Vital Conversations with Family in the Nursing Home: Preparation for End-Stage Dementia Care

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.     

Birth weight and mothers' adverse employment change

Low birth weight has been linked at the aggregate level to unemployment rates and at the individual level to subjective distress. We hypothesize that maternal underemployment, including unemployment, involuntary part-time work, and low wage work predicts decreased birth weight. The relationship of birth weight to maternal employment changes during pregnancy was studied prospectively in 1,165 singleton first births in the National Longitudinal Survey of Youth data set. Controlling for other significant risk factors, women who shifted from adequate employment to underemployment had significantly lighter babies. Plausible mediators of this relationship were explored, including prenatal health care, gestational age, and mother's weight gain, with results varying by type of underemployment. Two interactions also suggested that underemployment reduced the beneficial effect of mother's weight gain on birth weight. These findings were partially replicated for low birth weight (< 2,500 grams), indicating the medical significance of the effect.     

The identification of emotions from gait information

The present study examined the potential for information provided in a person's style of walking to reveal certain emotions. Ten subjects observed five walkers expressing four different emotions and made emotion identifications as well as judgments about specific gait characteristics. Results revealed that subjects were able to identify sadness, anger, happiness, and pride from gait information at better than chance levels; however, identifications of pride were significantly less accurate than were identifications of sadness and anger. In addition, subjects' acuracy varied across the five walkers. Results also revealed that gait characteristics such as the amount of arm swing, stride length, heavyfootedness, and walking speed differentiated the emotions expressed by walkers.Portions of this paper were presented at the 26th meeting of the New England Psychological Association, Boston, MA, November, 1986.Joann M. Montepare received a Ph.D. in Social-Developmental Psychology from Brandeis University. She is presently a postdoctoral research fellow at the Center for Research On Women, Wellesley College, Wellesley MA, 02181. Her research interests include the development of subjective perceptions of age and the impact of nonverbal information on social stereotypes of age. Sabra Goldstein and Annmarie Clausen hold B.A. degrees in Psychology from Wellesley College. Please address reprint requests to the first author.     

Closeness in Young Adult Sibling Relationships: Affective and Physiological Processes

What aspects of the relationships of young adult siblings are related to closeness or distance? This study takes a process approach to answering this question, contrasting it with the status approach of family structure variables. Close and distant sibling pairs were compared on physiological variables and specific aspects of warmth, con-flict, and power during two conversations - one on enjoyable topics and one on topics of disagreement. While there was no evidence that sibling closeness was related to family structure variables, differences in closeness were found in affective patterns and physiological responses during sibling interaction. Interaction between close sib-lings was characterized not only by higher positive affect but also by fewer power struggles and lower heart rate reactivity. Close siblings also had higher scores on emotional empathy and cognitive aspects of empathy such as perspective-taking than distant siblings. The developmental importance of considering power struggles in young adult sibling relationships was also discussed.     

Sociotropes, Systematic Bias, and Political Failure: Reflections on the Survey of Americans and Economists on the Economy

Objectives . Economic models of politics typically make two assumptions about voters: first, their motives are egocentric, not sociotropic; second, their beliefs are rational, not subject to systematic bias. Political scientists have presented strong evidence against the first assumption (Mansbridge, 1990), but have become increasingly willing to accept the second (Page and Shapiro, 1992; Marcus and Hanson, 1993). This article tests these two assumptions, then explores the tests' broader implications. Methods . I use the Survey of Americans and Economists on the Economy to test for egocentricity of motivation and rationality of belief. Results . Both standard assumptions fail for the case where the economic approach would seemingly be most relevant: economic beliefs. Conclusions . This is not necessarily cause for greater optimism about the efficiency of democracy: sociotropic voters with biased economic beliefs are more likely to produce severe political failures than are selfish voters with rational expectations.