Effects of Emotional Inoculation and Supportive Therapy on Stress Incurred from Nursing Home Placement

Research indicates that relocation of an elderly person to a nursing home constitutes a major stress to the individual which can be life threatening. The present study was designed to assess the efficacy of two different treatment approaches in attenuating that stress. Thirty-six elderly persons being placed in nursing homes for the first time were randomly assigned to one of three groups. Subjects in the Emotional Inoculation (El) Group x;ere seen for three consecutive days in the hospital, prior to entering a nursing home, for purposes of giving them information about the facility and preparing them for some of the stresses they might encounter. Individuals in the Supportive Therapy (ST) Group were seen for three consecutive days during their first x*eek in the nursing home for the purpose of support in working through difficulties they might be experiencing. Subjects assigned to the Control (C) Group received no treatment either previous or subsequent to location in a nursing home. All subjects were given a battery of tests to assess level of psychological functioning during their first two weeks in the nursing home and again after two months in the home. The results offered no conclusive evidence regarding the absolute or relative effectiveness of the treatments in modifying the stress incurred by nursing home placement. The only evidence suggesting treatment effectiveness was the two week post placement staff ratings which indicated that the subjects in the ST Group were significantly better adjusted than the C Group subjects. Additional data suggested that females evidenced more anxiety and depression than males and that those subjects who believed they had a choice in the specific nursing home in which they were placed were less hostile than those who believed they had no choice in facility. Individuals who perceived their stay in the nursing home to be temporary were rated as less hostile than those who believed they would be permanent residents

Nursing home admission: Effects, predictors of well-being and implications for counseling

Admission to a nursing home is a stressful life event demanding changes in all aspects of living. Becoming a nursing home resident was perceived by subjects in Gordon\u27s study (1985) to be the third most stressful life event preceded only by death of a spouse and divorce and followed by pregnancy and retirement. Researchers have disputed the direct relationship of relocation trauma to mortality (Borup 1983), but agree that certain factors increase the older person\u27s vulnerability to the stresses of relocation

Residence, perceived latitude of choice and desired control among the long-livin

Perceived control, perceived choice, and residential setting are important factors which need to be addressed in research involving long-living. The focus of this study was to determine the relationships among thee variables. The search for an interaction between residential setting (either high or low constraining) and perceived choice and its effect on perceived control distinguishes this study from previous research

Transfer Trauma Following a Community Evacuation of the Institutionalized Elderly

This study examined the impact of evacuation on the institutionalized elderly following the 1996–97 Greater Grand Forks flood. Older adults, living in two long-term care facilities, were evacuated to temporary shelters. Later moved to other long-term care facilities or to the homes of family members, they experienced multiple moves. In order to learn what impact the evacuation had on the institutionalized elderly, two major questions were studied. These were: (1) What were the experiences of the institutionalized elderly during the evacuation? (2) What were the coping strategies used by the institutionalized elderly? Data were gathered using triangulation: interviews, observation and supplemental resources. The information was analyzed to identify codes that represented the data. Codes produced categories of related information that were further defined as the themes of the findings. The identified themes were: advocating for an advocate, loss of community, diminishing locus of control, and negative correlation between multiple moves and health. This study found that the institutionalized elderly needed an advocate. Declining health and losses led to their inability to seek the services that they needed to maintain a quality of life. Family members, or if unavailable, other support networks were needed to fill this role. Community continued to be an important aspect of their lives. The elders\u27 sense of security and connectedness had stemmed from the supports available through the community. When this connectedness was lost the older adult ultimately experienced a decline in the support networks. Internal and external locus of control is essential to self-efficacy. When this locus of control was diminished or eliminated, the older adults in this study believed that they had little or no control over their lives. Multiple moves exacerbated transfer trauma leading to an inability to access past successful coping mechanisms. When they could no longer cope, the older adults were unable to draw the strength to deal with declines in physical and mental health. In general, this study found that transfer trauma related to evacuation and the efforts to find a permanent home had a negative effect that impacted the institutionalized elderly physically, emotionally and mentally

Adjustment to relocation to an assisted living facility

Assisted living has become the fastest growing senior housing alternative for older adults, yet little research has been conducted with residents of assisted living. Relocation involves a major life change and is associated with health problems, poor adjustment, and increased mortality. Research on relocation into nursing homes suggests declines in health and psychological well-being frequently follow relocation and are greatest one to two months following entry into the facility. Control over the decision to relocate and control within the facility following relocation have been related to physical and mental health. Assisted living residents are similar to nursing home residents so similar patterns of adjustment, though potentially less severe, are likely to be seen in assisted living residents. The current study compares 18 residents of assisted living with 19 community dwelling older adults at three times on various aspects of adjustment, including physical and functional health, depression, life satisfaction, affect, and anxiety over a three month period following relocation in the assisted living group. Assisted living residents did not show the expected decline over the first several months following relocation, perhaps due to health stabilization. However, residents of assisted living did report lower life satisfaction and exhibited greater disparity between actual and desired control than community residents. Moreover, both the community dwelling older adults and residents of assisted living were clinically distressed on measures of depression and anxiety. The groups did not differ on the amount of change in health and psychological well being experienced over time, demonstrating similar rates of decline over time. Decisional control was negatively related to depression and positively related to physical and functional health. In addition, actual environmental control was positively related to physical and functional health and life satisfaction and negatively related to depression, negative affect, and anxiety. Health has been related to depression and life satisfaction, and the significant correlations between health and the adjustment variables suggests that health played a role in the current study. Overall, the study demonstrated the importance of control, social support, and health of adjustment to relocation into assisted living facilities. Limitations and future directions are included

Individual Characteristics and Relocation Factors Affecting Adjustment among Relocated American and Egyptian Older Adults

Worldwide, the population of elders is increasing significantly. Relocation can be a positive or a negative experience, depending on many factors, including culture. The purpose of this study is to compare individual characteristics (age, gender, marital status, education, perceived health status, activities of daily living), relocation factors (movement preparation, time passed since relocation, closeness of prior home to the present, and whether relocation was from home or another facility), and adjustment in relocated American and Egyptian elders. This secondary analysis study merged data from two cross-sectional descriptive studies of a 104 elders relocated to retirement communities in Northeast Ohio and 94 elders relocated to retirement communities in Alexandria, Egypt. Our findings indicated that American elders have greater independence in daily activities (t (161.23) = −3.03, p = .003); better perceived health (χ2[3, N = 198] = 53.21, p \u3c .001), better education (χ2[1, N = 198] = 47.28, p \u3c .001), better preparation before the move (χ2[1, N = 198] = 40.58, p \u3c .001), and better relocation adjustment (t (196) = 9.42, p \u3c .001) than relocated Egyptian elders. Our results indicate that culture should be taken into account when caring for older adults who relocate to retirement communities. Additionally, interventions, such as counseling, and preparation before relocation are needed to help elders adjust to relocation

A Study of the Relationship Between Improvement in Physical Status and Self-esteem in Geriatric Patients

The improvement in physical abilities in the geriatric population after occupational therapy was investigated to determine whether self-esteem would also improve. Fifteen subjects from three different nursing homes were measured. All of the subjects were referred to occupational therapy by their physician. Treatment was implemented by trained rehabilitation aides after an occupational therapist assessed each subject and determined the need for therapy. Measurable goals were set for each subject to improve dysfunctional areas and reviewed with each resident and rehabilitation aide responsible for implementing the treatment program. Types of treatment consisted of active and passive range of motion, strengthening, retrograde massage, applying splints, fine and gross motor tasks, and increasing independence in activites of daily living. Data were collected on each subject twice, at four week intervals. Physical status was measured using standard rehabilitation tools. Self-esteem was assessed on a revised scale of the Tennessee Self Concept Scale. The investigation found neither a significant improvement in motor functioning nor a significant improvement in self-esteem. Furthermore, the subjects significantly deteriorated in physical status. The hypothesis that self-esteem will improve among the geriatric population remains untested due to the lack significant improvement in the subjects physical status. Implications and limitations of the study are discussed

A Study of the Relationship Between Improvement in Physical Status and Self-esteem in Geriatric Patients

The improvement in physical abilities in the geriatric population after occupational therapy was investigated to determine whether self-esteem would also improve. Fifteen subjects from three different nursing homes were measured. All of the subjects were referred to occupational therapy by their physician. Treatment was implemented by trained rehabilitation aides after an occupational therapist assessed each subject and determined the need for therapy. Measurable goals were set for each subject to improve dysfunctional areas and reviewed with each resident and rehabilitation aide responsible for implementing the treatment program. Types of treatment consisted of active and passive range of motion, strengthening, retrograde massage, applying splints, fine and gross motor tasks, and increasing independence in activites of daily living. Data were collected on each subject twice, at four week intervals. Physical status was measured using standard rehabilitation tools. Self-esteem was assessed on a revised scale of the Tennessee Self Concept Scale. The investigation found neither a significant improvement in motor functioning nor a significant improvement in self-esteem. Furthermore, the subjects significantly deteriorated in physical status. The hypothesis that self-esteem will improve among the geriatric population remains untested due to the lack significant improvement in the subjects physical status. Implications and limitations of the study are discussed

A Comparison Of Nursing Home Residents And Nursing Personnel In Terms Of Perceived Control Over The Resident’S Activities Of Daily Living

This study compared 23 nursing home residents’ and 23 nursing assistants’ control perceptions over the residents’ activities of daily living. Residents’ perceptions were measured with Chang’s Situational Control of Daily Activities (SCDA). Nursing assistants’ perceptions were measured by an investigator designed questionnaire, the Questionnaire of Activities of Daily Living (QADL). Scores of each group were compared using the ^ test which found both groups perceived a high degree of control over the residents’ activities. Based on this finding, the hypothesis that no significant difference in perceived control over residents’ daily activities exists between nursing home residents and nursing assistants was rejected. An additional finding was that nursing home residents’ perceptions of self control over their daily activities correlated significantly, when using Pearson’s v_, with their functional ability as measured by the Functional Assessment Form (FAF). The Geriatric Nurse Clinician can utilize results of this study in various care settings by affording clients maximum perceived control over their lives through shared decision making and providing for maximum client independent functioning. In the roles of practi­ tioner, counselor, educator and consultant, the Geriatric Nurse Clinician can assist other care providers to apply findings of this study to the development of policies, programs and procedures to enhance the elderly’s control perceptions