Etiology of dependence in older nursing home residents during morning care: The role of staff behavior.

In an observational-operant design study with 17 staff members and 36 elderly nursing home residents, sequential observations of resident–staff interactions were recorded daily during morning care over a 23-day period. Results suggest that independent behavior in self-maintenance care is not maintained by staff behavior but perhaps by intrinsic reinforcers or reinforcing agents other than staff, whereas dependent behavior is directly maintained by staff reinforcement. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of tail autotomy on agonistic behaviour in a territorial salamander

Assessment of potentially asymmetrical characters (such as fighting ability and resident advantage) is often important in determining the outcome of agonistic interactions. Loss of body parts, a predator defence mechanism used by many animals, may lead to a reduction in fighting ability and may be easily assessed by competitors. We investigated the influence of tail loss on the expression of agonistic behaviour in the territorial red-backed salamander, Plethodon cinereus. Residents and intruders were matched for body size, and pairs were tested in all combinations of tailed or tailless residents with tailed or tailless intruders. Neither residents nor intruders altered their behaviour based on their own tail condition, but they did alter their behaviour based on the tail condition of their opponents. Intruders showed more aggression or less submission towards tailless residents than towards tailed residents. When contests were between residents and intruders of the same tail condition (both tailed or tailless), intruders were more aggressive towards residents when both were tailless than when both were tailed, indicating that tail loss does not directly hamper aggressive displays. In contests where the asymmetry between residents and intruders was small (based on tail condition and residency status), intruders showed more aggression and less submission than in contests where the asymmetry was large. Residents did not differ in their behaviour for most comparisons. Thus, for intruders, the tail condition of residents is an important determinant of agonistic behaviour displayed in territorial contests. For residents, factors other than tail condition (such as resource value) may be more likely to influence their behaviour. Copyright 1998 The Association for the Study of Animal Behaviour. Copyright 1998 The Association for the Study of Animal Behaviour.     

Aging increases CD8 T cell apoptosis induced by hyperstimulation but decreases apoptosis induced by agonist withdrawal in mice

OBJECTIVE: To describe the innovative programs of three health maintenance organizations (HMOs) for providing primary care for long-stay nursing home (NH) residents and to compare this care with that of fee-for-service (FFS) residents at the same NHs. DESIGN: Cross-sectional interviews and case-studies, including retrospective chart reviews for 1 year. SETTING: The programs were based in 20 community-based nursing homes in three regions (East, West, Far West). PARTICIPANTS: Administrative and professional staff of HMOs in three regions and 20 NHs; 215 HMO and 187 FFS residents at these homes were studied. MAIN OUTCOME MEASURES: Emergency department (ED) and hospital utilization. RESULTS: All HMO programs utilized nurse practitioner/physician's assistants (NP/PA), but the structural configuration of physicians' (MD) practices differed substantially. At nursing homes within each region, all three HMO programs provided more total (MD plus NP/PA) visits per month than did FFS care (2.0 vs 1.1, 1.3 vs .6, and 1.4 vs .8 visits per month; all P < .05). The HMO that provided the most total visits had a significantly lower percentage of residents transferred to EDs (6% vs 16%, P = .048), fewer ED visits per resident (0.1 vs .4 per year, P = .027), and fewer hospitalizations per resident (0.1 vs .5 per year, P = .038) than FFS residents; these differences remained significant in multivariate analyses. However, the other two programs did not achieve the same benefits on healthcare utilization. CONCLUSIONS: HMO programs for NH residents provide more primary care and have the potential to reduce ED and hospital use compared with FFS care. However, not all programs have been associated with decreased ED and hospital utilization, perhaps because of differences in structure or implementation problems.     

Stigma among the stigmatized: Resident mobility, communication ability, and physical appearance as predictors of staff–resident interaction.

Two studies investigated the relation between 3 types of resident stigma and staff–resident interaction in a training center for the mentally retarded. Ss were 50 residents (median age 9 yrs) classified as moderately to severely retarded. In Study 1, using the results of questionnaires administered to the staff, it was found that resident communication ability and physical appearance were significant predictors of approval interactions, and resident mobility was the only significant predictor of disapproval interactions. In Study 2, using systematic observation of staff–resident interactions, it was found that resident mobility was the only predictor of the resident-initiated neutral and disapproval interactions, whereas resident mobility, communication ability, and physical appearance were significant predictors of staff-initiated approval and disapproval interactions. Possible causal paths underlying the obtained relations between resident stigma and staff-resident interaction are discussed. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of covert modeling and model reinforcement on assertive behavior.

Investigated the effect of covert modeling in developing assertive behavior in 45 17-52 yr olds. Nonassertive Ss received covert modeling (imagined scenes in which a model performed assertively), covert modeling plus reinforcement (imagined scenes in which a model performed assertively and favorable consequences followed model performance), no modeling (imagined scenes with neither an assertive model nor favorable consequences), or delayed treatment (no-treatment controls who subsequently received either covert modeling or modeling plus reinforcement). In 4 treatment sessions, both model and model-reinforcement conditions improved significantly on self-report inventories (Conflict Resolution Inventory, Action Situation Inventory, Wolpe-Lazarus Assertive Training Scale, and Wolpe's Willoughby Scale) and a role-playing test of assertiveness. The modeling-reinforcement group tended to show greater assertiveness at posttreatment assessment and follow-up. The effects of covert modeling were maintained up to a 3-mo follow-up assessment. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The socioecological model of procommunity action: The benefits of residential stability.

The authors conducted 3 studies to test a socioecological model of procommunity action. Study 1 showed that residents of stable communities purchased a "critical habitat" license plate to support preservation of the environment in their home state more often than did residents of mobile communities. Study 2 demonstrated that home game baseball attendance was less dependent on the team's record in stable cities than in mobile cities. Study 3, an experiment, showed that residential stability had a causal impact on procommunity behavior. Moreover, the effect of stability was partially mediated by identification with the "community." Together, these studies indicate that residential stability can lead to stronger identification with one's community, which, in turn, leads to more procommunity behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of pediatric resident and faculty learning styles: implications for medical education

This article compares resident and faculty learning strategies and styles and considers implications for teaching. The Kolb Learning Style Inventory was administered to 17 pediatric residents and 22 faculty in a pediatric department of an urban university-affiliated public medical center in 1991. Four scales--concrete experience (CE), reflective observation (RO), abstract conceptualization (AC), and active experimentation (AE)--are derived from self-ranking groups of words. Combining strategies leads to one of four styles: accommodator, diverger, converger, or assimilator. Analysis of variance and chi-square statistics were used to analyze strongest strategies and styles and to compare groups. It was found that resident and faculty preferred learning strategies and styles were significantly different. Resident strategies were spread primarily between concrete experience (40.5%) and active experimentation (40.5%), whereas faculty clearly preferred abstract conceptualization (77%). Most residents had either an accommodator or diverger learning style (81%), whereas most faculty were either assimilators or convergers (73%). This knowledge of learning strategy preferences and styles may have implications for design and delivery of instruction to residents.     

Give a person power and he or she will show interpersonal sensitivity: The phenomenon and its why and when.

The goal of the present research was to investigate whether high or low power leads to more interpersonal sensitivity and what potentially mediates and moderates this effect. In Study 1, 76 participants in either a high- or low-power position interacted; in Study 2, 134 participants were implicitly primed with either high- or low-power or neutral words; and in Study 3, 96 participants were asked to remember a situation in which they felt high or low power (plus a control condition). In Study 4, 157 participants were told to identify with either an egoistic, empathic, or neutral leadership style. In all studies, interpersonal sensitivity, defined as correctly assessing other people, was then measured using different instruments in each study. Consistently, high power resulted in more interpersonal sensitivity than low power. Feeling respected and proud was partially responsible for this effect. Empathic power as a personality trait was related to more interpersonal sensitivity, and high-power individuals who adopted an empathic instead of an egoistic leadership style were more interpersonally sensitive. (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.     

Further observational data on the behavioral and social world of institutions for the aged.

This study is an extension of previous observational work on the social ecology of dependence and independence in the institutionalized elderly. Observations of everyday, naturally occurring interactions between elderly residents of two different long-term institutions and their social partners were extended such that, aside from the identification of type of behavior, the dyadic form and continuity of each behavior was specified. The following were among the major results: (a) Previously found interaction patterns between elderly residents and their social partners, replicated in both a nursing home and a home for the chronically ill, supported the notion of discrepant social ecologies for dependent versus independent behaviors of residents; (b) specification of each behavioral act as to its dyadic form underscored the fact that the interactions were controlled largely by social partners and not by the elderly residents; (c) coding continuity or discontinuity of behavior suggested that independent behaviors were maintained by chaining; and (d) elderly residents in the home for the chronically ill evinced, as expected, more dependence-related behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of the efficacy of the physician order form for life-sustaining treatment

OBJECTIVES: The Physician Orders for Life-Sustaining Treatment (POLST), a comprehensive, one-page order form, was developed to convey preferences for life-sustaining treatments during transfer from one care site to another. This study examined the extent to which the POLST form ensured that nursing home residents' wishes were honored for Do Not Resuscitate (DNR) and requests for transfer only if comfort measures fail. DESIGN: The study used chart record data to follow prospectively a sample of nursing home residents with the POLST. SETTING: Eight geographically diverse, long-term, adult-care facilities in Oregon in which the POLST was in use. PARTICIPANTS: Nursing home residents (n = 180), who had a POLST recording DNR designation and who indicated a desire for transfer only if comfort measures failed, were followed for 1 year. MEASUREMENTS: For all subjects: treatment and disposition after significant health status changes; orders for narcotics and for provision or limitation of aggressive interventions. For hospitalized subjects: diagnosis, medical interventions, and DNR orders. For those who died: cause and location of death, life-sustaining treatments attempted, and comfort measures provided. RESULTS: No study subject received CPR, ICU care, or ventilator support, and only 2% were hospitalized to extend life. Of the 38 subjects who died during the study year, 63% had an order for narcotics, and only two (5%) died in an acute care hospital. A total of 24 subjects (13%) were hospitalized during the year. Hospitalized subjects' mean length of stay was 4.9 days, and the mean rate of hospitalizations for all subjects was 174 per 1000 resident years. In 85% of all hospitalizations, patients were transferred because the nursing home could not control suffering. In 15% of hospitalizations (n = 4), the transfer was to extend life, overriding POLST orders. CONCLUSIONS: POLST orders regarding CPR in nursing home residents in this study were universally respected. Study subjects received remarkably high levels of comfort care and low rates of transfer for aggressive life-extending treatments.     

Gender, language, and influence.

Mixed- and same-sex dyads were observed to examine effects of gender composition on language and of language on gender differences in influence. Ss discussed a topic on which they disagreed. Women were more tentative than men, but only in mixed sex dyads. Women who spoke tentatively were more influential with men and less influential with women. Language had no effect on how influential men were. In a 2nd study, 120 Ss listened to an audiotape of identical persuasive messages presented either by a man or a woman, half of whom spoke tentatively. Female speakers who spoke tentatively were more influential with male Ss and less influential with female Ss than those who spoke assertively. Male speakers were equally influential in each condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nurse staffing and quality of care in nursing facilities

A study of 198 nursing facilities in Maryland tested the hypotheses that: 1) the presence of more RNs improves the quality of nursing care; and 2) increased numbers of all types of nursing staff improve the quality of nursing care, based on a multidimensional measure of quality of nursing care. Findings indicate that the ratio of RNs to residents is directly related to a measure of resident rights deficiencies. In addition, the ratio of total nursing staff to residents is directly related to a lower overall deficiency index and a higher quality of care score.     

The impact on general practitioners of the changing balance of care for elderly people living in institutions

OBJECTIVES: To describe utilisation of general practitioners by elderly people resident in communal establishments; to examine variations in general practitioner utilisation and estimate the likely impact of the "downsizing" of long stay provision in NHS hospitals. DESIGN: Secondary analyses of the survey of disability among adults in communal establishments conducted by the Office of Population Censuses and Surveys in 1986, and projection to present day. SETTING: Nationally representative sample of communal establishments in Great Britain. SUBJECTS: Disabled residents aged 65 or more without mental handicap. RESULTS: Residents with higher levels of disability, disorders of the digestive system, resident in smaller local authority homes or larger voluntary residential homes were more likely to consult a general practitioner. For those who consulted, higher levels of disability and morbidity and residence in a private nursing home or a larger private residential home were all associated with greater general practitioner utilisation. Overall, when residents' characteristics and size of home was controlled for, residents in nursing homes had greater predicted utilisation than those in residential care homes. People who would previously have been cared for in NHS hospitals and are now cared for in nursing homes have high predicted utilisation due to their greater morbidity and disability. CONCLUSION: The "downsizing" of NHS provision for elderly people has increased demand on general practitioners by 160 whole time equivalents per year in Britain.     

Mapping replication origins, pause sites, and termini by neutral/alkaline two-dimensional gel electrophoresis

The authors assessed the effect of a control-relevant psychosocial intervention in 31 nursing home residents with either major depressive episode or minor depression. An initial group of 22 residents were randomized to either active treatment or waiting list. Four of 11 residents randomized to active treatment were deemed Responders, compared with 0 of 11 on the waiting list (P < 0.05). Of the total of 31 residents who participated in the intervention, 14 (45%) were deemed Responders during the intervention period. For these Responders, the Hamilton Rating Scale for Depression (Ham-D) and Geriatric Depression Scale scores improved significantly during the intervention. The improvement in the Ham-D was not sustained 2 months after intervention was terminated. These findings suggest that a psychosocial intervention enhancing socialization according to each resident's choice had a positive therapeutic impact on almost half of the nursing home residents with major or minor depression. However this effect could not be sustained by the residents without the support of the structured program.     

Narcissism, sexual refusal, and aggression: Testing a narcissistic reactance model of sexual coercion.

Laboratory analog studies investigated the theory that narcissism and reactance contribute to causing rape. In Study 1, narcissism correlated positively with rape-supportive beliefs and negatively with empathy for rape victims. In Study 2, narcissists reported more enjoyment than other men of film depictions that presented consensual, affectionate activity followed by rape (but not in response to either affection or rape alone). In Study 3, narcissists were more punitive than other men toward a female confederate who refused to read a sexually arousing passage aloud to them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Triterpene saponins from Abrus cantoniensis (Leguminosae). II. Characterization of six new saponins having a branched-chain sugar

A two-part study was conducted to determine the sources of variation in nasalance scores derived from the Nasometer. In Study #1, a function generator was used as a signal source to calibrate and input sine and square waves directly into the Nasometer. Ten stimuli ranging from 105 to 330 Hz in 25 Hz increments were evaluated. In Study #2, the same signal source and an amplified loudspeaker were used to calibrate and present square waves to the nasometer via five different sets of microphones. The sound pressure level of all stimuli was maintained at 88 dB. Each microphone set was calibrated using the 105 Hz signals. Results from Study #1 indicated consistent nasalance scores across all frequencies (i.e., all scores were within 2% of calibration). Results from Study #2 demonstrated deviations greater than 2% from calibration as a function of frequency for all five sets of microphones. The smallest deviation was 5%, whereas the largest deviation was 14%. We suggest that the variation in nasalance as a function of stimulus frequency may be due to a mismatch in the sensitivity of microphones (i.e., different frequency response characteristics). It is further suggested (a) that individual investigators determine the response characteristics of their microphones and (b) that relatively small variations in nasalance scores (i.e., 5-14%) either within or across speakers be interpreted with caution.     

Strategies to promote the use of advance directives in a residency outpatient practice

OBJECTIVE: To evaluate patient education and resident education strategies to promote advance directives in the outpatient setting, and to assess barriers to implementation. DESIGN: Controlled clinical trial. SETTING: The internal medicine residents' practice of an urban, university medical center. PATIENTS/PARTICIPANTS: Medical residents and 250 patients seen at least twice in the 3 months prior to the study. INTERVENTIONS: We randomized practice days: one to patient education, one to resident education, and three controls. Resident education consisted of a lecture, a videotape of a model advance directives discussion, and videotaping of an actual discussion by each resident, followed by individual review. Patient education consisted of distributing pamphlets in the waiting room and offering all patients an opportunity to discuss advance directives. MEASUREMENTS AND MAIN RESULTS: We interviewed 187 of these patients (response rate 75%) and surveyed 62 residents (response rate 70%). After 18 months, there were no significant differences in the number of advance directives in charts among the three groups. Documented advance directives discussions with patients in the resident education group increased from 3% to 17% (p < .001), more than those in the patient education (5%) or control group (10%, p = .04). Residents in the resident education group were more likely to report discussing advance directives than those in the patient education or control groups (p = .05). Lack of time (95%) and lack of continuity (76%) were the most frequently cited barriers. In multivariate logistic regression, nonwhite race and non-U.S. birth were negatively associated with patient interest in advance directives. Patient race and birthplace were not associated with actual discussions of advance directives. CONCLUSIONS: Even with intensive efforts to educate outpatients and residents about advance directives, important barriers remain, raising questions about how best to promote advance directives among outpatients.