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Social support and social networks are important correlates of elder mistreatment. This study tests hypothesized associations between perceived social support, social network size, and financial exploitation (FE). A population-based survey of 903 older adults (60+) in Allegheny County (Pittsburgh, Pennsylvania) found that lower perceived social support and larger social networks were simultaneously associated with higher risk for FE since age 60, controlling for known risk factors. The same associations were found for FE in the last 6 months. Older adults with larger social networks combined with lower perceived social support were most likely to report FE. When it comes to the role of social relationships and risk for FE, "more may not always be better." Encouragement to widen the social network by "making new friends" should be stressed less than making sure these new network members will truly be supportive of the older adult.

Objectives: To describe the development of the Pittsburgh Fatigability Scale (PFS) and establish its reliability and concurrent and convergent validity against performance measures., Design: Cross-sectional., Setting: University of Pittsburgh, Pittsburgh, Pennsylvania., Participants: Scale development sample: 1,013 individuals aged 60 and older from two registries; validation sample: 483 adults aged 60 and older from the Baltimore Longitudinal Study of Aging (BLSA)., Measurements: The scale development sample and BLSA participants self-administered an initial 26-item perceived fatigability scale. BLSA participants also completed measures of performance fatigability (perceived exertion from a standard treadmill task and performance deterioration from a fast-paced long-distance corridor walk), a 6-m usual-paced corridor walk, and five timed chair stands., Results: Principal components analysis with varimax rotation reduced the 26-item scale to the 10-item PFS. The PFS showed strong internal consistency (Cronbach's alpha 0.88) and excellent test-retest reliability (intraclass correlation 0.86). In the validation sample, PFS scores, adjusted for age, sex, and race, were greater for those with high performance fatigability, slow gait speed, worse physical function, and lower fitness, with differences between high and low fatigability ranging from 3.2 to 5.1 points (P < .001)., Conclusion: The 10-item PFS physical fatigability score is a valid and reliable measure of perceived fatigability in older adults and can serve as an adjunct to performance-based fatigability measures for identifying older adults at risk of mobility limitation in clinical and research settings., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Purpose: to examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience-perpetrator, frequency, and degree of upset-of psychological mistreatment in the past 6 months., Design and Methods: random digit dial telephone recruitment and population-based survey (telephone and in-person) of 903 adults aged 60 years and older in Allegheny County (Pittsburgh), Pennsylvania (693 non-African American and 210 African American). Covariates included sex, age, education, marital status, household composition, cognitive function, instrumental activities of daily living/activities of daily living difficulties, and depression symptoms., Results: prevalence rates were significantly higher for African Americans than for non-African Americans for financial exploitation since turning 60 (23.0% vs. 8.4%) and in the past 6 months (12.9% vs. 2.4%) and for psychological mistreatment since turning 60 (24.4% vs. 13.2%) and in the past 6 months (16.1% vs. 7.2%). These differences remained once all covariates were controlled in logistic regression models. There were also racial differences in the experience of psychological mistreatment in the past 6 months. Risk for clinical depression was also a consistent predictor of financial exploitation and psychological mistreatment., Implications: although the results will need to be replicated in national surveys, the study suggests that racial differences in elder mistreatment are a potentially serious issue deserving of continued attention from researchers, health providers, and social service professionals.

Community-based (multi-user) telehealth interventions may be beneficial for older adults, but there is little research regarding such interventions. As a first step in feasibility assessment, we used a qualitative descriptive approach to examine the acceptability and perceived value of community-based telehealth kiosks with regard to current health self-management practices of community-dwelling older adults. Participants included residents (n = 6) and community agency case managers (n = 3) of a U.S. Department of Housing and Urban Development-subsidized senior apartment building. Both positive impressions from and concerns of each group are presented. Findings helped guide plans for future telehealth kiosk implementation and training., (Copyright 2010, SLACK Incorporated.)

Background: The outcomes of informal caregivers of survivors of critical illness likely depend on patient characteristics, which may change over time. To date, few studies have examined patient-specific predictors of post-ICU informal caregiver burden, and none has tested whether predictors vary after hospital discharge., Methods: We designed a prospective, longitudinal observational study, enrolling 48 patient-caregiver dyads from four ICUs in a university hospital. Informal caregiver depression symptoms were measured with the Center for Epidemiologic Studies Depression scale. Lifestyle disruption was measured with the Activity Restriction Scale. Linear regression models were built to test for patient- and caregiver-specific predictors of depression symptoms and lifestyle disruption 2, 6, and 12 months after ICU admission., Results: Patients had a mean (SD) age of 52.5 (19.7) years, 67% were men, median (interquartile range) Acute Physiology and Chronic Health Evaluation score was 52 (38.5, 65). The caregivers had a mean (SD) age of 52.8 (12.8) years, 91.2% were women, and 48% were spouses. Predictors of caregiver depression symptoms were patient gender (men) at 2 and 12 months and tracheostomy at 12 months. Predictors of lifestyle disruption were patient education (more common among high school graduates) and patient gender (men) at 2 months, and tracheostomy, functional dependency, and patient gender (men) at 12 months., Conclusions: The determinants of post-ICU informal caregiver burden likely depend on characteristics of the patient as well as the caregiver and may vary over time. Further research is necessary to better understand the longitudinal determinants of burden in order to develop more effective caregiver interventions.

Background: Although religions is important to many people with cancer, few studies have explored the relationship between religious coping and well-being in a prospective manner, using validated measures, while controlling for important covariates., Methods: One hundred ninety-eight women with stage I or II and 86 women with stage IV stage breast cancer were recruited. Standardized assessment instruments and structured questions were used to collect data at study entry and 8 to 12 months later. Religious coping was measured with validated measures of positive and negative religious coping. Linear regression models were used to explore the relationships between positive and negative religious coping and overall physical and mental well-being, depression, and life satisfaction., Results: The percentage of women who used positive religious coping (i.e., partnering with God or looking to God for strength, support, or guidance) "a moderate amount" or "a lot" was 76%. Negative religious coping (i.e., feeling abandoned by or anger at God) was much less prevalent; 15% of women reported feeling abandoned by or angry at God at least "a little." Positive religious coping was not associated with any measures of well-being. Negative religious coping predicted worse overall mental health, depressive symptoms, and lower life satisfaction after controlling for sociodemographics and other covariates. In addition, changes in negative religious coping from study entry to follow-up predicted changes in these well-being measures over the same time period. Cancer stage did not moderate the relationships between religious coping and well-being., Conclusions: Negative religious coping methods predict worse mental heath and life satisfaction in women with breast cancer.

Many family caregivers are unprepared for the death of their loved one and may suffer from worse mental health as a result. We therefore sought to determine the factors that family caregivers believe are important to preparing for death and bereavement. Focus groups and ethnographic interviews were conducted with 33 family caregivers (bereaved or current) of terminally ill patients. The interviews were audiotaped, transcribed, and analyzed using the constant comparative method. Life experiences such as the duration of caregiving/illness, advance care planning, previous experiences with caregiving or death, and medical sophistication all impacted preparedness, or the degree to which a caregiver is ready for the death and bereavement. Regardless of life experiences, however, all caregivers reported medical, practical, psychosocial, and religious/spiritual uncertainty. Because uncertainty was multidimensional, caregivers often needed more than prognostic information in order to prepare. Communication was the primary mechanism used to manage uncertainty. Good communication included clear, reliable information, combined with relationship-centered care from health care providers. Finally, preparedness had cognitive, affective, and behavioral dimensions. To prepare, some caregivers needed information tailored to their uncertainty (cognitive), others needed to "mentally" or "emotionally" prepare (affective), and still others had important tasks to complete (behavioral). In order to better prepare family caregivers for the death of a loved one, health care providers must develop a trusting relationship with caregivers, provide them with reliable information tailored to their uncertainty, and allow time for caregivers to process the information and complete important tasks.

Objective: To examine the prevalence and sociodemographic correlates of written advance planning among patients with or at risk for dementia-imposed decisional incapacity., Design: Retrospective, cross-sectional., Setting: University-based memory disorders clinic., Participants: Persons with a consensus-based diagnosis of mild cognitive impairment (N = 112), probable or possible Alzheimer disease (AD; N = 549), and nondemented comparison subjects (N = 84)., Intervention: N/A., Measurements: Semistructured interviews to assess durable power of attorney (DPOA) and living will (LW) status upon initial presentation for a dementia evaluation., Results: Sixty-five percent of participants had a DPOA and 56% had a LW. Planning rates did not vary by diagnosis. European Americans (adjusted odds ratio = 4.75; 95% CI, 2.40-9.38), older adults (adjusted odds ratio = 1.05; 95% CI, 1.03-1.07) and college graduates (adjusted odds ratio = 2.06; 95% CI, 1.33-3.20) were most likely to have a DPOA. Findings were similar for LW rates., Conclusions: Although a majority of persons with and at risk for the sustained and progressive decisional incapacity of AD are formally planning for the future, a substantial minority are not.

The purpose of this study was to describe adherence to recommended preventive health practices among middle-aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and carereceiver) were also explored using the t test and the chi2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of age- and gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

Objective: To evaluate the morbidity from chronic pelvic pain after pelvic inflammatory disease (PID)., Methods: A total of 547 women were studied as part of the PID Evaluation and Clinical Health (PEACH) Study. Chronic pelvic pain was defined as pelvic pain reported at two or more consecutive interviews conducted every 3 to 4 months through 32 months and was graded as mild to moderate (low pain intensity) or moderate to severe (high pain intensity). Mean Medical Outcomes Study Short Form (SF-36) scores at 32 months were compared by chronic pelvic pain categories., Results: The mean (+/- standard deviation) physical health composite scores and mental health composite scores from the SF-36 were progressively lower among women with increasing grade of chronic pelvic pain (physical health composite scores: no chronic pelvic pain = 87.3 +/- 10.7, mild to moderate chronic pelvic pain = 79.1 +/- 14.6, moderate to severe chronic pelvic pain = 73.6 +/- 16.0, P < .01; mental health composite scores: no chronic pelvic pain = 78.7 +/- 13.6, mild to moderate chronic pelvic pain = 69.1 +/- 15.8, moderate to severe chronic pelvic pain = 67.5 +/- 17.1, P < or = .01). Individual physical function, bodily pain, general health, vitality, social function, and mental health scores were also significantly lower among women with chronic pelvic pain and by increasing grade of pain intensity., Conclusion: Chronic pelvic pain after PID is associated with reduced physical and mental health.

Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors., (2003 APA, all rights reserved)

In a sample of cancer patients (n = 75) and spousal caregivers (24 men and 51 women), restriction in caregiver routine activities mediated associations between caregiving stress (patient symptom severity) and caregiver depressed affect and resentment. Moreover, the antecedents and affective consequences of caregiver activity restriction were consistent with the theory of communal relationships (e.g., M. S. Clark & J. Mills, 1979, 1993). If a relationship had been communal in the past (i.e., characterized by mutual concern for and responsiveness to one another's needs), activity restriction was predicted by intimacy and affectional loss (rather than by the severity of patient symptoms) and in turn predicted caregiver depressed affect. Among caregivers in less communal relationships, activity restriction was predicted by severity of patient symptoms (rather than by intimacy and affectional loss) and in turn predicted resentment of care recipients and the caregiving role.

Background: Although interest in health promotion for the elderly is increasing, the issues of recruitment into such programs and self-selection have not been well explored. While clinical studies require high participation levels and expensive recruitment, community efforts are satisfied with recruiting small numbers of volunteers from poorly defined populations. These small samples may not be representative of the populations at risk., Methods: As part of the Rural Health Promotion Project, a Medicare demonstration, community-based recruitment methods were evaluated and participant characteristics were compared. A total of 3,884 individuals ages 65-79 were recruited in northwestern Pennsylvania, using four sequential recruitment strategies, varying in aggressiveness. The methods were: (A) mail only, (B) mail with phone recruitment follow-up, (C) mail with phone recruitment and scheduling, and (D) mail with aggressive phone recruitment and scheduling., Results: Recruitment yields were Method A, 13.5%; B, 21.1%; and C, 31.6%. The most aggressive Method (D) yielded 37.0% participation. More aggressive methods (C and D) recruited more educated individuals. No other demographic or health status differences were noted., Conclusion: These data show that large numbers of the elderly can be recruited into a health promotion program using aggressive methods and professional interviewers.