Response Bias Using Two-Stage Data Collection: A study of elderly participants in a program.

Researchers examining the effects of programs, in this case a state-level pharmaceutical assistance program for the elderly, sometimes must rely on multiple methods of data collection. Two-stage data collection (e.g., a telephone interview followed by a mail questionnaire) was used to obtain a full range of information. Older age groups were found to participate less frequently in the telephone interview, while certain demographic factors characterized mail questionnaire nonparticipants, all of which supports past research. Results also show that those in the poorest health are less likely to participate in the mail survey. Combining the two methods did not result in high attrition, suggesting that innovation can be successfully employed. Knowledge of the bias associated with each method will aid in targeting special groups.

A Job Diagnostic Survey of Nursing Home Caregivers: Implications of Job Redesign

Nursing home caregiving was analyzed as a job, subject to management intervention. Specifically examined was the usefulness of job redesign, a managerial intervention used to enhance worker motivation and effectiveness. Information from interviews with administrators was combined with survey data from aides and LPNs (n= 489) in 21 nursing homes to assess to need for, and feasibility of, redesign of caregiving work. Implementation principles and examples are included.

State-Level Pharmaceutical Assistance Programs for the Elderly: A national survey.

In order to put Pennsylvania's Pharmaceutical Assistance Contract for the Elderly (PACE) Program in a national context, a nationwide mail survey and telephone follow-up to each of the 58 State Unit Directors on Aging in the United States and its territories identified 10 programs. The results reported in this article are specific to the seven state-level pharmaceutical assistance programs which were in operation during the fiscal year 1984-85. In general, the programs varied on select program characteristics and on their efforts to address major policy issues. Data from the non-program states indicated support, legislative efforts, and a high interest in fiscal concerns. The findings reflect a lack of program uniformity and have implications for program development and implementation. Suggestions on how to identify the "optimum" or best combination of program and policy options are discussed.

Nursing Homes as a Setting for Psychological Practice: Public Policy Perspectives.

Recent federal legislation has provided renewed interest in improving the quality of nursing home care. The lack of both funding and personnel are significant barriers that may keep psychology's disciplinary expertise from being fully used in nursing homes. Nursing homes may be forced to undertake mandated activities (e.g., preadmission screening, nurses aides' training, and evaluation) without psychologists' expertise, relying either on medical practitioners with little knowledge of mental health interventions or on minimally qualified, entry-level mental health workers. Advocates for improved nursing home care must see the links among basic disciplinary skills, interdisciplinary collaboration, and improved care for mentally impaired elderly individuals.

Applied Developmental Psychology as an Implementation of the Life-Span View of Human Development

Application of knowledge about psychological development should, ideally, be theory based. As such, these applications represent “natural ontogenetic experiments”; the results of the evaluation of such interventions feed back to the theory, helping to support, falsify, or refine the ideas from the theory which led to the particular application. Such applied developmental intervention research is central within a currently popular perspective of life-span human development. Thus, applied developmental intervention research provides critical tests of such key concepts within this life-span perspective as: plasticity; multidirectionality; the synthesis of continuous and discontinuous processes across ontogeny; contextual embeddedness; and the role of individuals as agents in their own development. This paper elucidates some of the major features of the dynamic linkage between applied developmental psychology and this view of life-span human development. Key elements of this life-span perspective and the facts of developmental intervention, as seen from this perspective, are specified. Finally, the doctoral training program at the authors' institution is presented as one example of how this link may be institutionalized in the form of graduate education.

Evaluating Counseling Outcomes

Defines the range of interventions considered under the rubric of counseling for the elderly. Uses evaluation of treatments for depression among the elderly to exemplify the current state of outcome-evaluation research.

The Experience of Micro and Macro Events: A Life-Span Analysis

This study investigated how individuals retrospectively construe their lives in terms of major life events. Ninety-nine participants sorted a set of personal and historical events in terms of perceived importance for their lives. Analyses of variance with repeated measures and rank comparisons were computed. Overall findings revealed no cohort differences with regard to the perception of life events. However, within-cohort differences were found, indicating that more life events were recalled from the young adult years. Those experiences were also perceived as having been more important in the participants' lives than events from other age segments. With regard to historical events, war-related experiences were among the highest ranked. Analyses of variance revealed intracohort differences but not intercohort differences, indicating higher scores for the time between 1930 and 1948 relative to other historical periods.

Who Will Provide Long-Term Care in the Future?

Projects that long-term-care delivery system will face substantial barriers in the future in finding staff to provide services even without an increase in demand due to public or private insurance. Shift of the economy toward skilled service jobs; Changing demography of the work force; Policy elements and cohorts effects that shape the demand for long-term care personnel in the year 2000 and beyond.

Assessing Nursing Assistants' Knowledge of Behavioral Approaches to Mental Health Problems

Nurse's aides are the primary caregivers in nursing homes, a major receiving site for elders with behavioral and psychiatric problems. We describe the development, psychometric properties, and utility of a brief instrument designed to assess aides' knowledge of three specific mental health problems (depression, agitation, and disorientation) and behavioral approaches to them. The instrument was administered to 191 nurse's aides and 21 clinicians with training in behavioral management and experience with older residents. The nurse's aides averaged 11 of 17 correct answers, and the clinicians averaged 15 of 17 correct answers. Implications for staff training and consultation activities in nursing homes are discussed.

State Pharmaceutical Assisstance for the Elderly and Disabled: Planning Issues for Program and Non-Program States

The Medicare Catastrophic Coverage Act (MCCA) would have mandated federal assistance for Medicare beneficiaries who have high annual prescription medication costs, High national expenditures for such drugs have encouraged the development of private and state insurance programs to help with these costs. Ten state pharmaceutical assistance programs (SPAPs), designed to help certain elderly, low income, or disabled people, exist for those ineligible for Medicaid or unable to purchase coverage privately. Coordination of state and federal benefits was a consideration for established programs, and programs being planned needed to determine the feasibity of integration of federal assistance. But the enactment and subsequent appeal of the Act affected both planning and policy implications for these SPAPs. All U.S. states and territories were surveyed before the bill's repeal to collect data on the effects of MCCA for those with prescription drug programs and those without. The repeal of the federal program places pressure on the nonprogram states to proceed, perhaps more cautiously, to initiate program; for their own residents, given increasing out-of-pocket and insurance costs, and no federal program.

P-Technique Factor Analyses of the Multiple Affect Adjective Checklist (MAACL)

The Multiple Affect Adjective Check List (MAACL) has been found to have five first-order factors representing Anxiety, Depression, Hostility, Positive Affect, and Sensation Seeking and two second-order factors representing Positive Affect and Sensation Seeking (PASS) and Dysphoria. The present study examines whether these first- and second-order conceptions of affect (based on R-technique factor analysis) can also account for patterns of intraindividual variability in affect (based on P-technique factor analysis) in eight elderly women. Although the hypothesized five-factor model of affect was not testable in all of the present P-technique datasets, the results were consistent with this interindividual model of affect. Moreover, evidence of second-order (PASS and Dysphoria) and third-order (generalized distress) factors was found in one data set. Sufficient convergence in findings between the present P-technique research and prior R-technique research suggests that the MAACL is robust in describing both inter- and intraindividual components of affect in elderly women.

Examination of Priorities for Therapeutic Drug Utilization Review

Therapeutic Drug Utilization Review (DUR) is an important component of state-level pharmaceutical assistance programs.

The Relationship of Antipsychotic Drug Use, Resident Behavior, and Diagnoses Among Nursing Home Residents

Nursing homes have been criticized for frequent use and possible misuse of psycho-active agents. These issues are of clinical concern and policy relevance, especially since the passage of the Omnibus Budget Reconciliation Act (OBRA) of 1987. Using a sample of 419 residents, the authors examined the relationships among antipsychotic drug (AP) use, behavior, and mental health diagnoses. Only 23.2% of the residents were administered APs on a routine and/or "as-needed" basis. Based on the Multidimensional Observation Scale for Elderly Subjects (MOSES) ratings, AP users were more irritable, disoriented, and withdrawn than were nonusers. Also, AP users demonstrated agitated behaviors more frequently. Notably, AP users and nonusers differed significantly in terms of documented mental health diagnoses. Among AP users, 70.1% had documented dementia, 8.3% were psychotic or had other psychiatric disorders, and 21.6% had no mental health diagnoses. In contrast, the majority of nonusers had no mental health disorders. Logistic regression revealed that diagnostic factors, frequency of agitation, level of withdrawal, and marital status were significant predictors of AP use.