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Studies show that complaints about being forgetful are weakly correlated with standardized measures of memory impairment. Little attention has been paid to those complaints in a healthy elderly population. Therefore, this qualitative, grounded-theory study investigated the experiences and consequences of becoming forgetful. In-depth interviews with 32 participants were conducted and analyzed. The findings show that forgetfulness became part of daily life through 3 strategies, conceptualized as doing forgetfulness: (1) reducing complexity; (2) creating and maintaining routines; and (3) dealing with feelings of embarrassment and shame. The well-being of people experiencing forgetfulness depended on how successfully they performed the strategies of doing forgetfulness. Gaining insight into this process allows health care professionals to assess the phenomenon early and to individualize counseling and further diagnostic procedures.

This article describes how the 5 John A. Hartford Foundation (JAHF) Centers of Geriatric Nursing Excellence (HCGNE) extended their influence in nursing education, practice, and research by partnering with nursing schools and community agencies; developing coalitions; providing local, regional, and national leadership in geriatric initiatives; and by developing complementary funding sources to augment and promote sustainability. The HCGNE partnerships were a significant mechanism for building geriatric nursing capacity in numerous directions. The article provides an overview of HCGNE partnership initiatives, including descriptions of educational, provider, and governmental collaborations; facilitating factors; and outcomes. In addition, exemplars from each HCGNE illustrate successful strategies, lessons learned, and outcomes.

OBJECTIVES: This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS: Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS: The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS: Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.

Nursing is frequently described as a caring practice. What this concept means may be less clear. This paper considers nursing as a caring practice in three steps. First, the concept of practice based on Taylor's and MacIntyre's philosophical definitions of the term is described. Secondly, numerous notions of caring are presented; the call from some nurse researchers for quantification of the concept and why this is problematic is discussed; and an exposition of caring from a phenomenological perspective is provided. Finally, the notions of practice and caring are joined, and the concept of a caring practice is presented. Nursing as a public caring practice is illustrated with examples from an interpretive phenomenological study. In conclusion, it is claimed that a phenomenological view of caring combined with a comprehensive definition of practice is well suited to nursing, and allows for a description of nurses' caring practices from both a nursing and patient perspective.

Objectives Hearing loss is increasingly common among older persons and is negatively associated with health and well-being. Its impact on spouses, however, is poorly researched. This study analyzed the relationship between a spouse's self-assessed hearing loss and his or her partner's physical, psychological, and social well-being 5 years later. Methods Subjects were 418 older married couples from the Alameda County Study. Hearing loss and adjustment variables were assessed in 1994 and outcomes in 1999. Longitudinal analyses included multivariate statistical models using generalized estimating equations to adjust for paired data and partners' hearing loss, age, gender, chronic conditions, and financial problems. Results Spouse hearing loss increased the likelihood of subsequent poorer physical, psychological, and social well-being in partners. The negative impact of husbands' hearing loss on wives' well-being appears stronger than the reverse. Discussion Findings suggest that early diagnosis and treatment of hearing loss constitute important clinical strategies to enhance the well-being of both hearing-impaired individuals and their spouses and support policy change to cover hearing devices by insurance. Further research incorporating theoretical perspectives from communication theory and qualitative methodology would enhance understanding of how hearing loss impacts older couples and support refinement of interventions to promote quality of life.

Care of the elderly in Botswana is solely a family responsibility. In the absence of formal programs for the elderly it is important to understand the cultural beliefs that guide decision making regarding acceptance of elderly care. The purpose of this study was to explore the experiences of family caregivers to older persons in Botswana. Using grounded theory methodology, 24 caregivers who were caring for an older person were interviewed. The findings indicate that the perceptions that guided the caregivers' decision making process of acceptance or non-acceptance of assistance from both family members and the government fell into three inter-related but distinct categories: Stigma, Appropriate-inappropriate forms of care; and Sense of Place. It is recommended that cultural sensitivity should be considered in designing models of support for families who are looking after their older relatives. Finally, a clear understanding of the perceptions of family members' needs must be emphasized as these differ from health workers' perceptions of family needs.

Using the Japanese concept of ikigai, which describes a certain state of psychological well-being, this study explores how Japanese family caregivers of elderly parents with dementia pursue, maintain, or attempt to regain their psychological well-being in the face of the hardship of caregiving. Using constant comparative methodology, twenty-six Japanese women who were caring for an elderly demented parent or parent-in-law were interviewed. Based on the analysis of interview data, we define ikigai as certain life experiences and/or the positive emotion felt through those experiences that allow the caregiver to judge her life as good and meaningful, and to feel that it is worthwhile to continue living. Caregivers use various different means to pursue their ikigai depending on the context of care. The types of their pursuit of ikigai are examined in varying contexts of caregiving. Because the data suggest that ikigai experience influences how the caregivers' self-understanding changes over time, the notion of ikigai is further explored in relation to the construct of self-understanding.

This research evaluates the utility of two different definitions of successful aging in predicting well-being.We assessed the definitions of (a) self-rating and (b) Rowe and Kahn's criteria of absence of disease, disability, and risk factors; maintaining physical and mental functioning; and active engagement with life. We made associations with well-being for each definition using data from 867 Alameda County Study participants aged 65-99 years.The percentage of those rating themselves as aging successfully was 50.3% compared with 18.8% classified according to Rowe and Kahn's criteria. Although absence of chronic conditions and maintaining functioning were positively associated with successful aging for both definitions, many participants with chronic conditions and with functional difficulties still rated themselves as aging successfully; none were so classified according to Rowe and Kahn's criteria. On 14 of 15 measures, self-rated successful aging resulted in sharper contrasts for well-being.Understanding criteria used by older persons to assess their own successful aging should enhance the conceptualization and measurement of this elusive concept.

Lower-extremity amputation is a much feared complication of diabetes mellitus; however, 40% to 50% of these amputations are preventable. Peripheral neuropathy has been implicated as a cause in some 82% of diabetic amputations. Patient education on foot care is often not enough to prevent foot ulceration and potential amputation. Health care providers can lower the incidence of lower extremity amputation by using a Semmes-Weinstein monofilament to identify protective sensation loss and quickly taking measures to prevent ulceration. Diabetes patients who have a history of foot deformity, ulceration, or amputation of any part of the foot should be referred for special shoes or orthotics. This article reviews the methods for identifying those patients with diabetes that are at high risk for amputation and preventive interventions.

This study compares the health of 42 grandparent, 44 spouse, and 130 adult-child caregivers with 1,669 noncaregivers in 1994 and 1974. In 1994, all three caregiver groups had poorer mental health than the noncaregivers; grandparent caregivers also had poorer physical health and greater activity limitations. Spouse and adult-child caregivers had not differed from the noncaregivers 20 years prior, but grandparent caregivers had experienced poorer health than the noncaregivers and more stressful life events than the other caregivers. Caregiving appears to add new burdens to otherwise normal lives for spouse and adult-child caregivers, while being yet another aspect of a difficult life course for grandparent caregivers.

This study characterizes the demographic backgrounds of patients in an Israeli geriatric rehabilitation unit, determines the factors associated with their family relationships and the instrumental support they received, and emphasizes the importance of social roles as a personal resource. The study population consisted of 336 low-income Jews, all of whom were immigrants. Virtually all of the subjects had a small, close support network composed mainly of their children and spouses. Their children were the most important source of instrumental support during their hospitalization. The subjects' sources of instrumental support prior to hospitalization varied, depending upon their age, gender, marital status, and social roles. Social exchange theory provided a framework for explaining their social roles. Factors found to be predictors of good family relationships were marital status, living arrangements, instrumental support, social roles, and educational level.

The purposes of this study were to determine if there are differences in the mood states, health status, and caregiver strain between family caregivers of oncology outpatients with and without cancer-related pain. A convenience sample of 86 family caregivers of patients with cancer-related pain and 42 caregivers of pain-free patients participated in this study. Family caregivers of patients with cancer-related pain scored significantly higher on the tension and depression subscales of the Profile of Mood States and had a significantly higher total mood disturbance score than did caregivers of pain-free patients. Although family caregivers of patients with pain had lower health status scores and higher caregiver strain scores than caregivers of pain-free patients, these differences were not statistically significant. The results of this study suggest that the presence of pain in a cancer patient adversely affects the mood states of family caregivers, particularly their level of depression and anxiety, and that health care professionals need to assess the psychological needs of family members caring for cancer patients experiencing pain.

We investigated the relationship between baseline internal health locus of control (IHLC) and 6-year change in physical functioning in 356 older adults. IHLC was strongly related to change in physical functioning for women at all levels of baseline functioning, but only affected men with lower baseline functioning. Cross-sectional analyses indicated no relationship between IHLC and health seeking activities except changing eating patterns when sick. Other findings were that IHLC was related to depression and not having childhood illness for men and to number of negative life events for women. For both genders IHLC was related to the importance placed on good health.

Urinary retention has been proven to cause serious consequences in bladder function if left untreated. Yet the incidents described in this article suggest that urinary retention (UR) may be an under-recognized or overlooked clinical phenomenon in elderly hospitalized women. In each case, the work-up that documented UR was initiated only after appropriate nursing assessment. In each case, it became clear to the authors that there was little consensus on the accepted immediate management of UR. The purpose of this article is to define UR and its complications and risk factors, and to discuss assessment and immediate management of UR in the acute care setting.

The presentation of an AMI in the older person is often atypical, with a lower incidence of classic chest discomfort but increasing incidence of dyspnea, syncope, stroke, and acute confusion. Atypical presentation is especially common in those 85 years and older. The altered pattern of symptoms predisposes the elderly to a delayed or missed diagnosis. Delay in diagnosis may also occur when the ECG is nondiagnostic. In addition, enzyme elevations may be lower and fail to reflect the extent of myocardial damage. Thus, among the greatest challenges confronting critical care nurses is that of caring for elderly patients presenting with atypical AMI and concomitant polypathology. Nurses who are well informed about the normal age-related changes in the cardiovascular system contribute to more accurate and timely diagnosis and treatment of AMI in the elderly.

The purpose of this study was to develop concepts that facilitate our understanding of why family caregivers of demented elderly persons can continue caregiving despite various difficulties of care. Twenty-six Japanese daughter or daughter-in-law caregivers of elderly parents with dementia who lived at home or in long-term care facilities were recruited through various senior service organizations in Japan. The caregivers underwent unstructured interviews, and the interview data were analyzed using the constant comparative method. Three categories emerged as reasons for care continuation: value of care, maintainers of value, and reinforcers of care continuation. Value of care came from societal norms and attachment, and was the basis of caregivers' motivation to continue care. Several maintainers of value and reinforcers of care continuation also emerged from the analysis. The contents and some longitudinal changes in these categories were explained. The findings highlight the need to assess these categories separately in order to develop appropriate interventions and they have implications for future research and policy development.

This paper is a synthesis of knowledge about Alzheimer's disease (AD) and AD family caregiving published over the last decade (approximately 1979-1990). While there has been an increase in the volume of scientific work in this area, methodological difficulties, unclear findings, and gaps, particularly with regard to inclusion of ethnic minority populations, persist. The current research priority on evaluating intervention programs represents a worthy direction, yet such a focus may be premature until basic knowledge builds on, extends, and transcends the foundation established in the past decade.

Studies of people's experiences with personal control have been limited to anecdotal case histories or experimental stress research on healthy adults. The purpose of the study reported in this article was to determine, through interviews, the ways in which 57 adults with late-stage cancer described their noncontrollable situation and the things over which they maintained control despite their disease. Content analysis yielded four conceptual categories that emerged from the data. These categories characterized the patients' experience with cancer: monitoring progress, waiting it out, refocusing control, and turning it over. The authors delineate the meaning of these categories and discuss the implications of their findings for clinical practice.