Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care

BACKGROUND: Effective new strategies that complement primary care are needed to reduce disability risks and improve self-management of chronic illness in frail older people living in the community. OBJECTIVE: To evaluate the impact of a 1-year, senior center-based chronic illness self-management and disability prevention program on health, functioning, and healthcare utilization in frail older adults. DESIGN: A randomized controlled trial. SETTING: A large senior center located in a northeast Seattle suburb. The trial was conducted in collaboration with primary care providers of two large managed care organizations. PARTICIPANTS: A total of 201 chronically ill older adults seniors aged 70 and older recruited through medical practices. INTERVENTION: A targeted, multi-component disability prevention and disease self-management program led by a geriatric nurse practitioner (GNP). MEASUREMENTS: Self-reported Physical function, physical performance tests, health care utilization, and health behaviors. RESULTS: Each of 101 intervention participants met with the GNP from 1 to 8 times (median = 3) during the study year. The intervention group showed less decline in function, as measured by disability days and lower scores on the Health Assessment Questionnaire. Other measures of function, including the SF-36 and a battery of physical performance tests, did not change with the intervention. The number of hospitalized participants increased by 69% among the controls and decreased by 38% in the intervention group (P = .083). The total number of inpatient hospital days during the study year was significantly less in the intervention group compared with controls (total days = 33 vs 116, P = .049). The intervention led to significantly higher levels of physical activity and senior center participation and significant reductions in the use of psychoactive medications. CONCLUSIONS: This project provides evidence that a community-based collaboration with primary care providers can improve function and reduce inpatient utilization in chronically ill older adults. Linking organized medical care with complementary community-based interventions may be a promising direction for research and practice.     

The impact of childhood sexual abuse and family functioning on four dimensions of women's later parenting

OBJECTIVE: While child sexual abuse and its negative effects have been of increasing interest to researchers and practitioners, more empirical focus has been given to measuring mental health consequences rather than other areas of life functioning such as parenting. Furthermore, recent questions have been raised about whether documented negative effects of abuse stem from the abuse itself or the more general negative family environment which often accompanies it. The aim of the current study was to examine the impact of a history of child sexual abuse and more general family relationship quality on the parenting of a sample of low-income mothers. METHOD: The current study was a secondary analysis of archived data collected by Zuravin (1996) on 518 low-income mothers. Parenting was assessed using measures such as frequency of worry about child problems, views of self as a parent, and how child discipline problems were handled. RESULTS: Child sexual abuse was associated with more negative views of self as a parent and the greater use of physical punishment strategies even after accounting for differences in family-of-origin relationship quality. CONCLUSIONS: The findings indicate that sexual abuse may be a risk factor for more negative views of self as a parent beyond differences between abused and nonabused samples in more general assessments of family-of-origin quality. Implications for future research and intervention are discussed.     

Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.

Objective: The Helping Older People Experience Success (HOPES) program was developed to improve psychosocial functioning and reduce long-term medical burden in older people with severe mental illness (SMI) living in the community. HOPES includes 1 year of intensive skills training and health management, followed by a 1-year maintenance phase. Method: To evaluate effects of HOPES on social skills and psychosocial functioning, we conducted a randomized controlled trial with 183 older adults with SMI (58% schizophrenia spectrum) age 50 and older at 3 sites who were assigned to HOPES or treatment as usual with blinded follow-up assessments at baseline and 1- and 2-year follow-up. Results: Retention in the HOPES program was high (80%). Intent-to-treat analyses showed significant improvements for older adults assigned to HOPES compared to treatment as usual in performance measures of social skill, psychosocial and community functioning, negative symptoms, and self-efficacy, with effect sizes in the moderate (.37–.63) range. Exploratory analyses indicated that men improved more than women in the HOPES program, whereas benefit from the program was not related to psychiatric diagnosis, age, or baseline levels of cognitive functioning, psychosocial functioning, or social skill. Conclusions: The results support the feasibility of engaging older adults with SMI in the HOPES program, an intensive psychiatric rehabilitation intervention that incorporates skills training and medical case management, and improves psychosocial functioning in this population. Further research is needed to better understand gender differences in benefit from the HOPES program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological Adjustment of Children With Sickle Cell Disease: Family Functioning and Coping.

Objective: Using a risk and resistance model (J. L. Wallander, J. W. Varni, L. Babani, H. T. Banis, & K. T. Wilcox, 1989) to determine the effects of coping style and family functioning on children's adjustment to sickle cell disease (SCD). Participants: A sample of 73 caregivers and 23 children (ages birth to 18 years) admitted to a hematology acute care unit for pain or fever associated with SCD. Setting: A children's hospital on the East Coast of the United States. Outcome Measures: Disability stress, disease severity, child and parent coping, family functioning, and child adjustment were assessed with standard paper-and-pencil measures. Results: Results provide partial support for J. L. Wallander et al.'s (1989) risk-resistance model. Disability stress did not mediate the relation between disease severity and child adjustment, and severity of medical condition and medical stress did not predict adjustment. Child gender and child age predicted family functioning and child adjustment to SCD. Child or parent coping strategies did not moderate the association of disability stress and child adjustment. Conclusions: Individuals working with patients should be aware of other factors that may affect child outcome above disease severity; specifically, concerns of boys and girls with SCD and their caregivers should be assessed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-efficacy, optimism, health competence, and recovery from orthopedic surgery.

The authors tested whether self-efficacy for orthopedic rehabilitation tasks accounted for significant variance in rehabilitation outcome, over the variance accounted for by dispositional optimism, health competence, and health value. Whether health value moderated expectancy-outcome relationships also was examined. One hundred five older clients at 2 orthopedic rehabilitation facilities completed a battery of instruments; physical functioning also was assessed. After controlling for physical functioning at admission and for other variables, self-efficacy predicted significant variance in rehabilitation outcome. Health value did not moderate expectancy-outcome relationships. Results suggest that psychologists can improve patients' recovery from serious orthopedic problems by augmenting their self-efficacy beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Private health insurance coverage and disability among older Americans

OBJECTIVES: This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and older. METHODS: Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. RESULTS: Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. DISCUSSION: The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.     

Child functional independence and maternal psychosocial stress as risk factors threatening adaptation in mothers of physically or sensorially handicapped children.

This study investigated the contribution of child functional independence and maternal psychosocial stress to the adaptation of 119 mothers. Each mother had a child, aged 2–18 yrs, with a physical or sensory disability. Multiple dimensions of each construct were measured through self-report. Child functional independence did not uniquely explain variation in mothers' adaptation. However, maternal stress was uniquely associated with maternal mental health, but not physical health or social functioning, even when controlling for demographic status, disability type, and functional independence. Daily hassles and handicap-related psychosocial stress in particular put mothers at risk for reporting mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the pedunculopontine tegmental nucleus in relation to conditioned motor performance in the cat. II. Effects of reversible inactivation by intracerebral microinjections

OBJECTIVE: To describe lower-extremity functioning in community-dwelling older Mexican Americans and to examine its relationship with medical problems. DESIGN: Cross-sectional analyses of survey and performance-based data obtained in a population-based study employing area probability sampling. SETTING: Households within selected census tracts of five Southwestern states: Arizona, California, Colorado, New Mexico, and Texas. PARTICIPANTS: A total of 2873 Mexican Americans aged 65 years and older. MEASUREMENTS: A multidimensional questionnaire assessing demographic, sociocultural, and health variables. Standardized tests of lower-extremity physical functioning included measures of standing balance, repeated chair stands, walking, and an overall summary measure. RESULTS: Regression analyses revealed that being more than age 75 and female, having arthritis diabetes, visual impairments, or being obese or underweight were all significantly associated with performance on both individual and summary tests of lower-extremity functioning. In separate regression analyses, the total number of medical conditions was also associated with performance. CONCLUSIONS: The likelihood of predicting performance or inability to complete tests of lower-extremity functioning was greatest for those aged 80 and older, those with arthritis or diabetes, and those with three or more medical conditions. Because of the high prevalence of diabetes in Mexican Americans, documentation of the association of diabetes with performance-based tests of lower-extremity functioning may help guide early interventions targeted to prevent progression to more severe limitations or disability.     

A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome

Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abuse. The authors believe that digital hair strangulation should be included among the conditions that may be confused with child abuse. Digital hair strangulation (toe tourniquet syndrome) occurs primarily in infants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe tourniquet syndrome exists in the child abuse literature, it was hypothesized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting from intentional injury. A survey was conducted to test this hypothesis. Professionals from the fields of medicine, nursing, and child welfare were provided with a history and photographic findings of a child with a typical case of the toe tourniquet syndrome. Participants were surveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi 2 = 4.55, p = .03).(ABSTRACT TRUNCATED AT 250 WORDS)     

Child sexual and physical abuse and alcoholism: a review

OBJECTIVE: To examine possible relations between child sexual or physical abuse and adult alcoholism. METHOD: Studies reviewed included prospective studies, retrospective studies on the prevalence of child sexual or physical abuse in alcoholics and nonalcoholics, and retrospective studies in mental health clients and in population samples comparing the prevalence of alcohol use disorders in abused and nonabused subjects. RESULTS: Prospective studies do not indicate a significant association between child sexual or physical abuse and alcoholism. In contrast, studies among alcoholic women do suggest a relationship. Also, a significantly higher prevalence of alcohol problems in abused women than in nonabused women is found in population samples. The results of studies among mental health clients are inconclusive. In addition, several methodological limitations should be taken into consideration when evaluating results of the available studies. CONCLUSIONS: Current evidence is insufficient to draw conclusions about relationships between child sexual or physical abuse and alcoholism among men. Among females, however, there is a higher likelihood of alcohol problems if they were sexually or physically abused as children.     

Gambling, health and age: Data from the National Epidemiologic Survey on Alcohol and Related Conditions.

The health effects of recreational gambling are presently unclear, particularly across age groups. Theories of healthy aging suggest that social activities, including gambling, may be beneficial to the health of older adults. Using cross-sectional data from the National Epidemiologic Survey on Alcohol and Related Conditions (N=43,093), the authors examined associations between gambling (categorized as nongambling, recreational gambling, or problem/pathological gambling) and health and functioning measures stratified by age (40-64 years and ≥65). Problem/pathological gambling was uniformly associated with poorer health measures among both younger and older adults. Among younger respondents, poorer health measures were also found among recreational gamblers. However, among older respondents, recreational gambling was associated not only with some negative measures (e.g., obesity) but also with some positive measures (e.g., better physical and mental functioning). Longitudinal studies are needed to clarify the relationship between gambling and health in older adults in the context of healthy aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical fitness and psychological benefits of strength training in community dwelling older adults

Previous studies concerning psychological benefits of exercise among the elderly has focused predominantly on the effects of aerobic exercise. In the present study, psychological and behavioral adaptations in response to 12-weeks of strength training were examined in medically healthy but sedentary 42 older adults (mean age = 68 years). The purpose of this study was to evaluate the effects of high and low intensity resistance training intensity on a) muscular fitness, b) psychological affect, and c) neurocognitive functioning. Subjects were randomly assigned to high intensity/low volume (EXH: 2 sets of 8 to 10 repetitions for 75 to 85% of 1 RM), low intensity/high volume (EXL: 2 sets of 14 to 16 repetitions for 55 to 65% of 1 RM), or no exercise control programs. Prior to and following the 12-week program, subjects underwent comprehensive physiological and psychological evaluations. Physiological assessment included measurements of blood pressure, heart rate, arm and leg muscle strength, body composition, and oxygen consumption (VO2max). Psychological measures included evaluations of mood, anxiety, and physical self-efficacy as well as cognitive functioning. The results of this study indicated that both high and low intensity strength programs were associated with marked improvements in physiological fitness and psychological functioning. Specifically, subjects in the strength training programs increased overall muscle strength by 38.6% and reduced percent body fat by 3.0%. Favorable psychological changes in the strength-trained subjects included improvements in positive and negative mood, trait anxiety, and perceived confidence for physical capability. The treatment effects of neurocognitive functioning were not significant. In summary, this study demonstrated that participation in 12-weeks of high or low intensity strength training can improve overall physical fitness, mood, and physical self-efficacy in older adults while cognitive functioning remains constant.     

Age-associated predictors of medication adherence in HIV-positive adults: Health beliefs, self-efficacy, and neurocognitive status.

Objective: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. Design: Prospective, cross-sectional observational design. Main Outcome Measures: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). Results: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. Conclusion: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual and physical abuse in women with fibromyalgia: association with outpatient health care utilization and pain medication usage

OBJECTIVE: To evaluate the relationship between sexual and/or physical abuse and health care usage in patients with fibromyalgia (FM) and identify variables that may influence this relationship. METHODS: We assessed history of sexual/physical abuse, health care utilization, and medication usage, as well as related variables in 75 women with FM using standardized questionnaires, structured interviews, and laboratory pain perception tasks. RESULTS: Fifty-seven percent of FM patients reported a history of sexual/physical abuse. Compared to non-abused patients, abused patients reported significantly greater utilization of outpatient health care services for problems other than FM and greater use of medications for pain (P < or = 0.025). Consistent with our expectations, abused patients also were characterized by significantly greater pain, fatigue, functional disability, and stress, as well as by a tendency to label dolorimeter stimuli as painful regardless of their intensities (P < or = 0.05). Additional analyses suggested that the high frequency of sexual/physical abuse in our patients was associated primarily with seeking health care for chronic pain rather than the FM syndrome itself or genetic factors. CONCLUSION: There is an association in FM patients between sexual/physical abuse and increased use of outpatient health care services and medications for pain. This association may be influenced by clinical symptoms, functional disability, psychiatric disorders, stress, and abnormal pain perception. The relationships among these variables should be further tested in prospective, population-based studies.     

"Child health psychology": Erratum.

Reports an error in "Child health psychology" by Dennis Drotar, Suzanne Bennett Johnson, Ron Iannotti, Norman Krasnegor, Karen A. Matthews, Barbara G. Melamed, Sharon Millstein, Rolf A. Peterson, Debbie Popiel and Donald K. Routh (Health Psychology, 1989, Vol 8[6], 781-784). The name of the author, Sharon Millstein, should be Susan Millstein. It appears correctly in this record. (The following abstract of the original article appeared in record 2008-09118-001.) The term child health psychology refers to the field of research on the behavioral aspects of children's health and illness. At this time we need to continue the work of the child health psychology special interest group and to draw into the Division of Health Psychology a much larger number of developmental psychologists, who need to be informed about the relevance of their scientific training to child health issues. We call the Division's attention and that of granting agencies such as the National Institute of Child Health and Human Development to the following high-priority child health research issues: adherence to pediatric medical regimens; child health promotion; family influences on child and adolescent health and disease; and stress and coping in childhood illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child health psychology.

[Correction Notice: An erratum for this article was reported in Vol 9(6) of Health Psychology (see record 2008-09119-001). The name of the author, Sharon Millstein, should be Susan Millstein.] The term child health psychology refers to the field of research on the behavioral aspects of children's health and illness. At this time we need to continue the work of the child health psychology special interest group and to draw into the Division of Health Psychology a much larger number of developmental psychologists, who need to be informed about the relevance of their scientific training to child health issues. We call the Division's attention and that of granting agencies such as the National Institute of Child Health and Human Development to the following high-priority child health research issues: adherence to pediatric medical regimens; child health promotion; family influences on child and adolescent health and disease; and stress and coping in childhood illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical health problems, depressive mood, and cortisol secretion in old age: Buffer effects of health engagement control strategies.

Objective: This study examined the protective role played by control behaviors aimed at overcoming physical health problems (health engagement control strategies; HECS) in the associations between older adults' physical health problems, depressive mood, and diurnal cortisol secretion. It was expected that adaptive levels of HECS would buffer the adverse effects of physical health problems on depressive mood and diurnal cortisol secretion. Design and Measures: Physical health problems and HECS were measured in a cross-sectional sample of 215 community-dwelling older adults. In addition, participants' depressive mood and patterns of diurnal cortisol secretion were assessed across 3 days. Results: The findings demonstrate that physical health problems predicted high levels of depressive mood and diurnal cortisol secretion, but only among older adults who reported low levels of HECS (and not among older adults who reported high levels of HECS). Moreover, depressive mood completely mediated the buffering effect of HECS on the association between physical health problems and cortisol secretion. Conclusion: The results suggest that adaptive levels of HECS represent a psychological mechanism that can protect older adults from experiencing the adverse emotional and biological consequences of physical health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measuring abuse stress and negative cognitive appraisals in child sexual abuse: validity data on two new scales

The validity of two measures assessing degree of stress associated with sexual abuse was examined in a sample of 48 girls who had been sexually abused. The Checklist of Sexual Abuse and Related Stressors (C-SARS) assessed negative life events that were part of or were related to the abuse, and the Negative Appraisals of Sexual Abuse Scale (NASAS) assessed negative cognitive appraisals of threat, harm, or loss associated with the abuse. Total scores for victim reports of both stressful events and negative appraisals were positively and significantly related to two other measures of abuse severity: therapist ratings of abuse stress and the number of types of sexual abuse reported. Stressful event scores were also related to aggressive behavior problems, sexual concerns, and total symptom scores on the Child Behavior Checklist. Negative cognitive appraisal scores were related to victims' self-reports of depression, anxiety, and posttraumatic stress symptoms, and to parents reports of child depression and total symptoms. Regression analyses indicated that there were significant effects of negative appraisals on internalizing symptoms when controlling for the level of stressful events experienced. The results suggest that negative life events and negative appraisals associated with sexual abuse are valid constructs that help account for variability in mental health outcomes among child victims. The implications of these results and future research directions in examining variable outcomes among sexual abuse victims are discussed.     

Review of Child sexual abuse: Critical perspectives on prevention, intervention, and treatment.

Reviews the book, Child sexual abuse: Critical perspectives on prevention, intervention, and treatment edited by Christopher R. Bagley and Ray J. Thomlison (1991). This book is a compilation of a series of literature reviews originally commissioned by Health and Welfare Canada in 1987 and completed in 1988. The individual papers included in this edited version represent a cross section of Canadian academicians, clinicians, and case workers who are integrally involved in the policies and practices regarding child sexual abuse in Canada. The work provides a comprehensive perspective on prevention at the primary, secondary, and tertiary levels. The list of authors is impressive in terms of their expertise and experience. At a time when numerous books on child sexual abuse are appearing on the market, it is nice to see a book that has some unusual aspects. Aside from its distinctly Canadian perspective, the book addresses several important, yet frequently ignored, topics. The book provides an up-to-date review of several core issues: conceptualization of the problem, prevention strategies, impact of sexual abuse, investigative interviewing, treatment outcome studies, and treatment issues for child molesters. The more unique topics include a review of the strategies used to evaluate prevention programs, prevalence rates among a number of special populations, the role of medical practitioners in preventing and intervening in child sexual abuse, and sexual abuse and exploitation among disabled individuals. Overall, I can recommend this book for clinicians and researchers in Canada and elsewhere who are interested in child sexual abuse. This compilation of literature reviews highlights the leading role that Canadian social service agencies have taken in developing programs for sexually abused children and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older women: social cognitive theory correlates of health behavior

Most research about health promoting behaviors has focused on pre-old adults and men, despite clear evidence that the leading cause of death among postmenopausal women is related to health behaviors. This study applied social cognitive theory constructs to exercise, dietary, and stress management health behavior. The purpose of this study was to examine the ability of self-efficacy expectation and outcome expectancy to predict health behavior among older women. Community-dwelling women aged 65 to 92 years were interviewed with previously developed instruments and instruments designed specifically for this study (N = 225). Self-efficacy was the strongest predictor of each of the health behaviors (beta weights: dietary behavior .50; exercise, .39; stress management, .32). Outcome expectancy was not a significant predictor of exercise or dietary behavior. Outcome expectancy was a significant predictor of stress management behavior. The findings of this study, combined with the importance of health promotion behaviors among older women, justify the need for continued research about self-efficacy and health behavior among this vulnerable population.