Responsibility and the elderly: Applications to psychotherapy.

Based on the analysis of P. Brickman et al (see record 1982-30315-001), 4 models of psychotherapy are proposed. It is argued that a key element in clinical interventions with the elderly is the extent to which the intervention affects the elderly clients' perceived responsibility for the cause of and solution to their presenting complaints. The dangers of a medical model psychotherapeutic orientation that strips clients' feelings of control are discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models of helping and coping, responsibility attributions, and well-being in community elderly and their helpers.

The analysis of P. Brickman et al (see record 1982-30315-001), which separates attribution of a problem's cause and solution, was tested in 4 studies. Young and elderly adults' (n?=?210) well-being was related only to taking responsibility for solutions. The elderly compared with the young adults assumed less responsibility for problem cause and solution. They also preferred helping and coping models that assume low self-responsibility for solutions (e.g., medical model). This result was replicated with Meals on Wheels clients (n?=?51). An intragenerational helping pattern was found in Study 3. Lay helpers (n?=?63) helped mainly same-age recipients. Elderly and middle-aged helpers compared with young adults preferred using a medical model. Overall, a cohort bias in model preference was suggested. In Study 4, problem type and recipient age moderated attributions and model choice of young and middle-aged Ss (n?=?92). Relevance to the control literature and ethical and clinical implications of a medical-model bias are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults, reimbursement, and referrals: Implications for psychologists after Medicare reimbursement changes and before health care reform.

Psychologists' current provision of mental health services to older adults was investigated by a mail survey. One half of licensed psychologists in a metropolitan region in the Northeast were randomly sampled, with a return rate of 61% (n?=?37). 75% saw older adult clients (aged 65 and over), and 72% accepted Medicare payments. Older adults composed 8% of their practice. Solopracticing physicians were the chief referral link to and from the medical community. Barriers to providing mental health services included client's lack of social support network and low levels of reimbursement. The challenges of continuing psychologists' recent advances in serving the mental health needs of older adults in an era of health care reform and managed care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Models of helping and coping.

Draws a distinction between attribution of responsibility for a problem and attribution of responsibility for a solution. Four general helping models are derived. In the "moral" model, actors are held responsible for both problems and solutions and are believed to need only proper motivation. In the compensatory model, people are responsible only for solutions and are believed to need power. Individuals in the medical model are responsible for neither problems nor solutions and are thought to need treatment. In the enlightenment model, actors are responsible for problems but are unable or unwilling to provide solutions; they need discipline. It is maintained that each set of assumptions has characteristic consequences for the competence, status, and well-being of actors and that the wrong choice of model in a situation will undermine effective helping and coping. Competing models of responsibility in education, psychotherapy, law, and welfare are described, and research on attribution of responsibility is recommended as a way of addressing problems of both theoretical and social significance. (128 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-Monitoring and Self-Assessing Atomic Clocks

From digital communications to satellite navigation, remotely synchronized clocks play a role of primary importance. The failure of these clocks will lead to not only service interruptions, but also, in some cases involving satellite navigation, more dire consequences with potential loss of life. Consequently, ensuring the integrity of remote clocks is now an issue of considerable import. In this paper, we demonstrate that an atomic clock can autonomously assess its own frequency stability and integrity by comparing the phase of its output signal to a delayed version of itself in what is essentially an interferometric technique. Using a high-quality crystal oscillator, we demonstrate that fractional frequency jumps of $10^{-11}$ are easily observed and that a cesium atomic clock's short-term Allan deviation can be measured without reference to another standard in a fully autonomous manner.      

Gorham's disease: a literature review and case reports

Gorham's disease (disappearing bone disease, massive osteolysis, idiopathic osteolysis, essential osteolysis, progressive atrophy of bone, spontaneous absorption of bone, phantom bone, hemangiomatosis/lymphangiomatosis of bone, progressive osteolysis) is an extremely rare occurrence. There are fewer than 150 reported cases in the literature. This disorder can be characterized by spontaneous or posttraumatic progressive resorption of bone. The etiology is still very speculative, the prognosis unpredictable, and any effective therapy still unknown. This paper presents a review of the literature and two case reports of suspected Gorham's disease of the bones of the foot.     

Cross-Sectional Age Differences in Personality Among Medicare Patients Aged 65 to 100.

1,084 older Medicare recipients were orally administered the NEO Five-Factor Inventory (NEO-FFI; P. T. Costa & R. R. McCrae, 1992). Participants were assigned to groups based on gender and age (65-79 or 80-100). An analysis of covariance showed that women had significantly higher Neuroticism, Openness, and Agreeableness scores; that older participants were significantly higher in Agreeableness; and that age differences in Agreeableness were significantly greater in men than in women. With the exception of Agreeableness, this study provides no evidence for age differences among those in the last decades of life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resident training in nursing home care: survey of successful educational strategies

OBJECTIVE: To identify educational strategies for resident training in nursing home care deemed successful by a large number of programs. DESIGN: A mail survey with three follow-up mailings. PARTICIPANTS: Directors of accredited internal medicine and family practice residency programs. MEASUREMENTS: Open- and closed-ended questionnaire eliciting curricular content, instructional strategies, and evaluation techniques from programs offering a nursing home experience. Identification of barriers to implementation of a nursing home curriculum and recommendations for success were requested. MAIN RESULTS: Of the 814 surveys mailed, 537 were returned for a response rate of 66%. Nursing home experiences were required in 86% of family practice residency programs but in only 25% of internal medicine programs. Most geriatric medicine curricular content areas were taught in the nursing home; however, relatively little emphasis was given to rehabilitation, organization, and financing of health care, and coordination of care between acute and chronic settings. Direct patient care, bedside rounds, and lectures were the most common instructional strategies reported. Evaluation approaches included faculty observations, resident attendance, and chart reviews with written and skill-based examinations infrequent. Availability of faculty and conflict with other rotations were identified as the principal barriers to implementation of nursing home rotations. An organized nursing home curriculum supervised by enthusiastic faculty using a longitudinal rotation format with resident involvement in an interdisciplinary team was recommended. CONCLUSIONS: Educational strategies exist for successful implementation of a residency nursing home curriculum. Greater priority must be given to training residents in nursing home care and developing nursing home faculty to substantially increase the number and quality of physicians who practice in this setting.     

Assessment of delivery of preventive health services

We carried out a longitudinal survey to evaluate the users' attitudes to the introduction of telemedicine into the dialysis units of a renal ward in South Australia. The first questionnaire was distributed to all members of staff involved with the introduction of the system. There were 44 responses (80%). Staff were fairly positive about the telemedicine system, and felt that it was easy to use and reliable. They also clearly felt that the confidentiality and privacy offered by the system in an open ward were unsatisfactory. A second questionnaire was distributed to all staff about six months later and there were 40 responses (66%). Of these, 22 could be matched with the responses from the first survey (a response rate of 50% from the first sample). There were no significant differences in the staff members' feelings between the two surveys, except in two cases: there were significant changes in staff opinion about the degree of confidentiality (P < 0.05) and privacy (P < 0.01) offered by the system, with attitudes becoming more positive in each case. The results indicate the need for dialogue with users, in order to address their concerns regarding the system and practical difficulties. This study highlights the importance of planning, effort, cooperation and an appropriate culture within a renal unit in order for telemedicine to be accepted.