Evaluating the Ohio Elder Abuse and Domestic Violence in Late Life Screening Tool and Referral Protocol This article describes the evaluation processes employed in the Ohio project to develop and test screening tools and referral protocols on elder abuse and domestic violence. Three focus groups and a Roundtable of experts were utilized to develop the materials in the first year. In the second year, a formal quantitative evaluation that involved 160 practitioners in Ohio was implemented to review the materials and to use them with clients. Findings from the quantitative evaluation were incorporated to make changes that led to a final document that was much simpler, less lengthy, and more relevant to beginning practitioners. Read more
Application of Elder Abuse Screening Tools and Referral Protocol Techniques and Clinical Considerations This article discusses the techniques and clinical considerations in using elder abuse screening tools and referral protocol recently developed by The Benjamin Rose Institute and a multidisciplinary statewide roundtable for Ohio service providers. Various constructs of abuse on these tools are matched with case situations to demonstrate the practitioner's clinical decision-making process with reference to identifying abuse and selecting an appropriate referral source. In addition, clinical limitations and ethical dilemmas for practitioners in application of the tools and referral protocol are considered. Read more
Trying to Continue to do as Much as They Can do Theoretical Insights Regarding Continuity and Meaning Making in the Face of Dementia Face-to-face interviews were conducted with six individuals in the early stages of a dementia. Interviews were initiated to explore the day-to-day experiences of dementia. The commonality that emerged across the interviews was participants’ desire to maintain continuity with their previous way of life while coping with dementia-necessitated changes. We conceptualized this commonality in terms of Atchley’s (1989) articulation of continuity theory and Park and Folkman’s (1997) framework of meaning making. This research highlights how, despite their impairment, individuals with dementia not only are able but strive to maintain continuity and to make meaning of their situations. The results show that it is possible to gain insight from those in the early stages of dementia; the underlying practical and clinical implication is the importance of encouraging the maintenance of personhood by listening to the desires and concerns of those with dementia. Read more
Are Persons with Cognitive Impairment Able to State Consistent Choices Purpose: This study examined the decision-making capacity of persons with cognitive impairment with respect to their everyday care preferences and choices. This is the first in a series of articles to report on findings from a larger study that examines choice, decision making, values, preferences, and practices in everyday care for community-dwelling persons with cognitive impairment and their family caregivers. Design and Methods: Fifty-one respondent pairs, or dyads, were interviewed, that is, persons with cognitive impairment (n = 51) and their family caregivers (n = 51). All persons with cognitive impairment were interviewed twice within a week using a parallel interview to determine stability and accuracy of responses. The family caregiver was interviewed once. Results: Persons with mild to moderate cognitive impairment (i.e., Mini-Mental State Exam scores 13–26) are able to respond consistently to questions about preferences, choices, and their own involvement in decisions about daily living, and to provide accurate and reliable responses to questions about demographics. Implications: Including the perspective of persons with cognitive impairment in both research and practice has the potential to enhance their autonomy and improve their quality of life. Read more
A model intervention for elder abuse and dementia This article describes a 2-year collaborative project in Cleveland, OH, that improved the reporting and management of potential and suspected elder abuse situations involving persons with dementia. Educational curricula for cross-training, screening tools, and referral protocols were developed and tested for staff and volunteers in adult protective services and dementia care. A handbook for caregivers of persons with dementia was produced that enables caregivers to self-identify elder abuse risk and seek appropriate interventions to prevent abuse. Project organization, implementation, and evaluation are discussed along with strategies for replication in other communities. Read more
Sustained Personal Autonomy A Measure of Successful Aging Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period? Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years. Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes “favors family or self over agency assistance” and “does not expect filial obligation” were also independently associated. Discussion: The results are consistent with previous studies of successful aging and show that attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years. Read more
The Influence of Religious and Personal Values on Nursing Home Residents’ Attitudes Toward Life-Sustaining Treatments A cross-sectional survey design was used to interview 133 Jewish, Catholic and Protestant residents from 13 nursing homes to examine the influence of religious and personal values on attitudes toward life-sustaining treatments. Subjects on average were 83 years old, Caucasian and female, with more than half having Advance Directives (ADs). Jewish subjects, as well as those who relied on God, were better educated and more anxious about death, had significantly more positive attitudes toward life-sustaining treatments at the end-of-life. On the other hand, those who had implemented ADs desired fewer life-sustaining treatments. Finding demonstrate that understanding individual desires for life-sustaining treatments is complex. Practitioners who provide education on end-of-life decisions need to discuss a myriad of issues including individual religious and personal values and other characteristics in an effort to understand and respect treatment choices. Read more
The Influence of Formal and Informal Helpers on Primary Caregivers’ Perceptions of Quality of Care Primary caregivers’ perceptions of the overall quality of care given to their impaired elderly relatives are more strongly related to the perceived helpfulness of selected formal care providers (home aides, physicians, and social workers) than to the perceived helpfulness of selected kin caregivers. Caregiver race and age, the types of other family members who are helping, and whether a nurse is involved influence caregivers’ perceptions of the helpfulness of these formal care providers. Read more
