Characteristics of adult day care participants who enter a nursing home

The authors sought to determine the characteristics of individuals enrolled in adult day care who are most likely to enter a nursing home. The status of 201 adult day care participants was assessed at baseline and at least 3 years after baseline evaluation. Risk factors for nursing home entry were identified on the basis of staff and family caregiver reports, participant testing, chart review, and physician evaluations. Cox regression analyses of baseline data such as medical diagnoses, affect, and demographic information were used to identify risk factors for institutionalization. Multivariate Cox regression analysis identified depressed affect of the care recipient as an important predictor of institutionalization; other predictors were low frequency of socializing with relatives and friends, higher number of psychiatric diagnoses, and increased age. The findings highlight the importance of socialization and suggest that a focus on successful and reinforcing socialization should be an important component of adult day care programming. The results also suggest that addressing patient mental health variables may be important in delaying institutionalization in this population.     

Increasing therapeutic exercise participation by individuals with acquired brain injury using self‐recording and reinforcement

The purpose of this study was to evaluate the effects of self‐recording and contingent reinforcement on exercise participation by four adults with acquired brain injury. The results indicate that self‐recording and contingent reinforcement increased participation in stretching, aerobic, and weight‐lifting activities for each participant. The results also indicate that each participant was able to accurately self‐record his or her exercise participation. Possible operant conceptualizations for the observed behavior change, as well as limitations to the results, are briefly discussed. Copyright © 2008 John Wiley & Sons, Ltd.     

Predictors of exercise program participation in older women

Abstract

This study examined predictors of exercise program participation in females aged 60 to 89 years of age. Fifty-five exercise program participants and 50 non-exercising subjects were assessed on potential group predictor variables. Univariate analyses indicated that the Exercise compared to the Non-Exercise group had a stronger belief that they did not receive enough exercise in their everyday lives and in the health value of exercise, greater self-efficacy and enjoyment of exercise, and less physical discomfort associated with exercise. The Exercise group perceived exercise programs to be more available and greater family support to participate. Medical advice to exercise and exercise history did not differ significantly between groups. A logistic regression analysis indicated that of the variables assessed, belief that one is not receiving enough exercise in daily life and exercise availability were the most powerful predictors of exercise group membership. The implications of these findings for the promotion of exercise in older women are discussed.     

A comparison of the environments of day care centers and group day care homes for 3 year olds

Caregiver-child interaction and social participation were compared in community-based day care centers and group day care homes for three year olds. Use of group day care homes made it possible to control for group size and adult-child ratio. Day care homes were found to be more structured in terms of curriculum, and more flexible in terms of overall schedule and social-emotional climate. Adult child interaction was of higher quality during structured periods in day care homes. Social participation was of higher quality in day care homes. The adult-child interaction in both types of day care was impersonal and neutral in affective tone.     

Increasing senior citizen participation in a community-based nutritious meal program

Two experiments were conducted to compare the effects of several prompting and reinforcement procedures on the participation of elderly citizens in a nutritious meal program. Experiment I employed a variation of the multiple-baseline design across three groups of approximately 60 households each. Elderly persons not previously participating in the program were introduced to the following conditions: (1) public service radio announcements for four weeks to advertise the meal program and the availability of free transportation, (2) a home visit that served as a personal invitation and a second prompt for participation, (3) a followup telephone call, and (4) an incentive menu for participation, which was sent through the mail. Results indicated that the home visits and incentives were both effective as recruitment procedures and superior to other conditions; however, incentives proved to be the most cost-effective intervention. Experiment II used a variation of the multi-element design to compare the effects of scheduled activities and incentives in maintaining higher levels of participation by those persons who had attended the meal program at least once in the past, but whose current rate of participation was low. Results showed that activities improved attendance levels somewhat and that incentives substantially increased the number of meal program participants. Data from these experiments thus indicate that relatively inexpensive procedures may be used effectively to increase the extent to which elderly persons make use of potentially beneficial community-based services.     

Health care utilization by low-income clients of a community clinic: an archival study

An archival study was done of 500 medical records from a community clinic serving a low income predominantly Hispanic area of Los Angeles. The data collected included demographic characteristics and presented symptoms or reasons for visit, as well as diagnosis and treatment. The greatest number of patient visits were made for family planning services. A large porportion of the patients who received initial family planning services failed to return to the clinic for follow ups or additional supplies. A total of 208 pregnancy tests were performed in 151 of the 500 cases sampled. Of these, 152 were positive. The most frequently stated reason for requesting pediatric services was for physical exams, accounting for 30% of the visits. It should be noted that the discontinuity of care and insufficient utilization of preventive care seen in these results deserve serious attention by medical clinic administrators. The rate of patients who do not return for family planning after the initial visit is worrisome. A greater effort to attract women to family planning services at the time they request pregnancy verification could reduce the need for abortion of unwanted pregnancy. The data also indicate that changes in the wording of certain questions commonly asked of clients may be needed. This study allowed service providers to obtain important information about their performance, their needs, and the future direction that their services might take. This type of analysis is relatively low in cost and can yield important benefits, espicially if done on a periodical base in a search for policy implications.     

Preference for progressive delays and concurrent physical therapy exercise in an adult with acquired brain injury

The purpose of this study was to increase self-control and engagement in a physical therapy task (head holding) for a man with acquired traumatic brain injury. Once impulsivity was observed (i.e., repeated impulsive choices), an experimental condition was introduced that consisted of choices between a small immediate reinforcer, a large fixed-delay reinforcer, and a large progressive-delay reinforcer. The participant showed a preference for the progressive-delay option, even when the duration of the delay exceeded that of the fixed delay. The results have implications for establishing optimal choice making and teaching life-enhancing skills.     

Mental representations of attachment in day care providers

Mental representations of attachment of 31 day‐care providers were assessed using the Adult Attachment Interview (AAI), and compared with established observational measures of their behavior with the children under their care. Contrary to expectation, there was no significant association between the caregivers’ mental representations of attachment and their observed behavior. Teacher‐report ratings of aggressive behavior were obtained for 135 children who had been under the care of these providers. Ten of the 13 children who scored in the clinical range for aggressive behavior were known to have been under the care of a provider with a secure mental representation of attachment for an extended period of time (average 14 months), but the average age of first exposure to such a provider in this study was 16 months. For center‐based day‐care providers, standardized observational assessments of caregiving behavior appear to be unrelated to mental representations of attachment. Children who, during the second year of life, were cared for by providers with secure mental representations of attachment were not necessarily protected from abnormally aggressive behavioral outcome.     

Caregiver behavior in center and family day care

In an effort to examine relationships between variations within day care settings and adult caregiving behaviors the social experiences of 40 toddlers and their caregivers in family and center care were systematically observed. Caregivers were interviewed and conditions of caregiving recorded. Caregivers in both settings with fewer children in their care, who worked shorter hours, with less housework responsibilities engaged in more facilitative social stimulation, expressed more positive affect, were more responsive, and less restrictive and negative. Family day care caregivers who worked in spaces specifically designed to be safe and appropriate for children were less restrictive of toddler activity. Adult-child ratio and caregiver training appeared to be the best indicators of quality care in center day care, while a safe and appropriate caregiving environment and small groups appeared as quality indicators in family day care.     

Increasing participation and improving the quality of discussions in seventh-grade social studies classes

An experiment was conducted to evaluate procedures to improve classroom discussions in seventh-grade social studies classes. An increased number of students participated in discussions when rules were stated for discussions, students were praised for their contributions, the teacher restated or paraphrased students' contributions aloud or on the blackboard, the teacher planned an outline of discussion questions, student contributions to discussions were recorded and were used to determine part of the students' grades for the class, and discussion grades were publicly posted.The second part of the study focused on procedures designed to improve quality of classroom discussions. Students were taught to participate in discussions by providing reasons for their statements, comparisons between different points, or examples supporting their statements. As each type of contribution was taught, recorded, and counted toward part of the students' classroom grades, each type of contribution increased. Ratings of discussions by outside judges consisting of junior high school teachers, junior high school students, and persons experienced in conducting discussions, indicated that the training increased the overall quality of the discussions. Use of the quality training procedures, however, resulted in decreased levels of overall participation in discussion, a decrease that was reversed by the use of a group contingency for participation. Finally, the discussions after training seemed to be preferred by both the teacher and the students.     

Sex-typed play of toddlers in a day care center

By the age of 3, boys prefer gross motor and vehicle play and girls prefer doll and housekeeping play. The present study was an attempt to define the age at which these sex differences first appear by observing the play behavior of one- and two-year-olds in a day care center. We observed use of stereotyped toys in children 15 to 35 months old during free play. Boys played more with the masculine toys than with either of the other types, whereas girls showed almost equal use of all three types. Choice of sex-typed toys was more prevalent among older boys, while older girls showed less play with feminine toys than younger girls.     

Fathers' participation in the care of their preschool children

Correlates of fathers' participation in the care of their preschool children were investigated, using two indices of participation: (a) child-care tasks performed by the father independently; and (b) child-care tasks performed jointly with the mother. Subjects were 79 fathers and mothers of Caucasian middle-class 4-year-old girls and the girls themselves, and 36 fathers and mothers of a matched sample of preschool boys. Major factors examined as possible influences on participation included (a) maternal work-role pattern; (b) fathers' and mothers' sex-role ideology; and (c) family work load, i.e., family size and number of children under 6. Indices of variables conceptualized as possible consequences of participation included (a) girls' sex-role stereotyping; (b) fathers' self-perceptions of masculinity and femininity; and (c) wives' role-pattern satisfaction. Results indicated that fathers' independent (but not joint) performance of child-care tasks was significantly and positively related to maternal work-role variables and to nontraditional sex-role ideology of fathers and wives, but not to family work load. Independent (but not joint) participation was significantly and negatively related to daughters' stereotyping and to fathers' perceptions of themselves as stereotypically masculine. Wives' role-pattern satisfaction was unexpectedly found to be negatively related to both joint and independent participation.Data reported here were gathered as part of a research project supported by NIMH Grant #25215. The authors wish to acknowledge the collaboration of Susan Dibner.     

Personality characteristics associated with aerobic exercise in adult females

Using an index of aerobic conditioning 27 adult female joggers and 25 nonexercisers were identified. During individual interviews with each subject basic demographic data were obtained and blood pressure, vital capacity, resting pulse rate, and body fat were meaSured. All subjects completed Form A of the Sixteen Personality Factor Questionnaire (16PF). Statistically significant differences occurred on two primary factors, and one secondary dimension of the 16PF. The probability of three marginally significant differences out of 24 comparisons is well within the range of expected chance fluctuation. Thus, the study provided no evidence that personality characteristics are predisposing factors in the adoption of an aerobic jogging program by young adult females. The only statistically significant training effect was lower pulse rate; blood pressure, vital Capacity, and body fat were similar for the two groups. Finally, the results of this study of females were compared to those of a previous investigation of male joggers.     

A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee

The aim was to assess the self-efficacy and health outcomes of an adopted Arthritis Self-Management Programme (ASMP) among osteoarthritic knee sufferers in Hong Kong at 1 year. An experimental study with 95 participants assigned randomly to the intervention (n=45) or control group (n=50). Seventy-seven (81.1%) participants joined at least one out of three follow-ups in the 12 month period. Participants in the intervention group received a 6-week ASMP with an added exercise component in two general clinics. Outcome measures included arthritis self-efficacy (ASE) and health outcomes including pain and fatigue rating, self-rated health, daily activities limitation and number of unplanned arthritis-related medical consultations. Mean change (12 months minus baseline) and the effect size of the outcome measures were calculated by Mann-Whitney U test and nQuery Advisor 4.0. At 12 months, there were significant reductions of current pain (p=0.0001), pain at night (p=0.001), pain during walking (p=0.01) and number of unplanned arthritis-related medical consultations (p=0.03) and a significant increase in ASE for pain (p=0.01) and other symptoms (p=0.02) and self-rated health (p=0.04) among the intervention group but not for the control group. However, there were similarities in outcome measures of pain while switching from a sitting to a standing position, fatigue rating and physical functional limitation (p=0.15; p=0.22 and p=0.91, respectively) for both groups. Our findings add to the evidence that the modified arthritis empowering programme improved perception of control of osteoarthritis and three health outcomes after 12 months of treatment.     

Personality characteristics associated with aerobic exercise in adult males

Using an index of aerobic conditioning 23 adult male exercisers and 23 nonexercisers were identified. During individual interviews with each subject basic demographic data were obtained and blood pressure, resting pulse rate, and body fat were measured. All subjects completed Form A of the Sixteen Personality Factor Questionnaire (16PF). Statistically significant differences occurred on six primary factors and four Secondary dimensions of the 16PF. In comparison to the inactive subjects the exercisers, all of whom were joggers or runners, were more reserved, expedient, suspicious, forthright, liberal, and self-sufficient on the primary traits, and were more alert and independent, less discreet, and evidenced lower super-ego strength on the broader secondary patterns. The statistically significant training effects were lower pulse rate and less body fat, but did not include blood pressure.     

Family participation in the care of patients in public health disasters

The ethical implications of disaster planning garner increasing scrutiny. The role of families in disaster efforts is a topic that requires additional ethical examination. This article reviews the potential roles for families before and during disasters, with particular attention to the impact on children and vulnerable elderly patients. The potential positive and negative impact of family participation in different aspects of healthcare and disaster efforts is assessed.     

Recognizing social class in the psychotherapy relationship: a grounded theory exploration of low-income clients

The process of psychotherapy among 16 low-income clients was explored using grounded theory (Charmaz, 2006; Glaser & Strauss, 1967) in order to understand and identify their unique experiences and needs. Semistructured interviews were conducted with 12 women and 4 men who had attended at least 6 sessions of psychotherapy within 6 months of the interview. Our grounded theory that evolved depicted a tapestry of the dynamic process by which low-income clients experience social class within psychotherapy. Specific therapist behaviors that contribute to more and less positive experiences emerged from the data and pointed to the importance of acknowledging social class within the therapy room. The significance of therapists enhancing the 50-min hour via advocacy and meaningful moments within and outside of the therapy room was highlighted among all participants. Implications for practice with low-income clients and directions for future research are provided.