Ethical dimensions of intergenerational reciprocity: implications for practice

This paper reviews the moral and ethical context of family relationships and caregiver stress, with an emphasis on the implications for professional interventions. Three views of filial responsibility are presented: parental reverence, a debt of gratitude, and caregiving as an expression of friendship and love. Case studies are presented to illustrate how an exploration of ethically defensible limits to caregiving might proceed.

Daily illness characteristics and health care decisions of older people

Although investigations of health care decision making typically deal with patterns of health service use, increasing attention has focused on lay- and self-care actions in response to illness symptoms. This study examined the health care actions of a community sample of 142 older adults, who recorded illness symptoms and corresponding health care actions in daily health diaries for a 14-day period. Self-treatment and no-action decisions were found to be the most frequent response to illness symptoms. Professional-care decisions were associated with greater health care need, such as multiple symptoms and increased pain. Lay-care decisions were significantly related to symptoms of shorter duration. Women were also more likely than men to self-treat their illness symptoms. Results suggest that older people deal with a greater number of recurrent chronic symptoms than previously thought and that they make most treatment decisions without consulting their doctors or other health care providers. This investigation underscores the importance of a prospective diary methodology for studying the daily complexities of chronic illness experiences and for validating and conducting useful interventions.

Preventive health practices among older men and women

The preventive health practices of older men and women were examined from interviews with a community sample of 172 adults aged 64-96. Differences between men and women were found with only 10 of the 37 individual health practices. A mixed pattern was found in the relationship of personal and demographic characteristics, life outlook, self-health perceptions, and social network with health practices. The results suggest caution in interpreting how age and gender interact to influence the preventive health practices and health behaviors of older adults.

Daily symptoms and behavioral responses. Results of a health diary with older adults

Research on the health care behavior of older adults in response to symptoms will benefit from having data collection methods that can monitor health actions as they occur on a daily basis. In the present study, symptom experiences over a 2-week period and the actions taken in response to them were studied with a self-kept daily diary. Participants were 142 community-resident older persons, aged 62-94. Diary information about number of daily symptoms and the accompanying pain/discomfort was correlated with health perceptions and psychosocial indices obtained in an interview prior to the diary period. Women tended to take a more active response to symptoms than men, particularly in the area of personal care actions. Preventive health behaviors were not strongly related to symptom-related actions. Satisfaction with one's income was the only predictor of seeking professional assistance. Overall, the diary method is feasible to use with older adults, although certain groups may require special consideration (e.g., the visually impaired, persons with multiple symptoms per day, or those with a limitation on writing ability).

Correlates of preventive health behavior in late life

A sample of 172 community-resident older adults (aged 64-96) were interviewed to investigate correlates of their preventively oriented, health-related practices. Four health practice groupings were used: Information-Seeking, Regular Health Routines, Medical and Self-Examination, and Risk Avoidance. Results indicated modest associations among individual behaviors and among the four health practice groups. Gender (i.e., women) and a supportive family environment were among the consistent predictors of good health practices, although each of the four behavior groups tended to have its own set of major predictors.

Congruence of health and treatment perceptions among older patients and providers of primary care

High utilization of primary health care services by older adults, and factors which promote discrepancies between personal and professional health judgments, create a need for effective communication between providers and patients. The present study was designed to extend existing reports on the congruence of health ratings among older adult patients and their primary care physicians and nurses. Congruence ranged from 29 to 69 percent across fourteen health and treatment questions (N = 108 patient/provider pairs). Patients appeared to be more favorable on most questions, and questions with a present orientation exhibited greater congruence than those with a future orientation. Few variables predicted congruence. Providers' ratings were associated with congruence more strongly than were patients' ratings. Further research should examine the uniformity of content and structure in patient/provider communication both across providers, and with their individual patients.

Emerging trends in gerontology and geriatrics: implications for the self-care of the elderly

Increases in the world's older population have posed a significant challenge to available health care resources. For many older people, informal initiatives represent a necessary, rather than an optional health care strategy in the absence of alternatives. Those individuals with the greatest health and economic dependencies are often held responsible for their reliance on subsidized long-term care services. This tendency to blame the victim appears to transcend fundamental philosophic differences which have traditionally distinguished some collectivist and individualist societies. Although health care has been viewed traditionally by health professionals as their domain, self-care and lay initiatives have recently been recognized by professionals as important to the health care of different population groups including older people. The concept of self-care has been used in various ways by different people to describe a wide range of personal health behaviors encompassing lay care, self-help, enlightened consumerism, and various preventive measures as antidotes to the impairments of old age. This paper reports some of the outcomes of an international project which reviewed geriatric self-care in different countries and health care systems. Various influences on the evolution of interest in geriatric self-care were identified including: similarities and differences in health care systems: demographic changes; cohort differences; the emergence of professionals with specialized training in geriatric health care; and, the salience of biomedical models in addressing the health problems of aging. The role of professionals, especially those trained in geriatrics, is examined with an acknowledgment of the importance of a self-care strategy that is independent of professional dominance.(ABSTRACT TRUNCATED AT 250 WORDS)

Retinoic acid enhances the displacement of newly synthesized hyaluronate from cell layer to culture medium during early phases of chondrogenesis

Chondrogenic differentiation in mouse limb bud mesenchymal cells cultured at high density was suppressed by supplementation of the medium with retinoic acid (1 microgram/ml or 3.3 X 10(-6) M). Since in control medium overt chondrogenesis begins on day 3, retinoic acid was introduced on day 2 so that the relationship between initial biosynthetic changes and inhibition of chondrogenesis could be studied. During the first 24 h of exposure the treated cells remained viable but suffered 10% inhibition in growth and synthesized [3H]glucosamine-labeled glycosaminoglycan at a level 24% below untreated cells. The amount of labeled hyaluronic acid released into the culture medium by the treated cells was, however, 2-fold greater, on a per cell basis, than that in the untreated cultures. It is suggested that the displacement of hyaluronate may play a role in the disruption of mesenchymal cell differentiation and of limb morphogenesis as observed in other systems.

A brief life-graft technique for work with geriatric patients

Patients aged over 60 or older from the practice of a private physician (n = 32) and from a geriatric outpatient clinic (n = 132) responded to a questionnaire designed to assess perceived present and future health, treatment expectations, and general future projection. Of interest was the extent to which present health, as measured by a brief life-graft technique, might be predictive of perceptions in these other areas. Results from two samples were consistent in suggesting that present health ratings were related to anticipated future health, general future projection, and certain treatment expectations. However, expectations of when benefits from treatment would begin, and of the probable duration of treatment, were not predicted in either sample. The life-graft technique seems useful for practitioners' interactions with older patients and for understanding these patients' extended view of their health.

Consistency in patients' health and treatment expectations at a geriatric clinic

This study focused on predictors of consistency and inconsistency in health and treatment expectations among 77 new patients (mean age, 73) at a geriatric outpatient clinic. Just before their first appointment, and again one week afterward, the patients were asked about their overall health status, their specific illness complaints, their reasons for visiting the clinic, and their expectations regarding treatment and the future outlook. Few predictors of consistency were found for such outcome measures as the number of health problems reported, present and future health status, and the duration, difficulty and benefits of treatment. Inconsistency and uncertainty were more evident in these geriatric outpatients' perceptions, especially among those with self-rated poor health and mobility. This study emphasizes: 1) the importance to the treatment context of geriatric patients' inconsistencies about their health, and 2) the additional burden clinicians must bear in dealing with such discrepancies.

Mistreatment of the elderly in the domestic setting: an exploratory study

Professionals and practitioners (N = 228) involved in providing services to the elderly were interviewed regarding their experiences with the mistreatment of older people by their families. Semi-structured questions dealt with: case identification and follow-up procedures; perceptions of etiological factors; and descriptive typologies from illustrative case histories. Findings indicated that domestic mistreatment of the elderly was familiar to most professionals interviewed, to the extent that 60 per cent of the respondents dealt with such cases on a weekly basis. Among the 10 professional groups interviewed, there was little variation in their experiences with neglect; police officers, lawyers, community mental health and aging services workers had greater exposure to cases of physical abuse. Intentional mistreatment was typically viewed as a consequence of inadequacies in the caretaker, while unintentional cases were related to the victims' isolation. Most respondents indicated that there were no established procedures for dealing with, or following-up mistreatment cases, and over one-half reported that nothing was done. Differences in perception of the etiology of domestic mistreatment of the elderly were closely related to the occupational perspectives of the various respondent groups. Although incidence rates could not be established, 89 illustrative cases of domestic mistreatment of the elderly were indicative of the severity of the occurrences and the absence of appropriate interventions.

Aging opinion survey: a report on instrument development

Attitude instrument development remains a necessary task in aging research, for the eventual explication of attitude-behavior relationships. The present report describes initial development of the Aging Opinion Survey, an instrument based upon a multidimensional view of attitudes towards aging and the elderly. After identifying substantive attitudinal content areas, an initial 120-item pool was constructed, balanced across referent groups and direction of wording. Pilot analysis eliminated sixty items with minimal variances. Administration of the reduced item set to a subsequent sample of 200 gerontological practitioners and students produced four meaningful factors. Poor items were again eliminated and replacements constructed. Another administration (n=226) again produced four meaningful factors, three of which met the criterion of reliability: (1) Stereotypic age decrement, (2) Personal anxiety toward aging, and (3) Social value of the elderly. These scales appeared to reflect peer, personal, and generalized-elderly referents, respectively. Development and refinements of attitudes scales such as the Aging Opinion Survey are necessary elements for proceeding beyond the current theoretical and empirical difficulties in gerontological attitude literature.

Attitude instrument analysis: an examination of factor consistency across two samples

The factor analytic model of the practitioner-oriented opinions about people (OAP) was tested with a population of gerontological practitioners (N =558). A confirmatory factor analysis was performed to ascertain the degree-of-fit between these data and the published OAP factor model. After results supported the hypothesis that the two samples differed, a second factor analysis was designed to yield estimates of communalities by a least squares multiple regression technique. This analysis eliminated nine items not warranting inclusion in the instrument, redistributed the factors, and brought out a completely new factor. Finally, to test the hypothesis that attitudes toward aging and the aged are uncorrelated, a third analysis was performed in which the six scales of the oblique solution were refactored. The resulting higher order dimensions tended to support this hypothesis.

Attitudes toward aging as a function of in-service training and practitioner age

Age differences in attitudes toward aging were investigated as a function of a 3-hour training program with 322 women (18-74 years) from various geriatric health care and social service contexts. Using a quasi-experimental pre- and posttest design, sites were randomly divided into initial experimental and control groups, with all control participants receiving training following the research program. Results indicated few instances of unfavorable attitudes toward aging in any age group, with younger women evidencing less cynicism toward aging, less social distance from the aged, and slightly less stereotyping. Training appeared to result in less cynicism, stronger endorsements of family and public responsibility, and slightly greater anxiety. No Age X Pretest/Posttest interactions were found. The results are discussed in terms of their implications for service provider-client interaction, the correspondence of attitudinal and behavioral change, and appropriate instruments for assessing program impact.

Training for a supportive geriatric environment: a preliminary report

Gerontological manpower development is the goal of an ongoing project where various training modules are designed, tested, and evaluated within the institutional or community context where the service is delivered. This paper reports initial data on program effectiveness and attitudinal and work assessment changes resulting from staff training in environmental therapy.