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Background: Prodromes are signs and symptoms preceding attacks. Many Hereditary Angioedema patients are able to foretell the onset of attacks by having a prodrome. However, the clinical significance and practical value of prodromes as predictors of attacks needs to be assessed by objective measures. Objective: To prospectively evaluate associations between prodromes and attacks. Methods: 48 patients reported four occasions of prodromes, attacks or both. Pre-defined domains and scalable dimensions were assessed in each episode by a disease-specific instrument. Results: Participants reported 192 different events. Significant differences were found across all dimensions, indicating that prodromes are distinct from attacks. Positive correlations were found between the same attributes of prodromes and attacks. Specifically, pain was correlated in the extremities (r = .291, p < .05) and oropharyngeal clusters (r = .936, p < .01). Impairment was correlated across all clusters, most notably in the abdomen (r = .288, p < .05) and face (r = .588, p < .05) clusters. Dysfunction correlated for the abdomen (r = .366, p < .01), facial (r = .882, p < .01), extremities (r = .381, p < .05) and oropharyngeal (r = .790, p < .05) clusters. Experiencing a prodrome is associated with higher risk of attack in the abdomen (RR=2.30), urogenital (RR=16.39), facial (RR=2.94), extremities (RR=5.55) and oropharyngeal (RR=33.31) locations. Conclusions: Prodromes can be distinguished from attacks. Most patients with prodrome had subsequent attack, and their clinical features correlated in certain body locations. Experiencing prodromal signs and symptoms increase likelihood of having an attack.

We examined the association between employment-related characteristics and the quality-of-care migrant live-in caregivers provide to older care-recipients. Structured interviews were conducted with 115 migrant live-in caregivers, 72 older care-recipients, and 117 relatives of care-recipients. We conducted correlations among dependent (quality-of-care), independent (quality of relationship between caregiver and informant, caregiver perception of work, and problematic employment conditions), and demographic variables, and performed a path analysis by conducting a series of multiple regressions. Quality-of-care was most highly correlated with quality of relationship between informant and caregiver. Quality of relationship was predicted by caregiver perceptions of work, which was negatively predicted by problematic employment conditions. In the relatives-based model, quality of relationship was significantly better when the care-receiver was female and the care-recipient needed more assistance with activities of daily living. The study clarifies the role of caregiver work characteristics for quality-of-care and highlights the crucial role of the relationship with the care-recipient.

A disease-specific, patient-reported outcome instrument suitable for evaluation of prodromes and attacks of hereditary angioedema (HAE) is a clinical unmet need. We constructed such instrument and examined its validity, acceptability, and discriminative ability. Sixty-six patients participated in a survey addressing their demographics, social, and medical status. Discriminant content validity involved: (1) construct definition by in-depth cognitive debriefing interviews, (2) item selection identifying relevant categories, and (3) judgment of the format whereby questionnaires were tested on experienced patients and its content/reliability was validated. Prodromes and attacks affecting certain body systems (domains) were organized in “clusters”. Internal consistency, content, and convergent validities were analyzed. Analyses of variance and regression models were used to evaluate the discriminative ability of the instrument to differentiate between attacks and prodromes. The study demonstrates very high internal consistency (Cronbach’s α: attacks 0.88–0.98, prodromes 0.78–0.98). Analysis of variance confirmed significant differences between all dimensions and in pre-defined clusters (F (4, 61) = 45.74, p

We examined how family caregivers react, and what interventions they use in response to delusions exhibited by relatives with dementia in a community setting. Structured interviews were conducted with 68 family caregivers whose relatives were described as experiencing delusions based on the BEHAVE-AD or the NPI. Quantitatively, we cross-tabulated the type of response to delusion by the type of person providing the response and by the type of delusion manifested. Qualitatively, we analyzed open-ended responses to understand the types of caregivers’ responses to delusions, the contextual circumstances, and the impact of the responses. Caregiver responses to delusions included “Explaining that the delusion was wrong” (34% of responses), “Trying to calm down” (27%), “Agreeing with the delusion” (13%), “Distracting” (12%), and “Ignoring” (10%). Responses including “Anger, yelling or scolding,” were rare. The vast majority of reactions were by family caregivers of the persons with dementia. The relative frequency of the type of reaction tended to be consistent across delusion types. The qualitative analyses added some categories of reactions, but mostly highlighted issues to be considered when examining responses and their efficacy, including the use of multiple responses, and the manner and mood in which responses are conveyed. To cope with delusions, family caregivers develop intuitive intervention techniques. Understanding those interventions and reactions by caregivers and their relative efficacy can inform guidance programs for family caregivers. Improved support for family caregivers has the potential to positively influence the behavior of caregivers and older adults with dementia and improve their respective quality of life.

Chronic pain induces a multitude of harmful effects; recently it has been suggested that chronic pain is also associated with premature aging, manifested in shortened telomere length (TL). However, evidence for this hypothesis is scarce and inconsistent. The aim was twofold: 1) Investigate whether chronic pain is associated with premature aging, and 2) Determine whether physical exercise (PE) moderates this association if it exists. Participants were 116 male subjects, with (n = 67) and without chronic pain (n = 49). Blood samples for TL analysis were collected and participants were interviewed and completed questionnaires. As a part of the cohort, we included people with physical disability; this variable was controlled in the analysis. The TL of individuals with chronic pain was significantly shorter than that of pain-free individuals. Regression analysis revealed a significant moderating effect of PE on chronic pain and TL, above and beyond the effects of disability, age, and weight. Whereas chronic pain was associated with shorter telomeres in participants who did not exercise, this association was nonsignificant among participants who did exercise. The results suggest that chronic pain is associated with premature ageing; however, PE may mitigate this association and may protect individuals against the harmful effects of chronic pain. Perspective The study suggests that it is important to monitor signs of premature ageing among chronic pain patients as they are at risk. However, chronic pain patients may benefit from regular PE in this respect as it may moderate premature ageing.

Frail older people worldwide are increasingly being cared for in their own homes by migrant live-in care workers; however, extant literature on care relationships in this care context is sparse. The purpose of this mixed-methods study was to explore the quality and the nature of care relationships between full-time, live-in migrant care workers and older people in Israel. Quantitative and qualitative data were drawn from a 2014 survey of 116 migrant care workers and 73 older care recipients. Mean scores for four quantitative items relating to care relationships were examined and independent samplest-tests and Pearson correlations were performed, whereas qualitative data were examined using thematic analysis. Credibility of qualitative findings was checked by peer review. Most older people and migrant care workers gave high ratings to the four items. Significant correlations between the two groups were found for their responses on all four relationship items assessed, with only one item (‘get along well’) producing significantt-test differences. Qualitative data provided a deeper understanding of the quantitative ratings of care relationships. Four major qualitative themes emerged as inextricably tied with both groups’ perceptions of positive care relationships. These were: an emotional connection; reciprocity; effective communication; and meeting the older person's care needs. Study findings were interpreted through the theoretical lens of relationship-centred care. Implications of the findings for theory, practice and further research are discussed.

ObjectivesTo describe social engagement care (SEC) provided by live-in migrant caregivers for frail older adults compared with care recipients’ and families’ wishes for such care.MethodInterviews with care recipients, family members, and migrant caregivers assessed preferences for and provision of five types of SEC activities: knowing the older person as a person, knowing their main concerns, having personal conversations, going for walks, and sharing social or leisure activities.ResultsCare recipients and family proxies reported a moderate desire for SEC from migrant caregivers, except for sharing leisure activities, for which there was only a slight preference. Migrant caregivers reported these practices at somewhat higher levels compared with the other respondents. Migrant caregivers’ reports of practice show little relationship with care-recipients’ preferences, but care recipients tended to perceive practice as agreeing with their own wishes.DiscussionIt is important to include SEC as part of the role of live-in migrant caregivers of older persons. However, there is a need to differentiate among types of SEC and subsequently optimize the match between the care-recipient’s wishes and needs and the actual care provided.

An in-depth analysis of qualitative data regarding antecedents, consequences, and descriptions of delusions of persons with dementia (PwD) provided by family caregivers is presented. Three broad classifications of reasons given behind types of delusions are included, namely environmental factors, personal factors, and dementia, with dementia being the most prominent factor. We observed an overlap between known cognitive symptoms of dementia and the characteristics of the reported “delusions” in dementia. It therefore appears that what is often classified as a delusion of a seemingly psychotic nature is in fact the PwD’s disorientation combined with an attempt to fill in gaps caused by cognitive deficiencies.

ObjectivesTo clarify how work characteristics affect migrant live-in care workers’ burden/burnout as well as their job satisfaction.MethodsData from 116 migrant live-in care workers were collected in 2013–2014 in Tel Aviv and Jerusalem through structured interviews about their job satisfaction and their degree of burden/burnout. Due to the conceptual and empirical similarity (zero-order correlation and joint internal reliability), of burden and burnout, the 2 were combined into one variable. These outcome measures were examined in connection with the older person’s level of disability, care workers’ relationship with the older person, and their employment conditions.ResultsAccording to the regression models, work characteristics (care recipients’ functional status and care workers’ relationship with the care recipient) had a direct impact on burden/burnout. Employment-related variables (employment conditions and satisfaction with those conditions) had an indirect effect. A combination of work characteristics (relationship with the older person) together with the care worker’s response to employment conditions (satisfaction with employment conditions) had a direct influence on the care workers’ job satisfaction. Problematic employment conditions had an indirect effect.DiscussionThe results suggest that fostering better relationships and improving employment conditions could help reduce care workers’ burden/burnout as well as improve their degree of satisfaction.

Living and working conditions of 111 migrant live-in homecare workers caring for older care recipients in Israel were assessed using structured face-to-face interviews. Questions pertained to the categories of living conditions, food-related arrangements, and work conditions and benefits; the most important, most satisfactory, and least satisfactory items in these categories; as well as ratings of satisfaction in these areas. Problematic areas included resting days, hours worked per day, and ability to leave during the day. Mean satisfaction ratings were high (between a large to a very large extent) and were similar with respect to living conditions, food-related arrangements, and work conditions and benefits. Reported satisfaction with salary was significantly lower (between a moderate to a large extent). Items associated with reported satisfaction levels revealed the importance of comfort and control. The data indicate that discrepancies remain between recommended and actual working conditions for migrant live-in homecare workers in Israel.

This study investigated ageism among healthcare professionals in various therapeutic settings in Israel. Using a qualitative approach, the current study aimed to examine similarities and differences across healthcare disciplines. Three focus groups were conducted with physicians, nurses, and social workers. Data from each focus group were analyzed separately, and then commonalities and differences across the groups were evaluated. Three main themes relating to older adults emerged from the data. The first theme pertains to perceived difficulties that healthcare professionals experience in working with older adults and their family members; the second focuses on invisibility and discriminatory communication patterns; and the third theme relates to provision of inappropriate care to older adults. Similarities and differences across the three disciplines were found. The differences related mainly to the examples provided for manifestations of ageism in the healthcare system. Provision of inadequate treatment to older adults due to their age appeared to be the most complex theme, and is discussed at length in the Discussion. Briefly, the complexity stems from the fact that although some behaviors can be clearly described as inappropriate and undesirable, other behaviors such as avoidance of invasive medical procedures for older patients raise ethical dilemmas. Potentially, avoidance of invasive medical treatment can be perceived as compassionate care rather than as undertreatment due to ageist perceptions. A related dilemma, i.e., longevity versus quality-of-life, is also discussed in light of the finding that the balance of these two aspects changes as patients grow old.

Background:As more older persons opt to age in place, there is a growing trend to hire migrant workers as live-in caregivers to care for them. This raises the need to examine the quality of care they receive within this unique care setting. The objective of this pilot study was to establish the components of quality of care as provided by migrant live-in caregivers.Methods:We interviewed a convenience sample of older persons cared for by migrant live-in caregivers and their relatives. When relatives reported that older persons could not be interviewed due to advanced dementia, only relatives were interviewed. Overall, 72 older persons and 117 relatives were interviewed. We used the Quality of Care Questionnaire (QuCQ) developed for this study to examine the main components of quality of care in this population.Results:Factor analysis using older persons’ data revealed two factors. In the first factor, “caretaking,” items concerning provision of prompt care exhibited the highest loadings. Items measuring interpersonal aspects of the care dynamic had the highest loadings in the second factor, thus labeled “relationship.” The factor analysis based on relatives’ data yielded similarities and differences with the one based on older persons’ data. Yet, there were significant correlations between relative and older persons’ responses when using the older persons’ factor structure.Conclusions:According to older persons and relatives, quality of care depends on the extent to which older persons’ care-related needs, as well as social ones, are addressed. Appropriate evaluation of quality of care in the live-in setting is important for its improvement.

Background:Psychache can and does co-exist alongside resilience and coping amongst trauma survivors. This has been the center of the a-integrative theory of aging demonstrating an attitude to life based on cognitive and emotional dimensions. Aging of Holocaust survivors (HS) is especially difficult when focus is brought to the issue of integrating their life history. The present study aimed to investigate the interplay between psychache and resilience amongst aging HS.Methods:Cross-sectional study of HS and a matched comparison group recruited from the general population was carried out. All underwent a personal interview and endorsed quantifiable psychache and resilience scales.Results:We enrolled 214 elderly participants: 107 HS and 107 comparison participants. Mean age for the participants was 80.7± years; there were 101 women and 113 men in each group. Holocaust survivors did not differ in the level of resilience from comparisons (mean: 5.82 ± 0.68 vs. 5.88 ± 0.55, respectively). Psychache was significantly more intense in the HS group (F(8,205) = 2.21; p < 0.05).Conclusions:The present study demonstrates the complex interplay between psychache and resilience. Aging HS still have to cope with high levels of psychache while realizing a life-long process of development through resilience.

This study compares formal and informal caregivers’ perceptions of delusions and hallucinations in older persons with dementia (PWDs). The study population consisted of 151 community-dwelling PWDs aged 65 and older, 90 formal caregivers, and 151 informal caregivers residing in Israel. Assessments included the Behavioral Pathology in Alzheimer’s Disease Rating Scale, Neuropsychiatric Inventory, Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living, and Mini-Mental State Examination. Informal caregivers reported higher rates and a higher level of severity of delusions and hallucinations than formal caregivers. Different caregivers showed varying degrees of emotional involvement, empathy, and efforts to find the meaning of the delusion for the person experiencing it. Family members and staff members may see different parts of the total picture. The combination of both points of view is essential in order to establish an accurate, comprehensive assessment of dementia symptoms and to enhance the understanding of the reality of the different parties.

Background: To clarify physicians’ actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice.Methods: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31–70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two.Results: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance.Conclusion: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

Objective To portray the emotional and behavioral reactions of persons with dementia to the delusions and hallucinations they experience, according to the reports of their family caregivers. The article also explores the relationship between those reactions and background variables. Methods Study participants were family caregivers of 74 older persons with a diagnosis of dementia (aged ≥ 65) residing in the community recruited from adult day centers and support groups for caregivers of persons with dementia and by advertising online. Assessments included the Behavioral Pathology in Alzheimer's Disease, the Neuropsychiatric Inventory, the Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living questionnaire, and the Mini-Mental State Examination. Results Findings concerning emotional reactions reveal that close to half of the delusions resulted in discomfort, whereas around 40% did not. We found significant differences in the discomfort associated with different types of delusions, with delusions of abandonment, danger, and infidelity associated with more discomfort than other delusions. Around half of the delusions were associated with a behavioral manifestation. Conclusion The findings highlight the need to examine the emotional impact of delusions and hallucinations as part of their assessment and as a consideration in treatment decisions.

To date, little research has systematically explored the retention of self-identity in dementia and its potential use for the individualization of care. The purpose of this study is to determine the impact of role-identity-based treatment for persons with dementia. We recruited a total of 93 elderly persons with dementia (mean Mini-Mental State Exam score = 10.58) for this study. Experimental (treatment) group participants were engaged in activities designed to correspond to each participant's most salient self-identity. The treatment group showed a significant increase in interest, pleasure, and involvement in activities, fewer agitated behaviors during treatment, and increased orientation in the treatment period. The experimental treatment had effects that were superior to those of the nonexperimental activities. The results highlight the powerful roles that perception of self and fulfillment of self-identity play in overall well-being.

In this study, we explored perceptions of the salience of self-identity in persons suffering from dementia as perceived by the participants themselves, by family, and by staff caregivers. Four types of role-identity were explored: professional, family role, hobbies/leisure activities, and personal attributes. Participants were 104 persons with dementia, 48 of whom attended six adult day care centers while 56 resided in two nursing homes in the Washington, DC metropolitan area. Participants, relatives, and staff members were interviewed to obtain information about past and present self-identity roles of participants and attitudes toward these roles. Findings demonstrate that the importance of role identities decreases over time and with the progression of dementia. The family role was found to be the most important and salient role identity according to all the informant groups. The professional role was the one that showed the steepest decline in importance from past to present. Gender differences were detected for the importance of professional role identity. Participants rated their roles in the past as less important and those in the present as more important compared to family members. Family members reported greater decline in the importance of role identities for those participants with greater cognitive impairment. Participants with moderate cognitive impairment reported greater decline in the importance of role identities than did the participants with severe cognitive impairment. Understanding the past and present self-identities of persons with diminished cognitive abilities is crucial in the effort to provide individualized care and enhance participant experiences.

In this study, the impact of past experiences, present stressors, and expectations of future stress on psychological distress were explored. Participants were 38 male and 41 female spouses of patients hospitalized with non-life-threatening diseases. Participants completed questionnaires on which they appraised past, present, and future stressors and described their levels of psychological distress. Five models of the relationships between appraisals of past, present, and future stressors with psychological distress were examined. Only one model was confirmed by the data. It suggests that an appraisal of past stressors affects the appraisal of present stressors only indirectly, through its effect on the appraisal of future stressors. This model also maintains that only the appraisal of present stressors affects psychological distress directly. The implications of these findings for stress research are discussed.

This is a qualitative and quantitative study examining institutional staff members’ reactions to delusions experienced by nursing home residents. Participants were 38 nursing home residents aged 65 and older, diagnosed with dementia. Data were collected from 8 nursing homes in Israel between June 2007 and January 2009. Assessments included Behavioral Pathology in Alzheimer’s Disease Rating Scale, Neuropsychiatric Inventory: Nursing Home version, Etiological Assessment of Psychotic Symptoms In Dementia, Activities of Daily Living, and Mini-Mental State Examination. A wide variety of interventions with dementia-related symptoms was found to be effective to varying degrees. This included general approaches for a variety of symptoms as well as symptom-specific interventions. Caregivers do not always seem to be aware that multiple approaches are available to them when dealing with dementia. The most effective approaches may be those tailored to the individual. Combining interventions may increase overall effectiveness. Caregiver’s experience and the institutional culture may affect the choice of intervention used, either positively or negatively.

In spite of the theoretical recognition regarding the role of coping as a moderator, empirical findings indicate that it has only a modest effect as such. This study was designed, therefore, to examine the moderating effect of demographic variables (DV) on coping effectiveness, i.e. active cognitive coping, avoidance coping and active behavioural coping. The study sample was comprised of 12 male and 65 female patients with rheumatoid arthritis who were treated in three outpatient clinics of large hospitals in Israel. Findings suggest that demographic variables do play an important, and somewhat surprising, role in the effectiveness of coping strategies to temper psychological distress. Of the various demographic variables studied, marital status was found to have a significant effect on active cognitive coping and avoidance coping, and adherence to a religious belief system was found to have a significant effect on avoidance coping. The implications of the results for coping effectiveness are discussed.

An ethnography of an Israeli nursing ward is used to conceptualize four basic dilemmas that constitute the life world of residents: (1) new modes of somatic attention developed in the face of bodily decrepitude, (2) maintenance of social relations from a dependent position, (3) reconstruction of sel

This article examines how institutionalized life and its interactional dynamics are combined by the elderly in order to construct a unique time perspective. It is based on a four year anthropological fieldwork conducted in the nursing ward of a large geriatric center in Israel. The ethnography describes three time-structuring processes: (1) Revising the Past—constituting boundaries between past and present through “obiographies of illness”; (2) Denying the Future—constructing boundaries between present and future throuh a distinct perception of death and dying; and (3) Arresting Time—stituting the present as boundless through the construction of “limbo time”. It discusses how the ward's ‘clockwork environment’ of rigid schedule and daily activities serves as a framework for these processes, whose ultimate goal is to defy the regime of the clock.

This study investigated the meanings and etiologies of hallucinations in persons with dementia. Participants were 74 nursing home residents aged ≥65 diagnosed with dementia. Most of the reported visual and auditory hallucinations involved talking to persons who are not present, a phenomenon described as either a visual or auditory hallucination, or both. All participants who were reported to experience a hallucination had poor vision. Current results suggest that hallucination was a term staff caregivers used for the phenomena they could not easily explain, demonstrating their lack of understanding of the resident and/or the phenomena they termed hallucination. The classification of hallucinations into subtypes may not be meaningful, and most visual and auditory hallucinations were not associated with negative affect. Some hallucinations occurred out of boredom, which exacerbated the sensory deprivation experienced by these persons, thereby increasing the likelihood of hallucinations.

One of the common symptoms of dementia is delusions. Due to a biological conceptualization of the behaviors represented as delusions, these are classified as psychotic symptoms. This is a qualitative and quantitative study aiming to describe the delusions experienced by older persons with dementia and the context of occurrence, and to elucidate their etiology. Participants were 74 nursing home residents aged 65 and over, diagnosed with dementia, from nine nursing homes in Israel. Participants with delusions were found to have significantly more difficulties in performing ADLs, and poorer vision and hearing. Based on assessment using the BEHAVE-AD, six categories of delusions were examined: 1. One's house is not one's home, 2. Theft, 3. Danger, 4. Abandonment, 5. Misidentification, and 6. Other non-paranoid. Common themes appeared across delusions including reality, disorientation, re-experience of past events, loneliness and insecurity, boredom, and trigger. Current results suggest that delusions may not represent psychotic symptoms for most participants, because they sometimes represented reality, or were neither firm nor incontrovertible. Thus, utilizing the term delusion relegates the person's behavior to the domain of severe psychiatric phenomena and precludes understanding its true meaning.

Background Recent research suggests that there are clinical and biologic characteristics typical of late onset depression (LOD). Furthermore, evidence has been put forward that LOD may be a prodrome of dementia. Objective This study aims to assess the association between LOD and the development of dementia. Setting The study was conducted in a tertiary care, university-affiliated mental health center providing services for an urban catchment population of 800 000 subjects. Method A retrospective, case-controlled study was used. Results Fifty-one patients with LOD who developed dementia at least 1 year after diagnosis of LOD were defined as the index group: 18 males and 33 females, with a mean age of 75.4 ± 9.2 years. These were compared with 51 patients with LOD who did not develop dementia during a 10-year follow-up period. Dementia types were as follows: 73% Alzheimer disease, 24% vascular and mixed dementia, and 3% Parkinson dementia. Patients with LOD who developed dementia were significantly characterized by having longer hospitalization for their first depressive episode ( P = .048), having a family history of dementia ( P = .022), and having been exposed to the Holocaust as young adults ( P = .013). Conclusions Patients with a history of significant traumatic experience in early life and a prolonged onset of depression may be at particular risk of developing dementia. This issue requires further long-term prospective studies.

Israeli nurses’ knowledge of health care reforms Objectives. This study examines health care reforms’ implementation processes from the perspective of nurses’ knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses’ knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses’ knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses’ roles (managerial vs. staff nurses), years of experience, and level and type of education? Method. The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses’ knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. Results. Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms’ knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non-nursing academic degree were all positively related to higher levels of reforms’ knowledge. Conclusion. These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.

It has been suggested that external factors, such as perceived control of life and social support, influence the interactions of impairment, disability and handicap in the WHO model. Therefore, we assessed the effect of these two factors on the relationships between disability, handicap and quality of life in patients recovering from stroke. One hundred individuals, retrospectively and randomly selected from participants in an inpatient stroke rehabilitation program, were tested one year after discharge, using the Functional Independence Measure, the London Handicap Scale, the Life Satisfaction Assessment, the Tel-Aviv Social Support Instrument, and the Perceived Stress Scale. Impairment, disability, handicap and quality of life after stroke correlated positively and significantly with each other. Significant moderation of the influence that disability exerts on handicap was affected by perception of control, and by the influence of handicap over quality of life by social support. Thus, external factors can cause inconsistent interactions between components of the WHO model. Patient outcome may be improved if such factors are considered.

In this study, we explored the role-identity of nursing home residents suffering from dementia, as well as the potential for utilizing their enduring sense of self-identity for enhancing their quality of life. Four types of role-identity were explored: professional, family-role, leisure activities, and personal attributes. The methodology included structured interviews and a case study. Participants for the interviews were 38 residents of two nursing homes in Israel. Residents, relatives, and staff members were interviewed to provide information about past roles and the degree to which those roles are maintained in the present, and about strategies for bolstering the sense of self-identity. A large range of roles were identified. All role identities deteriorated significantly, with family roles retaining the greatest prominence in the present. However, much heterogeneity was manifested in all roles. Both staff members and relatives felt that a sense of identity in residents could be enhanced in most of the residents, which would exert a beneficial effect on their well-being. Caregiving respondents anticipated that this improvement would be substantial for about half of the residents. The case study illustrates how self-identity can change throughout dementia, and how it can be utilized to improve quality of life.

This study examines social support effect on stress and adaptation through the mediating effect of control. Participants in the study were 12 male and 65 female rheumatoid arthritis patients who were being treated in the outpatient clinics of three large hospitals in Israel. Findings suggest that social support did have a significant effect on stress and adaptation, though this effect was through the mediating effect of control and not as a buffer as was suggested previously. Implications of the results for nursing science are discussed.

In order to learn how geriatric centres were coping during the Gulf War (1991), questionnaires were distributed to 116 unit head nurses in 16 institutions in Israel. Additional information was obtained from the directors of nursing and national supervisors in a meeting 3 1/2 months after the cease-fire. Questions focused on organization of work, behaviour of staff, patients and their families, main problems, solutions and recommendations. Data showed a very high level of commitment by staff, flexibility, initiative and creativity in meeting the emotional, physical and safety needs of the aged. Stress level was highest in the 'Scud' areas and among the aged who are mentally alert. Families visited less but increased contact by telephone. Management was supportive with guidance, transport, child care facilities, etc. They also provided beds and food for spouses of the aged residents. Major problems related to safety measures (sealing rooms, moving patients during attacks), physical exhaustion and emotional stress of staff, and reorganization of care programmes. Recommendations included development of a master plan for non-conventional attacks, preparation of buildings with structural improvements, recruitment and training of volunteers, clarification of roles of staff and education for them.

There is a growing recognition of the need to evaluate quality of care. As the aged are a particularly vulnerable group, often dependent on care-givers for their remaining years, it is important to control related services. An interdisciplinary workgroup prepared a tool which lists cues to be considered in determining the quality of care for the aged in ambulatory services, home care programmes, short-and long-term institutions. The cues fall into six domains: physical environment, psychosocial environment, basic personal care, health care, family involvement and manpower. The tool can be used by clients and families for selecting placement for care; by caregivers in choosing or remaining in a place of work; by those administratively responsible for care, such as supervisors, or licensing bodies for controlling performance and policy; and by other involved persons, such as educators, researchers, volunteers or funding agencies for their specific purposes.

The need for institutional care rises with increasing age. Those over age 75 constitute half of the admissions of all aged to general hospitals and long-term care institutions in Israel (Ministry of Health and Central Bureau of Statistics, 1978). The institutionalized aged are usually physically and/or psychologically handicapped. Therefore the environment should facilitate the use of their residual abilities. Physical characteristics of the building can promote or reduce activity, social interaction and general satisfaction (Moos and Lemke, 1980). Several physical characteristics of an institution which can have pronounced effects on patient care are discussed in this paper. Newcomer and Caggiano (1981) recommend a variety of shapes, sizes, textures and colours of the gardens with adaptation to the patients’ handicaps. Harpaz et al. (1981) found that over half of the residents of Tel-Aviv homes for the aged frequent public gardens. This activity differentiates them from younger people and is significantly related to mobility. Communal space permits group activity, a feeling of ‘togetherness’ and participation by handicapped persons. Communal space can include entrance halls, day rooms, dining rooms, staff offices and therapy rooms. Moos (1981) reports that patients have more freedom of choice and environmental control where communal space is available. The provision of communal areas is indicative of the institution’s appreciation of their patients’ needs of expanded territoriality (Newcomer and Caggiano, 1981). Adaptation of communal space to the aged’s needs can influence the quality of the environment (Moos and Lemke, 1980).

We can communicate warmth, wring, and respect.