The inaccuracy of nurses' perception of elderly patients' well-being

Abstract

Thirty elderly day hospital patients rated two aspects of their well-being: life-satisfaction and depression. The key-nurse estimated these values for each patient, using the same, validated scales. Patients' ratings of life-satisfaction and depression intercorrelated. as did the nurses' estimates, but the nurses' scores were unrelated to those of the patients. Patients' well-being correlated with their estimates of the time they spent in solitary activity, whereas nurses' estimates correlated with overt engagement and behavioural dependency. It is likely that general nurses' lack of perception of their elderly patients' well-being arises, in part, because their assessments are based on aspects of their patients' overt behaviour which are unrelated to actual well-being.     

Possible selves in adulthood and old age: a tale of shifting horizons

Young, middle-aged, and elderly adults (N = 308) evaluated themselves on 6 dimensions of psychological well-being according to present, past, future, and ideal self-assessments. Young and middle-aged adults saw considerable improvement in themselves from the past to the present on all dimensions of well-being. The elderly, however, indicated largely a perception of stability with prior levels of functioning. Future ratings showed that the 2 younger groups expected continued gains in the years ahead, whereas the oldest respondents foresaw decline on most aspects of well-being. The comparison of present and ideal self-ratings supported (cross-sectionally) the hypothesis that with age, individuals achieve a closer fit between their ideal and their actual self-perceptions.     

Subjective perception of health in elderly inpatients

There is evidence that subjective health is an important variable in general health outcomes. It can be an indicator of the individual's overall health status, creating a reliable and valid estimate about health. Quality of life (QoL) assessment can be associated with the individuals' subjective assessment of their own health status. The aim of the present study was to investigate variables associated with subjective perception of health in older inpatients. Ninety elderly inpatients over 60 years old were interviewed. The perception of health assessment (healthy/unhealthy) allocated elders in either of two groups. All the elders answered sociodemographic questions, the WHOQOL-100 and the Beck Depression Inventory (BDI). Comparing the group that considered themselves unhealthy to the other group, the former showed a tendency of worse QoL assessments in five out of six domains investigated. Significant differences were found for the physical and level of independence domains, as well as overall QoL. There was a significant association between health perception and lower intensity of depressive symptoms, as well as better QoL perception in the level of independence domain. This study shows the existence of an association between depressive symptoms and health assessment. It also suggests that the independence dimension is important in the elders' perception of their health status. These findings can help identify cause-effect relations between variables in aging studies involving health indicators and bring new intervention proposals for the elderly.     

Feelings of attachment to siblings and well-being in later life

On the basis of an adult model of sibling attachment, I hypothesized that the well-being of older persons depends on their perception of the closeness of the sibling bond, on their perception of any disruption of that bond, and on the sex combination of the siblings being considered. In all, 83 persons, aged 61 to 91 years, were interviewed about their relationships with each of their living siblings. They rated their feelings of closeness, conflict or rivalry, and indifference to the sibling. A measure of depression was used as the indicator of well-being. Separate correlational analyses were carried out for the four sex combinations of siblings. Closeness of the bond to a sister (by both men and women) was related to less depression. Also, women's perceptions of conflict and indifference in their relationships with sisters were related to increased depression. Findings are interpreted in terms of attachment theory and sex role expectations.     

Positive perception of time and its association with successful ageing / Percepción positiva del tiempo y su relación con el envejecimiento exitoso

Abstract

The objective of this study was to explore the relationship between perception of time and indicators of successful ageing. The study evaluated preference in temporal orientation, perception of speed of the passage of time and a wide range of psychosocial well-being and health indicators. The sample consisted of 1,178 people aged over 60 years from the ELES longitudinal study, which was representative of the Spanish population. Results showed that: (a) the majority of people of all ages are oriented to the present, although as they become older there is a shift towards the past; (b) orientation to the present implies higher levels of well-being and health, as opposed to orientation to the past; and (c) a perception of a faster passage of time is associated with well-being. In conclusion, the way in which older people perceive time is an indicator of adaptation, well-being and health.     

The psychosocial effects of rheumatoid arthritis on the patient and the well partner

Rheumatoid arthritis (RA) is a chronic disorder that can have a severe impact on patient's lives. This present study investigated four questions regarding the psychosocial effects on patients and their well partners. First we found that depression for both patients and partners were slightly elevated and 35.7% of patients and 23.3% of well partners had scores above the cut-off for possible clinical depression on the Center for Epidemiological Studies Depression Scale. Second, there was no significant difference between the patients' level of distress and that of the partners. Third, there were moderate positive correlations between patients' and partners' scores on measure of psychological functioning. Fourth, there were no differences in either the patients' or partners' well-being based on the gender of the patient. Finally, an exploratory analysis was conducted to examine the factors which influence the patients' and partners' depression and their view of the relationship.     

Discrepancies between patients' and partners' perceptions of unsupportive behavior in chronic obstructive pulmonary disease

The literature on chronic diseases indicates that partner support, as perceived by patients, contributes to well-being of patients in either a positive or a negative way. Previous studies indicated that patients' and partners' perceptions of unsupportive partner behavior are only moderately related. Our aim was (1) to investigate whether discrepancies between patients' and partners' perceptions of two types of unsupportive partner behavior-overprotection and protective buffering-were associated with the level of distress reported by patients with chronic obstructive pulmonary disease (COPD) and (2) to evaluate whether the direction of the differences between patients' and partners' perceptions was associated with distress (i.e., whether patient distress was associated with greater patient or greater partner reports of unsupportive partner behavior). A cross-sectional study was performed using the data of a sample of 68 COPD patients and their spouses. Distress was assessed using the Hopkins Symptom Checklist-25. Patients' and partners' perceptions of unsupportive partner behavior were assessed with a questionnaire measuring overprotection and protective buffering. Distress was independently associated with patients' perceptions of protective buffering and discrepancies in spouses' perceptions of overprotection. Regarding the direction of the discrepancy, we found that greater partner reports of overprotection as compared with patient reports were related to more distress in COPD patients. Our study showed that patients' distress was associated not only with patients' perceptions, but also with discrepancies between patients' and partners' perceptions of unsupportive partner behavior.     

Pain language of bone marrow transplantation patients.

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.     

Self- and social perception of physical appearance in chest wall deformity

This study analyzes self- and social perception of physical appearance in patients with chest wall deformity (CWD), including both pectus carinatum and pectus excavatum. Self-perception of appearance in 76 patients with CWD and social perception of patients' appearance by 20 adult and 20 adolescent raters was assessed using the Appearance Rating Scale (Stangier et al., 2000) and evaluated for agreement and multivariate correlates. Results indicate no agreement between self- and social rating. Based on mean scores patients rated their appearance significantly more negatively than adult raters but only slightly different than adolescent raters. Adolescent raters' judgment of the patients' appearance was related to CWD characteristics, while self-rating rather seems to be related to psychosocial factors. Because adolescents are a relevant peer group for adolescent patients with CWD their evaluation of the appearance might influence patients' self-image and might affect their psychological functioning. Effective interventions focusing on social interactions are needed.     

Changes in Subjective-Objective Sleep Discrepancy Following Inpatient Cognitive Behavior Therapy for Insomnia

Discrepancy between objective and subjective sleep parameters is a frequent symptom in persons suffering from insomnia. Since it has an impairing effect on daytime well-being and neglects possible positive objective improvements, it would be useful if it was treated. Apart from hypnotics, cognitive behavior therapy (CBT-I) is the therapy of choice for chronic forms of insomnia. However, there is limited information about whether CBT-I can also improve subjective-objective sleep discrepancy. We investigated a large sample of patients showing chronic forms of insomnia regarding their subjective-objective sleep discrepancy pre and post CBT-I. Objective sleep data were obtained from 3 nights (2 baseline nights and 1 night after therapy) using polysomnography in our sleep laboratory. All 92 patients participated in a 14-day inpatient program with CBT-I including psychoeducation about subjective-objective sleep discrepancy. Repeated measures analyses showed an improvement in subjective-objective sleep discrepancy parameters after CBT-I. Those parameters were also correlated with perceived quality of sleep. We conclude that CBT-I is a useful tool to improve subjective-objective sleep discrepancy in patients showing chronic forms of insomnia.     

Mindfulness and Emotional Distress: the Mediating Role of Psychological well-Being

The present cross-sectional study aimed to clarify the relationships among specific facets of dispositional mindfulness, psychological well-being, and emotional distress. To understand the relationships among these variables is crucial in order to expand the knowledge of the processes underlying mindfulness effects and to develop effective interventions. The participants (119 Italian males and females; mean age = 29 years) completed self-report questionnaires assessing mindfulness (i.e., observing, describing, acting with awareness, non-judging of inner experience, non-reactivity to inner experience), emotional distress, and psychological well-being. Path analysis revealed that each facet of mindfulness played a unique role in influencing emotional suffering. In line with our prediction, no significant correlation emerged between the observing facet and either psychological well-being or emotional distress. Both the capacity to describe inner events and to act with awareness had an indirect effect on emotional distress, which was fully mediated by the perception of psychological well-being. On the other hand, the capacity for non-reacting to emotions and thoughts directly influenced emotional distress. Interestingly, non-judging inner events showed both a direct and indirect effect on the outcome variable. These findings confirmed the significant role of psychological well-being in mediating the relationship between some facets of mindfulness and emotional distress. Moreover, different mindfulness abilities play specific roles in reducing emotional distress, so mindfulness should be considered as a multidimensional construct.     

How time flies: a study of novice skydivers

Although time distortion is commonly reported during a traumatic experience, there is little research addressing the phenomenon. This study investigated the role of affect in time perception in a very stressful experience by indexing novice tandem skydivers' (N=76) levels of fear and excitement before the skydive and soon after landing. Estimations of how long skydivers thought their experience lasted were obtained after landing. Whereas increased fear was associated with the perception of time passing slowly, increased excitement was associated with the perception of time passing quickly. These data support models of time perception based on avoidance and approach motivations influencing time distortion.     

Impact of patient suffering on caregiver well-being: the case of amyotrophic lateral sclerosis patients and their caregivers

The impact of patient suffering on family caregivers is an understudied but important topic. This study of patients with amyotrophic lateral sclerosis (ALS) and their caregivers examined the associations of two components of patient suffering: patient physical symptoms, and mental distress, as well as the patient's support for the caregiver, with caregiver well-being. The sample consisted of 52 patients with ALS and their caregivers. Patients and caregivers each completed a structured survey assessing multiple domains including demographics, health, and well-being. Specifically, patients rated their own physical symptoms and mental distress. Caregivers rated their own daily affect, and the extent to which they perceived the patient as supportive. Caregivers also reported whether or not they had found any benefit in dealing with the patient's illness. Regression analyses yielded significant associations of patient distress with caregiver negative affect; patient support was associated with greater caregiver positive affect, and patient symptoms and support were associated with greater likelihood of caregiver benefit finding. There was a significant two-way interaction of patient symptoms by support, namely, benefit finding was not only more likely with greater physical suffering and patient support, but it was also the case that caregivers who perceived the care recipient as unsupportive could only find benefit when this person experienced intense physical suffering. Support interventions for ALS patients and their caregivers should devote particular attention to how caregivers may be affected by witnessing their loved one's sufferings, as well as identify and address challenges in support exchanges between caregivers and patients.     

视觉工作记忆参与融景知觉

融景知觉现象是指观察者任意时刻虽然只能观察到部分刺激模式,却能基于部分刺激模式形成完整知觉。完成融景知觉的关键在于需要将时间序列上的信息进行整合。根据视知觉与视觉工作记忆动态交互模型,完成信息整合需视觉工作记忆的参与。然而以往研究均关注融景现象的知觉加工特性,尚未涉及视觉工作记忆在该现象中的作用机制。笔者采用双任务范式,要求被试完成规则或不规则刺激模式的融景知觉,同时操纵工作记忆负荷,以考察记忆负荷对融景知觉的影响。结果发现,高记忆负荷显著降低不规则刺激的融景知觉绩效(实验一);且该效应并非由记忆负荷对融景刺激维持阶段的影响所致(实验二)。上述结果说明,至少对不规则图形的融景知觉需要视觉工作记忆参与。     

Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients

To investigate how time perception may contribute to the symptoms of self-harming Borderline Personality Disorder (BPD) patients, 19 self-harming BPD inpatients and 39 normal controls were given measures of time perception, impulsivity, personality, emotion, and BPD characteristics. A test sensitive to orbitofrontal cortex (OFC) function ("Frontal" Behavior Questionnaire) was also administered, as the OFC has been associated with impulsivity and time perception. BPD patients produced less time than controls, and this correlated with impulsiveness and other characteristics commonly associated with BPD. BPD patients were also less conscientious, extraverted, and open to experience, as well as more impulsive (self-report and behaviorally), emotional, neurotic, and reported more BPD characteristics, compared to controls. The results suggest that some of these core characteristics of BPD may be on a continuum with the normal population and, impulsivity in particular, may be related to time perception deficits (i.e., a faster subjective sense of time). Finally, BPD patients scored higher on the Frontal Behavior Questionnaire, suggesting that some symptoms of the BPD syndrome may be related to problems associated with the OFC. A control spatial working memory task (SWM) revealed that SWM deficits could not explain any of the BPD patients' poor performance. While impulsivity was correlated with time perception across all participants, emotionality, introversion, and lack of openness to experience were not. This suggests that different symptoms of the borderline personality syndrome may be separable, and therefore, related to different cognitive deficits, and potentially to different brain systems. This may have important implications for treatment strategies for BPD.     

Decisions About Testing and Termination of Pregnancy for Different Fetal Conditions: A Qualitative Study of European White and Pakistani Mothers of Affected Children

The aim of this study is to explore reasons for and against prenatal testing and termination for a range of conditions in women from two different ethnic backgrounds. A total of 19 Pakistani and European women in West Yorkshire, UK, who either had a child with a genetic condition or had terminated a pregnancy for one, completed a questionnaire about their attitudes regarding prenatal testing and termination for 30 different fetal conditions and were interviewed about their reasons for their responses. There were more similarities than differences between the Pakistani and European white women. The most important factor in most women’s decisions about termination of pregnancy was their perception of the quality of the life of a child with the genetic condition, in particular, whether the child would be “suffering.” This was described as either physical suffering, as a result of medical treatment, or as emotional suffering, as a result of psychological and/or social factors. These findings highlight the need for detailed information about the potential quality of life for the child and the child’s family to enable parents to make informed choices, particularly the extent to which the child is likely to suffer, the nature of such potential “suffering” and the extent to which the child could lead a “normal” life. The findings also challenge stereotypes about cultural differences in attitudes about termination of pregnancy.     

COGNITIVE APPRAISALS OF LIFE STRESS AND DEPRESSION IN THE ELDERLY: A CROSS-CULTURAL COMPARISON OF ASIANS AND CAUCASIANS

Cognitive models of depression have not been adequately tested in different cultural settings involving personally relevant events that affect the lives of the elderly. A cross-sectional comparison was made of cognitions obtained from Asian and Caucasian subjects, residing in Canada and the United States. The objective was to determine whether cognitive appraisals of stressful events would differentiate the elderly in the two cultural groups. Results supported the hypotheses that cognitive appraisals of locus of control, uncertainty, self-responsibility, self-confidence in future coping and fear about future recurrence of negative events are strongly associated with the depressive responses of the elderly in general. A comparison of the cognitive appraisals of the elderly in the two cultural groups showed depressed Asians more significantly than depressed Caucasians, reporting more external locus of control and self-blaming attributions. The results have implications for community workers, psychotherapists and social welfare agents concerned with the mental well-being of the elderly and the care of the elderly from different cultures.     

Metamemory beliefs and episodic memory in obstructive sleep apnea syndrome

This study assessed metamemory and its role in actual episodic memory performance in 26 patients with obstructive sleep apnea syndrome and 27 healthy controls. Metamemory knowledge and memory beliefs were assessed using the Metamemory Inventory in Adulthood. Episodic memory performance was investigated with the Remember/Know paradigm. Subjective sleepiness was evaluated. Patients underwent a polysomnographic assessment. In contrast to the control group's more stable memory beliefs, patients self-assessed their memory as declining across time, and felt more anxious about their memory. There was only a modest difference between patients' self-perceptions of their memory capacities and those of the control group, but patients' actual memory performance was strongly disturbed. While the latter was significantly correlated with severity of obstructive sleep apnea, scores on the Metamemory Inventory in Adulthood scales were not correlated with physiological measures, subjective sleepiness, or episodic memory performance. Obstructive sleep apnea may affect prefrontal cortex functioning and hence the ability to assess one's own memory impairment.