Determinants of the Rigor of State Protection Policies for Persons With Dementia in Assisted Living

Continued growth in the number of individuals with dementia residing in assisted living (AL) facilities raises concerns about their safety and protection. However, unlike federally regulated nursing facilities, AL facilities are state-regulated and there is a high degree of variation among policies designed to protect persons with dementia. Despite the important role these protection policies have in shaping the quality of life of persons with dementia residing in AL facilities, little is known about their formation. In this research, we examined the adoption of AL protection policies pertaining to staffing, the physical environment, and the use of chemical restraints. For each protection policy type, we modeled policy rigor using an innovative point-in-time approach, incorporating variables associated with state contextual, institutional, political, and external factors. We found that the rate of state AL protection policy adoptions remained steady over the study period, with staffing policies becoming less rigorous over time. Variables reflecting institutional policy making, including legislative professionalism and bureaucratic oversight, were associated with the rigor of state AL dementia protection policies. As we continue to evaluate the mechanisms contributing to the rigor of AL protection policies, it seems that organized advocacy efforts might expand their role in educating state policy makers about the importance of protecting persons with dementia residing in AL facilities and moving to advance appropriate policies.     

Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care

Despite a shift from institutional services toward more home and community-based services (HCBS) for older adults who need long-term services and supports (LTSS), the effects of HCBS have yet to be adequately synthesized in the literature. This review of literature from 1995 to 2012 compares the outcome trajectories of older adults served through HCBS (including assisted living [AL]) and in nursing homes (NHs) for physical function, cognition, mental health, mortality, use of acute care, and associated harms (e.g., accidents, abuse, and neglect) and costs. NH and AL residents did not differ in physical function, cognition, mental health, and mortality outcomes. The differences in harms between HCBS recipients and NH residents were mixed. Evidence was insufficient for cost comparisons. More and better research is needed to draw robust conclusions about how the service setting influences the outcomes and costs of LTSS for older adults. Future research should address the numerous methodological challenges present in this field of research and should emphasize studies evaluating the effectiveness of HCBS.     

Two lives in transition: Agency and context for assisted living residents

This research uses data on two “focal case” individuals residing in one residential care/assisted living (RC/AL) facility, collected as part of a larger ethnographic study exploring later-life transitions, including those leading to the moves into housing and care settings. In-depth examination of the 10-year transition histories of these two women highlights the major erosion of autonomy with advancing frailty, illness, and relocation into supportive housing. A second major theme is that an understanding of the contemporary events and challenges for these two individuals is substantially enhanced by nesting them within the temporal context of earlier life events, including personal relationships, social events, and preferences. Individual history, elicited from resident, family, staff and professional views, serves to contextualize current choices and reactions to key events. As researchers, adding this temporal context moves our understanding of their identities well beyond a simplistic snapshot view as “resident” in AL.     

Translation of words and concepts in social policy

This paper describes how optimal matching or sequence analysis can be used to empirically evaluate the use of ideal typologies to describe the lifecourse. In our illustration, the lives of over 250 individuals, originally members of the Boyd Orr study as children in the 1930s, now in early old age (aged 65–75 years) have been reconstructed using sequence data derived from life grid interviews. Individuals are allocated to various ideal types for three distinct pathways or trajectories describing a person’s labour market, relationship and housing histories. Finally, these allocations are examined in relation to an individual’s self‐reported quality of life (QoL) in an attempt to explore the extent to which the experience of structurally advantaged or disadvantaged states are related to a good QoL in later life. Our findings suggest that individuals assigned to structurally advantaged statuses, in each of the trajectories, generally experience higher levels of QoL compared to those assigned to structurally disadvantaged positions. In particular, the single best predictor of high levels of self‐reported QoL is for those who became owner–occupiers late in life (typically council property purchasers). This suggests that the experience of stability during earlier parts of the lifecourse can provide opportunities within a de‐institutionalised lifecourse that we are witnessing at the beginning of the 21st century. The results suggest that the contemporary circumstances of older people are more important for their QoL. Yet, these circumstances are, in part, conditioned by their lifecourse.     

Intimate partner violence and PTSD: the moderating role of emotion-focused coping

Intimate partner violence (IPV) affects millions of women every year, often resulting in posttraumatic stress disorder (PTSD). The strength of the relationship between IPV and PTSD has been shown to be affected by factors such as the amount of violence exposure and the style of coping in which the individual engages. For example, emotion-focused coping has been shown to be strongly related to IPV exposure and the expression of PTSD symptoms. This topic was explored in IPV survivors, with the finding that more frequent use of emotion-focused coping was associated with both higher violence exposure and heightened PTSD symptoms. Regression analyses revealed that emotion-focused coping moderated the relationship between IPV exposure and PTSD symptoms. More specifically, the results suggest that while individuals low on emotion-focused coping had fewer PTSD symptoms than women who frequently used emotion-focused coping, these individuals reported higher PTSD symptoms in the presence of frequent violence exposure. For individuals who frequently engaged in emotion-focused coping, violence exposure was less strongly associated with symptoms of PTSD.     

Mindfulness: an intervention for anxiety in schizophrenia

Despite evidence that individuals with schizophrenia spectrum disorders experience significant and persistent symptoms of anxiety, there are few reports of the use of empirically supported treatments for anxiety in this population. This article describes how we have tried to adapt mindfulness interventions to help individuals with schizophrenia who experience significant anxiety symptoms. Although mindfulness has been widely used to help individuals without psychosis, to our knowledge, this is the first study adapting it to help those with schizophrenia manage worry and stress. We provide an overview of the intervention and use an individual example to describe how our treatment development group responded. We also explore directions for future research of mindfulness interventions for schizophrenia.     

Relational Autonomy in Assisted Living: A Focus on Diverse Care Settings for Older Adults

Consistent with Western cultural values, the traditional liberal theory of autonomy, which places emphasis on self-determination, liberty of choice, and freedom from interference by others, has been a leading principle in health care discourse for several decades. In context to aging, chronic illness, disability, and long-term care, increasingly there has been a call for a relational conception of autonomy that acknowledges issues of dependency, interdependence, and care relationships. Although autonomy is a core philosophy of assisted living (AL) and a growing number of studies focus on this issue, theory development in this area is lagging and little research has considered race, class, or cultural differences, despite the growing diversity of AL. We present a conceptual model of autonomy in AL based on over a decade of research conducted in diverse facility settings. This relational model provides an important conceptual lens for understanding the dynamic linkages between varieties of factors at multiple levels of social structure that shape residents' ability to maintain a sense of autonomy in this often socially challenging care environment. Social and institutional change, which is ongoing, as well as the multiple and ever-changing cultural contexts within which residents are embedded, are important factors that shape residents' experiences over time and impact resident-facility fit and residents' ability to age in place.     

Patient-perceived effectiveness and impact on quality of life of solifenacin in combination with an α-blocker in men with overactive bladder in Sweden: a non-interventional study

Treating male lower urinary tract symptoms (LUTS) by targeting the prostate would have limited effect on overactive bladder (OAB) symptoms. This study assessed perceived symptoms and quality of life (QoL) of male patients with OAB treated with an α-blocker plus solifenacin in daily clinical practice. Male patients aged ≥40 years were included after the decision was made to initiate treatment with an α-blocker for LUTS plus solifenacin for OAB symptoms. The primary endpoint was change in patient perception of bladder condition (PPBC) questionnaire score over 6?months. Other assessments included the OAB-questionnaire short form (OAB-q SF) and International Prostate Symptom Score (IPSS). Interpretation of the study data was hindered by not meeting the enrollment target and a high dropout rate. In 36 evaluable patients, mean (SD) PPBC score improved from 4.3 (0.93) at baseline (“moderate” to “severe” problems) to 3.5 (1.06) at month 6 (“minor” to “moderate” problems). OAB-q SF scores and total IPSS also improved. In this patient population, treatment with solifenacin and an α-blocker resulted in improvements in male patient perception of their LUTS and QoL, although the results should be interpreted with caution due to the low number of patients with complete data.     

Sexual Abuse Allegations by Children with Neuropsychiatric Disorders

All Swedish court cases from 2004 and 2006 concerning alleged child sexual abuse (sexual harassment excluded) were identified through criminal registers. Fourteen cases (one boy) concerned a child with a neuropsychiatric disorder. The diagnostic groups were mental retardation (10 cases), autism (three cases), and ADHD (one case). Psychiatric experts were engaged in only two cases. When experts were involved, the courts focused on credibility issues. When the courts applied neuropsychiatric arguments in the absence of an expert, they used developmental arguments. When the authors found that significant neuropsychiatric issues were not discussed by the court it concerned interpretations of symptoms and developmental standpoints. The results illustrate the complexity and pitfalls of drawing conclusions about associations between symptoms and personality characteristics on one side and accuracy of sexual abuse allegations on the other. Moreover, the results highlight the importance of a high quality system for providing courts with adequate neuropsychiatric knowledge.     

Sexual abuse allegations by children with neuropsychiatric disorders

All Swedish court cases from 2004 and 2006 concerning alleged child sexual abuse (sexual harassment excluded) were identified through criminal registers. Fourteen cases (one boy) concerned a child with a neuropsychiatric disorder. The diagnostic groups were mental retardation (10 cases), autism (three cases), and ADHD (one case). Psychiatric experts were engaged in only two cases. When experts were involved, the courts focused on credibility issues. When the courts applied neuropsychiatric arguments in the absence of an expert, they used developmental arguments. When the authors found that significant neuropsychiatric issues were not discussed by the court it concerned interpretations of symptoms and developmental standpoints. The results illustrate the complexity and pitfalls of drawing conclusions about associations between symptoms and personality characteristics on one side and accuracy of sexual abuse allegations on the other. Moreover, the results highlight the importance of a high quality system for providing courts with adequate neuropsychiatric knowledge.     

Perspective-taking and memory capacity predict social network size

Human social networks typically consist of a hierarchically organized series of grouping levels. There is, however, considerable variation between individuals in the sizes of any given network layer. We test between two possible factors (memory capacity and theory of mind) that might limit the size of two different levels within human social networks (support cliques and sympathy groups). We show that the size of an individual's support clique (the number of individual's in the innermost circle of friends) is better explained by individual differences in social cognition (mentalising skills). However, the size of the sympathy group (the most frequent social partners) is better explained by individual's performance on memory tasks.     

A scoping review of co-morbidity in individuals with disordered gambling

Individuals with disordered gambling often report at least one other lifetime psychiatric diagnosis. Although prevalence rates vary, there is substantial evidence for co-morbidity being the rule rather than the exception. Despite this known association, there has not been a recent comprehensive review of co-morbidity in disordered gambling other than prevalence surveys. The goal of this study was to broadly summarize and review the current literature on the extent, range and nature of disordered gambling co-morbidity. Following an initial search and screening of 6 databases, 251 articles were included in the final synthesis and evaluation. The main findings showed that few studies examine the mechanisms of co-morbidity in gambling beyond prevalence rates; few studies report on temporal sequencing of gambling and co-morbid disorders; there is a lack of treatment evaluation studies designed specifically for dual-diagnosis individuals; there is a need for system-level initiatives to address co-morbidity at the policy level; and the substance use literature may act as a useful model for guiding future gambling research on co-morbidity. The results suggest that despite a reasonable amount of published research on co-morbidity in disordered gambling, most study conclusions relegate to acknowledgements of high co-occurrence between disorders without follow-up.     

Addressing group dynamics in a brief motivational intervention for college student drinkers

Previous research indicates that brief motivational interventions for college student drinkers may be less effective in group settings than individual settings. Social psychological theories about counterproductive group dynamics may partially explain this finding. The present study examined potential problems with group motivational interventions by comparing outcomes from a standard group motivational intervention (SGMI; n = 25), an enhanced group motivational intervention (EGMI; n = 27) designed to suppress counterproductive processes, and a no intervention control (n = 23). SGMI and EGMI participants reported disruptive group dynamics as evidenced by low elaboration likelihood, production blocking, and social loafing, though the level of disturbance was significantly lower for EGMI individuals (p = .001). Despite counteracting group dynamics in the EGMI condition, participants in the two interventions were statistically similar in post-intervention problem recognition and future drinking intentions. The results raise concerns over implementing individually-based interventions in group settings without making necessary adjustments.     

An exploratory study examining needs,access, and competent social services for the transgender community in Phoenix,Arizona

ABSTRACT

Phoenix is the sixth largest city in the United States, with a vibrant yet underserved lesbian, gay, bisexual, transgender, and queer (LGBTQ) population. Despite an extensive community presence, social service delivery bias persists among members of the LGBTQ community, but more often among transgender individuals. Existing research has examined social services from the perspective of either the client or the practitioner. This exploratory study specifically examines social services in the Phoenix metropolitan area for the transgender community. Data collected from interviews with participants and providers contributed to an assessment of the current level of social services for the transgender community, with a specific emphasis on identifying service gaps and recommendations for culturally competent and comprehensive services.     

Establishing Continuity of Self-Memory Boxes in Dementia Facilities for Older Adults: Their Use and Usefulness

Spatial and detailed design aspects of dementia care centers deserve attention because they contribute to the overall experience of vulnerable individuals who need more support from the designed environment. This study examined the use and usefulness of memory boxes (wall-mounted display cases) at the entrances to resident rooms in dementia care facilities. Environmental walk-throughs, photodocumentation, memory box inventory, and staff interviews in three residential care facilities confirmed that memory boxes were beneficial in creating identity, assisting in orientation and wayfinding, and encouraging reminiscence. An additional use that emerged from this study was their usefulness as a tool for staff.     

Anger, irrational beliefs, and dysfunctional attitudes in violent dating relationships

The purpose of the present investigation was to evaluate whether perpetrators of dating violence could be differentiated from their nonviolent counterparts on measures of anger and cognitive distortion, specifically Ellis's (1994) irrational beliefs and Beck's (1976) dysfunctional attitudes. Of the 95 male and 152 female undergraduates surveyed, 27% (24 males and 43 females) reported using some form of physical aggression against their current dating partner in the past year. On a self-report measure of anger (State-Trait Anger Expression Inventory), violent individuals reported higher levels of Anger Out and lower levels of Anger Control compared to nonviolent participants. While there were no differences between violent and nonviolent participants' levels of Trait Anger, the results suggest that violent individuals have difficulty controlling angry feelings when they arise, which may increase the likelihood of externally directed forms of anger expression. No significant group differences emerged on questionnaire measures of irrational beliefs and dysfunctional attitudes. Within the violent sample, there was no differential pattern of correlations between measures of anger and cognition relative to the nonviolent sample. The present data suggest that while trait-based measures of cognitive distortion explain little variance in self-reported acts of dating violence, future research should investigate whether (a) cognitive distortions are present during affect-inducing partner conflict situations, or (b) vary with violence severity.     

‘Situative cognition’: barrier to teaching across cultures

In an unsettled world, the migration of significant numbers of individuals across national and even continental boundaries has changed the demographics of many nations with profound effects on their schools. Frequently, teachers are confronted with classes characterized by ethnic and cultural diversity for which they are either underprepared or totally unprepared. Despite their dedication, teachers have been shaped by their own cultural upbringing, and there may be a disconnect between their cultural values and identities and those of the children in their transformed classrooms. This disconnect has been called ‘situative cognition’. The challenge for teacher educators, particularly in western nations, is to enable prospective teachers to understand the complexity of educational dynamics in diverse classrooms, to examine their own experiences with diverse groups especially regarding culture, race, ethnicity and social class, and to develop strategies for working proactively with students in their own increasingly diverse communities.     

Abuse,neglect and exploitation in assisted living: an examination of long-term care ombudsman complaint data

Long-term care ombudsmen are advocates who empower and assist residents with complaints relating to quality of care and violations of resident rights in assisted living (AL) and skilled nursing facilities (SNF). Given that long-term care residents are vulnerable to elder abuse, neglect and exploitation (ANE), and existing gaps in the literature addressing ANE in AL, more research is needed to understand the prevalence of ANE in these communities. Ombudsman complaint data (n = 140,497 complaints) in 3,171 Texas long-term care facilities were analyzed using proportion Z tests. Findings showed that SNF had higher rates of ANE per resident. For both AL and SNF, verbal/psychological abuse was the most reported type of ANE and sexual abuse was the least reported. AL residents had disproportionately high rates of financial exploitation. We explored factors that may contribute to these findings and recommend strategies for preventing ANE.     

Detained girls' treatment engagement over time: The role of psychopathology and quality of life

Although treatment engagement is considered important to achieve positive outcomes, it is still not well known why some girls in detention are more engaged in treatment than others. This is the first study to examine to what extent psychopathology and self-perceived quality of life (QoL) are related to treatment engagement. Participants were 108 detained girls (M_age = 16.21) who completed standardized questionnaires about mental health problems and QoL, and were interviewed with a structured diagnostic interview to assess DSM-IV psychiatric disorders. One and two months after this baseline assessment, the girls reported how much they engaged in treatment. The results showed low levels of treatment engagement and no significant changes in treatment engagement over time. Overall, detained girls with internalizing disorders reported higher treatment engagement scores, while the reverse was true for girls with externalizing disorders. Regarding QoL, the girls with greater satisfaction about their physical and psychological health and about their environment reported higher treatment engagement, while the opposite was true for the domain of social relationships. Our findings emphasize the need for strength-based and motivational approaches and techniques in residential treatment programs for girls, in order to enable change.     

A Longitudinal Test of the Selective Exposure Hypothesis

Field research which supports the conclusion that mass mediacampaigns are ineffective has generally been difficult to interpretbecause of methodological limitations. Despite these limitations,the argument that individuals will expose themselves only toinformation which is consistent with their current attitudesis generally offered as an explanation for the negative results.The research reported here uses data from a public health massmedia campaign to test this selective exposure hypothesis. Usingthe variables of media campaign exposure, health knowledge,and health attitudes, the results indicate support for the effectivenessof the media campaign and little support for the selective exposurehypothesis.