bluuebunny/crossref_metadata_2025 huggingface dataset:
Language and Words
Authors: Chang Hui-Ching
Published: June 2009

Despite attention to effects of Confucianism on Asian communication, views of Confucian philosophy are hampered by predilection to look at its social implications rather than Confucius's many observations about words and speaking. Comprehensive examination of Confucian Analects yields four principles: (a) words define and reflect moral development, (b) beautiful words lacking substance are blameworthy, (c) actions are more important than words, and (d) appropriate speaking relies on rules of propriety. Five weaknesses are found in current views linking Confucianism and Asian communication: (a) collectivist metaphors are inappropriately foregrounded, (b) social position is assumed incompatible with individual will, (c) moral character is excluded from discussion of language in Confucian societies, (d) personal freedom is thought the essence of ability to reason and formulate messages, and (e) Confucianism is used retroactively to explain observed communication behaviors in Confucian societies. Research suggestions from several disciplines and methodologies are offered.
Self-Disclosure Responses to Stigmatizing Disclosures
Authors: Le Poire Beth A. , Ota Hiroshi , Hajek Christopher
Published: June 2009

Knowledge gained through symbolic and instrumental interpretations of attitudes toward persons with AIDS suggests that positive attitudes toward gays or persons with AIDS (symbolic factors) and less knowledge and greater fear ofAIDS contraction (instrumental factors) will lead to more convergence of self-disclosure outcomes in interactions with gays or persons withAIDS. The initial prediction, and the findings of the current investigation, are consistent with a communication accommodation theory prediction of greater convergence being related to greater liking or tolerance of an interaction partner's group membership. Finally, whereas the extant literature regarding whether more convergence should be evidenced in nonstigmatized, gay, or potentially HIV+ interactions was inconsistent, the current investigation found selfdisclosure convergence on privateness, emotional intensity, and social desirability across all interactions regardless of stigmatization condition. Convergence on uniqueness and vulnerability was most evidenced in the nonstigmatized condition.
Politeness Judgments in Personal Relationships
Authors: Dillard James Price , Wilson Steven R. , Tusing Kyle James , Kinney Terry A.
Published: June 2009

Brown and Levinson's politeness theory specifies five strategies for achieving politeness. Although the strategies are presented as ordered and mutually exclusive, there is reason to believe that they are neither The authors offer an alternative means of classifying requests that is grounded in the phenomenology of the social actor and depends on three message features: explicitness, dominance, and argument. Separate samples of judges viewed video clips of one college student attempting to influence another and provided judgments ofpoliteness (n = 100), explicitness and overall dominance (n = 435), linguistic dominance (n = 80), or argument (n = 60). A regression analysis predicting politeness was conducted using message as the unit of analysis. The results showed a strong, negative relationship between politeness and dominance and weaker, positive associations with explicitness and argument.
Strategies of Verbal Dueling
Authors: Schwebel David C.
Published: June 2009

Verbal dueling is the artful exchange of rapid nonserious insults between two or more participants. Using ethnographic data collection techniques, conversations that transpired in the dining hall of a college dormitory were recorded to identify verbal dueling among students. Examples of verbal duel openings and closings are presented to illustrate how the openings and closings signal a change in footing. Examples of duel segments are provided, interspersed with an analysis and discussion of the strategies duelers and audience members use to influence other conversants, dictate the flow of the conversation, and win the verbal duel.
You, We, and I
Authors: Vogelzang Leo N. , Euwema Martin C. , Nauta Aukje
Published: June 2009

Forty-eight individuals were asked to participate in dyadic role plays that were recorded on videotape and transcribed. The tapes were scored on effectiveness of conflict management, and the transcriptions were scored on integrative and distributive conflict behavior, perceived friendliness, and the use of words of communality ("we," "us"). In line with the hypotheses, correlation and regression analyses demonstrated positive relations with the use of words of communality and integrative conflict behavior and with effectiveness of conflict management. On the basis of only 7% of all words used in the conversations, variance in conflict behaviors and friendliness could be assessed for about 50%.
Conflict and Consonance in Media Opinion
Authors: Eilders Christiane
Published: June 2009

This article examines the degree of conflict and consonance in the editorials of five German quality newspapers between 1994 and 1998. The degree of correspondence in the media system is discussed against the background of Germany's pluralistic media structure on the one hand and concepts of public opinion on the other hand. Rather than investigating the differential issue selection among the newspapers, the analysis compares the opinions on issues correspondingly addressed by several newspapers. It focuses on the newspapers' positions regarding fundamental political conflicts and identifies spheres of consensus and conflict in the media system. Although the newspapers represent distinctly different political orientations, each of them also showed issue-specific deviations from its general preference for left or right policy alternatives. Results indicate considerable degrees of consonance regarding external relations issues and education policy. Conflict evolved around law and order and migration issues.
The Internet and Knowledge Gaps
Authors: Bonfadelli Heinz
Published: June 2009

Although the knowledge gap hypothesis is often mentioned in connection with the social consequences of the Information Society, there is little discussion of its theoretical background or specific empirical evidence. Therefore, this article explores the theoretical potential of the knowledge gap perspective for Internet research and presents data based on two recent Internet surveys, which demonstrate a double digital divide. Access to the Internet in Switzerland is still dominated by well-educated, affluent, young males and between 1997 and 2000 the gap between those who do and those who do not have access widened not narrowed. Furthermore, there are gaps in the use of the Internet too. More educated people use the Internet more actively and their use is more information oriented, whereas the less educated seem to be interested particularly in the entertainment functions of the Internet.
Research Note: Mass Communication as Participation
Authors: Mühlenfeld Hans-Ullrich
Published: June 2009

Web-radio in Germany is becoming rather popular and gives numerous people the opportunity of spreading their own radio programmes to millions of potential listeners. However, web-radio in Germany faces several hurdles, political and economic ones. This article gives an overview of the problems and attempts to depict the position of today's German web-radios within the general broadcasting system. It also looks at other forms of alternative broadcasting, such as the open channel, and compares their respective historical backgrounds.
Research Note: Online Journalism in the Low Countries
Authors: Deuze Mark , Paulussen Steve
Published: June 2009

This research note reports the findings of two web-based surveys of online journalists, conducted in the Netherlands and Flanders in 1999 and 2001. By indicating their basic, occupational and professional characteristics, the survey results provide a profile of the online journalists working for Dutch and Flemish print, broadcast and online-only news websites. The results suggest that `technology-driven', `audience-oriented' and `service-minded' are three appropriate adjectives to describe the first generation of online journalists in the Low Countries.
Decision-Case Mix Model for Analyzing Variation in Cesarean Rates
Authors: Eldenburg Leslie , Waller William S.
Published: June 2009

This article contributes a decision-case mix model for analyzing variation in c-section rates. Like recent contributions to the literature, the model systematically takes into account the effect of case mix. Going beyond past research, the model highlights differences in physician decision making in response to obstetric factors. Distinguishing the effects of physician decision making and case mix is important in understanding why c-section rates vary and in developing programs to effect change in physician behavior. The model was applied to a sample of deliveries at a hospital where physicians exhibited considerable variation in their c-section rates. Comparing groups with a low versus high rate, the authors’ general conclusion is that the difference in physician decision tendencies (to perform a c-section), in response to specific obstetric factors, is at least as important as case mix in explaining variation in c-section rates. The exact effects of decision making versus case mix depend on how the model application defines the obstetric condition of interest and on the weighting of deliveries by their estimated “risk of Cesarean.” The general conclusion is supported by an additional analysis that uses the model’s elements to predict individual physicians’ annual c-section rates.
Rumour and Other Narratives of Political Violence in West Papua
Authors: Kirsch Stuart
Published: June 2009

This article addresses the neglected subject of political violence in the Indonesian province of Irian Jaya, known locally as West Papua. It asks how this regime of political violence is reproduced in and through representations of culture, gender and difference. It argues that rumours about state-sponsored violence contribute to both the experience and expression of terror. It examines how West Papuans understand, subvert and imagine alternatives to the political and symbolic forms of violence in which they are enmeshed. Finally, it compares rumour to ethnographic accounts and human rights reports, arguing that anthropologists have both political and ethnographic responsibilities to `bear witness' to political violence and the mechanisms through which it is reproduced as terror.
Idols of Our Tribes?
Authors: Shanafelt Robert
Published: June 2009

This article discusses relativism and the evaluation of belief in contemporary ethnography. Various examples of conflicting beliefs are described, as well as the author's experience of a disagreement with members of a Christian community, the New Order Amish, over the nature of evolution and spirituality. Because conflicts over `truth' are an increasingly prominent feature of our globalizing world, now more than ever they must be dealt with directly. With this in mind, pragmatic suggestions are given about how to evaluate beliefs in terms of differing domains of truth.

If we believe in any revealed religion and, for instance, we have to admit that Christ is the son of God, then he is not the Messiah still awaiting in Jerusalem. And if Mohammed is the prophet of Allah, then it is mistaken to offer sacrifices to the Plumed Serpent. If we follow the most enlightened and indulgent of deisms, prepared to believe at once in the Communion of Saints and the Great Wheel of the Tao, then we will reject, as fruit of error, the massacre of infidels and heretics. If we are worshipers of Satan, we will consider puerile the Sermon on the Mount. If we are radical atheists, every faith will be nothing but misunderstanding. Therefore, given that in the course of history many have acted on beliefs in which many others did not believe, we must perforce admit that for each, to a different degree, history has been largely the Theater of an Illusion. (Eco, 1988: 2—3)
Indigenous Peoples, Postcolonial Contexts and Genomic Research in the Late 20th Century
Authors: Ventura Santos Ricardo
Published: June 2009

In the 1960s the human geneticist James V. Neel and collaborators launched a research program aimed at investigating the human biology of South American indigenous populations, which would become one of the most influential such studies in the second half of the 20th century. In the first part of this article I explore the trajectory of some components of the Amazonian research program and situate it in the context of worldwide human biological research in the 1960s and 1970s. In the second half I suggest that the comparative analysis of previous research on the human biology of indigenous peoples might provide insights into highly debated issues pertaining to contemporaneous research agendas, including the `Human Genome Diversity Project' (HGDP).
Objectifying the Past
Authors: Kurkiala Mikael
Published: June 2009

This article discusses an emergent indigenous counter-discourse on Lakota (Sioux) Indian history. This discourse challenges the widely accepted narrative of Lakota history that sets their date of arrival in the Black Hills of South Dakota in the 18th century. Modern Lakota historians maintain that the Lakotas have always been in the sacred Black Hills and that the conventional narrative of the Lakota past serves to legitimize their displacement. From a perspective inspired by the writings of Michel Foucault this article argues that, although this discourse can be seen as reflecting an attempt to regain a privileged position of defining Lakota history and identity, it also reproduces the very logic of modern `grand narratives'. Lakota oral tradition, however, is based on a fundamentally different logic from modern historiography, and it is here, the article suggests, that a more fundamental form of resistance is maintained.
`What the Fuck is a Vietnam?'
Authors: Alneng Victor
Published: June 2009

With the introduction of the reform project doi moi in 1986, Vietnam turned to tourism as a major new economic resource. Demands from international visitors have entailed a commodification of the Vietnam War. This article approaches tourism as an ideologically saturated nexus where identities and worldviews are continuously being represented, consumed, reconfirmed, negotiated and modified. Practices and narrations of Western backpackers, who travel to Vietnam spurred by phantasms of Vietnam as a war, are related to discourses of Vietnam in tourism literature, popular media, academia, journalism and politics, and traced to a `popcolonial' fantasy of Western superiority. At the core are the hegemonic implications the `been there, done that' cliché carries when war and tourism go hand in hand. It is argued that the dichotomies of here/there and war/peace need to be dislodged in order to understand the ideologies of both tourism and war.
Interpreting the Meaning of Ombudsman Data Across States: The Critical Analyst-Practitioner Link
Authors: Huber Ruth , Borders Kevin , Netting F. Ellen , Kautz James R.
Published: June 2009

In this article, the authors report data from four states that have computerized their long-term care ombudsman databases and are using the same software. The authors explore the apparent differences among these four states to encourage critical thinking in interpreting the meaning of these data. Just as a national ombudsman database draws closer, so does the need for practitioners, researchers, educators, and policy makers to be vigilant in understanding that data must be contextualized. Otherwise, premature and inaccurate conclusions may be drawn. Critically important is the link between those persons who analyze and interpret and the ombudsman practitioners who collect and report these data.
Characterization of Family-Generated Videotapes for the Management of Verbally Disruptive Behaviors
Authors: Werner Perla , Cohen-Mansfield Jiska , Fischer Jacqueline , Segal Gabriela
Published: June 2009

In this study, the authors examined the characteristics of family-generated videotapes used to manage the manifestation of verbally disruptive behaviors (VDB) in nursing home residents. Videotapes prepared by the relatives of 30 verbally disruptive nursing home residents to be shown to residents were systematically observed and coded for content and mode of presentation. The relationship between the videotapes' characteristics and their impact on the resident was studied. The majority of the time in the videotape was spent talking about the past or present of the family, was characterized by an overall feeling of respect, and did not show great variability in the features examined. Videotapes coded as showing more love and those not talking about current events were associated with higher effectiveness in reducing VDB. This treatment proved to be an appropriate and rewarding avenue to involve family members in the care of their frail institutionalized elderly relatives.
Very-Old Rural Adults: Functional Status and Social Support
Authors: Kivett Vira R. , Stevenson Michelle L. , Zwane Christine H.
Published: June 2009

This 20-year follow-up study examined the physical, psychological, and social outcomes, and social supports of 49 survivors of an original sample of 418 rural adults who were aged 65 years and older in 1976. The majority of adults lived alone but received regular assistance. Families, especially adult children, were their primary social supports. Very few formal supports were used. Psychological well-being among the very-old was good as expressed through life satisfaction and morale, despite multiple health problems and moderate levels of dependence on others for activities of daily living and instrumental activities of daily living. Both the cross-sectional and the longitudinal data from this study support the need to rethink issues of social support, independence, and family relationships in very-old age.
Gender Differences in Nutritional Risk Among Older Rural Adults
Authors: Quandt Sara A. , Chao Dinnie
Published: June 2009

Older adults are vulnerable to nutrition-related health problems due to health and psychosocial changes that accompany aging. Those in rural communities face additional problems. This study characterizes the nutritional risk of rural older adults using the Nutritional Risk Index (NRI), paying particular attention to gender differences in risk. Data come from face-to-face interviews with a random sample of 638 White rural adults aged 55 and older. Women scored significantly higher on the NRI, indicating greater nutritional risk. Women were more likely to report NRI items related to oral health, special diets, disease interference with eating, gastrointestinal problems, and anemia, whereas men were more likely to report smoking regularly. A comparison with the application of the NRI in other populations indicates that it is sensitive to nutrition-related health conditions that may be more prevalent in rural populations, making it a useful tool for measuring nutritional risk.
Elder Abuse and Case Outcome
Authors: Wolf Rosalie S. , Pillemer Karl
Published: June 2009

Throughout the health and human service systems, interest in the outcome of interventions has been gaining momentum. The purpose of this article is to investigate case resolution, a common social service outcome measure, as it is applied to cases of elder abuse. An in-depth assessment and reassessment (at 6 months) of 59 abuse cases revealed that resolved cases were more likely than unresolved cases to be associated with neglect, increased social support to the victim, reduction in stress, reduction in the interdependency of the victim and perpetrator, and change in the living situation of the victim. For victims of psychological, physical, or financial abuse, as well as those victims who are not willing to accept services or change their living arrangements, the analysis suggests that the level of future risk of abuse may be a more appropriate outcome measure than case resolution.
The Relationship Between Work Strategies Used by Informal Caregivers and Care Receivers and Clinical Outcomes
Authors: Van Ess Coeling Harriet , Biordi Diana
Published: June 2009

Historically, informal caregiving literature has focused on caregivers' reports of the burden associated with the work of care. Increasingly, however, both care givers and care receivers are beginning to accentuate the positive aspects of care in the home and identify work strategies that work for them. This study sought to examine the relationship between use of three care-related work strategies (delegating, developing competence, and positive problem orientation) and the following two outcome measures: mood disturbance and subjective well-being. Significant correlations were found between usage of each of these strategies and desired outcomes, indicating value in using these strategies. Different conditions of the variables of care receiver functional status, kin relationship, and gender were found to influence the degree of correlation between work strategies and desired outcomes, suggesting the need to individualize implementation of these strategies for each caregiver/care receiver situation.
Quality of Life in Assisted Living Facilities: Viewpoints of Residents
Authors: Ball Mary M. , Whittington Frank J. , Perkins Molly M. , Patterson Vickie L. , Hollingsworth Carole , King Sharon V. , Combs Bess L.
Published: June 2009

Assisted living facilities are nonmedical, residential settings that provide housing, food service, personal services, and watchful oversight to frail elders and other persons with physical and mental disabilities. This study presents results of research on residents' views of quality of life and is based on data from interviews with 55 residents in 17 assisted living facilities in three suburban counties in Georgia. The authors identified 14 domains of quality based on the combined values expressed by residents in interview data. Domains included aspects specifically related to quality of care as well as components of the broader concept, quality of life, such as independence and autonomy, social relationships, and meaningful ways to spend time. A key to quality was an individualized approach to care and goodness of fit between a person's unique needs and the ability of a facility to meet them.
Predictors of Perceived Support Quality in Visually Impaired Elders
Authors: Reinhardt Joann P. , Blieszner Rosemary
Published: June 2009

Although there is a strong empirical link between support quality and health in later life, research on the predictors of support quality is lacking. Significant predictors of components of kin and non-kin perceived support quality were identified and compared in 241 visually impaired elders reporting on their closest friend and closest family member. Results revealed differ ential patterns of predictors for family and friend support components. Having a spouse as closest family member was associated with higher perceived affective and instrumental family support. Significant interactions for family relationship type and sex showed that for males, but not females, having a spouse as closest family member was associated with lower perceived affective and informational friendship support. Participant age was positively associated with instrumental family support, but negatively associated with instrumental and affective friendship sup port. Overall, functional disability had a negative association with support quality. Strategies for increasing support quality are discussed.
Effects of Adult Day Service Programs on Time Usage by Employed and Non-Employed Caregivers
Authors: Jarrott Shannon E. , Zarit Steven H. , Stephens Mary Ann Parris , Townsend Aloen L. , Greene Rick
Published: June 2009

Adult day service (ADS) programs provide caregivers with a block of time away from their relative but may not reduce the overall time they spend caregiving. The current study addresses time estimates of caregiving activities among employed and non-employed caregivers of relatives with dementia who attended an ADS program for 3 months. ADS restructured caregiving activities by reducing the time caregivers spent dealing with behavior problems, reducing the time care-recipients spent alone, and increasing the time caregivers spent away from their relatives. Differences in how ADS restructures time for employed and non-employed caregivers are discussed. Day care supplements help provided by the caregiver and other informal sources and provides caregivers with uninterrupted time away from their relative.
The Psychological and Physical Costs of Caregiving: The Canadian Study of Health and Aging
Authors: O’Rourke Norm , Tuokko Holly
Published: June 2009

Persons with dementia and their caregivers were randomly identified as part of the Canadian Study of Health and Aging. The current study examines the interrelation among demographic and illness variables relative to various outcomes of caregiving ( n = 181). From these analyses, two pairings of canonical variates emerge as significantly correlated: The first suggests an underlying affective construct related to activities of daily living and problematic behaviors; the second reflects a caregiver health construct composed of demographic variables, depressive affect, and diagnosis of the care-recipient. These findings suggest that negative caregiving outcomes may arise within distinct affective and physical health domains. Illness would appear to manifest within either system where a predisposition exists among caregivers faced with specific stressors.
Difference by Race in Long-Term Care Plans
Authors: Mitchell Jim , Mathews Holly F. , Hack Kimberly A.
Published: June 2009

The underrepresentation of African American elders in institutional care is attributed to their greater desire for family care compared to Whites. Data from in-home interviews with 604 African Americans and Whites aged 65 and older are used to explore whether differences by race in long-term care plans substantiate this claim. Contrary to expectations, African American elders were more likely than Whites to have made long-term care plans and to include institutional as well as family care in their plans. Multivariate findings were that African American elders with more education were more likely than others to have made long-term care plans and educational attainment predicted plans for institutional care. Findings suggest that long-term care decision making is likely idiosyncratic rather than the result of careful consideration of care options in light of impending long-term care needs.
Dementia and Food Exchange in Nursing Home Dining Areas
Authors: Silver Stephanie A. , Albert Steven M.
Published: June 2009

Some investigators have reported that residents of nursing homes engage in food exchange during meal times, and that demented residents may be more likely to engage in such behaviors, usually taking food as part of more general disinhibited behavior. We investigated this claim directly using a behavioral observation protocol. Over two 12-day periods, a total of 111 residents in two nursing home dining rooms was observed to determine the prevalence of food exchange. Food exchange behaviors were noted among demented and nondemented residents. Overall, the prevalence of such behaviors was low; less than 10% of residents were observed taking or giving food. Demented residents were somewhat more likely to take food than nondemented residents; however, these differences did not achieve statistical significance. Dining room staff intercepted food exchanges in only about one quarter of such cases.
Older Adults' Use of Medical and Alternative Care
Authors: Wellman Beverly , Kelner Merrijoy , Wigdor Blossom T.
Published: June 2009

This article reports on a study of 77 older adults, 35 of them patients of family physicians and the other 42 patients of alternative practitioners. We compare the two groups along a number of dimensions and identify differences in health problems, social characteristics, practitioners consulted, reasons for choice of therapy and practitioner, pathways taken to care, and length and frequency of practitioner visits. The data show that few older adults sought care fromalternative practitioners and that those who did so had distinctive social and health characteristics. All the older adults began their search for care with conventional medical doctors. Most remain within the medical system. Those who moved beyond it had not found relief from their chronic problems and also had access to wider sources of information about alternatives, provided mainly by family and friends. The pathways followed by patients of alternative practitioners were complex and varied, but these patients did not forsake medical care.
The Impact of Congregation-Related Variables on Programs for Senior Adult Members
Authors: Knapp James L.
Published: June 2009

The growing number of elderly individuals is beginning to have an impact on the composition of local churches. Using a national probability sample of Churches of Christ ( N = 753), three hypotheses are tested. An examination of frequencies indicates that the program offered most often for senior adult members by local congregations is visitation to shut-ins. Results of chi-square tests reveal that having an organized senior adult ministry greatly enhances the number of programs for senior adults. Finally, multiple regression is used to test a model of factors believed to influence how “elder friendly” a local congregation is. The percentage of the congregation over the age of 65 has little influence. Of greater importance is the amount of money budgeted for senior adult ministry, as well as the size of the congregation and whether an organized effort to minister to senior adults is in place. Implications for religious leaders and researchers are discussed.
Development of an Instrument to Measure Resident Satisfaction With Assisted Living
Authors: Sikorska-Simmons Elzbieta
Published: June 2009

This article describes the development of the Resident Satisfaction Index (RSI) to measure the quality of assisted living from the residents' perspective. In total, 156 residents in 13 assisted living facilities participated in the study. Exploratory factor analysis confirmed five hypothesized RSI subscales representing resident perceptions of health care, housekeeping services, physical environment, relationships with staff, and social life/activities. Cronbach's alpha for the RSI subscales ranged from .77 to .86, and for the entire index, it was .92. The correlation of the RSI with the Affect Balance Scale (ABS) was .53, providing further support for its construct validity. The instrument could be used by policy makers and professionals interested in improving the quality of life for the frail elderly in assisted living.
Rural Mental Health and Elders: Historical Inequities
Authors: Lawrence Susan A. , McCulloch B. Jan
Published: June 2009

Although there have been unexpected and unintended consequences—and what many might consider inadequate care—America has consistently attempted to care for its mentally ill. This article provides a historical review of the pathways this care has taken, with particular focus on the persistent inequities older and rural adults experience with regard to mental health care. The care of people with mental illness has taken different forms as social, political, and economic environments have changed. The persistent social construction of myths about aging in rural areas and ageist biases necessitate greater advocacy if more equitable care is to be provided. This will unquestionably involve addressing the myths surrounding rural life, removing the stigma attached to mental illness, becoming aware of the biases inherent in current service delivery systems, and developing new and different models for the delivery of care that is appropriate to diverse, rural settings.
Program Development and Innovation
Authors: Bull C. Neil , Bane Share DeCroix
Published: June 2009

In the face of geographic isolation, economic deprivation, the lack of a well-defined human infrastructure, and limited economies of scale, innovation and flexibility must be the catchwords to ensure the adequate development of mental health services and programs in rural areas. The adaptation of urban models is possible, especially if rural cultural values are taken into account. The major components that should be part of a rural model of mental health service delivery are reviewed, focusing on the barriers of distance, individuals' privacy, the coordination and use of the present but often weak human infrastructure, and coordination between agencies and across political boundaries.
Family Relationship Histories, Intergenerational Relationship Quality, and Depressive Affect Among Rural Elderly People
Authors: Whitbeck Les B. , Hoyt Dan R. , Tyler Kimberly A.
Published: June 2009

Based on a sample of matched adult children and aging parents in the rural Midwest, this study examined the effects of family relationship history on depressive symptoms among elderly parents. The study used reports from both adult children and aging parents regarding intergenerational affectional solidarity and relationship strain. Aging parents reported levels of depressed affect. Adult children's recalled early relationships with their parents were associated with elderly parents' reports of depressed affect through the effects of early family relationships on contemporary relationships. Reports of early relationships and contemporary relationships were separated by 5 years. It is suggested that family relationship characteristics persist across time and that family relationship patterns affect the abilities of family members to negotiate support for elderly parents.
Continuity and Change in the Family and Community Life of Older People
Authors: Bernard Miriam , Phillipson Chris , Phillips Judith , Ogg Jim
Published: June 2009

The research reported here examines the family and community networks of elderly people living in three urban areas of England: Bethnal Green (an inner-city area of London), Wolverhampton (a metropolitan borough in the West Midlands), and Woodford (a northeastern suburb of London). These were the locations for landmark community-based studies in the 1940s and 1950s. The present study shows that although most older people still have kinship-based networks, the ways in which kinship is experienced—especially concerning the interchange of care and support—are different. Relationships between the generations have altered, with support more often being located within a framework of equality and mutual reciprocity. Predictably, too, retirement is now more common, with leisure activities being much more central to the lives of older people. The study raises questions about how policy and practice now need to respond to what is a much more complex and dynamic experience of the family and community lives of older people.
When a Case Management Program Closes: Impact as Perceived by Frail Elders and Their Family Caregivers
Authors: Browne Colette V. , Braun Kathryn L.
Published: June 2009

Geriatric case management programs benefit elders and their caregivers by providing technical and emotional support and linkages to services and financial assistance. This study used qualitative and quantitative data to document the perceived impact felt by clients and their families when this assistance is withdrawn. Attempts were made to contact all 205 former clients of a case management program in Honolulu 6 months after program closure. Of these, 118 were still living at home, 20 had entered nursing homes, 28 had died, and 39 were lost to follow-up. Compared to a previous 6-month period, the percentage who entered nursing homes was similar, whereas the percentage that died was higher. Half of responding caregivers reported a deterioration of their own health and increased emotional fatigue. Data suggest that the program was perceived by elders and their caregivers to be a critical component in providing support and maintaining the safety of frail elders in home settings.
State and Local Initiatives and Research Questions for Rural Long-Term Care Models
Authors: Kuder Linda , Beaulieu Joyce , Rowles Graham
Published: June 2009

This closing article describes rural long-term care models, including the Community Partnership Program in Eau Claire, Wisconsin, the Mountain Empire Older Citizens, Inc., in Big Stone Gap, Virginia, and the Oregon Senior and Disabled Services Division, and relates these efforts to the concepts of the preceding research articles. Overarching themes are discussed, such as flexibility and local control, consumer-driven focus, the importance of health policy at both the state and federal levels, the significance of partnerships, and newprofessional roles. Finally, research questions in the areas of long-term care service development in rural areas and crosscutting issues in case management are identified to guide future research and program development efforts.
Tai Chi as a Means to Enhance Self-Esteem: A Randomized Controlled Trial
Authors: Li Fuzhong , Harmer Peter , Chaumeton Nigel R. , Duncan Terry E. , Duncan Susan C.
Published: June 2009

Using a randomized controlled trial, this study examined whether a 6-month Tai Chi exercise program enhanced elderly individuals' multidimensional, hierarchical physical self-esteem. Participants either continued their daily routine activities or participated in a Tai Chi exercise class performing slow rhythmic movements. Both global and domain-specific physical esteem measures were assessed at baseline, at 3 months, and at the 6-month termination of the intervention. Growth curve models were used to analyze the repeated-measures data. Results indicated that individuals who participated in the 6-month Tai Chi exercise program showed increased levels of global self-esteem, domain-specific physical self-worth, and subdomain-specific esteem of attractive body, physical strength, and physical condition. Thus, Tai Chi, a simple, low-cost form of physical activity, has the potential to alter favorably specific facets of physical self-worth/ esteem in older adults, which may in turn enhance important aspects of their quality of life.
Geographic Access and Service Use in a Community-Based Sample of Cognitively Impaired Elders
Authors: Fortney John , Chumbler Neale , Cody Marisue , Beck Cornelia
Published: June 2009

Objective: The purpose of this research was to determine whether geographic access influences service utilization in a community-based sample of older adults with cognitive impairment. Methods: A telephone screener for cognitive impairment was administered to 9,100 elderly Arkansans with caregivers, resulting in a sample with 317 elder/caregiver dyads. Self-reported service utilization was collected for three sectors: home health, physical health, and mental health. Geographic access was measured from (a) self-reported awareness of services in each sector and (b) the travel time to the closest provider in each sector calculated using a Geographic Information System. Results: Travel time significantly predicted home health service utilization while perceived awareness significantly predicted mental health service utilization. Neither measure of geographic access predicted use of physical health services. Discussion: Because rural elders with less geographic access receive fewer home/mental health services, they may be at greater risk for hospitalization or nursing home placement.
Family Satisfaction With Nursing Home Care for Relatives With Dementia
Authors: Ejaz Farida K. , Noelker Linda S. , Schur Dorothy , Whitlatch Carol J. , Looman Wendy J.
Published: June 2009

Families of residents with dementia from five nursing homes were interviewed to assess if they believed improvements were needed in the care provided to their relatives. Quality of care was assessed in a variety of service and staff areas that factored into two domains of care: (a) environmental and administrative services and (b) direct care. Families who perceived significant improvements were needed in environmental and administrative services had more negative interactions with staff, perceived nurse assistants as being insensitive, and helped relatives with more activities of daily living (ADL). With respect to direct care, families perceived significant improvements were needed when they had more negative interactions with staff and helped their relatives with more ADL. These findings highlight the importance of promoting positive familystaff interactions, providing direct care in a sensitive manner, and exploring the reasons why families get involved in ADLto improve family satisfaction with care.
Incorporating Feminist Ethics Into Case Management Programs
Authors: McAuley William J. , Teaster Pamela B. , Safewright Marcia P.
Published: June 2009

This article focuses on the potential for and value of including a feminist ethics paradigm within long-term care case management policies and programs. We describe our experience as evaluators of a pilot case management program in a single state. Because this project was newand many of the administrative details were left open at its initiation, it offered a useful laboratory for examining the emergence of elements that were more consistent with the feminist ethics paradigm versus a regulatory system approach to social services. Finally, we describe ways to assure that feminist ethics and regulatory system approaches are appropriately balanced in case management programs.
Implementing a Case Management Program Designed to Enhance Primary Care Physician Practice With Older Persons
Authors: Netting F. Ellen , Williams Frank G.
Published: June 2009

A qualitative analysis of the implementation of a case management program is presented. This collaborative research design uses semistructured interviews and observational field methods. Nested within a changing health care environment and a corporation that is restructuring, three physician practices form the intervention sites. During the course of the project there is high turnover among project staff and physicians. This analysis begins with the intervention in which case managers mobilize resources, monitor medication and health care compliance, educate elderly participants and physicians, counsel participants, and provide caregiver support and follow-up. Adjusting to and defining the case management role, structuring supervision and nurturing the intervention, and communicating (both written and face-to-face) with diverse physicians are ongoing tasks throughout project development. The importance of clear communication, the need for great flexibility, and the search to maintain project integrity (keeping sight of the intervention) emerge as critical themes.
Changes in Resident and Facility Risk Factors for Psychotropic Drug Use in Nursing Homes Since the Nursing Home Reform Act
Authors: Castle Nicholas G.
Published: June 2009

The purposes of this article are to identify resident and facility risk factors for the use of psychotropic drugs since the implementation of the Nursing Home Reform Act (NHRA) and to compare these results with resident and facility risk factors prior to the implementation of the NHRA. The results update our knowledge of resident risk factors for psychotropic drug use and identify important but previously unexplored facility risk factors for their use. No evidence was found that particular types of nursing homes, such as for-profits, were systematically more likely to use psychotropic drugs. There was some evidence to suggest that operating characteristics of nursing homes, such as Medicaid census, are more influential in changing psychotropic drug use. In addition, both resident and facility risk factors for psychotropic drug use differed pre and post-implementation of the NHRA. Antipsychotic drug use increased slightly during this study period.
Service Use, Caregiving Mastery, and Attitudes Toward Community Services
Authors: Miller Baila , Mukherjee Snigdha
Published: June 2009

The purpose of this study was to determine correlates of selected caregiver attitudes toward community services in a sample of 215 spouse caregivers of persons with dementia. Predictors of two types of attitudes differed, confirming the multidimensionality and specificity of attitude for mation. Caregivers with higher levels of caregiving mastery, lower levels of caregiverprepared ness, less education, and more helpers had a greater likelihood of having confidence and trust in use of services. Women, African Americans, service users, and those with lower levels of caregiv ing mastery had a greater likelihood of accepting government and community services. The find ings highlight the complexity of the idea that improving attitudes toward community services will lead to greater use of caregiver support resources.
Differences in the Perceived Need for Assistive Services by Culturally Diverse Caregivers of-Persons With Dementia
Authors: Kosloski Karl , Montgomery Rhonda J. V. , Karner Tracy X.
Published: June 2009

Various explanations have been advanced to explain why older members of ethnic minority groups in the United States tend to use proportionally fewer assistive social and medical services than nonminorities. One possibility is that culturally based differences in attitudes toward need for particular services affect the likelihood of use. Data were analyzed from 2,947 Black, His panic, and White caregiving dyads participating in the Demonstration Grants to States program. Hierarchical logistic regression models were estimated separately for three discretionary ser vices (adult day care, in-home respite, and meal services) and one nondiscretionary service (home health care). Hypothesized outcomes were observed in all of the service models tested
Family Members' Perceptions of Quality of Life Change in Dementia SCU Residents
Authors: Kutner Nancy G. , Mistretta Elizabeth F. , Barnhart Huiman X. , Belodoff Brooke Fielding
Published: June 2009

Global ratings of change in residents'physical, emotional, social and cognitive functioning were obtained in interviews with family members of 67 special care unit (SCU) residents and 16 non- SCU control group residents of an intermediate carefacility (ICF). In cumulative logistic regres sion models, with adjustment for covariates (including length of residence in the facility), the odds of being rated by family members as better in emotional and social functioning since enter ing the facility were significantly greater for SCU than for non-SCU dementia residents. The odds of being rated as better in emotional functioning were also significantly greater for resi dents of the higher staffed SCU floor compared to residents of the lower staffed SCU floor. Rat ings by institutional caregivers and data collected by direct observation were consistent with these findings. Family members' perception of positive change among residents is a logically desirable SCU outcome.
Parenteral Nutrition‐Associated Metabolic Bone Disease: Pathophysiology, Evaluation, and Treatment
Authors: Seidner Douglas L. , Licata Angelo
Published: June 2009

Parenteral nutrition (PN) is generally given to provide adequate amounts of macronutrients and micronutrients to allow recovery after injury and illness. Maintenance of the skeleton is often neglected when one prepares a PN prescription. Although this may not be critical for the brief length of time that most patients receive PN, it becomes an important consideration in patients who need long‐term PN, during which time metabolic bone disease (MBD) can develop. It is therefore important to have an understanding of the factors involved in normal bone metabolism and the impact that PN has on this process. This review describes some of the important factors that may play a role in the development of parenteral nutrition‐associated metabolic bone disease (PN‐MBD) and discusses a strategy for the diagnosis and treatment of this problem.