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This prospective cohort study examines the impact of depressive symptoms on changes in self-reported physical functioning in 574 low-functioning older persons. The data were collected in two waves in 1993 and 1995. Initial levels of depressive symptoms were not predictive for subsequent change in self-reported physical functioning. Changes in self-reported physical functioning were only moderately associated with changes in performance-based physical functioning. The strongest congruence of measured change between self-reported and performance-based physical functioning was found in older persons with increased depressive symptoms. The results suggest that preventing an increase in depressive symptoms may help prevent further deterioration in physical functioning in poorly functioning older persons.

We studied the impact of four psychological attributes (neuroticism, extraversion, mastery or perceived control, and general self-efficacy expectancies) on changes in disability in a community-based sample of 575 low-functioning elderly persons between 1993 and 1995. Unlike elderly persons with low or medium levels of mastery and general self-efficacy expectancies, older persons with high levels of such attributes showed no significant increase of disability between 1993 and 1995. However, multivariate analyses showed only unique contributions of mastery to changes in disability. Neuroticism and extraversion were found to be not related to changes in disability, supporting previous research outcomes. Findings highlight that, particularly, feelings of perceived control are crucial for maintaining functional ability in later life.

This article deals with the reciprocity of social support in personal relationships and with its connection to well-being, particularly loneliness. After reviewing briefly the concept of reciprocity, we develop four methods for constructing indices of the reciprocity of social support based on data on ego-centered networks of personal relationships. The four indices showed that on the average, the respondents' relationship networks were strongly reciprocal. The results did not make it unequivocally clear whether overbenefiting (versus underbenefiting) and loneliness were linked via a U-shaped association, as suggested by the literature, or via a linear or inverse U-shaped association. The use of more specific indices is recommended for a more extensive investigation of the association between reciprocity and loneliness.

Background: Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. Methods: In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. Results: A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Conclusion: Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital. [ABSTRACT FROM AUTHOR]

This paper examines the moderating effects of three psychological attributes (neuroticism, self-efficacy expectancies and mastery) on the association between functional limitations (motor and cognitive limitation, vision and hearing loss) and disability ((instrumental) activities of daily living, role function and social function) in a sample of 624 community-dwelling older persons. In contrast to our hypothesis, we did not find any evidence for interaction effects. This means that low levels of psychological resources do not exacerbate the effect of functional limitation on disability in community-dwelling older persons. We found significant unique contributions of the psychological attributes to disability. Even when all three psychological attributes were taken into account, neuroticism and mastery had unique effects on social and role function, and self-efficacy expectancies had unique effects on (instrumental) activities of daily living. We conclude that the effects of functional limitation and psychological attributes on disability can be considered as additive. Older persons with less psychological resources are particularly at risk in developing disability. Keywords: Functional limitation; Disability; Psychological attributes; Aging

Objective: We examined the effectiveness of reverse worded items as a means of reducing or preventing response bias. We first distinguished between several types of response bias that are often confused in literature. We next developed arguments why reversing items is probably never a good way to address response bias. We proposed testing whether reverse wording affects response bias with item-level data from the Multidimensional Fatigue Inventory (MFI-20), an instrument that contains reversed worded items. Methods: With data from 700 respondents, we compared scores on items that were similar with respect either to content or to direction of wording. Psychometric properties of sets of these items worded in the same direction were compared with sets consisting of both straightforward and reversed worded items. Results: We did not find evidence that ten reverse-worded items prevented response bias. Instead, the data suggest scores were contaminated by respondent inattention and confusion. Conclusions: Using twenty items, balanced for scoring direction, to assess fatigue did not prevent respondents from inattentive or acquiescent answering. Rather, fewer mistakes are made with a 10-item instrument with items posed in the same direction. Such a format is preferable for both epidemiological and clinical studies. [ABSTRACT FROM AUTHOR]

This article examined the predictive role of perceived control in long-term changes in disability among 1541 independently living older persons. Disability referred to self-reported difficulties with (instrumental) activities of daily living. Perceived control referred to the extent to which one assumes oneself as having control over one's life chances, unlike the fatalistic assumption that one's life is ruled by external factors. Data on disability and perceived control were collected in 1993 and recollected in 2001. Covariates included age, gender, living arrangement, level of education, and the number of chronic medical conditions. Regression equations were estimated with disability in 2001 as outcome and the selected variables as predictors. The level of perceived control decreased and the level of disability increased significantly over an 8-year period. The predictive role of perceived control for subsequent change in disability was statistically significant but not very strong. The association between perceived control in 1993 and disability in 2001 was stronger for older persons (>65 years) compared to younger persons (=65 years). [ABSTRACT FROM AUTHOR]

Objectives. This longitudinal study examined patterns of psychological distress in couples facing colorectal cancer within 6 months after surgery. In addition, correspondence in psychological distress was investigated between patients and their spouses, taking into account the gender of the patient. Method. The study had a longitudinal design, involving three assessment points; (T1) within 2 weeks after surgery, (T2) 3 months after baseline and (T3) 6 months after baseline. At T1, respondents were asked to indicate how they felt during the week prior to surgery. At T2 and T3, respondents reported their feelings during the preceding week. Psychological distress was measured using the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) in 137 couples. Results. Concerning the week prior to surgery, females reported more distress being a patient, whereas males reported more distress being a spouse. In comparison with a reference group, females as well as males, regardless of their role, showed increased levels of psychological distress prior to surgery. At 3 and 6 months following surgery, increased levels of distress continued to exist in females, whereas males' distress returned to normal levels. Neither within female-patient couples, nor within male-patient couples, were associations between patients' and spouses' distress found. Conclusion. We demonstrated a considerable impact of the cancer diagnosis on both female and male patients and their spouses before and 3 months after surgery. Six months after surgery, females, in particular, appear to be vulnerable to distress. [ABSTRACT FROM AUTHOR]

AbstractSome clinical trials perform repeated measurement over time and estimate clinically relevant change in an instrument’s score with global ratings of perceived change or so-called transition questions. The conceptual and methodological difficulties in estimating the magnitude of clinically relevant change over time in health-related functional status (HRFS) are discussed. This paper investigates the concordance between the amount of serially assessed change with effect size estimates (the researcher’s perspective) and global ratings of perceived change (the patient’s perspective). A total of 217 patients who were scheduled for diagnostic examination were included, and the Minnesota Living with Heart Failure Questionnaire, extended with MOS-20 items, was assessed before and after medical intervention (percutaneous transluminal coronary angioplasty, coronary artery bypass grafting or pharmaco-therapy). Global questions were applied to assess perceived change over time for every item from domains of physical and emotional functioning and used as the external criterion of relevant change in the analysis of items. Global questions corresponding with overall change in these domains were used in the comparison of change in physical and emotional functioning scales. Two effect size indices were used: (i) ES (mean change/SDpooled) and (ii) ES (mean change/SDchange). A method is described to calculate a value indicating the extent of discordance between the researcher’s interpretation of magnitude of change and the external criterion (the patient’s perspective). Findings suggest that effect size (ES) (mean change/SDpooled) was in keeping with the magnitude of change indicated by patients’ judgements, or their category of subjective meaning, for all scales. Furthermore, in cases in which the magnitude of change estimated with the SRM (mean change/SDchange) was not confirmed empirically by the external criterion ratings, the discordance could be interpreted as a trivial discordance. [ABSTRACT FROM AUTHOR]

This article presents results from a follow-up study in the Netherlands among 292 patients with early rheumatoid arthritis (RA). The main focus of this paper is on (changes in) personality characteristics, coping strategies and psychological status between the first and second wave (T1 and T2). On personality characteristics and psychological status RA patients are compared with a reference group (N = 173) from the general community. The levels of self-esteem, neuroticism and social desirability of RA patients were significantly different when compared to those of control subjects. As far as the coping strategies ‘emotional expression’ and ‘confrontation’ were concerned, RA patients presented less favourable scores than subjects from the reference group. Along the same line, psychological status was also found to be significantly different in the groups. The results on personality characteristics and psychological status remained stable after 12 months (T2). The patients' functional status appeared to be rather strongly associated only with level of self-esteem. In addition, depression on T1 could be explained mainly by personality-related aspects rather than functional status and tenderness. This pattern was also present in explaining the variance of T2 depression. However, in this latter regression analysis functional status did not contribute to depression. From the results it can be concluded that factors related to the disease process such as activity restrictions and tenderness, are not or only slightly related to the psychological status of RA patients. In addition, penonality characteristics, especially the level of self-esteem, appeared to be an important determinant of depressive mood in patients with RA. These findings may contribute to the treatment of RA patients by explicitly paying attention to the relevance of personality-related aspects in (self-) management programmes. [ABSTRACT FROM PUBLISHER]