Journal of Applied Gerontology

Although decisions regarding the level of active intervention specified for a chronic care patient would ideally be made by autonomous individuals, these decisions may be influenced by a number of physical, psychological, and social factors. Some aspects of one's life experience would usually be considered reasonable criteria to form the basis for these decisions (e.g., severity of physical impairment), but the influence of other factors (e.g., social isolation) may be less appropriate. This study examines the characteristics associated with the specification of comfort measures only on the charts of patients in a Canadian chronic care hospital. Based on the results of multiple logistic regression models, patients with comfort measures only specified were significantly more likely to be older, recently admitted, incontinent, requiring special nutritional regimens, and were less likely to have been visited recently by key contact persons. The results raise the ethical question of what dimensions of quality of life should be considered as relevant determinants of advance treatment plans for the elderly.

This study examines case management service allocations to a clinical, nonrandom sample of persons with Alzheimer's disease (N = 822). Service allocation rules are estimated using logistic regression. The latent index of the likelihood of providing case management services is regressed on patients' enabling, need, and predisposing characteristics and organization affiliation. Significant predictors include patient unmanageability, memory problems, gender, previous case management use, no other service use, family problems, and center affiliation. Less functional patients may receive case management services when more functional patients may not, thus indicating a temporal dimension to case management allocation because people later in their disease trajectory are more likely to be directed toward case management services. This suggests that the efficacy of case management services may depend on the timing of the help in relation to the client's disease severity.

This study assessed life-style behaviors in a cross-sectional random sample of urban Black elderly with and without cardiovascular disease. Those with cardiac disease reported behavior modifications for salt mtake, fat intake, and smoking but more often reported being overweight and performing less exercise than did those elderly without cardiac disease. There remains substantial room for improvement in health maintenance and health promotion behaviors in this population, suggesting the need of intensive educational interventions. Additionally, Black elderly with cardiac disease had worse scores on a depression scale and a health locus-of-control question, suggesting the need for psychological assessment and intervention in this population.

This study examined the sources of depressive symptoms experienced by frail Black and Hispanic elderly persons experienced in terms of life strain/stresses and coping resources. Overall, results indicate that women in both groups express more depressive symptoms than do men; and Hispanic elders report more depressive symptoms than do Black elders. Common predictors for the two groups were being female, greater numbers of physical illnesses, poor perceived health, more perceived unmet needs, and less sense of control in life. Unique predictors for the Black elders were a higher level of impairment in instrumental activities of daily living, loss of a significant other, involuntary relocation, and fewer formal care providers. For Hispanic elders, the unique predictor of depressive symptoms was few informal helpers.

This study addresses discharge planners'perspectives on the adequacy of informal care expected to be provided to older adults immediately following discharge from the hospital to home care. Professional discharge planners anticipated that 25% of the caregiving units would be deficient in performing the tasks expected of them because patient care was too demanding, the caregiver had too many other duties, and the caregiver was too frail. Patients with more physical and cognitive disabilities were viewed to be at risk of inadequate informal care, as were poorer patients and patients living alone. Age of caregiver and size of helping network were not related to adequacy ratings. However, adult children, as opposed to spouses or other relatives, were expected to provide better care to confused older adults.

In this study, data from the 1987 Medicare and Medicaid Automated Certification Survey (MMACS) is analyzed to determine the extent to which nursing home staffing and resident care management practices, such as urethral catheterization and physical restraint use, vary across a sample of 10 standard metropolitan statistical areas (SMSAs). After controlling for influential differences in case mix related to facility characteristics and the functional severity of the nursing home population at risk, significant SMSA effects associated with staffing and practice outcome measures were found by weighted least squares regression. Potential sources of variation related to local market conditions and state nursing home policy are considered.

From data on 205 board and care homes that serve the poor elderly in seven states, structural and process variables were used to construct seven indexes covering dimensions of quality that contribute to the safety and quality of life of residents. Systematic differences were found in the indexes among homes of differing size and staffing patterns, as well as between proprietary and nonprofit facilities. For several dimensions of quality, state funding appears to result in improved quality. Overall, governmental regulatory policies did not significantly effect board and care home quality.

A substantial body of research has focused on the interstate migration of elderly households to the Sunbelt. Most of this research has concentrated on permanent moves, but seasonal migration of elderly households to Sunbelt locations has become an increasingly important social phenomenon. Although some have suggested that such temporary migration serves as a precursor ofpermanent locations, recent analyses have found that such seasonal migration constitutes an alternative elderly life-style. Using 1980 census data, this study empirically examines the similarities and differences in these two types of elderly migration flows to a Sunbelt state such as Arizona. The statistical results indicate that seasonal and permanent migration are correlated in different ways to the variables usually found to be determinants of elderly migration flows and suggest the two types of elderly migration are related but separate phenomena.

This article reviews the literature of life satisfaction in retirement, focusing on the retiree's personality. Personality effects are examined in a context including other determinants of life satisfaction: involuntary retirement, stress, health, finances, and activities, and issues of control and adaptivity are explored. Heuristic models specifying direct and indirect effects of personality traits on life satisfaction in retirement are proposed. The models are based on the findings reviewed and on a variety of theories, including five-factor personality theory, stress theory, and attachment theory. Directions for retirement counseling, planning, and research are suggested.

There is general agreement that to maintain quality of life for an aging individual, independence and self-direction need to be sustained. Relationships between levels of physical activity and changes in neuromuscular capacities among 30 women and 32 men (average age = 71 years) were examined, and four dimensions of functional neuromuscular capacities were evaluated: body agility, balance, upper-extremity function, and speed of movement planning/execution. Selected anthropometric and phystological characteristics were also measured. Physical activity habits were assessed by questionnaire and interview. Positive and potentially important relationships between physical activity levels and selected neuromuscular abilities were found. Activity habits were significantly related to general anthropometric and physiological characteristics. This study suggests that selected functional neuromuscular capacities are better maintained in healthy, physically active older adults, and the nature of capacities affected may be different for men and women.