual nursing interventions to direct nurses in enhancing the spirituality of clients and implementing holistic nursing care.     

Goals and everyday problem solving: Manipulating goal preferences in young and older adults.

In the present study, we examined the link between goal and problem-solving strategy preferences in 130 young and older adults using hypothetical family problem vignettes. At baseline, young adults preferred autonomy goals, whereas older adults preferred generative goals. Imagining an expanded future time perspective led older adults to show preferences for autonomy goals similar to those observed in young adults but did not eliminate age differences in generative goals. Autonomy goals were associated with more self-focused instrumental problem solving, whereas generative goals were related to more other-focused instrumental problem solving in the no-instruction and instruction conditions. Older adults were better at matching their strategies to their goals than young adults were. This suggests that older adults may become better at selecting their strategies in accordance with their goals. Our findings speak to a contextual approach to everyday problem solving by showing that goals are associated with the selection of problem-solving strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General practice patients' beliefs about their symptoms

BACKGROUND: Patients' beliefs about symptoms are major influences on consultation and its consequences. However, little information is available about the beliefs of patients when they consult their general practitioner (GP). AIM: To describe and quantify the range of beliefs of patients about their symptoms before consultation, and to test the hypothesis that patients who attribute symptoms to stress or lifestyle would expect less benefit than others from physical medicine but more from lifestyle change and emotional support. METHOD: Interviews with 100 patients attending one of two general practices were used to form a questionnaire, which was completed by 406 patients attending one of three general practices in contrasting areas of Greater London. This measured the frequency of specific beliefs about the causes of their symptoms and about effective forms of help. Patients were seen before their consultation. RESULTS: The most common aetiological beliefs concerned stress and lifestyle. In general, the mechanisms underlying symptoms were thought to be disturbances in bodily functioning rather than pathological processes. The most valued form of help was explanation and discussion of symptoms. Nevertheless, about half the patients expected benefit from medication and only slightly fewer from hospital investigation or treatment. Patients who attributed symptoms to stress or lifestyle were no less likely to expect help from medication or specialist referral, but they were more likely to see benefit in explanation and counselling or lifestyle change. CONCLUSIONS: These findings suggest hypotheses for future research into the effects that patients' attributions of their symptoms to stress and lifestyle have on their health care demands, emphasize the importance of routinely assessing patients' beliefs on consulting the GP, and provide information that can help to direct this assessment in the individual case.     

Adrenergic stimulation of Na/K pump current in adult rat cardiac myocytes in short-term culture

This research examined self-perception and the perception of age groups by young and elderly adults from the perspective of social identity theory and social categorization theory. Respondents rated either themselves or unfamiliar stimulus persons from three age categories in adulthood: young, middle-aged, and elderly. As expected, an ingroup bias was found in the evaluation of elderly adults. Specifically, compared to ratings made by younger adults, older adults evaluated elderly persons more favorably. Moreover, as predicted, elderly adults' self-evaluations and those of young adults asked to imagine themselves as elderly were more positive than the ratings made by respondents who evaluated an unfamiliar older adult (e.g., elderly woman, elderly man). Both cognitive and motivational processes were discussed as contributing to the phenomenon of self-other discrepancy in beliefs about and attitudes toward older adults.     

Loss of Distinctive Features and a Broader Pattern of Priming in Alzheimer's Disease.

The results of 2 experiments support the contention that patients with Alzheimer's disease (AD) show a relative loss of the semantic features that distinguish concepts from one another and that the representations of pairs of concepts consequently share a larger proportion of their associated features in AD than in normal aging (A. Martin, 1992). In Experiment 1, AD patients listed fewer features for a set of concepts than did healthy older adults and were more deficient at listing features if the features were distinctive to particular concepts than if they were shared by multiple concepts. In Experiment 2, AD patients showed online priming at levels of relatedness at which healthy older adults did not. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Occupational settings facilitating wisdom-related knowledge: The sample case of clinical psychologists.

Wisdom can be defined as expert knowledge in the fundamental pragmatics of life. Examined here is whether clinical practice may facilitate access to and acquisition of such knowledge. Spontaneous think-aloud responses to 2 wisdom-related dilemmas from 12 young (aged 26–37 yrs) and 12 older (aged 65–82 yrs) female clinicians were compared with responses obtained from 17 young (aged 28–37 yrs) and 19 older (aged 64–75 yrs) other female professionals. Raters judged clinicians' responses as higher on 5 criteria of wisdom: factual knowledge, procedural knowledge, life-span contextualism, value relativism, and management of uncertainty. Contrary to most studies of cognitive aging, young and older adults did not differ. Rather, each age-cohort group received highest ratings when responding to a life dilemma matched to their own life phase. The application of a wisdom framework to assessing therapeutic treatment goals and therapist interventions as well as global changes in client's beliefs during therapy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cost and value analysis of two interventions with incontinent nursing home residents

OBJECTIVE: More than half of nursing home residents suffer from urinary incontinence. These residents typically have long stays and, because of comorbid cognitive and physical impairments, have little hope of living again in a noninstitutional environment The value of interventions to change functional status of this chronically institutionalized population is often questioned. This paper explores this value issue in the context of two incontinence management interventions that have been shown to improve functional status: (1) Functional Incidental Training (FIT), and (2) Prompted Voiding (PV). The relative value of the different interventions for the nursing home population was estimated using paired preferences. DESIGN: The cost of two interventions (FIT and PV) that target incontinent nursing home residents was related to the value of these interventions as perceived by consumers of nursing home services. Both interventions decrease incontinence frequency, and one intervention also improves mobility endurance. PARTICIPANTS: Ninety incontinent nursing home residents received the intervention; 37 older nondemented board and care residents and 31 family members of the nursing home residents provided estimates of the intervention's value. MEASUREMENT: The staff-time allocations involved in implementing both interventions were documented in more than 85 resident care episodes. These time data were converted to labor cost based on the cost of nursing aides who would actually implement the intervention. The value of each intervention was assessed by asking consumers to make choices between the intervention and its associated outcomes (such as increased dryness) and other nursing home services of known cost (e.g., moving to a private room). RESULTS: Both interventions had labor costs that were greater than "usual care" costs. The additional cost was estimated to be $4.31 per resident per day for PV and $6.42 per resident per day for FIT if these programs were implemented from 7 AM to 7 AM. Consumer preference data indicated that consumers preferred the FIT and PV outcomes to more expensive alternative services, calculated to cost $10.00 per day, often marketed to consumers, CONCLUSION: Consumers may prefer the FIT and PV interventions relative to the typical services often marketed to the nursing home consumer. The analysis completed in this paper suggests that both interventions have value for frail residents likely to live out their lives in a nursing home.     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia.

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Videothoracoscopy for diagnosis and treatment of respiratory tract diseases

Orthopaedic nurses often are well-educated in dealing with patients' physical and psychologic needs but lack education in caring for the spiritual needs of man. Nurses must realize they, themselves, have spiritual needs and must invest in clarifying their own values and beliefs as well as their patients. To perform a complete spiritual assessment, nurses need to become familiar with the concept of spirituality and what it means in the care of patients. Providing spiritual care is individualized and often complex. The nursing process enables the nurse to plan patient care. Providing spiritual care is a challenge orthopaedic nurses must recognize and assume responsibility for.     

Cervical cancer: a developmental perspective

Cervical cancer is a disease that affects women worldwide. In some countries it is the leading cause of death among women. Although the incidence of cervical cancer has decreased with the advent of the Papanicolaou smear, it remains a problem in adult women. Cervical dysplasia most often affects women in their 20s; carcinoma in situ affects women 30 to 39 years of age; and invasive carcinoma affects women older than 40 years. These age groups fall into the final three of Erickson's eight stages of ego development. However, taking a developmental approach in planning nursing interventions for women with cervical cancer has its drawbacks. Much of developmental theory research has been conducted on nonrepresentative samples, with women being underrepresented. A template for exploring patient problems from a life stage (developmental) perspective has been developed within the context of three different nursing diagnoses (sexual dysfunction, spiritual distress, and alteration in family processes).     

Restraint-free care: how does a nurse decide?

Decisions by nurses to avoid physical restraint use in older adults is a complex process that requires individualized, comprehensive assessment and creative problem-solving. Institutional and social policy increasingly support a standard of restraint elimination influencing care decisions with frail older adults. It has become clear that the decision to avoid or use physical restraint is influenced as well by nurses' attitude or beliefs about the efficacy of restraint. To further understand how decisions are made to avoid physical restraint, it is important to also explore the degree to which nurses possess knowledge, autonomy, and accountability in this decision-making process. Understanding how decisions are influenced will advance the development of restraint-free care interventions for older adults.     

Glycerol gangliotomy of the second dorsal cervical root in rats: an experimental study to evaluate a minimal invasive approach for the treatment of the chronic cervicogenic headache

The purpose of this integrated literature review (1980-1997) is to describe and summarize specific nursing interventions that have been devised to aid community-dwelling older adults with self-administration of prescribed medications. Interventions that combine patient education with written information or follow-up phone calls produce the most positive results. By using interventions supported by research, nurses will provide more effective and efficient care to older adults managing medications at home.     

Goal-directed memory: The role of cognitive control in older adults' emotional memory.

The present study revealed that older adults recruit cognitive control processes to strengthen positive and diminish negative information in memory. In Experiment 1, older adults engaged in more elaborative processing when retrieving positive memories than they did when retrieving negative memories. In Experiment 2, older adults who did well on tasks involving cognitive control were more likely than those doing poorly to favor positive pictures in memory. In Experiment 3, older adults who were distracted during memory encoding no longer favored positive over negative pictures in their later recall, revealing that older adults use cognitive resources to implement emotional goals during encoding. In contrast, younger adults showed no signs of using cognitive control to make their memories more positive, indicating that, for them, emotion regulation goals are not chronically activated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)