Commentary: Barriers to a Sustained Restraint-Free Environment

A restraint-free culture is becoming a standard practice in the provision of long-term care services for older people, a standard by which licensure and accreditation agencies evaluate providers. Although most health care providers initiate restraint-elimination processes, many fail to achieve the intended result or sustain the practice because of a variety of barriers. Faltering organizations find themselves faced with monumental changes in administrative and supervisory staff, substantial recruitment and retention crises, and inadequate attention to a culture of continuous learning, teamwork, and leadership skill building. This article informs policy makers about the barriers to achieving and sustaining a restraint-free environment and suggests public policy agendas and processes to improve conditions for the aging population.     

The effect of variability in the fertility schedule on numbers of kin

The kinship formulas developed by Goodman, Keyfitz, and Pullum (1974) are extended to encompass populations in which fertility varies among women. An expression is derived to determine the amount by which the number of sisters in a heterogeneous population exceeds that in a population with homogeneous fertility. This expression, which is a function of the variance in the gross reproduction rate of the population, can readily be applied to numbers of other kin, such as aunts and cousins. Several trial calculations indicate that calculations of average numbers of sisters based on an assumption of uniform fertility could result in an underestimate of about 13 percent.     

Sex differences in life cycle measures of widowhood

Using formulas which measure life cycle characteristics of widowhood as a function of life table survivorship and age at marriage, we illustrate changes in patterns of widowhood and widowerhood since 1950, as well as differences by race, by age of bride and of groom, and by age differences between spouses. Although the current inequality in the risks of widowhood and widowerhood for the average couple is mostly due to sex differences in mortality, a one year age difference between spouses has about the same impact as does a one year difference in life expectancy. Calculations based on current distributions of age of groom by age of bride indicate that the older the age of groom, the greater the age difference between spouses and the higher the likelihood of a woman outliving her husband: the typical groom who marries in his fifties faces a 4 to 1 chance that he will be outlived by his spouse.     

The Post-Hospital Mental Patient and Family Therapy: Prospects and Populations*

Changes in the pattern of delivery of mental health services have led to dramatic increases in the number of patients discharged from mental hospitals. These post-hospital mental patients represent a new challenge to the field of family therapy. Of the approximately 1 million patient admissions to state and county mental hospitals, general hospitals, and private psychiatric hospitals, over 380,000 are married, and more than half of the remaining patients are estimated to be living with family. Almost 135,000 admissions receive family therapy during their hospitalization, and an estimated 650,000 mental patients will return to their families upon discharge.     

Some methodological problems in estimating incidence and prevalence in child sexual abuse research

Research into child sexual abuse is fraught with methodological problems. This paper provides an overview of some common aspects of them. Definitional inconsistencies are frequent, including that of child sexual abuse itself and what age limits define a child. Other methodological difficulties include determining the number of children sexually abused in any period of time, choice of sample, the type and number of questions asked, factors such as publicity associated with the historical period, and estimates of the rate of increase of child sexual abuse over time. It is suggested that greater consistency, particularly of definition, would assist comparative conclusions to be made with less ambiguity and greater validity.     

Demography of the marriage market in the United States

In this paper, a new index designed to measure the relative availability of unmarried men and women is introduced. Termed the "Availability Ratio," the measure is defined as the number of suitable persons divided by the average competition. Suitability, in turn, is defined in terms of race, age and education. After various experimental tests, particular age and eeducational constraints were empirically derived from marriage data. Persons of opposite sex sharing living quarters are tested as unavailable. Estimates are also made of those presumed to be unsuitable on the basis of the % of persons aged 45-74 who have never married. Adjustments for the census undercount are given. 1980 and 1970 estimates are presented for the US population. Subsequent analyses will focus on metropolitan areas, which are more likely to function as actual marriage markets in contrast to the nation as a whole. The substantive evidence indicates that women under 25 are in a good position to find a mate, but that after this age, their prospects deteriorate rapidly. The outlook is especially poor for the more educated women at older ages, especially black women. At ages 40-49, for example, there are fewer than 3 suitable men available for every 10 college-educated women. The results suggest that the combination of preferences of women for older men (or men's tastes for younger women), combined with higher survival rates for women at older ages, results in a very unbalanced market situationn for all but the youngest cohorts of men and women.     

Improved estimation procedures for multilevel models with binary response: a case-study

During recent years, analysts have been relying on approximate methods of inference to estimate multilevel models for binary or count data. In an earlier study of random-intercept models for binary outcomes we used simulated data to demonstrate that one such approximation, known as marginal quasi-likelihood, leads to a substantial attenuation bias in the estimates of both fixed and random effects whenever the random effects are non-trivial. In this paper, we fit three-level random-intercept models to actual data for two binary outcomes, to assess whether refined approximation procedures, namely penalized quasi-likelihood and second-order improvements to marginal and penalized quasi-likelihood, also underestimate the underlying parameters. The extent of the bias is assessed by two standards of comparison: exact maximum likelihood estimates, based on a Gauss–Hermite numerical quadrature procedure, and a set of Bayesian estimates, obtained from Gibbs sampling with diffuse priors. We also examine the effectiveness of a parametric bootstrap procedure for reducing the bias. The results indicate that second-order penalized quasi-likelihood estimates provide a considerable improvement over the other approximations, but all the methods of approximate inference result in a substantial underestimation of the fixed and random effects when the random effects are sizable. We also find that the parametric bootstrap method can eliminate the bias but is computationally very intensive.