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Objective and subjective severity of visual impairment were examined in relation to the receipt of social support over time among 384 adults with age-related macular degeneration. Both types of impairment were related to greater family support, with those with discrepant subjective and objective impairment (high and low, respectively) reporting the most instrumental support. [ABSTRACT FROM AUTHOR]

The purpose of this research was to determine whether race had a significant, unique impact on adaptation to a common late-life impairment, age-related vision loss, after accounting for sociodemographic, health, functional disability, and personal and social resource variables. Older visually impaired African American (n = 61) and Caucasian (n = 488) applicants for vision rehabilitation service were interviewed in their homes. The results demonstrated that race accounted for unique variability in the domain-specific indicator of adaptation to age-related vision loss. The results support the importance of further work examining race differences in adaptation to specific chronic impairments in later life. [ABSTRACT FROM AUTHOR]

This article describes the development and evaluation of a short form of the 24-item Adaptation to Age-Related Vision Loss (AVL) scale. The evaluation provided evidence of the reliability and validity of the short form (the AVL12), for significant interindividual differences at the baseline and for individual-level change in AVL scores over time. Thus, the AVL12 maintains strong psychometric properties and is a shorter, more efficient measure for assessing adaptation to age-related vision loss in both research and clinical settings. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to identify factors associated with attitudes, knowledge, and fear of age-related vision impairment in a representative sample of US adults age 55 and older. Data were obtained from a national telephone survey. Attitudes toward vision impairment and aging were positive, but fears were extensive and knowledge was lacking. Higher socioeconomic status and experience with nonrelated persons who were visually impaired predicted better attitudes and greater knowledge. Being a women and having experience with persons who were visually impaired predicted lower fear. Findings emphasize the importance of accurate knowledge and training about visual impairment for practitioners working with this population. [ABSTRACT FROM AUTHOR]

Responding to the September 11, 2001 terrorist attacks, the NIH Office of Behavioral and Social Science Research developed a measure to assess bias in studies of mental health resulting from these events. Studies that have reported a negative mental health impact from September 11th have focused on adults of all ages and have had limited preattack comparison data. However, at the time, we were studying depression among older adult vision rehabilitation applicants in the New York City metro area. Thus, we were in an unique position to examine any potential biasing effects of September 11th given our proximity to one of the attack sites. CES-D scores and life satisfaction were compared for those providing data 2 months prior (n = 111) or 2 months after September 11th (n = 58). Significant biasing effects of September 11th did not emerge, nor were there any interaction effects of the event with age, gender or education. Failure to find bias from September 11th in our sample reflects, in part, the resiliency of older adults who have coped with other stressful events in their lifetimes. [ABSTRACT FROM AUTHOR]

The present study developed a typology of self-reported coping strategies used by older adults in adapting to vision impairment using qualitative analyses. Narrative data were examined from three previous quantitative studies of adaptation to vision loss. Major themes in coping with vision loss included difficulty in balancing norms of independence with the functional losses resulting from eye disease, and the importance of the informal social network. Importantly, a number of coping mechanisms that have not been examined in prior quantitative work were identified through the present qualitative analyses. Implications of this typology of self-reported coping with age-related vision loss for research and practice are discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: . One can conceptualize adaptive technology as a resource used by disabled older adults in order to maintain competence in everyday life. This study examined the independent relationships between optical and adaptive device utilization and change in functional disability and depression among older adults with age-related vision impairments. Methods. We interviewed older adults (n = 438) with a recent vision impairment applying for vision rehabilitation services both pre-service and at the 6-month follow-up. We conducted hierarchical regression analyses with functional disability and depressive symptoms as criteria. In order to identify their independent direct effects, we entered optical and adaptive device use into the final step, preceded by Time 1 criterion scores, demographics, baseline disability or depression (depending on criterion), and total rehabilitation service hours. RESULT: . Optical, but not adaptive, device use was significantly associated with declines in functional disability and depressive symptoms over time. Discussion. We propose that these differential effects result from the fact that optical devices optimize residual vision and thus allow for greater continuity in the way tasks are accomplished (i.e., reading still performed visually), whereas use of adaptive aids (e.g., talking books) involves learning new methods in order to compensate for lost functions and thus is not as desirable either functionally or psychologically. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This article focuses on the effects of perceived overprotection, a potentially problematic aspect of receiving support, on the ability to adjust to a chronic impairment, specifically, age-related vision loss. Perceived overprotection is an especially critical issue in this population of chronically ill older adults because of the safety issues associated with vision impairment and because perceptions on the part of the older adult that the support providers are overprotective may lead to excess disability. METHODS: Participants were 584 older men and women with age-related vision impairment who applied for services at a vision rehabilitation agency. Path analysis was used to examine the effects of perceived overprotection on two positive indicators of adjustment: vision-specific adaptation and environmental mastery. Moreover, antecedents of perceived overprotection were examined. RESULT: Higher levels of perceived overprotection were associated with less optimal adjustment to age-related vision loss, with lower scores on measures of vision-specific adaptation and environmental mastery. Higher levels of functional disability and instrumental support received were associated with higher levels of perceived overprotection. DISCUSSION: Findings indicate that support providers of older adults with visual impairment as well as vision rehabilitation service providers need to be aware of the detrimental impact of perceived overprotection. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This paper focuses on predictors and patterns of support provision over time among disabled older adults. The ability to provide support to others may become an especially critical issue for persons who are dealing with a progressive, chronic impairment that typically results in increased functional disability and thus places them in greater need for support. METHODS: This multilevel analysis examined change in support provision over time, as well as the degree to which sociodemographics, health, functional disability, use of rehabilitation services, and the receipt of support predicted support provision. Participants, 449 older adults with a progressive, chronic visual impairment, were interviewed three times over an 18-month period. RESULTS: Affective and instrumental support provided to family and friends each showed a decrease over time. Age, gender, and education emerged as predictors of support provided at baseline. Receipt of support was positively related to support provision at all three time points, both within and across support types. DISCUSSION: Findings indicated that there may be feasible ways of providing support, even by older adults who are in need of support themselves. [ABSTRACT FROM AUTHOR]

Objective: To identify best practices to support and grow the frontline nursing home workforce based on the lived experience of certified nursing assistants (CNAs) and administrators during COVID-19., Study Setting: Primary data collection with CNAs and administrators in six New York metro area nursing homes during fall 2020., Study Design: Semi-structured interviews and focus groups exploring staffing challenges during COVID-19, strategies used to address them, and recommendations moving forward., Data Collection: We conducted interviews with 6 administrators and held 10 focus groups with day and evening shift CNAs (n = 56) at 6 nursing homes. Data were recorded and transcribed verbatim and analyzed through directed content analysis using a combined inductive and deductive approach to compare perceptions across sites and roles., Principal Findings: CNAs and administrators identified chronic staffing shortages that affected resident care and staff burnout as a primary concern moving forward. CNAs who felt most supported and confident in their continued ability to manage their work and the pandemic described leadership efforts to support workers' emotional health and work-life balance, teamwork across staff and management, and accessible and responsive leadership. However, not all CNAs felt these strategies were in place., Conclusions: Based on priorities identified by CNAs and administrators, we recommend several organizational/industry and policy-level practices to support retention for this workforce. Practices to stabilize the workforce should include 1) teamwork and person-centered operational practices including transparent communication; 2) increasing permanent staff to avoid shortages; and 3) evaluating and building on successful COVID-related innovations (self-managed teams and flexible benefits). Policy and regulatory changes to promote these efforts are necessary to developing industry-wide structural practices that target CNA recruitment and retention., (© 2022 Health Research and Educational Trust.)

This qualitative study aimed to provide an in-depth understanding of the challenges experienced by certified nursing assistants and administrators during the unprecedented COVID-19 crisis. We conducted 6 administrator interviews and 10 remote focus groups with day and evening CNAs at 5 nursing homes ( N = 56) in downstate New York. Content analysis was conducted, and emerging themes were identified across sites and roles. Results showed numerous challenges for both CNAs and administrators including many that were personal. These personal challenges included feeling helpless, anxious, or fearful; experience of COVID illness; and balancing high concurrent demands of work and family. There were also many operational challenges such as a lack of COVID testing capacity, information, and consistent guidance and support, staffing and equipment. Understanding these challenges can facilitate goals to promote future safety, skill refinement, and enhanced resilience in the workforce.

Objectives: Alcohol and substance misuse has been under-acknowledged and underidentified in older adults. However, promising treatment approaches exist (e.g., brief interventions) that can support older adults with at-risk alcohol and substance use. Postacute rehabilitation settings of Skilled Nursing Facilities (SNFs) can offer such programs, but little is known about patient characteristics that are associated with the likelihood of participating in interventions offered in postacute rehabilitation care. Thus, the objective of this study was to identify individual patient characteristics (predisposing, enabling, and need-related factors) associated with participation in a brief alcohol and substance misuse intervention at a SNF., Methods: This cross-sectional study analyzed medical record data of postacute care patients within a SNF referred to a substance misuse intervention. Participants were 271 patients with a history of substance misuse, 177 of whom enrolled in the intervention and 94 refused. Data collected upon patient admission were used to examine predisposing, enabling, and need-related factors related to likelihood of program participation., Results: Older age and ethnic minority status were associated with a reduction in likelihood to participate, while widowhood increased the likelihood of participation., Conclusion: Upon referral to a substance misuse intervention, clinicians in SNFs should be cognizant that some patients may be more likely to refuse intervention, and additional efforts should be made to engage patients at-risk for refusal., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

The majority of older adult nursing home residents have dementia and are at risk of not having their care needs met, largely due to communication deficits. Promoting comfort and minimizing distress for these residents is important. Direct care workers (DCW) and clinical staff completed a 6-day training on a person-directed care (PDC) model-a model guided by the needs of the individual that focuses on empowering DCW to understand and support resident preferences and remaining abilities supported by relationship development and consistent staffing. A retrospective comparison was conducted of residents in two PDC communities with matched residents (n = 72) and three traditional communities (n = 72) on functional and clinical outcomes over a 6-month period. A two-way analysis of variance showed a significant interaction between group and time, where only those in the PDC group had a decreased number of clinical symptoms (e.g., pain, depression, agitation) over time. This study found support for the benefit of PDC on clinical outcomes of interest over time. PDC training for DCW and clinical staff promotes quality care and the reduction of clinical symptoms, leading to improved quality of life. [Journal of Gerontological Nursing, 46(8), 7-11.]., (Copyright 2020, SLACK Incorporated.)

The choice to utilize hospice care in the nursing home when residents are experiencing progressive decline can promote positive quality of care and comfort for residents at the end of life. Concurrent hospice and nursing home care can be less aggressive, and improve symptom management and perceived quality by family members. Using a secondary analysis of retrospective data from the electronic medical record, this study identified predictors of hospice use among 300 nursing home decedents using a six-month look back period. Findings showed that having poorer physical status (weight loss), cognitive status, and having had a "goals of care" conversation were significantly associated with greater likelihood of using hospice in the nursing home in the last six months of life. Interdisciplinary team members who provide care on a daily basis and are in a position to detect worsening medical condition of residents and can facilitate advance planning. Care planning that includes examining goals of care and communication with hospice providers when multiple care providers are involved is essential.

Older adults with vision loss and a friend or family member were interviewed over a 2-year period. We examined the effects of driving cessation on life satisfaction among older adults and a social contact. Drivers' use of public transportation was examined as a moderator. Driving cessation was associated with a decline in life satisfaction among social partners but not for the drivers. Drivers' use of public transportation at baseline moderated the effects of cessation on changes in well-being among social partners, but had little effect on the life satisfaction of the drivers. Life satisfaction was greater among the social partners of ex-drivers who used public transportation more frequently. The association between driving cessation and well-being should be studied in the context of older drivers' social networks. Infrastructure (e.g., subways and buses) that supports transportation needs plays an important role in mitigating the effects of cessation on older adults' social networks.

Nursing home residents with advanced dementia experience significant symptom burden and may be unable to articulate their needs. Observational tools, such as the Pain Assessment in Advanced Dementia (PAINAD) scale, are available to evaluate changes in behavior that may signify discomfort or pain. Studies proposing a short and effective curriculum, primarily for certified nursing assistants (CNAs) on how to use and incorporate the PAINAD in daily patient care, are scarce. This performance improvement project involves the design and implementation of a training curriculum for CNAs for using the PAINAD and discusses barriers to be considered for further projects. Certified nursing assistant perceptions of their experience with the training and the use of the tool were also assessed with a brief evaluation. Seventy-three initial PAINAD forms were completed along with 52 follow-up PAINAD forms. A paired t test (N = 52) showed a significant decrease in the PAINAD scores from initial (mean, 6.06) to follow-up (mean, 1.85) (P < .001), suggesting a reduction of patient discomfort. The process of collecting and examining these data was meant to reinforce the identification and reduction of behavioral distress through the application of this tool. The training was perceived as effective and the tool as easy to use, indicating it can be incorporated into daily care responsibilities of CNAs.

Aims and Objectives: To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire., Background: Although depression is common among nursing homes residents, its recognition remains a challenge., Design: Observational baseline data from a longitudinal intervention study., Methods: Sample of 155 residents from 12 long-term care units in one US facility; 50 were interviewed in Spanish. Convergence between clinician and researcher ratings was examined for (i) self-report capacity, (ii) suicidal ideation, (iii) at least moderate depression, (iv) Patient Health Questionnaire severity scores. Experiences by clinical raters using the depression assessment were analysed. The intraclass correlation coefficient was used to examine concordance and Cohen's kappa to examine agreement between clinicians and researchers., Results: Moderate agreement (κ = 0.52) was observed in determination of capacity and poor to fair agreement in reporting suicidal ideation (κ = 0.10-0.37) across time intervals. Poor agreement was observed in classification of at least moderate depression (κ = -0.02 to 0.24), lower than the maximum kappa obtainable (0.58-0.85). Eight assessors indicated problems assessing Spanish-speaking residents. Among Spanish speakers, researchers identified 16% with Patient Health Questionnaire scores of 10 or greater, and 14% with thoughts of self-harm whilst clinicians identified 6% and 0%, respectively., Conclusion: This study advances the field of depression recognition in long-term care by identification of possible challenges in assessing Spanish speakers., Relevance to Clinical Practice: Use of the Patient Health Questionnaire requires further investigation, particularly among non-English speakers. Depression screening for ethnically diverse nursing home residents is required, as underreporting of depression and suicidal ideation among Spanish speakers may result in lack of depression recognition and referral for evaluation and treatment. Training in depression recognition is imperative to improve the recognition, evaluation and treatment of depression in older people living in nursing homes., (© 2017 John Wiley & Sons Ltd.)

Objectives: Use of exercise technologies has benefits for community-dwelling older adults in terms of improved gait and balance. But research on the feasibility of use of exercise technologies in various geriatric health care settings is lacking. Hence, the current study examined the feasibility of implementing an exercise technology intended to augment rehabilitation in patients receiving post-acute care (PAC) in a skilled nursing facility (SNF). We focused on 3 indicators of feasibility: extent of usage (including predictors of more intense use), patients' acceptability of the technology, and limited efficacy., Design: Cross-sectional study with data from patients' electronic medical records (EMR), exercise technology portal, and patient interviews., Setting: SNF., Participants: A sample of post-acute patients (n = 237)., Measurements: Sociodemographic and health-related variables, time spent using the technology, and 8 items of the Physical Activity Enjoyment Scale (PACES)., Results: Average time spent using the technology varied greatly (range, 1-460 minutes). A regression analysis showed that patients who had a longer length of stay (β = .01, P < .05) and were younger (β = -0.01, P < .05) spent significantly more time using the technology. Acceptability of technology was high among patients. Finally, patients who used the technology had lower 30-day rehospitalization rates., Conclusion: Exercise technology is feasible to use in supporting rehabilitation in patients receiving PAC in a SNF and seems to have beneficial effects., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To examine personal characteristics, disease-related impairment variables, activity limitations, and environmental factors as correlates of social participation in older adults with vision loss guided by the World Health Organization's International Classification of Functioning, Disability and Health Model., Design: Baseline data of a larger longitudinal study., Setting: Community-based vision rehabilitation agency., Subjects: A total of 364 older adults with significant vision impairment due to age-related macular degeneration., Main Measures: In-person interviews assessing social participation (i.e. frequency of social support contacts, social/leisure challenges faced due to vision loss, and of social support provided to others) and hypothesized correlates (e.g. visual acuity test, Functional Vision Screening Questionnaire, ratings of attachment to house and neighborhood, environmental modifications in home)., Results: Regression analyses showed that indicators of physical, social, and mental functioning (e.g. better visual function, fewer difficulties with instrumental activities of daily living, fewer depressive symptoms) were positively related to social participation indicators (greater social contacts, less challenges in social/leisure domains, and providing more support to others). Environmental factors also emerged as independent correlates of social participation indicators when functional variables were controlled. That is, participants reporting higher attachment to their neighborhood and better income adequacy reported having more social contacts; and those implementing more environmental strategies were more likely to report greater challenges in social and leisure domains. Better income adequacy and living with more people were related to providing more social support to others., Conclusion: Environmental variables may play a role in the social participation of older adults with age-related macular degeneration.

Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N = 300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.

The present study addresses older adults' developmental regulation when faced with progressive and irreversible vision loss. We used the motivational theory of life span development as a conceptual framework and examined changes in older adults' striving for control over everyday goal achievement, and their association with affective well-being, in a sample of 364 older adults diagnosed with age-related macular degeneration. Using longitudinal data from 5 occasions at 6-month intervals, we examined intraindividual change in control strategies, and how it was related to change in affective well-being, in terms of self-rated happiness and depressive symptoms. Mixed model analyses confirmed our hypotheses that (a) intraindividual change, particularly in selective primary control and in compensatory secondary control (CSC), predict change toward higher happiness ratings and lower depression; and (b) as functional abilities (instrumental activities of daily living) declined, CSC became increasingly predictive of better affective well-being. Overall, the findings suggest that CSC strategies are essential for maintaining affective well-being when physical functioning declines. Intensified selective primary control striving may be effective to achieve goals that have become difficult to reach but are not associated with affective well-being, possibly because struggling with difficulties undermines the experience of enjoyable mastery. In contrast, goal adjustments and self-protective thinking may help to find pleasure even from restricted daily activities., ((c) 2016 APA, all rights reserved).)

With the progression of dementia, the need for families and health care providers to have discussions about end-of-life (EOL) treatments arises. EOL treatment decisions often involve whether or not medical interventions intended to prolong life-such as resuscitation, artificial nutrition and hydration, and use of antibiotics-are desired. It is unclear if family satisfaction with care in the nursing home may be associated with involvement in EOL treatment discussions. The frequency of discussions that family members reported having with health care team members regarding multiple life-sustaining treatments and symptom management for their relatives with advanced dementia were examined over a 6-month period along with the association of these particular discussions with care satisfaction over time. Results showed that greater frequency of discussion of EOL treatment wishes was positively associated with higher care satisfaction scores among family members of nursing home residents with dementia. When considered together, greater frequency of discussion of artificial hydration was uniquely associated with greater care satisfaction and increased care satisfaction over time. Social workers must ensure that EOL treatment discussions with older adults in the nursing home and their family members take place and that preferences are communicated among the various interdisciplinary health team members.

Purpose: This was a Phase II pilot study of a problem-solving treatment (PST) to address subsyndromal depression in residents of long-term care facilities. Our goal was to demonstrate PST implementation feasibility and to identify PST's potential for reducing depressive symptoms in this geriatric health care setting., Methods: Eligible participants were randomized to receive a PST treatment (six 1-hour sessions) or a social contact comparison (6 "friendly" visits) after an initial baseline assessment. Follow-up assessments occurred 7 weeks later (after treatment) and 2 months posttreatment. The basic analytic approach was based on an intention-to-treat analysis., Findings: We enrolled 21 elderly subjects in the PST group and 16 elderly subjects in the social contact comparison group. The PST group experienced a decline in depression scores compared with the social contact group. Although not statistically significant (likely due to the small sample size), PST was associated with decreased depressive symptom scores for those who were able to complete the intervention. Implementation proved to be difficult in terms of study recruitment and intervention acceptance and adherence., Implications: These study findings point to the potential benefits of an integrated mental health component in long-term care, involving rehabilitation professionals who are already working with the older adults in both postacute/short-stay and long-stay settings., (Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.)

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.

Objectives: The life-span theory of control is applied to study change in vision-specific control strategies in visually impaired older individuals, depending on performance in instrumental activities of daily living (IADL) and depressed mood., Method: Longitudinal data from visually impaired individuals (at baseline: N = 364; mean age = 82.8 years; visual acuity less than 20/60) measured at three occasions with 1-year intervals in-between were analyzed. A newly established vision-specific control scale to assess selective primary control (SPC), selective secondary control (SSC), compensatory primary control (CPC), and compensatory secondary control (CSC) was used. Linear and nonlinear (quadratic and piecewise) generalized mixed models with gamma response distribution to fit the skewed data were applied., Results: CPC progressively increased as IADL capacity decreased up to a turning point, at which CPC plateaued, whereas all other strategies declined linearly with IADL decrease. Controlling for depressed mood did not change these relationships for CPC, SPC, and SSC but absorbed IADL-related decline of CSC. Higher depression was associated with less SPC, SSC, and CSC, but only slightly with less CPC., Discussion: IADL plays an important role triggering a shift in adaptational strategies from selective control to CPC in visually impaired older adults and possibly other disabled populations.

Objectives: This study's purpose was to investigate changes in perceived overprotection - a problematic aspect of close relationships - over time in relationship to instrumental support receipt and vision rehabilitation service use in a sample of older adults with vision impairment., Methods: Participants were 584 older adults with chronic vision impairment who were interviewed three times over a 12-month period. Longitudinal data were analysed using a latent growth curve methodology to examine change over time in perceived overprotection and instrumental support in relation to vision rehabilitation service use., Main Outcome Measures: Self-reported levels of overprotection and receipt of instrumental support. Results. Over time perceived overprotection increased but not instrumental support. While perceived overprotection was positively associated with instrumental support initially, over time this relationship did not emerge. Perceived overprotection and instrumental support functioned as predictors of vision rehabilitation hours. However, over time vision rehabilitation service use did not influence these social supports., Conclusions: Perceived overprotection increases over time, yet this change is unaffected by rehabilitation service use and instrumental support. Both family members and elders need to be involved in the vision rehabilitation process and educated about how some level of independence can be regained.

Objective: To provide an in-depth assessment of challenges faced by older adults with recent vision loss and to determine changes in the nature of these challenges over time for the purpose of informing the design of vision rehabilitation services., Design: Longitudinal, qualitative study with three time points., Setting: Vision rehabilitation agency., Subjects: Three hundred and sixty-four older adults aged 65 with significant vision impairment due to age-related macular degeneration., Interventions: In-person interviews conducted at baseline, one year and two years and coded using a qualitative analytical approach., Main Measures: Open-ended questions assessing challenges faced due to vision loss in functional, social and psychological life domains., Results: Almost all participants reported a wide variety of challenges across all three domains with the most variety in the functional domain. Over a two-year period, functional challenges (e.g. using transportation) increased, social challenges (e.g. recognizing people) remained stable, and psychological challenges (e.g. negative affect) decreased overall., Conclusions: Although functional challenges are predominant, social and psychological challenges are quite common and need to be addressed in vision rehabilitation. Rehabilitation planning should also consider that vision-related challenges can change over time.

Objectives: Distressing behavioral symptoms often associated with dementia are not uncommon in the long term care setting. Culture change with its "person-centered approach to care" provides a potential nonpharmacological intervention to reduce these symptoms. The purpose of this study was to examine the relationship between a culture change initiative and nursing home elders' behavioral symptoms., Design: Seven long term care communities (nursing units in 3 skilled nursing facilities) participated in a culture change intervention designed to transform the nursing home experience from a traditional hospital-model of care to one that is person-centered. Six comparison communities were matched to the intervention communities and continued to function along the typical nursing home organizational structure. Data were collected at baseline and 2 years later., Methods: Subjects were 101 elders (intervention group n = 50, comparison group n = 51). Each elder's primary day certified nursing assistant completed the Cohen-Mansfield Agitation Inventory, examining frequency of behavioral symptoms, including verbal and physical agitation as well as more forceful behaviors (eg, hitting, kicking) at both data collection periods., Results: After controlling for functional status and race, a significant condition by time interaction was found for physical agitation and forceful behaviors with the person-centered group maintaining levels of behavioral symptoms as compared with a significant increase over time among the comparison group. A trend with the same pattern was found for verbal agitation., Conclusions: Person-centered care demonstrated potential as a nonpharmacological intervention for distressing behavioral symptoms. The positive impact of culture change appears to extend to elders with cognitive impairment who are less obvious beneficiaries of this model, featuring the central principals of autonomy and person-centered care., (Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Objective: To examine whether vision impairment is a predictor of intensity of occupational therapy utilization and outcomes in a sample of older adults ages ≥55 receiving subacute rehabilitation in a long-term care setting., Method: Data for this cohort study were collected by means of structured, in-person interviews with 100 older adult rehabilitation patients at admission to a subacute unit in a long-term care facility and by medical chart review after discharge., Results: Regression analyses indicated that after controlling for sociodemographic, health, and social support variables, worse contrast sensitivity was a significant predictor of decreased time in occupational therapy, and worse visual acuity was a significant predictor of higher functional dependency at discharge., Conclusion: Vision impairment may prevent full use of occupational therapy and hinder occupational therapy efficacy in subacute care settings. Study findings underscore the importance of developing low vision rehabilitation interventions that can be delivered in conjunction with more traditional subacute rehabilitation., (Copyright © 2012 by the American Occupational Therapy Association, Inc.)

Objective: A growing number of nursing homes across the country are embarking on culture change transformations that focus on maximizing elder residents' quality of life (QOL). Challenges to culture change implementation include the wide range of possible interventions as well as a lack of research-based evidence to guide these choices. The purpose of this study was to determine those components of nursing home QOL that are associated with elder satisfaction so as to provide direction in the culture change journey., Design: A cross-sectional study using a survey administered face-to-face., Setting: Three large urban nursing homes within a long term care system in New York State., Participants: Sixty-two elder nursing home residents participated in face-to-face interviews. All elders had resided in their nursing communities for at least 3 months before participation., Measurements: The survey included the Quality of Life Scales for Nursing Home Residents, which examines elder QOL in 11 domains: autonomy, dignity, food enjoyment, functional competence, individuality, meaningful activity, physical comfort, privacy, relationships, security, and spiritual well-being. Elder satisfaction with the nursing home and nursing home staff were also examined., Results: After accounting for cognitive and physical functioning, among the QOL domains, dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction. Additionally, dignity remained a significant predictor of elder satisfaction with staff., Conclusion: These results provide one possible path in the culture change journey based on empirical findings., (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)

This study used vision loss due to age-related macular degeneration to learn about adaptation processes related to chronic functional impairment, focusing on Horowitz and Reinhardt's (1998) concept of Adaptation to Age-related Vision Loss (AVL) as the outcome. We hypothesized that impacts of visual acuity on AVL are mediated by perceived functional vision losses and functional abilities, and tested for "adaptive" weakening of this impact with ongoing loss. Longitudinal data covering a one-year interval from samples with age-related macular degeneration gathered in New York (N = 361) and Heidelberg (Germany, N = 90) were used. We analyzed the hypothesized causal structure by modeling latent change scores, and checked if those with low, medium, and high levels of vision loss at baseline differ in the relations between one-year change scores. Results confirmed that impacts of vision loss on AVL are mediated by decline in functional ability. However, under the most severe levels of vision loss at baseline, functional decline showed only a minor impact on AVL change not explained by a lack of further decline in vision. Findings confirm the effectiveness of adaptation in terms of reduced reactivity to functional losses across increasing level of chronic impairment. Thus, adaptation, weakening the impact of chronic functional impairment on psychological outcomes over time with disease progression, deserves consideration in the study of psychological consequences of chronic physical health conditions in old age., ((c) 2011 APA, all rights reserved.)

This study used the life-span theory of control (Heckhausen, J., & Schulz, R.) to examine adaptation to disability in old age. A narrative approach to data collection was used to assess the strategies employed by 364 older adults with macular degeneration to deal with daily challenges. Findings revealed a rich array of strategies. Compensatory Primary Control was reported by nearly all respondents, Compensatory Secondary Control by a majority, and Selective Primary Control by half of the participants. Selective Secondary Control was the least reported. Differences in strategy use depending on level of vision impairment were the most pronounced within the category of Compensatory Primary Control for strategies that involved using help from others and alternative means. Within the category of Selective Secondary Control, effort to maintain a positive outlook was associated with higher impairment levels, whereas within the category of Compensatory Secondary Control, attempts not to dwell on problems related to vision were associated with lower impairment levels. Implications for conceptual development and future research are discussed.

This study draws on an evolutionary model of exchange in relationships to examine the nature of perceived reciprocity in the context of kin and non-kin relationships among a sample of visually impaired older adults (age 63-99). Further, we examined the direct and moderating impact of functional impairment and adaptation to visual impairment on the nature of perceived reciprocity. Results showed that the greater the degree of genetic relatedness the more imbalanced the exchange. It was also found that degree of adaptation to visual impairment moderated the association between genetic relatedness and perceived exchange, such that the greater the degree of genetic relatedness the more people reported they gave rather than received except at very low levels of adaptation, when people received more than they gave the greater the degree of genetic relatedness. Thus, an evolutionary model was supported such that imbalanced exchange was found more with greater degrees of genetic relatedness, but the direction of exchange was different for high versus low levels of adaptation to vision impairment.

Objectives: To examine the effect of personal (coping strategies and locus of control) and social resources (family and friendship support) on adjustment to chronic vision impairment in older adults at baseline (rehabilitation service application), 6 months, and 18 months later., Method: 313 community dwelling, English speaking older adult applicants to a vision rehabilitation agency in the northeast were interviewed in their homes following informed consent., Results: A larger portion of variability was accounted for in positive compared to negative outcomes. Greater use of acceptance coping, less use of wishfulness coping, lower endorsement of chance locus of control, and higher family support were associated with better baseline adaptation, yet these predictors had little effect on short- or long-term change in adaptation. Higher friendship support predicted increased adaptation to vision loss at both follow-up points. Friendship support was also associated with decreased depression at Time 3, and lower use of wishfulness was related to decreased depression at Time 2., Conclusion: Results showed differential effects for positive versus negative outcome variables, short- versus long-term adaptation, personal and social resources, and within social resources, for family versus friendship support.

Objective: To enhance our understanding of coping and rehabilitation in the context of adaptation to disability by examining how coping may change over a two-year time period, and how different vision rehabilitation services may affect coping over time., Design: Longitudinal two-wave study (baseline and two-year follow-up)., Setting: Vision rehabilitation agency., Subjects: Older adults with visual impairment., Method: In-person interviews using structured assessments of functional vision loss and functional disability, rehabilitation service use and coping strategies., Results: Ninety-five people participated in both study waves. Findings showed change in patterns of coping over the two-year period of the study, as participants adjusted to living with age-related vision loss. Although instrumental coping was the only coping mode with evidence for average change (a decrease), affective and escape/distraction strategies showed individual variation in change over time. Rehabilitation use explained variance in coping at time 2 over and above impairment status and coping at time 1. Those who used a greater number of assistive aids between time points were likely to report more instrumental coping at time 2, and those who used counselling between time points were likely to report more affective coping at the two-year follow-up. Finally, those who used more optical aids were likely to report more escape/distraction coping at time 2, whereas those who saw a low vision specialist tended to report less of this type of coping over time., Conclusions: Findings suggest that rehabilitation interventions can affect coping patterns over time, and that direction and magnitude of such an effect may depend on the type of rehabilitation received.

There has been a great deal of interest in identifying the impact of rehabilitation on psychological well-being, as well as functional ability, among elders with disabilities, but empirical data remain limited. This descriptive study of participants in vision rehabilitation service examines the effect of specific vision rehabilitation services (low vision clinical services, skills training, counseling, optical device use, and adaptive device use) on change in depression among a sample of older adults with age-related vision impairments. Participants (N = 95) were interviewed at application for services and then approximately two years later. Findings from hierarchical regression analyses indicated that low vision clinical services, counseling, and use of optical devices, in separate models, each significantly contributed to a decline in depression, after controlling for age, health status, vision status, functional disability, as well as baseline depression. When all service variables were entered into the same equation, they explained an additional 10% of the variance in change in depression. Given the well documented robust relationship between disability and depression, findings point to the influence of vision rehabilitation interventions on both physical and psychological functioning, and underscore the need for future, controlled research on rehabilitation service models that address mental health issues.

Objective: Authors examined the potential risk factors of major and subthreshold depression among elderly persons seeking rehabilitation for age-related vision impairment., Methods: Participants (N=584), age 65 and older, with a recent vision loss, were new applicants for rehabilitation services. Subthreshold depression was defined as a depressive syndrome not meeting criteria for a current major depression (i.e., minor depression, major depression in partial remission, dysthymia) or significant depressive symptomatology., Results: Seven percent of respondents had a current major depression, and 26.9% met the criteria for a subthreshold depression. Poorer self-rated health, lower perceived adequacy of social support, decreased feelings of self-efficacy, and a past history of depression increased the odds of both a subthreshold and major depression, versus no depression, but greater functional disability and experiencing a negative life event were significant only for a subthreshold depression. Only a history of past depression was significant in increasing the odds of having a major versus a subthreshold depression., Conclusion: Results highlight similarities in characteristics of, and risk factors for, subthreshold and major depression. Future research is needed to better understand both the trajectory and treatment of subthreshold depression, relative to major depressive disorders.

Purpose: This study examines the extent and independent correlates of congruence between disabled elders and their caregivers on several aspects of the caregiving experience., Design and Methods: Participants were 117 visually impaired elders and their caregivers. Correlational analyses, kappa statistics, and paired t tests were used to examine the extent of congruence. Hierarchical multiple regression analyses identified significant correlates of congruence on four target issues: elder's functional disability, elder's adaptation to vision impairment, caregiver's overprotectiveness, and caregiver's understanding of the vision problem., Results: Caregivers assessed elders as more disabled and rated themselves as more overprotective than did the elders. Although independent correlates varied by target issue, two domains most consistently influenced congruence across measures: the caregiver's assessment of the elder's status and quality of the relationship., Implications: Findings underscore the importance of addressing congruence by target issue, rather than as a global characteristic of the caregiving relationship.

Objective: This article examines stability and change in social negativity and the links between social negativity and instrumental support over time among disabled older adults. The analyses focused on family relationships because social negativity tends to be more prevalent in family compared with nonkin relationships. Social negativity received and initiated are each addressed separately to determine whether or not they show similar patterns and links to instrumental support over time., Methods: Latent growth curve methodology was used to examine change over time in social negativity and instrumental family support in relation to age, gender, and family network size at baseline. Participants, 570 older adults with chronic visual impairment, were interviewed three times over an 18-month period., Results: Social negativity received showed a decrease over time, whereas levels of social negativity initiated remained more stable. Links with instrumental support were positive but stronger for received compared with initiated social negativity., Discussion: The differential pattern of stability and change over time in received versus initiated social negativity and their links to instrumental support suggest different origins for the initiation versus receipt of social negativity.

Hierarchical linear modeling was used to examine the degree of individual change in friendship and family networks and support over time as a function of sociodemographic characteristics, rehabilitation use, and disability. Participants, 449 older adults, had age-related vision loss, a common, chronic impairment that tends to worsen over time. Three interviews were conducted (baseline and 6- and 18-month follow-ups). All network and support variables showed a decrease over time. Regarding factors predicting individual variation, age (younger) and education (lower) were associated with greater baseline friendship support, rehabilitation was related to maintaining a larger friend network, and disability was positively associated with family network and support. Results supported the importance of examining rates of individual change and factors associated with variability in multiple support components by relationship type.

This study examined the influence of health, social support, disability, and vision rehabilitation services on depression among visually impaired older adults seeking vision rehabilitation services. Participants (n = 95) were interviewed at application and approximately two years later. The first hierarchical regression model focused on concurrent relationships at baseline. The second model used baseline health and social support variables, along with indicators of change in vision and use of rehabilitation services, in order to predict change in depression over time. Findings indicate that being unmarried, in poorer health, having lower quality of relationships with family, and lower stability in friendships were significant independent risk factors for initial depression, explaining 50% of the variance. Decline in depression over time was predicted by younger age, better self-rated health, stability of friendships, and use of rehabilitation services that, along with baseline depression, explained 61% of the variance in depressive symptomatology at the two-year follow-up. Findings highlight the importance of qualitative aspects of social support for older disabled adults, as well as the distinction that needs to be made between factors that predict concurrent mental health status and those predicting change in status over time.

The interactive relationship of high and low friend and family support for adaptation to chronic vision impairment was examined in 241 men and women. Two 2 (High/Low Family Support) x 2 (High/Low Friend Support) x 2 (Gender) multivariate analyses of covariance tested for psychological well-being, one with qualitative support measures, the other with quantitative support measures. Two analyses of covariance models tested for adaptation to vision loss. A significant multivariate 3-way interaction effect for qualitative support was found. Women with high support from both friends and family had better psychological well-being, whereas men with high support from both friends and family or just from family had better psychological well-being. Two univariate main effects showed that participants with high qualitative friend support and high quantitative family support had better adaptation to vision loss. Findings demonstrate the complexity of measuring and understanding relationships among social support, well-being, and domain-specific adaptation to chronic impairment.

The importance of friendship and family support in adaptation for 241 elders experiencing age-related vision loss was examined. Adaptation was operationalized with two global measures of psychological well-being (life satisfaction, depressive symptoms) and a domain-specific measure, adaptation to vision loss. Hierarchical regression analyses tested the effects of sociodemographic, vision, health, and functional disability variables in the first step, family support quality in the second step, and friendship support quality in the third step. Variables entered at each step contributed significant portions of explained variance in outcome variables. Thus, the importance of friendship support, independent of family support, in adaptation to chronic impairment was demonstrated. The effect of relationship type and gender on multiple support components was also assessed. Scores for family support were higher than those for friend support on almost all components. Close relationships were perceived as providing greater attachment in females and greater instrumental assistance and social integration in males.

We explored personal autonomy issues within family caregiving relationships and found little evidence of significant autonomy conflicts. Findings did suggest, however, that family members were more sensitive to autonomy issues than were their frail older relatives and that both groups defined the disability itself as the major impediment to autonomy in later life. Findings support the usefulness of an expanded definition of autonomy, emphasizing the importance of goal-directed behavior, which may be inhibited by intrinsic conditions as well as external forces.