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<p> This study compared the efficacy of using online dementia training modules on both direct and non-direct care providers in long-term care settings and how this impacted their delivery of Person Centered Care (PCC), as well as their knowledge of caring for residents with a diagnosis of Alzheimer Disease (AD), dementia. Traditional educational opportunities for staff working specifically with demented residents inside Memory Care Units (MCU) were investigated, along with an alternative approach of training all staff (to include direct and non-direct care providers). The option of utilizing online dementia training modules for all staff was then evaluated by using an observational Person Centered Care tool, to see if education had made an impact on interactions between staff and the demented residents that they care for. This study utilized a single-group, repeated measures design to test a 10-week, standardized and computerized set of 10 interactive training modules in a 60-bed MCU . Fifty-one observations were made between MCU residents and staff and included in this study, employing a single-group pre-post-posttest design. The findings suggest that online dementia training modules may be beneficial for both knowledge and delivery of PCC to staff in MCUs who care for residents with a diagnosis of AD.</p><p>

A combination of aging and poverty is becoming dominant in African society today, at a time when African countries are expected to be recovering from poverty, and are projected to house the economic growth of the next century. The emergence of aging in African context and the aging of the world population will expose the weakness of the current mechanisms used for older people around the world. As economies grow around the world, the distribution gap between the affluent and the poor widens, and the constant struggles for wealth, power, and social status, amidst scarce resources, continue to be sustained. To remain in charge of economic resources, the powerful few devise means to disenfranchise the weak, and witchcraft accusation is one of such tools used in Northern Ghana today. A new wave of witchcraft accusation has caught the attention of many in Northern Ghana. These victims with certain socioeconomic characteristics appear helpless and without defense against such accusations. As a result, they suffer untold hardships and are often compelled to leave their homes and to reside in camps reserved for witches. This study was undertaken to identify those sociodemographic characteristics, which are commonly shared by witchcraft accusation victims. These sociodemographic characteristics can be used to predict those who are most likely to be discriminated against using accusations of witchcraft in Northern Ghana. As age places more strain on existing systems and as more people survive into old age with inadequate healthcare, more accusations may be predicted to occur against the elderly, unless enough government intervention is used to address the present redistribution of income in third world countries.

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This study explored how the relationship between religiousness and psychological distress varies by religious affiliation (Christian or Jewish) and by gender. Analyses were conducted on data collected during interviews with 143 community dwelling older adults employing measures with acceptable psychometric properties. Independent variables included organizational and intrinsic religiosity. Resources including physical health, social support, and personal efficacy were included as control variables. The dependent variables were symptoms of depression and anxiety. Supplemental analysis examined clinically significant depression and anxiety. Results of bivariate correlational analyses revealed significant relationships among gender, education, physical health, social support, personal efficacy, depression, and anxiety. Hierarchical regression analyses were then conducted in which the independent and control variables were entered in three steps: (1) demographics (gender, religious affiliation, education), (2) resources (physical health, social support, personal efficacy), and (3) religiosity and interaction terms. Christians were found to be more intrinsically religious than Jews but not more organizationally religious. Jews displayed a higher risk for clinical anxiety than Christians and women displayed a higher rate of depression and anxiety symptoms and higher risk for clinical depression and anxiety than did men. Contrary to predictions, higher levels of organizational religiosity were associated with a higher rate of anxiety symptoms. Religious affiliation and religiousness interacted in association with depression. Higher organizational religiosity was associated with depressive symptoms and clinical depression to a greater extent for Jews than for Christians. In addition, gender and religiousness interacted in association with anxiety. Lower organizational religiosity was associated with anxiety symptoms to greater extent for women than for men. On the whole, Christians displayed less depression and anxiety at higher levels of religiousness than did Jews, underscoring the complex relationships among religion, religiousness, and mental health in late life. This study also provides evidence that women in late life without religious resources may be more vulnerable to mental illness than their male counterparts. However, no reliable relationship has of yet been established among gender, religiousness, and mental health in later life.

This study, conducted in New York City in 1988, examined the performance of 86 visually impaired elders on five adaptive tasks: maintenance or restoration of self esteem, use of help, activities of daily living, social and recreational activities and understanding of loss. These adaptive tasks were chosen because they are most frequently cited in the literature of disability; arising from the fields of aging, chronic illness, and blindness. Intervening variables were health, social supports, and coexisting life events of change and loss. Respondents ranged in age from 60-99 years and had three times of onset since vision loss: 0-1 year, 2-3 years, and 4+ years. Data were collected in in-person interviews of approximately one hour's duration. Frequency distributions, bivariate correlations, and multivariate analytic techniques were used to identify the salient variables associated with performance of each adaptive task. Study findings indicate that age and time since onset do not influence performance of adaptive tasks. Dependence in activities of daily living is a predictor of low self esteem. Medical problems are a predictor of dependence in activities of daily living. Decreased participation in social and recreational activities and dependence in activities of daily living are more frequently due to vision loss than to other health problems. Both need and availability are predictors of use of help. Understanding of loss is associated with higher education, low self esteem, and living alone. Vision impairment has a great subjective importance to the elderly who give up much that has meaning to them in their struggle to adapt to diminished sight. Implications for clinical practice and further research are discussed.

Much of the relevant literature has indicated that age homogeneity of the neighborhood is beneficial for the elderly in increasing life satisfaction and morale, in fostering contacts with friends and neighbors, and in creating a high level of social activity. However, the dependent variables used in these studies may create distortions in comparing age homogeneous and age heterogeneous neighborhoods. Life satisfaction and morale may be too global as dependent variables and based on too many factors in a person's environment to compare the effects of different neighborhood structures. Contacts with neighbors and friends may not be meaningful in all areas requiring primary group supports. Therefore, in this study of 1423 elderly people in New York and Florida, Litwak's "Theory of Shared Functions" is used to suggest the application of another type of dependent variable (performance of primary group functions) to compare age homogeneous and age heterogeneous areas. The effect of homogeneity would depend on the degree the structure of primary groups available matches the requirements for the function to be performed. Age homogeneity, while increasing the concentration of proximate age peers, may create distance from kin who have the most long term commitment. Therefore, one type of function (participation in leisure), which is based on common or age-related interests, is shown to be strongly facilitated by age homogeneity. Another (watching one's place), which benefits from proximity of neighbors, but not from a loss of speed of reaction by the elderly, is weakly facilitated. Another (help in long illness), which is based on long term commitment, is affected little by age homogeneity. With moderate long term commitment required, neighbors and friends are able to substitute for kin. However, when larger degrees of long term commitment are required, for help with money matters, or help in long illness for those who are disabled, very old, or have low income, there is a significant decrease in the level of primary group aid between age heterogeneous and age homogeneous areas. This is particularly so for the elderly who are handicapped or who have multiple resource deficiencies, and are most affected by lack of kin. The effects of homogeneity are found to be largely independent of state of residence.

Previous research has shown that adult children are the predominant service and health care providers to the impaired elderly. However, relatively little is known about the conditions under which caregiving is either enhanced or hindered. Therefore, the purpose of this study was to systematically examine the caregiving relationship in order to better understand its causes and consequences. Data were collected via in-depth structured interviews with a sample of adult children (n = 131) identified as the primary caregiving relative to an older parent currently receiving home care or day care services. Bivariate and multivariate analytic techniques were utilized to identify the most salient variables associated with the two dependent variables of interest: caregiving involvement (the task and time commitment) and caregiving consequences (the perceived impact of providing care). Study findings indicate that the typical caregiving child is a late middle-aged daughter who holds concurrent responsibilities to other family members as well as working outside the home. Emotional support was the most universal caregiving activity although substantial proportions also assisted with linkage tasks, instrumental services as well as financial assistance. The primary strains of caregiving were found to be the result of the emotional aspects of providing care and the restrictions on time and freedom necessitated by caregiving responsibilities. The most salient independent predictors of caregiving involvement were: the parent's level of impairment; the quality of the parent-child affective relationship; the child's sex and marital status; and the degree of anticipatory planning for caregiving. Contrary to expectations, the child's employment status did not impinge upon fulfilling caregiving responsibilities. The significant variables predicting perceived negative consequences included: the extent of caregiving involvement; the parent's level of impairment; the perception of unmet service needs; the quality of the parent-child affective relationship; and the child's social class, sex, and health status. The extent of formal service utilization did not emerge as a significant predictor of caregiving consequences although the qualitative data gave support to the hypothesis that service input reduced caregiving strains. Implications for policy, practice, and service delivery in support of families caring for frail older relatives are discussed.

An aging HIV population carries a magnified risk of degenerative conditions such as cardiovascular disease (CVD) and osteoporosis. Recent studies have demonstrated that the growing population of older HIV-infected women is at special risk for these complications. To what extent the metabolic consequences of menopause or other related disease predictors such as depression influence this gender disparity is not known. The overall goal of this dissertation is to better characterize the etiology of low bone density and accelerated CVD in HIV-infected postmenopausal women. Current gaps in knowledge surrounding women aging with HIV, particularly as it relates to CVD and bone loss, are discussed in Chapter One. Chapter Two reports findings from a systematic review of low bone density and fractures in HIV-infected postmenopausal women. To gain a better understanding of CVD risk in HIV-infected postmenopausal minority women, a cross-sectional study was conducted and is presented in Chapter Three. Quantitative findings from a longitudinal analysis of bone density in postmenopausal minority women with HIV are reported in Chapter Four. Finally, in Chapter Five, findings from the previous chapters are summarized and synthesized into a concluding chapter; implications and future recommendations are also discussed.

This study had three main goals. The first was to describe the institutionalized Black aged in terms of their relevant demographic characteristics and reasons for admission. The second was to explore the relative importance of ethnic and cultural factors in service delivery to this population. The third was to examine the role which the Black family plays within the institutional setting as measured by patterns of visiting and task performance. The application of the Shared Function Thesis to the situation of aged Blacks in nursing homes resulted in the formulation and testing of eight hypotheses. These hypotheses put forth possible explanations as to how the family and the nursing home work together as a Shared Function and how this cooperative relationship affects resident satisfaction with care and resident morale. Data on these areas were obtained in structured interviews with nursing home administrators, residents, and family members. The sample was drawn from five selected voluntary nursing homes in New York City. A combination of random and purposive sampling resulted in the selection of 93 residents who were interviewed as part of the study between January and September 1978. Sixty-four of the 93 residents in the study sample had family available. Twenty-seven of these family members were interviewed. In addition, data on resident physical and mental health status, as well as corroborative data on family involvement were collected in questionnaires completed by the nursing home staff. Several major findings emerged in each area. Data on the demographic characteristics of this population were compared to existing norms for Black aged in the community. The institutionalized persons in the study sample were significantly older and there were many more widowed and never married persons. These findings would seem to indicate that lack of spouse or other familial supports in the face of advancing age and impairment is a major reason for admission to the nursing home. It was also found that availability of family was significantly related to sex of the older person. Black aged males in the study sample were less likely than aged females to have family available. On the question of ethnic factors in service delivery, two major findings emerged. The nursing homes which serve a majority of Black residents and were therefore defined as "ethnic" were more likely than the non-ethnic nursing homes to include cultural components in routine activities. These components included the celebration of holidays important to Black aged, the regular provision of ethnic foods and the inclusion of Black music and art in social activities. The second finding was that consumer attitudes were related to the ethnic orientation of the host facility. This was especially true for issues of matching provider and consumer on the basis of ethnicity than for the inclusion of cultural components in routine activities for which there was ample support from most residents and family members. With reference to the third area, the role of the family within the nursing home, data were obtained on patterns of visiting and patterns of task performance by family members and friends. On both indicators of shared function, visiting and task performance, there was evidence that family continue to play a meaningful role in the lives of their aged members even after institutionalization. Findings indicate that friends also visit frequently. Resident and family reported levels of visiting were very high and were above established norms for all Blacks in nursing homes. The reported level of visiting was also significantly higher than that reported for a sample of predominantly white, middle-class institutionalized aged in a similar study in the same locale. With respect to task performance by family and friends, the most commonly reported tasks performed were the provision of food treats, shopping and running errands, and the provision of clothing. Both the level of visiting and task performance were significantly related to resident and family satisfaction with care in a positive direction.