Preparedness of representatives for people with dementia in a self-directed program

ABSTRACT

Representatives enact their role as decision-making partners across the intersection of participant direction (PD) and dementia care. Self-rated preparedness for key dimensions of the role endorsed by a panel of experts in PD and dementia was assessed by telephone survey of 30 representatives of persons with dementia in a PD program. The sample (daughters 60%; Black 50%; rural 70%) was diverse in length of time in the role and additional responsibilities. They represented participants with moderate to advanced dementia and ≥ two additional chronic illnesses. Overall preparedness scores were in the pretty well to very well prepared range, with variation across dimensions and between individuals. Preparedness varied according to what has to be done day-to-day in dynamic or unpredictable situations, gauging decisional capacity, anticipating changing needs, ensuring safety, supporting a dementia-capable care team and negotiation. Stress was related to having a safety net of capable back-up supports and dementia care literacy. Areas of strength, individual variation and particular challenges along the trajectory of representing can guide development of support counselor interventions to provide representatives with tailored training and resources as they enable the benefits of PD for persons with dementia.     

Standardizing the care of detox patients to achieve quality outcomes

Providing appropriate treatment for detoxification patients is both challenging and difficult because alcohol abuse and dependence are largely underestimated in the acute hospital setting. Alcohol withdrawal syndrome is treated not only by addictionologists on chemical dependency units, but also by primary care physicians in acute inpatient settings. The need for consistent inpatient treatment through the use of identified protocols can help provide safe and effective care. The need for consistent, inpatient medical-surgical detoxification treatment in our organization became apparent with the staff's identification of patient care concerns. Using an organizational approach, a multidisciplinary team was created to standardize the care of detoxification patients, beginning with patient admission and ending with discharge and referral for outpatient management. Standardization would ensure consistent assessment and intervention, and improve communication among the clinical team members. A protocol was developed for both the emergency department and the inpatient units. The goals of the team were to decrease the adverse events related to detoxification, such as seizures and aggression, and provide a consistent method of treatment for staff to follow.     

The role of social support in the psychological well-being of African American girls who experience dating violence victimization

The goals of this study were to test the relationship between dating violence victimization (i.e., verbal, emotional, and physical abuse) and psychological well-being (i.e., depressive symptomatology, self-esteem, and body image) among 522 African American girls, and to determine whether social support acted as a buffer of negative effects (moderator) or as an intervening factor (mediator) in the relationship between dating violence victimization and psychological well-being. Results from structural equation modeling indicated that dating violence victimization was associated with negative psychological outcomes. Although social support did not moderate this relationship, it served as a mediator of the relationship between dating violence victimization and psychological well-being. Dating violence programs for African American girls should consider how to incorporate family, church, and other networks in the community to foster support, and allow adolescent girls to discuss their abusive experiences in a nonblaming environment. If programs are able to buoy girls who experience dating violence, then they may be able to ameliorate the associated negative psychological sequelae.     

Effects of the Home Learning Environment and Preschool Center Experience upon Literacy and Numeracy Development in Early Primary School

This study investigates the influence of aspects of home and preschool environments upon literacy and numeracy achievement at school entry and at the end of the 3rd year of school. Individuals with unexpected performance pathways (by forming demographically adjusted groups: overachieving, average, and underachieving) were identified in order to explore the effects of the home learning environment and preschool variables on child development. Multilevel models applied to hierarchical data allow the groups that differ with regard to expected performance to be created at the child and preschool center levels. These multilevel analyses indicate powerful effects for the home learning environment and important effects of specific preschool centers at school entry. Although reduced, such effects remain several years later .     

Newlywed Couple Leisure: Couple Identity Formation Through Leisure Time

An interpretative phenomenological study of newlywed couple leisure was conducted to understand the role of leisure in the development of relationship dynamics and couple identity. Nine couples were interviewed twice, using open-ended questions that explored the role of leisure in their relationship development. Data were analyzed using interpretive phenomenological processes. Couples viewed leisure as a crucial part of their relationships, helping them develop their identities as couples through creating shared meaning and opportunities to improve communication and conflict management skills. Findings can be used to encourage couple exploration of positive leisure experiences during courtship and early marriage, including therapeutic interventions and relationship education programs that teach couples to incorporate joint leisure strategically into their relationships.     

THE LIQUIDITY SERVICE OF BENCHMARK SECURITIES

We demonstrate that benchmark securities allow heterogeneously informed investors to create trading strategies that are perfectly aligned with their signals. Investors who are informed about security‐specific risks but uninformed about systematic risks can take an offsetting position in benchmark securities to eliminate exposure to adverse selection in systematic risks, while investors who are informed about systematic risks but uninformed about security‐specific risks can trade systematic risks exclusively using benchmark securities. We further show that introduction of benchmark securities encourages more investors to acquire both security‐specific and systematic‐factor information, which leads to increased liquidity and price informativeness for all individual securities. (JEL: G10, G12, G14)     

A photovoice study of older adults' conceptualizations of risk

Risk is a multifaceted and complex concept that mediates quality of life through the balance between risk taking and risk avoidance. Society expects older adults to identify and manage their personal risks yet little is known about the meaning of risk in their daily lives and how they balance the tensions between taking and avoiding risks. Therefore the purpose of this study was to explore how older adults construe risk. A qualitative exploratory study that incorporated photovoice methodology was used. Seventeen older adults, over a weeklong period, took pictures and kept a log of the places, spaces, events, activities, or situations that best represented risk. Subsequently, they participated in a follow-up individual interview. Older adults viewed risk both positively and negatively, judging the saliency of a risk according to criteria that related both to the risk itself and to personal characteristics. Although risk was avoided in specific situations, risk taking was participants' primary approach to risk, which assumed three forms: adaptive, opportunistic, and/or unjustifiable. Contrary to societal views, older adults view risk as constructive and personally relevant, and as something to be taken and need to be supported in risk taking rather than risk avoidance.     

Factors associated with advance care planning among older women in Southwest Florida

As the nation's population continues to age, many older women will face care needs that can be anticipated in advance. However, little is known about the advance care plans of older women and the characteristics of those who plan. This study utilized a stratified random sampling design to survey older women (n = 124) in the state of Florida regarding their attitudes toward future care and planning behavior in social-environmental, health, and financial domains. Regression analyses were conducted to determine factors most predictive of attitudes toward future care and planning behavior by domain. Results suggest that advanced age predicts greater planning behavior, while living alone is associated with less advance care planning behavior. Other factors associated with less planning by domains of care needs include income status, chronic health conditions, educational attainment, and religious status. Nonaccepting attitudes toward planning were associated with a decreased likelihood to have advance care planning documents.