Religiosity and self-destructive crises in the institutionalized elderly

The relationship of religiosity to self-destructive behavior has largely been considered in terms of the impact of religious affiliation, or church membership, on rates of suicide for various geographical populations. This study departs from that approach and focuses instead on the relationship of intensity of religious commitment to the use of indirect life-threatening behavior (ILTB) among elderly, chronically ill hospital patients. A rating scale to measure the occurrence of ILTB was developed and administered to a sample of 58 patients in a Veterans Administration hospital. Findings for this sample indicate that intensity of religious commitment is a potentially more meaningful measure of religiosity than is formal church membership, that intensity of religious commitment tends to vary inversely with the extent of ILTB observed for the patient, and that "stigma avoidance" may play a role in the tendency for certain religious affiliates to make more extensive use of ILTB.     

Stimulating the creativity of elderly institutionalized women through works of art

The present article reports a controlled intervention study concerning the effects of a nondirected use of pictures of works of art as a way of stimulating creativity in elderly institutionalized women. Participants were randomly allocated either to the intervention (n = 20) or to the control (n = 20) group. After the intervention significant improvement in ratings between the groups was measured, with the intervention group more open and flexible and with a stronger deposition to a creative behavior than subjects in the control group. They also showed greater freedom and variation than the control group in drawing circles and making pictures. In puzzle tests the intervention group constructed increasingly imaginative, irregular, and open alternatives with colored patterns. The control group constructed closed and black forms. Importantly, the status of increased creativity continued to exist four months after the intervention. No changes were seen in the control group. This group showed a rational and precautious personality.     

Training of conversational skills with institutionalized elderly: a preliminary study

16 residents in a Residential Care Home for elderly people volunteered and were trained in a social skills program aimed at increasing conversational skills. Subjects were assigned randomly to three groups, one experimental and two control groups (placebo and waiting list). The techniques used in the experimental group were behavior rehearsal, feedback, modeling, discriminative reinforcement, verbal instructions, and homework. Relative to control groups, experimental subjects showed significant increases in conversational skills, such as receiving information, speaking-up, and giving information. They also showed a significant decrease in their scores on Zung's Self-rating Scale of Depression compared with the two control groups. They showed an increase in assertive responses and a decrease in aggressive and inhibited responses. These changes remained when follow-up was made 3 mo. later, suggesting the potential utility of this training program with elderly persons residing in old people's homes.     

Advancing age progressively affects obstacle avoidance skills in the elderly

The ability to adequately avoid obstacles while walking is an important skill that allows safe locomotion over uneven terrain. The high proportion of falls in the elderly that is associated to tripping over obstacles potentially illustrates an age-related deterioration of this locomotor skill. Some studies have compared young and old adults, but very little is known about the changes occurring within different age groups of elderly. In the present study, obstacle avoidance performance was studied in 25 young (20-37 years) and 99 older adults (65-88 years). The participants walked on a treadmill at a speed of 3 km/h. An obstacle was dropped 30 times in front of the left foot at various phases in the step cycle. Success rates (successful avoidance) were calculated and related to the time available between obstacle appearance and the estimated instant of foot contact with the obstacle (available response times or ARTs ranging from 200 to more than 350 ms). In addition, latencies of avoidance reactions, the choice of avoidance strategies (long or short step strategy, LSS or SSS), and three spatial parameters related to obstacle avoidance (toe distance, foot clearance, and heel distance) were determined for each participant. Compared to the young, the older adults had lower success rates, especially at short ARTs. Furthermore, they had longer reaction times, more LSS reactions, smaller toe and heel distances, and larger foot clearances. Within the group of elderly, only the 65-69 year olds were not different from young adults with respect to success rate, despite marked changes in the other parameters measured. In particular, even this younger group of elderly showed a dramatic reduction in the amount of SSS trials compared to young adults. Overall, age was a significant predictor of success rates, reaction times, and toe distances. These parameters deteriorated with advancing age. Finally, avoidance success rates at short ARTs were considerably worse in elderly participants who sustained recurrent falls in the six-month period prior to the assessment compared to those who sustained no or only one fall. An exercise program has been shown to improve avoidance success rates, especially at short ARTs, but the training effects on the determinants of success still need to be assessed.     

Application of social skills training in a group of institutionalized aggressive elderly subjects

A social skills training program consisting of instructions, modeling, role playing, and feedback was carried out with a group of 6 verbally aggressive institutionalized elderly patients. Dependent measures included confirmed incidents of verbal aggressive behavior monitored across an ABAB design with a 5-month follow-up period. Results indicated that verbally aggressive behavior can be significantly decreased in a group-training setting and subsequently generalized to ward and other socialized behavior. Ancillary aspects of the study include the role of social reinforcement, participant modeling, and staff attitude, perception, and motivation. Implications for future research are discussed.     

Characteristic patterns of word association responses in institutionalized elderly with and without senile dementia

This study examined the responses of 91 institutionalized elderly persons to the Goldfarb-Halpern Word Association Test (1981), Journal of Speech and Hearing Research, 24, 233–246. Subjects with senile dementia evidenced a characteristic pattern of responses which included marked reduction of paradigmatic responses, no decrease in syntagmatic responses, and a marked increase in unclassifiable and multiword responses not previously reported in the literature. The declines and increases appeared linear and progressive with severity of dementia. The pattern was distinct from that of any other adult group previously tested with this tool. Institutionalized elderly subjects without senile dementia performed similarly to previously tested noninstitutionalized elderly. Theoretical and clinical implications are discussed.     

Evaluating the relative effectiveness of three aversion therapies designed to reduce craving among cocaine abusers

Crack cocaine use and dependence has been steadily increasing since the mid‐1980s. Treatment approaches vary from simple psychotherapy to intensive medication regimens. One clear phenomenon that has been implicated in the continued use and abuse of crack cocaine is craving. Craving is believed to be a response that has been conditioned with previous drug using episodes, and is elicited by environmental cues. The current study investigated the use of three aversion therapies (chemical, covert sensitization, and faradic) designed to eliminate craving for cocaine. Seventy subjects were randomly assigned to one of three aversion treatments or a relaxation control condition. Results indicate that aversion therapy reduces crack cocaine craving. The use of aversion therapy as an adjunct to traditional treatment programs for reducing craving is discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Chained schedules of avoidance: Reinforcement within and by avoidance situations

Four rats were exposed to chained schedules with variable-cycle avoidance in both links. Responding in the initial link cancelled shocks scheduled once per minute and, according to a conjoint fixed-ratio schedule, produced a terminal link where scheduled shock rates varied from 0 to 8 shocks per minute in different conditions of the experiment. Response rates in the terminal link increased as a function of the scheduled shock rate. Response rates in the initial link, on the other hand, decreased as a function of the shock rate actually received (rather than scheduled) in the terminal link. While consistent with other studies of aversive control, these results differ from those obtained in chained schedules of positive reinforcement in that increases in reinforcement within the terminal link of the chain did not systematically increase the reinforcing value of that link.     

Exercise training can improve spatial characteristics of time-critical obstacle avoidance in elderly people

Fall prevention programs have rarely been evaluated by quantitative movement analysis methods. Quantitative movement analyses could provide insight into the mechanisms underlying the effects of training. A treadmill obstacle avoidance task under time pressure has recently been used to evaluate a fall prevention exercise program for community-dwelling elderly people and it showed that participants improved their obstacle avoidance success rates. The mechanism, by which the increased success rates were achieved, however, remained to be determined. Participants were elderly who had fallen at least once in the year prior to participation. They were assigned to either the exercise or the control group. The control group did not receive any specific treatment. The exercise group was administered a five week exercise program, which consisted of exercises on a functionally oriented obstacle course, walking exercises, and practice of fall techniques. Pre- and post-intervention laboratory obstacle avoidance tests were conducted. Three possible determinants of success were investigated, namely avoidance reaction times, the distribution of avoidance strategies, and three spatial parameters (toe distance, foot clearance and heel distance). Analysis yielded significant TimexGroup interactions in heel distances. The exercise group increased heel distance, while the control group did not. Increased heel distance may result in reduced risk of heel contact with the obstacle and, consequently, larger success rates. The remaining parameters showed no effect of training. In conclusion, the training program was effective in improving time-critical obstacle avoidance skills. In every day life, these effects of training may contribute to less obstacle-related fall incidents in elderly. In addition, these findings could indicate that the execution of other time-critical events, like an actual fall, could also be improved by training.     

Timing of avoidance responses by rats

Three rats were trained on an unsignalled shuttlebox-avoidance task under three response-shock intervals (10, 20, and 40 sec). Under all conditions, subjects developed excellent temporal gradients of avoidance; that is, response rate was an increasing function of time since last response. Although the response rate at any given interval of time after the previous response was inversely related to the response-shock interval, there was an underlying similarity in the temporal gradients for the three intervals. In all cases, response rate relative to the maximum response rate was approximately equal to the proportion of the interval that had elapsed. This suggests that rats in unsignalled avoidance are estimating time from response completion, and that the units of the estimate are proportional parts of the response-shock interval.     

Control of avoidance by a response-produced stimulus

Three pigeons were trained to press a foot pedal to postpone electric shock. The safety signal was a tone of 1000 Hz, which sounded for 5 sec following each press; silence therefore served as a warning signal. After the performance approached asymptote, test sessions were interspersed among the training sessions. Following a warm up, the shock was omitted (extinction), and no tone or a tone of 250, 500, 1000, 2000, or 4000 Hz was presented following each press for the remainder of the session. Gradients of generalization plotted in terms of the number of times the tone was produced on each test peaked at 1000 Hz, indicating that the performance was controlled by the frequency. Since this dimension is orthogonal to absence of tone, the gradient cannot be attributed to differences in the magnitude of change in the warning signal. It was concluded that response-produced stimuli reinforce avoidance behavior.     

Developing proper mealtime behaviors of the institutionalized retarded

The institutionalized mentally retarded display a variety of unsanitary, disruptive, and improper table manners. A program was developed that included (1) acquisition-training of a high standard of proper table manners and (2) maintenance procedures to provide continued motivation to maintain proper mealtime behaviors and decrease improper skills. Twelve retardates received acquisition training, individually, by a combination of verbal instruction, imitation, and manual guidance. The students then ate in their group dining arrangement where the staff supervisor provided continuing approval for proper manners and verbal correction and timeout for improper manners. The results were: (1) the trained retardates showed significant improvement, whereas those untrained did not; (2) the trained retardates ate as well in the institution as non-retarded customers did in a public restaurant; (3) proper eating was maintained in the group dining setting; (4) timeout was rarely needed; (5) the program was easily administered by regular staff in a regular dining setting. The rapidity, feasibility, and effectiveness of the program suggests the program as a solution to improper mealtime behaviors by the institutionalized mentally retarded.