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This chapter examines mortality in long-term care home (LTCH) residents as associated with the use antipsychotic medication when combined with other psychotropic medications. The data at census-level pertain to all new admissions to long-term care homes (LTCH) in Ontario, Canada, during a given financial year (i.e., over 20,000 LTCH residents). The observations include comprehensive assessment upon admission and at quarterly intervals thereafter for a maximal period of 1-year after the initial assessment. The mortality data derive from three linked databases, with mortality classified as death within 90 days of the final assessment. The findings indicate that combinations of concurrent daily usage of antipsychotic medication with daily usage of other psychotropic medications (particularly antidepressants and analgesics) are associated with relatively low mortality, whereas intermittent usage (e.g. pro re nata; as needed) is associated with relatively high mortality.

Single-session therapy is being implemented in a number of mental health settings to increase the accessibility and efficiency of services, despite limited evidence supporting its utility. This stu...

This study examines the world's Top 100 age class performance times by Master athletes in marathon running. The predominant paradigm for this type of research assumes that the outcomes represent a "virtual" cross-sectional study with important implications about aging. This article critiques this perspective and presents alternative models that include temporal dimensions that relate to cohort differences, age changes and historical transitions. One purpose of this study is to compare these models with respect to goodness of fit to the data. A second purpose is to evaluate the generalizability of findings from the fastest divisional age class quartile to the slower quartiles. Archival listings by the Association of Road Racing Statisticians include a maximum of 100 fastest age class performances in marathon running performances by men and women. This database includes 937 performances by 387 men performances and 856 performances by 301 women. The mean ages are 62.05 years for men and 60.5 years for women. The mean numbers of performances per runner are 6.64 for men and 6.4 for women. Analysis by mixed linear modeling (MLM) indicates best goodness of fit for logarithms of performance time by a model that includes linear and quadratic expressions of age at entry into the database (termed "entry cohort") and subsequent age changes (termed "elapsed age") as variables. Findings with this model show higher performance times in women than men. Rates of increase in performance time are higher at older cohort ages and elapsed ages. Performance time increases with interactions between cohort age and elapsed age, cohort age and gender, and elapsed age and gender (i.e., with greater increases in women than men). Finally, increases in performance time with cohort age and elapsed age are higher in slower than faster performance quartiles, with athletes in the faster quartiles more likely to have multiple data entries and athletes in the slower quartiles single data entries. Implications of these findings are discussed.

This article is about relationships between subjective well-being (SWB) and variables such as demographics, intentional activities, personality traits, and personal characteristics. Causal interpretation of these relationships is usually asymmetric from the variable to SWB, although the literature also contains interpretations of reverse or bidirectional causality. Evidence reviewed here suggests that heritable personality traits may underlie some of these relationships. A consequence is that covariance may be lower than lower than indicated by phenotypic (within individual) correlations. The article discusses some implications for positive psychology. Keywords: subjective well-being, happiness, satisfaction, heritability, general factor of personality This article discusses models of probabilistic causation that encompass well-being measures and their correlates. Causal models contain a set of variables overlaid by two mathematical structures: a graph indicating causal direction in relationships between variables, and probabilistic estimates related to such relationships. Received opinion influences the former while methodological considerations affect overall confidence in a model (e.g., type of data, statistical power). Lyubomirsky, King, and Diener (2005) comment on an established bias in causal attribution even with data from one-time assessment: "associations between desirable life outcomes and happiness have led most investigators to assume that success makes people happy." (p. 803). A focus of the article is on comparison this assumption with alternative propositions. The article begins with a brief discussion of definitions and well-being measures used in positive psychology, followed by a description of causal assumptions that may pertain to relationships involving these measures. The next two sections respectively discuss correlates of well-being and the relevance of higher-order dispositions to these relationships. The final section considers some implications for positive psychology. Throughout the article, we highlight contributions by Canadian researchers. Definitions and Measures Definitions of well-being include the following. Subjective wellbeing (SWB) is an "evaluation of life in terms of satisfaction and the balance between positive and negative affect" (Keyes, Shmotkin, & Ryff, 2002, p. 1007). Psychological well-being (PWB) refers to "perception of engagement with existential challenges of life" (p. 1007). Eudaimonic well-being (EWB) includes "feelings of personal expressiveness" associated with the "pursuit of excellence, virtue, and self-realisation" (p. 42; Waterman et al., 2010). Canadian proponents of existential and eudaimonic conceptions of wellbeing include O'Brien (2008), Ryan, Huta, and Deci (2008), and Wong (1998). The most common names of SWB measures are satisfaction and happiness scales, with comparable measures known as affect, morale, or self-reported depression scales (Kozma, Stones, & McNeil, 1991). A Canadian measure used frequently in North America, Europe, and Asia is the Memorial University of Newfoundland Scale of Happiness (MUNSH; Kozma, Stone, Stones, Hannah, & McNeil, 1990; Kozma & Stones, 1980, 1983, 1987, 1988; Kozma, Stones, & Kazarian, 1985; Kozma et al., 1991; Stones & Kozma, 1986a). Along with widely cited measures of satisfaction, such as the Satisfaction with Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985), evidence for psychometric adequacy is convincing. Measures that fall under Keyes et al.' s (2002) existential challenge rubric include Canadian scales addressing life attitudes (Reker & Peacock, 1981), perceived well-being (Reker & Wong, 1984), and personal meaning (Wong, 1998). A widely used battery by Ryff (1989) measures independence and self-determination, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. …

Fleeting exposure to photographic images in newspapers, magazines, advertisements and elsewhere is part of everyday life. Some of these images stick in our memory while we quickly forget others. This article reviews previous research, provides a theoretical model and presents new findings to elucidate emotive influences that make photographs memorable. Earlier research identified pleasantness and arousal as the main emotions elicited by photographs. The new study used an experimental design that manipulated level of emotion (anxiety) before viewing photographs. Specifically, participants either received or did not receive emotive priming before viewing a set of fifty-seven photographs, each exposed for six seconds. They rated each photograph on emotive measures immediately after exposure and recalled as many photographs as possible after viewing the full set. The findings show that emotion induced by priming affected both emotive appraisal and which photographs viewers recalled. Anxious viewers we...

Earlier evidence was not conclusive about whether hearing loss is associated with mood (i.e., depressive symptoms and anhedonia) and social engagement (i.e., reduced psychosocial involvement and reduced activity levels) in elderly residents living in complex continuing-care facilities. If hearing impairment results in poor mood and lower levels of social engagement, then remedying hearing impairment might result in a higher quality of life. Purpose The purpose of this study was to determine if functional hearing impairment in continuing-care residents is associated with mood and social engagement. Design and methods This study included all residents in Ontario who were admitted to complex continuing-care facilities between April 2000 and March 2001. Through the Canadian Institute of Health Information, we gathered health information by using the Minimum Data Set 2.0 questionnaire. Results The results were consistent with our hypothesized direct effect of functional hearing impairment on mood. Path analyses showed that hearing impairment impairs linguistic communication and that impaired linguistic communication is related to lower levels of mood and social engagement. Implications This study adds to the literature supporting an association between hearing impairment and mood. It suggests that remedying hearing impairment may lower levels of poor mood in residents of complex continuing-care facilities. This, in turn, may reduce the negative effects of hearing impairment on social engagement and increase the quality of life for residents of these facilities. This study also suggests that questionnaires used to assess hearing, such as the Minimum Data Set 2.0, are suitable for early identification of hearing problems and may be used to refer residents to audiological services.

L'objectif de cette etude est d'analyser les liens qui existent entre le diagnostic et le traitement de la depression dysphorique-anhedonique, au moyen du Minimum Data Set 2.0. Les participants provenaient de deux secteurs des soins de longue duree : 70 vivaient en maison de retraite et 92 dans un centre de soins pour anciens combattants. Les echantillons etaient differents pour ce qui est de la distribution sexuelle et la cognition. Une serie de regressions logistiques mesurant les donnees demographiques, le type d'infrastructure et la cognition montrent que les symptomes dysphoriques permettent de predire la depression diagnostiquee, tandis que les symptomes anhedoniques permettent de predire l'utilisation d'antidepresseurs sans diagnostic concomitant. Les resultats sont compatibles avec l'hypothese que, dans des contextes de soins de longue duree, les symptomes anhedoniques contribuent dans une moindre mesure au diagnostic de la depression que les symptomes dysphoriques. Cependant, les resultats qui indiquent que les symptomes anhedoniques sont lies au traitement ont une incidence sur les protocoles de programmation des soins. The purpose of this study was to examine the relationships of diagnosis and treatment of depression with anhedonic and dysphoric symptom presentation, using the Minimum Data Set 2.0. Participants were from two sectors of longterm care: 70 nursing home residents and 92 residents in a Veterans' Care Service. The samples differed in their sex distribution and in cognition. A series of logistic regressions that controlled for demographics, type of facility, and cognition showed that dysphoric symptoms predicted diagnosed depression, whereas anhedonic symptoms predicted anti-depressant medication use without a concomitant diagnosis. The findings are consistent with a hypothesis that, in long-term care settings, anhedonic symptoms contribute less to a diagnosis of depression than do dysphoric symptoms. However, findings that anhedonic symptoms relate to treatment have implications for care-planning protocols.

Understanding how hostility may affect health risk is predicated on articulating its core physiological, psychological and social features. Barefoot [Barefoot, J.C. (1992). Developments in the measurement of hostility. In: Friedman, H.S. (Ed.), Hostility , Coping and Health , pp. 13-31. American Psychological Association, Washington, D.C] emphasized the importance of cognitive, affective and behavioural components. The present study examined whether hostile people differ from non-hostile people on measures of emotional verbal behaviour. Forty participants were interviewed about an anger-eliciting experience. Interviews were transcribed and evaluated for the use of emotional language using the Dictionary of Affect in Language [Whissell, C.M. (1989). The dictionary of affect in language. In: Plutchik, R. and Kellerman, H. (Eds.), The Measurement of Emotions. Emotion : Theory, Research and Experience . Vol. 4. Academic, San Diego]. Independent judges read the transcripts and rated the amount of anger experie...

Attitudes toward elder abuse differ with age, ethnicity, profession, and training. This article introduces a threshold model in order to reconcile findings on attitudinal differences within a unifying theoretical framework. The model assumes that individuals rate the abusiveness using consistent standards but different thresholds. Predictions from the model include consistency among individuals in their ratings of different behaviours (i.e., high relative consistency), but variation in the levels of rating (i.e., systematic departures from absolute consistency).Samples of 339 seniors and 233 professionals rated 112 items representing a wide range of abuse severity. The findings suggested high relative consistency but systematic deviations from absolute consistency, with higher ratings (i.e., lower thresholds) by professionals than seniors, and by residents of smaller (rural) rather than larger (urban) communities. The implications of the threshold model include prevention through elder-abuse education and reporting practices.

Considerable burden is reported by informal caregivers of older individuals with cognitive impairment. Significant progress in the understanding of determinants of this burden has been achieved. However, further progress could be attained if we considered important methodological issues that may have limited our understanding of caregiver burden. These issues include subgroups of care recipients and caregivers, measurement issues, research design, and statistical techniques. Fifty-three studies published between 1980 and 1997 (inclusive) that focused on caregiver burden were abstracted to determine the extent to which the methodological issues discussed above were considered. Overall, we found considerable variability among the studies surveyed. Further understanding of the caregiving process and reductions in caregiver burden will depend on the attention to methodological issues and understanding of burden across the whole caregiving career.

Background: Previous research on risk of delirium in acute hospital settings identified mainly patient variables (e.g., age) that are not amenable to intervention. The purpose of this study was to develop a model for new delirium in hospitalized older patients that included process of care and social variables. Methods: A prospective cohort study was undertaken in a community hospital in Ontario, Canada. Research paticipants included 156 hospitalized patients age 65+ years and without delirium on admission who were admitted to a medical or surgical unit. The measures included daily appraisal of delirium using a standardized and validated tool, and assessment of patient, process of care, and social variables. Results: Delirium developed in 28 of the 156 patients (17.9%). Older age and cognitive impairment were significant patient variables. Significant process of care variables included a high number of medications administered during hospitalization, surgery, a high number of procedures during early hospitalization (e.g., x-rays, blood tests), and intensive care treatment. Conclusions: Approximately one older patient in five developed delirium after admission to a medical or surgical unit. Risks not easily amenable to intervention included age, cognitive dysfunction, surgery, and intensive care requirements. Risk factors that are potentially modifiable included number of medications and number of procedures. Future research might focus on the efficacy of such intervention to reduce new-onset delirium in acute hospital settings.

Purpose: The objective of this study was to determine the validity and reliability of instruments used with Alzheimer's patients when administered in the home of participants. Methods: Twenty patients diagnosed with Alzheimer's disease were administered standardized tests to measure cognition (Mini-Mental State Examination and Alzheimer's Disease Assessment Scale) and mood (Geriatric Depression Scale and Short Happiness and Research Protocol). Patients were re-assessed after two weeks. All assessments were conducted in the patients' homes. Criterion and divergent validity were determined with correlations, and reliability was assessed with intra-class correlations. Ethics approval and consent were obtained prior to recruitment. Results: The correlation between instruments measuring cognition was 0.87, between instruments measuring mood it was 0.72. Intra-class correlations between test and re-test ranged from 0.75 to 0.93. With the low within-patient variability observed, small sample sizes would...

Reductions in healthcare spending and current demographic trends will result in increasing demands to care for aging relatives, especially those with cognitive impairment (e.g., Alzheimer's disease). Taking care of older individuals with cognitive impairment can be very challenging and burdensome. Caregiver burden is associated with negative outcomes such as caregiver depression and increased likelihood of patient institutionalization. One hundred eleven patients and their spousal caregivers were studied using a pre-post design. All subjects received a comprehensive medical intervention that included medical management of patients' problems and education of caregivers. We examined changes in patients' function and caregiver burden. At follow-up, patients' cognition and independence in activities of daily living had continued to deteriorate whereas their mood was improved. Regression analyses showed that changes in caregiver burden were positively associated with changes in the frequency of dysfunctional behaviors but not with changes in cognition. Gender was also related to changes in caregiver burden; male caregivers were more likely than female caregivers to report reductions in burden at follow-up. These data suggest medical interventions may provide some relief to caregivers of cognitively impaired older patients, but more research is required to identify the causal agents of this effect.

Issues in the measurement of subjective well-being (SWB) include the relative balance between scale brevity and measurement accuracy. Because accuracy is expected to vary negatively with the length of a scale, the brevity/accuracy trade-off has pragmatic implications for survey research. This article begins by examining minimal psychometric criteria to evaluate short measures of SWB. These criteria include content validity (i.e., four basic categories are cited), criterion validity, internal consistency, and test-retest reliability. Several measures frequently used in large-scale surveys are shown to fail against one or more of these criteria. Consequently, a new brief measure was developed and shown to satisfy all the criteria. It is termed the Short Happiness and Affect Research Protocol (SHARP). This measure contains 12-items derived from the Memorial University of Newfoundland Scale of Happiness (MUNSH), with the content balanced over positive and negative, and short-term (affective) and long-term (dispositional) components. The internal consistency, temporal stability, and criterion validity coefficients for the SHARP are comparable to those of the MUNSH, which is among the most accurate measures of self-reported SWB.

Veenhoven (1994) contrasted hypotheses of whether happiness is a trait or state, concluding that it is a state variable. This article critiques the conceptual foundation of Veenhoven's paper, and examines technical deficiencies in his review of evidence. Based on previous findings and new analyses, we conclude that happiness has both traitlike and statelike properties, but that individual differences in happiness endure despite its situational reactivity, and explain greater variance than situational effects.

RÉSUMÉCette étude porte sur les différences individuelles dans les attitudes vis-à-vis de l'abus et des mauvais traitements faits aux personnes âgées et d'autres questions de moral sociale contemporaine. La première étude faisait partie d'une enquête de grande envergure dont l'objectif consistait à établir des exemples d'abus et de mauvais traitements faits aux aînés au moyen d'un sondage auprès de 572 personnes âgées et médecins. En utilisant une série de grilles d'analyse de validation de construits, un test unifactoriel d'attitudes vis-à-vis de l'abus et des mauvais traitements faits aux aînés (Elder Abuse Attitude Test – EAAT) a été élaboré pour mesurer les différences individuelles dans l'évaluation des exemples d'abus et de mauvais traitements faits aux personnes âgées. Ce test comportait 13 questions et un taux de cohérence interne de plus de 0,9. La seconde étude comprenait le test unifactoriel d'attitudes vis-à-vis de l'abus et des mauvais traitements faits aux aînés dans un sondage sur les attitudes vis-à-vis de questions sociales plus générales. Les résultats du test, les 31 questions du sondage et des échelles d'attitudes extrêmes et conciliantes ont été analysés dans le cas de 257 répondants. Les corrélations simples et l'analyse factorielle ont révélé un lien entre le test, l'échelle d'attitudes extrêmes et les questions soulignant que société devrait fournir des ressources financières et d'autres types de ressources pour la prévention et le traitement de l'abus à l'égard des enfants, des conjoints et des personnes âgées. Les attitudes extrêmes n'ont pas été corrélées avec quatre autres attitudes. L'article conclut que les personnes susceptibles d'adopter des attitudes extrêmes sont davantage persuadées que la société a la responsabilité d'éliminer les situations d'abus.

Nineteen community volunteers for a reminiscence intervention were grouped into those attending no more than one-quarter of sessions and those attending approximately three-quarters of sessions. A model of psychological well-being was used to discriminate these groups. Predictions from the model were confirmed in two analyses: attendance was related negatively to baseline mood but positively to baseline happiness; the acute/chronic environmental discrepancy term of the model was negatively related to attendance. The model correctly assigned 16/19 (85%) of subjects to attendance categories.

Hypotheses on the relationship of affect intensity to psychological well-being were compared between formulations by Larsen and Diener (1987) and Stones and Kozma (1991). The former anticipate a null relationship whereas Stones and Kozma's prescription is more complex. They hypothesize affect intensity to comprise two components which (1) respectively exhibit negative linear and positive quadratic trends on happiness, (2) predict happiness in a subtractive combination, but (3) have a null relationship with happiness in a summative combination. The hypotheses by Stones and Kozma were confirmed with the first two factors from the Affect Intensity Measure Simplified (AIMS). Affect intensity and its relationships to happiness are subsequently discussed from quantitative and qualitative perspectives.

RÉSUMÉLes résultats d'un sondage mené auprès de 1449 adultes, répartis selon les groupes d'âge suivants: jeune, âge moyen et vieux, ont démontré que l'humeur compte deux composantes invariantes liées à l'âge, soit la vigueur et l'affect. La structure factorielle variait selon l'âge dans le cas de l'affect, mais non de la vigueur. Chez les adultes plus âgés, l'étude a établi deux facteurs unipolaires de l'affect, tandis que dans les deux autres groupes, un facteur bipolaire de l'affect a été obtenu. De ces analyses factorielles, une échelle de l'humeur (Memorial Mood Scale, ou MUMS) a été élaborée ainsi qu'une valeur prévisionnelle et fiable pour tous les groupes d'âge. Grâce à cette échelle, des différences moyennes de niveau par âge ont été observées en ce qui touche la vigueur et l'affect, et l'humeur générale a pu être mesurée. Les résultats étaient plus élevés chez le groupe des plus âgés sur ces trois plans. La vigueur et l'affect ont révélé des schémas invariants selon l'âge et le moment de la journée. La vigueur suivait un schéma diurnal inversé en forme de U, tandis que l'affect présentait un schéma principalement linéaire, ce qui suggère des évaluations de l'état somatique et des conditions environnantes, respectivement.

A mathematical model is applied to happiness and mood data from a successful group therapy intervention with elderly nursing home residents (Rattenbury and Stones, 1989). The model permits estimations of acute environmental change within and across therapy sessions, and the comparison of such estimates with the changes in happiness from before to after the total intervention. The findings show intervention success (i.e., the change in happiness) to correlate with across session changes, and particularly those in the basal (presession) acute environment, but with no correlation between therapeutic success and within session changes. These findings suggest a positive facilitation to the chronic environment during the progression of therapy.

RÉSUMÉCet article examine l’évolution de la théorie et la recherche sur le bonheur deux décennies après la publication du Psychological Well-Being in Later Life (Butterworths, 1991) par Albert Kozma, Michael Stones, et Kevin McNeil. Les avancements empiriques majeurs comprennent de nouvelles connaissances au sujet des contributions au bonheur résultants d’effets liés génétiquement et leur personnalité. Les traits de personnalité exercent des relations plus fortes avec le bonheur que ne l’était il ya 20 ans et de contribuent à la covariance entre le bonheur et certains ses prédicteurs. Accents de recherche en évolution comprennent les façons dont les effets qui sont génétiquement liés influencent la manière dont on forme et réagit à son environnement.

Objectives To assess the environment of an emergency department (ED) and its impact on care of adults aged 75 and over, using a ‘senior-friendly’ conceptual framework that included the physical environment, social climate, hospital policies and procedures, and wider health care system. Methods In this focused ethnography, we collected and analysed data from the ED of a regional acute care hospital located in Ontario, Canada from October 2007 to January 2008. Data collection included interviews with seniors or their proxy decision-makers, staff and key community informants; on-site observations; a staff survey; and hospital administrative data. Data sets were individually analysed and a synthesis of findings developed to formulate recommendations for policy, practice and education. Results Staff expressed their vision of providing senior-friendly care. However, the ED was fast-paced, overcrowded, chaotic and lacked orientation and wayfinding cues, as well as appropriate equipment and furniture, all of which created barriers to providing appropriate care. Seniors' expectations often went unmet and staff expressed moral angst at recognizing unmet needs. Some hospital policies and procedures compounded these difficulties, including hallway practice, lack of off-hour access to multidisciplinary health care professionals, and the inability of patients to access food and drink. Better communication and coordination between the ED and other components of the health care system are needed. Conclusions The ED is an important part of seniors' health care. Changes to policy and practices, and enhanced education must occur to better meet the complex health care needs of seniors. This assessment provides a method that can be replicated elsewhere to generate site-specific recommendations and initiate capacity development processes to enhance senior-friendly care.

Data from 690 persons in three adult age groups were used to evaluate the generality of a componential model of happiness (Kozma et al., 1990). The model postulates that long- and short-term affective states combine in an additive manner to produce current happiness. The short-term components should be more susceptible to environmental manipulation than the long-term ones and should change more readily with an appropriate experimental manipulation. Subscales of the Memorial University Mood Scale (MUMS) were used to assess short-term affect while the experience subscales of the Memorial University of Newfoundland Scale of Happiness (MUNSH) and Diener's Long-term Satisfaction Scale were used to measure long-term affect. Overall current happiness was assessed by a seven-point avowed happiness rating scale. The Velten mood induction procedure was used to manipulate current affective state. In five of six comparisons, changes on short-term components were significantly greater than on long-term components. Age differences in reactivity to mood induction emerged only when a negative induction procedure was followed by a positive one. Under these conditions, the youngest cohort responded more consistently than the oldest cohort. An additive model, based on long- and short-term affect, age, and sex produced the best explanation for current happiness.

We tested a mathematical model of psychological well-being (PWB) with data from a paradigm that included a negative mood induction followed by a positive induction. The propositions from the model encompass the hypothesis that the relative mood prior to either induction has implications for the magnitude of subsequent induction effects, such that relative mood is defined by current mood as a ratio of the prevailing mood that is predicted by the model. The findings confirm the hypothesis that the relative mood at baseline predicts mood change in a nonoverlapping time period, even after control for potentially mediating variables.

A model of happiness is described that is based on nonlinear mathematics. Happiness at timet+1 is given by:Hnext=M(1−H)H+I, whereH is happiness at timet, M is a person parameter, andI is an environmental impact term comprised of a prevailing component (Ip) and an episodic component (dI). Eight properties of the model are detailed and its utility illustrated for reconciling problematic issues in the literature that include the positive skew in the distribution of psychological well being (PWB) scores, the stability and change in PWB, and the relationships of emotionality with global PWB and its indicators. The operationalization of the model is described from the population level down to that of the single case.

The issue has been raised previously that the use of the correlation or squared correlation as an estimate of determination depends on the type of model that is considered (Ozer, 1985). We identify three models of subjective well-being and show that the respective estimates of determination require different interpretations of the correlation statistic. The differences are illustrated using data from the Newfoundland Longitudinal Study of Aging. (NLSA).

The present paper evaluates relevant findings on long- and short-term affective states in subjective well-being and argues for a componential model that combines the two into the more general concept of happiness. Two age parameters, one for long-term and one for short-term affect are added to the simple model to account for age changes in happiness. Measures of long- and short-term affect are presented, as is a paradigm for separating the components. Support for the simple model is provided by an experimental investigation with 64 college students who were exposed to positive and/or negative mood induction. As expected, the induction had substantially greater effect on short- than on long-term affect measures, particularly the negative induction procedure. These findings are consistent with predictions. However, multiple age cohorts will have to be assessed within a longitudinal framework to obtain values for the age parameters.

RÉSUMÉPour cette étude, une quantité de données démographiques sur la santé et la personnalité ont été recueillies à partir d'échantillons de persones âgées institutionnalisées et non-institutionnalisées à Terre-Neuve. Puis ces données ont été reportées au nombre de médicaments utilisés. Dans les deux échantillons, l'analyse a démontré que l'usage de médicaments peut être prédit d'abord et avant tout en tenant compte de la gravité de la maladie (Disease Severity), une combinaison du nombre de différentes maladies ou désordres et leur gravité. Ce facteur représente entre 28 et 33 pour cent de la variance. Aucun autre facteur n'a prédit l'usage de médicaments chez les personnes âgées institutionnalisées. Cependant, chez les gens âgés non-institutionnalisés, le baromètre de la santé (Health Rating), c'est-à-dire la façon dont la personne perçoit son état de santé, représente un autre 5 à 7 pour cent de la variance. Il n'y a aucun effet de réciprocité entre la gravité de la maladie (Disease Severity) et le baromètre de la santé (Health Rating), mais ces deux facteurs contribuent indépendamment et de façon complémentaire à prédire l'usage de médicaments. Ces deux facteurs servent également à prédire l'usage total de médicaments et les changements de médications durant une période de 12 à 18 mois. Le sexe et l'âge ne représentent pas des éléments qui aident à prédire l'usage de médicaments lorsqu'on tient compte de la variance causée par la gravité de la maladie (Disease Severity) et le baromètre de la santé (Health Rating).

Background: depression is a major disabling condition among older adults, where it may be under-diagnosed for a number of reasons, including a different presentation for younger people with depression. The Minimum Data Set 2.0 (MDS 2.0) assessment system provides a measurement scale for depression, the Depression Rating Scale (DRS), in addition to other items that may represent depressive phenomenology. Objective: the ability of the DRS to predict the presence of new depression diagnoses at follow-up, among hospitalised older adults admitted without depression, is examined. Methods: the study sample consists of all persons aged 65 years or more admitted between 1996 and 2003 to a complex continuing care (CCC) bed in Ontario without a recorded depression diagnosis. The sample was restricted to those who remained in hospital for about 3 months (n = 7,818) in order to obtain follow-up assessmentinformation. Logistic regression was used to explore the relationship between admission characteristics (i.e. DRS scale items, other MDS 2.0 items related to DSM-IV criteria for depression) and receipt of a depression diagnosis on the follow-up assessment. Results: a new depression diagnosis at follow-up was present in 7.5% of the individuals. The multivariate model predicting depression diagnosis included only the DRS scale, sadness over past roles, and withdrawal from activities. Conclusions: the DRS score at admission was predictive of receiving a depression diagnosis on a follow-up assessment among older adults admitted to the CCC. Further, the predictive ability of the DRS is only modestly improved by the addition of other items related to DSM-IV criteria.

Several driver, crash, and vehicle characteristics may affect the fatality risk of drivers involved in crashes. To determine the independent contribution of these variables to drivers' fatality risk, we used data from single-vehicle crashes with fixed objects contained in the US Fatal Accident Reporting System. A multivariate logistic regression revealed that the odds ratio (OR) of a fatal injury increased with age, reaching 4.98 (99% confidence interval (CI) = 2.01-12.37) for drivers aged 80 + compared with drivers aged 40-49 years. Female gender (OR = 1.54, 99% CI = 1.35-1.76) and blood alcohol concentration greater than 0.30 (OR = 3.16. 99% CI = 1.96-5.09) were also associated with higher fatality odds. In comparison with front impacts, driver-side impacts doubled the odds of a fatality (OR = 2.26, 99% CI = 1.92-2.65), and speeds in excess of 111 kilometers per hour (kph: 69 mph) prior to or at impact were related to higher fatality odds (OR = 2.64, 99% CI = 1.82-3.83) compared with speeds of less than 56 kph (35 mph). Three-point seatbelts were protective against fatal injuries (OR = 0.46, 99% CI = 0.39-0.53 compared with no belt). These data suggest that increasing seatbelt use, reducing speed, and reducing the number and severity of driver-side impacts may prevent fatalities. The importance of age and gender suggests that the specific safety needs of older drivers and female drivers may need to be addressed separately from those of men and younger drivers.

There is a growing need for an integrated health information system to be used in community, institutional and hospital based settings. For example, changes in the structure, process and venues of service delivery mean that individuals with similar needs may be cared for in a variety of different settings. Moreover, as people make transitions from one sector of the healthcare system to another, there is a need for comparable information to ensure continuity of care and reduced assessment burden. The RAI/MDS series of assessment instruments comprise an integrated health information system because they have consistent terminology, common core items, and a common conceptual basis in a clinical approach that emphasizes the identification of functional problems.

Objectives. The purpose of this study was to investigate the predictors of caregiver burden and depression, including objective stressors and mediation forces influencing caregiving outcomes. Methods. This investigation is based on the 1994 Canadian Study of Health and Aging (CSHA) database. Participants were 613 individuals with dementia, living in either the community or an institution, and their informal caregivers. Participants for the CSHA were identified by screening a large random sample of elderly persons across Canada. Structural equation models representing four alternative pathways from caregiving stressors (e.g., functional limitations, disturbing behaviors, patient residence, assistance given to caregiver) to caregiver burden and depression were compared. Results. The data provided the best fit to a model whereby the effects on the caregiver's well-being are mediated by appraisals of burden. A higher frequency of disturbing behavior, caring for a community-dwelling patient, and low informal support were related to higher burden, which in turn led to more depressive symptomatology. Caregivers of patients exhibiting more disturbing behaviors and functional limitations received less help from family and friends, whereas those whose care recipients resided in an institution received more informal support. Discussion. Our findings add to the preexisting literature because we tested alternative models of caregiver burden using an unusually large sample size of participants and after overcoming methodological limitations of past research. Results highlight the importance of the effective management of disturbing behaviors, the provision of formal services for caregivers with highly impaired patients and no informal support, and the improvement of coping skills in burdened caregivers.

A little investigated explanation for the high temporal stability in SWB scores is the stability of predictors. In the current investigation, over 400 participants were followed over a 48-month period during which SWB and predictor measures were taken at the beginning, the middle, and the end of the study. Predictors of SWB included demographic variables, domain satisfactions and stresses, current hassles and uplifts, and personality characteristics and styles. Component measures of SWB included both long- and short-term affect measures. As expected, long-term components of SWB yielded average temporal stability coefficients of 0.60 while short-term components averaged coefficients of only 0.35. With the exception of demographic variables, that fail to achieve significant predictive power and daily hassles, that have small predictive power, only personalty factors and domain satisfactions, averaged over all domains, reached the stability of long-term SWB components. When structural equation modelling was employed with significant SWB predictors, including prior SWB scores, top-down and bi-directional models provided the best fit for the data. These results are more consistent with our earlier hypothesis that SWB has both trait- and state-like properties than with one that attributes SWB stability solely to environmental and personality variables.

Literacy is defined in the Oxford English Dictionary as the ability to read and write, and illiteracy as an inability to read. Hardy, Segatore and Edge (1993) suggest a serious problem of illiteracy among student nurses that endangers patient safety. Their evidence is entirely anecdotal, some of which is misclassified as literacy errors. They provide no substantive or statistical evidence to support their claims. Educators making serious and provocative charges on such flimsy grounds ought either to recant or obtain evidence that is more convincing.

Publisher Summary This chapter presents the use of longitudinal and experimental data to demonstrate that motoric expertise is affected not only by lifestyle but also by life attitudes. The chapter reviews the applied measurement of competence, and then discusses evidence on the utility of postural control to index motoric competence, and presents new data on factors affecting unipedal balance. These data suggest that lifestyle orientation has a more powerful influence on motoric expertise than processes intrinsic to aging. The chapter discusses two studies of unipedal balance: the first is a longitudinal extension to four years of the Functional Age and Physical Activity (FAPA) study and it examines the factors related to the stability and reactivity of balance with an interval greater than one year. If balance can indeed be considered an index of motoric competence with implications for successful aging, retention of the skill can be anticipated to vary with baseline differences in stable prohealth behavior and life attitudes. The second study attempts to differentiate the immediate effects of smoking on balance from longer-term influences by varying the time of day at which the test is performed. It is concluded from the research that the retention of motoric expertise in later life can be affected by life attitudes and lifestyle. The findings are obtained using a balance task possessing generalized implications for other functions, and for which any loss in expertise is thought to represent an acquired decrement. Balance is considered a more useful index of motor expertise because it possesses both generalized implications for other functions and sensitivity to a more global range of lifestyle and life attitude parameters.

I Cognitive Factors.- 1 Development of a Mathematical Model of Memory for Clinical Research Applications in Aging.- Storage and Retrieval Contributions to Memory Dysfunction in Clinical Aging Populations.- Measurement of Storage and Retrieval Processes.- Conclusions, Limitations, and Prospects.- Appendix 1.A.: Memory Measurement Using the Two-Stage Model.- 2 Aging and Memory Disorders: A Neuropsychological Analysis.- Declarative Memory.- Implicit Memory.- Prospective Memory.- Concluding Remarks.- II Behavioral-Physiological Factors.- 3 Neuromuscular Performance of the Aged.- Balance in Upright Posture.- Human Walking Performance and Aging.- Age-Related Changes in Human Voluntary Strength.- Conclusion.- 4 Electrophysiology and Aging: Slowing, Inhibition, and Aerobic Fitness.- CNS Aging.- Slowing in Old Age.- Central Inhibition and Aging.- Event-Related Potentials in Atypical Aging.- Physical Fitness and Brain Functioning.- Summary.- III Toward an Integration of Cognitive and Behavioral-Physiological Factors.- 5 Physical Activity and Cognitive Changes with Aging.- Central Processing, Active Behavior, and Specific Motor Responses.- Factors Contributing to Impaired Response.- Impact of Habitual Activity.- Practical Implications.- Conclusions.- 6 The Measurement of Individual Differences in Aging: The Distinction Between Usual and Successful Aging.- General Issues.- Indexing Individual Differences in Usual Age.- An Index of Successful Aging.- Studies 1 to 4: Methods.- General Discussion and Conclusions.- IV Discussion.- 7 Cognition, Motor Behavior, and the Assessment of Atypical Aging.- Cognition and Motor Behavior.- Atypical Aging.- What Does Atypical Mean?.- Methods of Assessing Aging.- When Do We Stop Analyzing Atypicality?.- Summary.- Author Index.

The goal of aging research once was conceived quite simply: to understand the aging process and study its ramification. Since we know that different species, subgenera, and within humankind, different racial and socioeconomic groups, have different life spans, comparative biology and human demography provide important points of inroad for investigating the aging process (McDaniel, 1986; Rockstein, Chesky, & Sussman, 1977). A second but contentious route might be derived from the medical sciences, wherein diseases such as progeria, Werner’s syndrome, and Parkinson’s disease have been suggested by some authorities to provide models of accelerated but normal aging (Barbeau, 1976; Hayflick, 1977). Other researchers within the life sciences focused their collective interest on individual differences or functional aging (Borkan & Norris, 1980a, 1980b; Dirken, 1972; Heron & Chown, 1967; Murray, 1951). Although these latter researchers may have met with limited success (Costa & McCrae, 1980), the measurement of individual differences remains an important issue in the biology and psychology of aging.

Background The objective of this study was to examine the Minimum Data Set (MDS) and Geriatric Depression Scale (GDS) as measures of depression among nursing home residents. Methods The data for this study were baseline, pre-intervention assessment data from a research study involving nine nursing homes and 704 residents in Massachusetts. Trained research nurses assessed residents using the MDS and the GDS 15-item version. Demographic, psychiatric, and cognitive data were obtained using the MDS. Level of depression was operationalized as: (1) a sum of the MDS Depression items; (2) the MDS Depression Rating Scale; (3) the 15-item GDS; and (4) the five-item GDS. We compared missing data, floor effects, means, internal consistency reliability, scale score correlation, and ability to identify residents with conspicuous depression (chart diagnosis or use of antidepressant) across cognitive impairment strata. Results The GDS and MDS Depression scales were uncorrelated. Nevertheless, both MDS and GDS measures demonstrated adequate internal consistency reliability. The MDS suggested greater depression among those with cognitive impairment, whereas the GDS suggested a more severe depression among those with better cognitive functioning. The GDS was limited by missing data; the DRS by a larger floor effect. The DRS was more strongly correlated with conspicuous depression, but only among those with cognitive impairment. Conclusions The MDS Depression items and GDS identify different elements of depression. This may be due to differences in the manifest symptom content and/or the self-report nature of the GDS versus the observer-rated MDS. Our findings suggest that the GDS and the MDS are not interchangeable measures of depression.

Our intent in this study was to investigate structural relationships among happiness scales, and to determine whether the happiness construct could be represented adequately by a single score index. Second order principal factors analyses were computed on six data sets representing eight samples of subjects where the variables were comprised of global or sub-global indices of happiness. Single factor solutions were obtained from every analysis. The findings were interpreted as, (1) supporting a hierarchical, rather than an orthogonal multicomponent, model of relationships among happiness scales and, (2) indicating that the construct can be represented adequately by a single score index in social indicators research.

The objective of this research was to investigate age differences in the structure of semantic memory. The tasks employed (i. e., vocabulary, word fluency by conceptual category cueing and word fluency by initial consonant cueing) were representative of different age trends in quantitative test scores. Matching across age levels (young versus middle-aged) was in terms of family membership. Results showed a greater intra-individual variability and lower relationships between aspects of semantic memory by the time of middle-age. The results were viewed from process-oriented and environment-oriented explanatory perspectives.