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Background Intergenerational friendship has proved useful for older people in increasing socialisation. We explored the feasibility of school students Skyping older people in care homes with the long-term aim of reducing loneliness. Methods Six school students from one secondary school and twenty older people, including seven with mild to moderate dementia, from three care homes, engaged in Skype video-calls over six weeks. A conversational aid aimed to help school students maintain conversations was employed. Students and care staff completed feedback forms after each session on video-call usage, usefulness of the conversational aid, and barriers and benefits of video-calls. Six care staff provided further feedback on residents’ experiences through unstructured interviews. Interviews and field notes were thematically analysed. Results Residents enjoyed Skype-calls with school students. Over six weeks, video-calls became longer, and more residents participated. Analysis revealed four themes. First, the intervention led to increased mobility for three older people and improved self-care in regard to personal appearance for five residents. Second, school students and older people formed friendships which inspired the need to meet in person. Third, the use of video-calls enabled participants to view each other’s environments in real time. Last, directly experiencing the intervention was important for the continued participation of the care staff in the study. Skype-calls between schools and care homes are feasible and may help reduce loneliness. Conclusions Institutional collaboration between educational settings and care homes through cost effective video-calls can be useful to increase socialisation for older people, and promote later on-going use with other external organisations to help reduce loneliness and social isolation., Highlights • Older people in care including those with dementia are capable of forming new non-familial social relationships using video-calls. • Regular video-calls for older people increases mobility, self-care and socialisation. • Intergenerational video-calls between care homes and schools are feasible to reduce loneliness in older adults. • A conversational aid is useful in aiding conversations to form new friendships.

Objective: This case report presents a patient with central retinal artery occlusion (CRAO) who was successfully treated with hyperbaric oxygen (HBO2) but subsequently suffered a recurrence of his visual loss. Methods: CRAO may be treated successfully with HBO2 if treatment is undertaken promptly after the onset of vision loss. The goal ofHBO2 therapy is to oxygenate the ischemic inner retinal layers via diffusion from the hyperoxygenated choroidal circulation until recanalization of the central retinal artery occurs. Results: A 71-year-old man presented with hand motion vision and fundus findings of CRAO in his left eye. Treatment with HBO2 was initiated approximately 9.5 hours after loss of vision. The patient experienced return of vision to a near-normal level during HBO2. His vision loss recurred, however, 15 minutes after the HBO2 session. There was a delay to follow-up HBO2 treatments, and the improvement of vision that resulted from these subsequent HBO2 sessions was much less than that experienced during his initial HBO2 treatment. Conclusions: Recovery of vision during initial HBO2 treatment indicated that this patient’s retina had not yet suffered irreversible ischemic damage at that point in time. CRAO patients with a good result from initial HBO2 treatment should be admitted to a stroke center and should have their visual status monitored hourly. Should vision loss recur, ag- gressive use of intermittent 100% normobaric and hyperbaric oxygen is indicated to preserve retinal function until central retinal artery recanalization occurs. An evidence-based management plan for such patients is presented.

Little research has examined the impact of being an accompanying spouse on British military foreign postings. The aim of this qualitative study was to investigate the experiences of 13 military spouses from 11 different overseas locations. Data were collected via an online forum and thematic content analysis was conducted. Key findings revealed that, regardless of the location, reactions to overseas posting varied considerably and were related to the military spouse's personality and personal circumstances, as well as their relationship with family, husband and their support networks. Spouses experienced a loss of control over their lives that was in some cases psychologically distressing. The findings corroborate and extend the findings from a previous study that was limited to one location, further highlighting the need for pre-established support resources from the military and healthcare professionals to be readily accessible for all military spouses. Importantly, such support provision may also facilitate the military spouse in regaining some control over their everyday life, enhancing their well-being and the experience for the family.

Objective To compare our institution with national benchmark times, and identify rate-limiting steps in the process by conducte a retrospective review of the turnaround times in 2009 at the Carilion Clinic Breast Care Center (CCBCC). To evaluate patient satisfaction with the turn around times. Methods A retrospective chart review was performed to evaluate the time intervals from abnormal screening mammogram to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to MRI, and MRI to surgery of all patients seen for breast cancer in 2009. A patient survey was mailed out to all patients (131) managed from abnormal screening to surgery in 2009, assessing their satisfaction with the turnaround times from screening mammogram to call back, call back to diagnostic mammogram, diagnostic mammogram to biopsy, biopsy to results call, biopsy result to MRI appointment, MRI appointment to surgery consult, and surgery consult to surgery; and assessing possible reasons why patients may perceive the process to be delayed. The MEANS procedure was applied to evaluate the turnaround times, and a Box and Whisker Plot statistical comparison was made between patient satisfaction and turnaround times. Results The mean turnaround time at the CCBCC in 2009 from abnormal screening mammogram to surgery was 45 d. This falls within the 75th %ile of the National Quality Measures for Breast Centers (NQMBC), established by the National Consortium of Breast Centers (NCBC). Of 131 surveys mailed out, 57 were returned (44%). The patient satisfaction rates for each interval ranged from 96%–100%, with an overall satisfaction rate of 98% for abnormal screening mammogram to surgery. Discussion The CCBCC ranks at the 75%ile in overall turnaround times; however, this turnaround time included an interval of MRI, not previously measured in NQMBC benchmark. Rate-limiting steps were identified as the time from screening mammogram to diagnostic mammogram, and biopsy to surgery-specifically, the sub-interval MRI to surgery. Since 2009, the CCBCC has already improved the process for obtaining insurance approval and preauthorization for MRIs; and has added an additional breast surgeon to share the burden of benign cases, and a nurse practitioner to see post-op and follow up patients, improving the accessibility to the primary breast surgeon specialist. Consideration should be given to future time interval studies that evaluate breast cancer turnaround time including MRI to help establish benchmarks.

Military spouses frequently cope with separation, but limited research reviewing the impact of an overseas relocation when a spouse accompanies their serving husband/wife has been conducted. A search for studies reviewing the impact of foreign postings on these accompanying spouses was undertaken utilizing 12 databases and other resources. Ultimately, 12 studies were analyzed and four key themes produced: functioning of a military family on an international posting, loss, wellbeing and support. Overall, additional stressors are associated with an overseas posting and experiences are specific to an individual and their circumstances. Further research is required to examine the potential relationship between a spouse's experiences overseas and the impact on their health and wellbeing. This would help to identify possible areas of health care provision and support necessary to maximize a military spouse's experience.

Purpose: The purpose of this study is to suggest a new approach to identifying patterns of comorbidity and multimorbidity. Design and Methods: A random sample of 1,039 rural community-resident American Indian elders aged 60 years and older was surveyed. Comorbidity was investigated with four standard approaches, and with cluster analysis. Results: Most respondents (57%) reported 3 or more of 11 chronic conditions. Cluster analysis revealed a four-cluster comorbidity structure: cardiopulmonary, sensorymotor, depression, and arthritis. When the impact of comorbidity on four health-related quality of life outcomes was tested, the use of the clusters offered more explanatory power than the other approaches. Implications: Our study improves understanding of comorbidity within an understudied and underserved population by characterizing comorbidity in conventional and novel ways. The cluster approach has four advantages over previous approaches. In particular, cluster analysis identifies specific health problems that have to be addressed to alter American Indian elders’ health-related quality of life.

The use of restraints in nursing homes has been curtailed in the United States since the passage in 1987 of federal legislation regulating restraint practices. This study used focus groups with administrators and nursing staff in a skilled nursing facility to examine their views of restraints and perceptions of conditions in the nursing home environment that affect restraint use. Although respondents lacked a shared definition of a “restraint, ” they did identify contextual factors that in combination with resident characteristics produced situations in which restraint use was justified. Implications of these findings for staff education on restraint reduction are discussed.

Caregiver burden is a key construct in gerontological research, however, burden measures are rarely evaluated for their cultural validity. This study used focus groups (N = 33 participants) to elicit Pueblo Indian family caregivers' interpretations of an existing burden scale. Qualitative analysis of the focus group discussions on the relevance of the 22 scale items revealed similarities and differences with non-Indian endorsements of these burden constructs. Items measuring the strains created by caregiving within the extended family were emphasized, whereas items reflecting the importance of individual concerns were seen as less important. Findings are discussed in terms of the Pueblo cultural orientation to elder care.

Purpose: The purpose of this study was to evaluate burden experienced by a group of American Indian primary family caregivers and to determine if caregiver burden is a multidimensional concept. Design and Methods: This analysis is based on the results of a survey questionnaire administered to 169 Pueblo primary family caregivers in New Mexico. Results: Analysis of the items composing the Caregiver Burden scale indicated that caregiver burden is multidimensional and consists of several types of burden. Caregiver burden, as identified in this sample, is composed of four dimensions: role conflict, negative feelings, lack of caregiver efficacy, and guilt. Investigations of caregiver burden should consider the multidimensionality of this experience and evaluate burden accordingly. Implications: By identifying the specific type of burden that a caregiver experiences, interventions can be targeted more accurately to support family caregiving.

This study identifies the informational factors and judgment processes involved in making two case management decisions within a consolidated long-term care program: evaluating risk of nursing home placement and choosing a care plan. A multidisciplinary case management team formulated these decisions for hypothetical clients described in vignettes (N = 1,507). The team used information about the client's condition and the program's available resources in judging risk of institutionalization, but only client-related information in selecting a care plan.

This study examines the extent to which a client's choices are incorporated in care decisions within a prepaid, community-based long-term care program. Decision criteria used by the program's case management team regarding client autonomy included indicators of risk to client stability and of limits on organizational resource capacity. Under certain "high-risk" conditions, self-determination could decrease in importance in light of the care needs of the program's total client population.

Little systematic information exists on how the older adult reacts to normal physical changes with age. The personal perception and treatment of the aging body are particularly significant given the predominantly negative cultural values associated with senescence in American society. This study used a qualitative approach to examine continuity and change in physical self-evaluation and self-care among a group of healthy men and women in their fifties and seventies. Focused interviews were conducted to identify the evaluative criteria that these individuals apply to the aging body and the behavioral outcomes of the self-assessment process. Analysis focused on sex differences, perception of personal control over health and well-being, continuity of approach to the body, and the perception of time left to live. Findings highlighted personal and social resources and common behavioral strategies employed by older persons in managing the aging physical self.