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Errata

The following abstracts were accepted for presentation at the 56th Annual Scientific Meeting of The Gerontological Society of America, November 21–25, 2003, in San Diego, California, and were omitted from The Gerontologist, Volume 43, Special Issues I and II, October 2003.

F. Whittington, M. Ball, B. Connell

Participant(s):

F. Whittington (Georgia State University, Atlanta, GA). Goodness of Fit in Assisted Living: Rationale and Methods of the Study

M. Ball, C. Hollingsworth (Georgia State University, Atlanta, GA). Moving to Assisted Living: Control of Decision Making

S. King, C. Elrod, M. Lepore (Georgia State University, Atlanta, GA). Social Adaptation in Assisted Living: Preserving Resident Identity and Choice

M. Perkins, M. Ball, B. Combs (Georgia State University, Atlanta, GA). Creating Meaning in Assisted Living

Despite the recent rapid growth of the assisted living industry, little research has been done on residents—how they decide to move to assisted living facilities (ALFs), how they adapt to their new living arrangement, and their search for meaning in the new environment. This symposium will use data gathered from a 2-year study of 5 ALFs varying in size, location, racial composition, and resident fees to examine these questions. Data collection methods included participant observation and informal interviewing during 457 visits over a 13-month period, 119 in-depth interviews with residents, providers, and family members, and review of residents' records. Data were analyzed using the grounded theory method. In 4 presentations, members of the research team show that the transition to assisted living consists of a number of decision making points, each of which can involve resident participation and affect transition outcomes. While having some control over the process improved resident satisfaction, in the majority of cases family members made most decisions. After the move, social adaptation to the home was influenced by the circumstances of the decision to move; choice of facility; individual characteristics, such as health status and personality; the ability to maintain lifestyle preferences; environmental factors, such as the ability to personalize space; and the type, frequency, and quality of social interactions with other residents, staff, and families. Achieving "a good resident-facility fit" provided residents with an environment where they were more likely to develop meaningful relationships, engage in meaningful activities, and maintain meaningful roles.

Poster: Gender, Humanities, and The Arts Participant(s):

The Aging of "Baby Boomer" Women and the Potential for Increased Alcohol Use

H. Braunschweig, Case Western Reserve University, Cleveland, OH.

Women constitute the majority of the over-65 population, and this number grows disproportionately annually. With the "Baby Boomers" soon entering old age, this number will skyrocket. While previous studies have looked at male alcohol use, little attention has been focused on women. The present study investigates alcohol use in 5000 older and "Baby Boomer" women between the ages of 50–102 collected from the 1974–1994 National Household Survey on Drug Abuse. This study examines the patterns of alcohol use and abuse in these populations as well as determines the potential risks that these women face in their future. Results indicate that more than 15% of older women regularly drink in excess of the recommended guidelines. As they age, the women are also at greater risk for developing mental and physical disorders and losing essential social networks. These risks have been shown to increase the incidence of alcohol misuse and lead to a swifter progression of alcohol-related illnesses. This research has implications for public policy issues regarding treatment and education about alcohol abuse specifically for the growing older population of "Baby Boomers" and can lead to potential interventions to prevent a future generation of addicts.

Alternative Measures of Masculinity and Their Relationship with Health Among African American Men

W. Duck, Wayne State University Institute of Gerontology, Detroit, MI.

The way masculinity is conceptualized by men may have negative consequences on health, especially if their masculinity beliefs are in opposition to health seeking and health promoting behaviors. To investigate the relationship between masculinity and health, a study using open-ended questions about masculinity and manhood was conducted. This paper reports on a study of 120 African American men, stratified by age, younger men (18–39) and older men (40 and older). Structured interviews were conducted that explored participants' beliefs about masculinity in relationship to health (mental and physical) across the life span. In addition to open-ended questions about masculinity, a standardized masculinity measure was also used to assess masculinity. Demographic and health information was also collected using surveys (such as the SF-12). Regression models and bivariate correlations were used to assess the relationship between masculinity concepts developed from in-depth interviews, masculinity scores, and responses to the health survey. The study found that some specific masculinity beliefs (i.e. economic aspirations, high masculinity scores) are related to both physical and mental health. The open-ended masculinity responses that emerged from interviews provide an insight into the examination of masculinity. The methodology used to produce this model provides results with different types of masculinity ideologies similar to those outlined in masculinity scales. Similar to masculinity scales, coded open-ended masculinity responses can be examined with various demographic and health topics. This methodology also proves a useful alternative way of studying masculinity in relation to health using masculinity responses constructed by the research participant.

When Men Don't Feel Conventionally Masculine: Themes and Reported Age Changes

B. Turner, Gerontology Center, University of Massachusetts Boston, Boston, MA.

This study asked how men who did not identify with primary styles of conventional masculinity experienced themselves as masculine or feminine, and how these perceptions had changed over their adult years. Qualitative data were drawn from the male sample (n = 237, age range 19–87 years) of the cross-sectional Boston Area Study (Turner, 1994). Most men were readily coded for 1 or more of Huyck's conventionally masculine styles of physical power (Macho), protector-provider (Family Man), and work achievement (Leader). But a substantial minority (22%) identified with none of the 3 major styles; these "no-major" men were similar in age to those who did. When asked "do you think of yourself as masculine?," one-fourth of no-major men said "no" and one-tenth called themselves androgynous. The rest thought of themselves as masculine, or mostly so. Some of the latter espoused masculine traits not subsumed in the 3 major styles; others limned a version of Family Man that featured neither provision nor protection. No-major men who minimized gender differences had thought them greater and, often, seen themselves as stereotypically masculine when they were younger. They attributed these shifts to the influence of higher education, a variety of "conversion experiences," and shifts in women's roles. Notably, only the handful of no-major men who felt inadequately masculine had lower self-esteem (SE).

Negotiating and Managing Intimacy When the Self Is Threatened: Gendered Care & Spouses With Alzheimer's Disease

J. Hayes, University of Kansas, Lawrence, KS.

This paper examines whether and how AD caregivers' perceptions of identity change in their afflicted spouses affect caregivers' experiences of intimacy. I also explore how gender as a way of organizing social life can also be a way of shaping the AD caregiving experience among married couples, specifically, the extent to which intimate relations are also gendered relations. The study group was comprised of spousal caregivers recruited from support groups in the states of Kansas and Missouri and from the Alzheimer's Disease Center (ADC) at the Univ. of Kansas Medical Center (KUMC). In-depth interviews were conducted with 14 men and 15 women whose spouses had Alzheimer's disease (AD). The intensive interviews confirmed that identity change on the part of sick spouses has important implications for intimacy, although not always in adverse ways. The majority of caregiver husbands and wives reported diminished intimacy as a result of the AD. Both men and women felt as though they would retain feelings of closeness to their afflicted spouses, although wives were more likely to report that their spouses' identity change altered how they identified themselves in relation to their spouses, and this had important implications for intimate relations. Husbands were guided by a strong moral imperative to care for their wives, while women were motivated by duty. Findings suggest that caregiving and intimacy are very different experiences for men and women, and point to the need for caregiver education related to this topic.

Body Images and Beauty Work Among Aging Women

C. Shehan, D. Dirks, T. Koropeckyj-Cox, University of Florida, Gainesville, FL.

Recent research has revealed that young women regard their bodies as works-in-progress, spending much time, effort, and money in maintaining ideal body images. Very little research in gerontology has addressed issues of appearance among older women. In this study, we focus on body images and beauty work among middle-aged and older women. We conducted in-depth, structured interviews with 42 middle-aged and older women (mean = 52.7) during November 2001. Seventy-four percent of the participants were white, non-Hispanic. The mean rating women gave to their bodily appearance was 6.56, on a scale of 1 (least attractive) to 10 (most attractive). Only 2 percent of the women in the study said that appearance was not important in their everyday lives. When asked what changes had occurred in their bodies since they were age 20, participants were most likely to mention negative changes in the appearance and functioning of their bodies. Positive changes included increased confidence and more relaxed attitudes about appearance. Participants anticipated a continuation of the negative body changes they had already been experiencing; but many talked about their hopes that their appearance would not decline markedly and described their strategies for warding off the bodily signs of aging. Many participants talked about how aging bodies serve as an indicator to others, and a reminder to themselves, that they are old women, an undesirable status in our society. Results suggest that the body work engaged in by younger women to maintain an attractive and youthful appearance continues through life.

The Arts and Humanities: Essential Tools for Teaching Empathy in Gerontology

A. Basting, Center on Age and Community, Milwaukee, WI.

The arts and humanities provide powerful tools for teaching empathy to undergraduate students. This is of particular importance to degree and certificate programs in aging, as empathy can improve caregiving, research, and policy practices and decisions. From observing plays to role playing, and from writing journals to reading novels, the arts and humanities encourage understanding across differences, including, but not limited to, aging. This paper points to the successes, limitations, and special challenges facing the integration of the arts and humanities into gerontological education courses. The author looked at undergraduate gerontology certificate programs across the country to find which courses integrate the arts and humanities and how. The limited number of these programs alone suggest that the value of such integration is not yet clear to the larger gerontological community. Based on this research, the author shares a syllabus that she created that examines the theoretical roots of empathy from an interdisciplinary perspective, as well as how specific arts and humanities projects use empathy in a way that can inform the field of aging.

HIV Risk Behaviors of Aging African-American Women in Detroit: Analysis From a Community Organization Client Log Database

J. Gleason-Comstock, A. Streater, R. Young, Wayne State University, Detroit, MI, C. Bolden, Community Health Awareness Group, Detroit, MI.

Community Health Awareness Group (CHAG) is the largest community-based organization providing HIV prevention counseling and testing to the African-American community in Detroit. In 1998, Wayne State University Department of Community Medicine researchers and CHAG developed a Confidential Client Daily Activity Log to track clients between HIV primary and secondary prevention services and care services. The Log consists of 36 variables including encounter site, gender, HIV status and risk behaviors. 35% of clients in the Client Log database of 34,500 unduplicated individuals are 45 years and older and 24% of those are women. The 2824 women ages 45 to 95 years are an average age of 50.8 years (s.d. = 6.8). The proportion of new client contacts that are older women increased from 7.6 to 9.3% in the last three years. At every encounter, clients self-report HIV risk behaviors. Older women's most frequently cited risk behavior is unprotected sex (33%). Non-injection drug use (alcohol, cocaine, crack, marijuana) accounts for 31% of all risk behaviors. Injection drug use accounts for 20%. 9% of women report they do not have any HIV risk behaviors. Of the 1585 HIV positive women in the Client Log database, 562 (38%) are aged 45 and older.

Body Image, Sexuality and Health at Older Ages: A Typology of Measurement

S. Leitsch, S. Lindau, M. Raycroft, University of Chicago, Chicago, IL.

Among older women, positive body image (BI) is associated with better overall health and sexual function. Declines in physical and cognitive functioning and changes in social roles may affect BI as women age, compromising one's sense of wholeness or humanness. We examined the bivariate relations between BI, sexuality and health indicators among a quota sample of 55 women between the ages of 58–93, selected to vary by race, age, partner status, and education. The typology used operationalizes the concept of BI with both objective and subjective, direct and indirect measures.

Body Mass Index (BMI) was not associated with general health or sexuality. Women who strongly identified with feeling feminine were less likely to report recent poor health and impaired vision (2). These women also had more sexual partners (2). In contrast, feeling attractive was not associated with either health or sexuality. Women who reported impaired smell reported fewer sexual partners in the last year (2) and less satisfaction with their sex life (2). Older women's silhouette identification correlated with BMI (1). However, larger silhouette identification, rather than BMI, was associated with a greater number of co-morbid conditions (2). (1) p < 0.01, (2) p < 0.05.

Support: Hartford Foundation, Robert Wood Johnson Foundation, University of Chicago Center on Aging.

Health-Related Quality of Life: Baseline and Norm Comparisons in a Fall Prevention Clinical Trial for Community-Dwelling Older Women

R. Lindquist, J. Wyman, C. Gross, J. Peters, N. Nachreiner, K. Talley, University of Minnesota, Minneapolis, MN.

Fullness of life for frail older women is diminished by falls and fears of falling. A randomized clinical trial (RCT) of a multifactorial fall prevention program which included exercise versus a health education (control) program comprising 12 weeks of home-based intervention and 16 weeks of computerized telephone follow-up was designed to reduce falls of high-risk older women. Beyond anticipated physical effects of exercise, there is significant potential for impact on health-related quality of life (HRQL) measures. This report describes and compares groups' baseline HRQL data, demographics, medical and fall histories to each other, and also compares group HRQL measures to national norms. HRQL domains included psychosocial function (e.g., fear of falling, confidence, depressive symptoms, social network); physical function (e.g., SF-36 physical subscales); sleep problems; and health perceptions. A probability population-based sample of 159 community-dwelling women selected by criteria: age >70 years, mentally intact, ambulatory, >2 fall risk factors, non-exercising, medically stable and cleared for exercise participation, owned a telephone, and had ability to read, were randomized into the RCT's two intervention groups. Randomization of subjects to groups was successful, with no significant baseline differences in HRQL domains or other key study variables. Preliminary results were similar with the exception of higher general health, social function, role-emotional, and mental health scores for subjects, as compared with SF-36 national norms for women age 65 or older. These analyses set the stage for future evaluations to detect changes in HRQL resulting from subject participation in the RCT on fall prevention.

Gender Interactions and Sense of Control

D. Alley, E. Crimmins, University of Southern California, Los Angeles, CA.

The purpose of this study was to examine the relationship between gender and predictors of sense of control. These include age, education, functional impairment, and social support. This analysis is based on data from the 1995 Aging, Status, and Sense of Control study of community-dwelling adults aged 18 to 95 (N = 1971). As hypothesized, functional impairment predicted a lower sense of control in both genders. In addition to higher education and stronger social support, number of children and having been divorced were related to a greater sense of control in both genders. Gender negatively interacted with age such that women reported progressively lower sense of control with increasing age as compared to men. There were no significant interactions between gender and education, health measures and social support.

Poster: Nursing Homes and Long Term Care Participant(s):

Characteristics of Nursing Home Decedents

A. Bercovitz, University of Maryland School of Medicine, Baltimore, MD, L. Burton, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, A. Gruber-Baldini, University of Maryland School of Medicine, Baltimore, MD.

Almost one-fifth of the 65 and over population dies in a nursing home. However, relatively little is known about the experience of people who die in nursing homes. This study is based on data from the Epidemiology of Dementia in Nursing Homes database, a prospective cohort of 2285 new admissions to nursing homes, from a representative sample of nursing homes in Maryland. We compared demographic, health and functional characteristics of nursing home residents who died in the nursing home (n = 713) to those who were not discharged during the two-year study period (n = 605). Decedents were divided into those that died in the first 30 days after admission (termed early deaths, n = 123) and those who died after thirty days (termed late deaths, n = 590). Early deaths were different from late deaths and not discharged residents. A greater proportion of early deaths were totally dependent or required extensive assistance in their ADLs on admission. Less than 1/5 of early deaths were fully continent of both bowel and bladder on admission, compared to 26% of late deaths and 35% of not discharged residents (overall p <.001). 25% of early deaths, 58% of late deaths and 67% of not discharged residents had a diagnosis of dementia (overall p <.001). Late deaths fell midway between early deaths and not discharged residents on measures of ADL dependence, continence, dementia and number of chronic conditions on admission. Comparison of change in ADL functioning over time found that late deaths showed more decrement in function than did not discharged residents.

Paper: Cohort Comparisons

A. Eisenstein, Evanston Northwestern Healthcare, Evanston, IL, Chair.

Participant(s):

Do Elderly Cancer Patients Respond to Quality of Life Measures Differently Than Their Younger Counterparts?

A. Eisenstein, K. Yost, D. Cella, Evanston Northwestern Healthcare, Evanston, IL.

Many quality of life (QOL) measures have been validated among the elderly, however none specifically target issues facing geriatric cancer patients. The purpose of this study was to evaluate the need for a QOL scale addressing the specific concerns of geriatric cancer patients. We did this by analyzing response pattern data on 2355 cancer patients who completed the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. Four age groups were analyzed: 17–55 (n = 958); 55–64 (n = 643); 65–75 (n = 552); 75–99 (n = 202). Chi-square tests assessed the relationship between response category and age, and between missing responses and age for individual FACT-G items. A subset of items most frequently missed by patients 75–99 ("case" items) was identified. The FACT-G total and subscale scores were calculated with and without the "case" items. Responses and proportion missing differed significantly by age for a majority of the 27 FACT-G items. Two items each from the social/family and emotional well-being domains had the highest proportion missing among those 75–99. FACT-G total and subscale scores did not differ meaningfully when calculated with and without the 4 case items. Nevertheless, elderly patients answered QOL questions differently and were more likely to have missing data than younger patients. While total QOL scores were not affected by differences in response by age group, it is noteworthy that older patients respond differently to individual questions within each QOL domain. Thus, to enhance interpretation of QOL measures such as the FACT-G, geriatric specialists should be aware that some questions might lose relevance among the elderly.

Born to Live: Micropreemies in the NICU and Beyond

P. Ingalls, Bernard, ME.

Two medical specialties have seen technological advances that have major impacts on society: assisted reproduction and neonatology. The former is responsible for a 400% increase in multiple pregnancies of three or more. Prematurity and severe birth complications have gone up proportionally. In 2001, the rate of prematurely born infants was 11.9 percent. Neonatology endeavors to keep these micropreemies alive with a rising rate of success.

Micropreemies in the NICU experience continuously traumatic stress. Their survival rate is due to the medical staff's dedication, modern technologies, and pharmaceuticals as described in Baby ER by Edward Humes. The preemies suffer endlessly through medical emergency procedures, surgeries, tests, transfusions, and toxic medications, etc. Micropreemies are fed by gavage tubes inserted directly into their stomachs, hooked on ventilators, oxygen tubes, pumps, intravenous lines, sense pads, and other wires. They go through near death experiences for months on end.

Beyond the visible disabilities such as seizures, cerebral palsy, organ damage, retinopathy, etc., studies have shown that developmental delays, motor, speech, cognitive, and behavioral problems show up later to varying degrees.

Our society endeavors to keep all infants alive when possible. The same premise, however, carries a responsibility of follow-up care when these babies are released from the NICU. The effects of trauma(s) suffered in the NICU are life-long. So far, there is no data at all whether such effects are influential in the declining years of those who began their lives in the NICU as the earliest surviving micropreemies are just reaching adulthood.

Parental Longevity as a Predictor of Morbidity and Mortality? Findings From the Normative Aging Study (NAS)

E. Lawler, D. Gagnon, A. Spiro III, J. Gaziano, MAVERIC, Boston, MA.

Objective: To determine if maternal and paternal deviation from life-expectancy is predictive of age of onset of major chronic diseases in adult offspring using data from the NAS.

Methods: The NAS collected data on parental longevity at baseline and follow-up visits. For each parent we calculated differences between observed longevity and gender/birth cohort specific life-expectancy using historical life tables. Cox's Proportional Hazards Ratios (RR) were used to examine age of onset of ischemic heart disease (IHD), non-skin cancers (CA), and stroke (CVA) in sons as a function of parental life-expectancy deviation for mothers (mRR) and fathers (pRR).

Results: Out of 2250 NAS participants, complete data on parents' longevity were available for 1594 mothers and 1711 fathers (1390 parental pairs). A 10-year increase in maternal and paternal lifespan predicts lower mortality mRR = 0.88, p = 0.001; pRR = 0.92, p = 0.007 respectively. A 10-year increase in maternal and paternal lifespan is associated with lower rates of IHD mRR=0.92, p = 0.005 and pRR=0.88, p = 0.001. Maternal and paternal longevity are not significantly associated with CA mRR = 0.99, p = 0.64, pRR = 1.02, p = 0.45 or CVA mRR = 0.90, p = 0.19, pRR = 0.96, p = 0.63. When two parents lived 21+ years beyond their life-expectancy, subjects have significantly lower mortality rates compared to those with two parents who lived +/–10 years of their life-expectancy RR = 0.42, p = 0.001.

Conclusions: Based on the NAS experience, increases in both maternal and paternal longevity appear to correlate with longer life and delayed onset of IHD in offspring, however time to development of other diseases, including cancers and stroke, are not predicted by parental longevity.

A Comparison of Older and Younger Adults Who Have a Serious Mental Illness and Live in Remote Regions, M. Bédard, Lakehead University, Thunday Bay, Ontario, Canada, C. Gibbons, G. Mack, Lakehead Psychiatric Hospital, Canada.

More information is desirable regarding older adults with a serious mental illness (SMI) who live in remote regions. The goal of this study was to compare the situation and needs of older adults (65+) living in a remote region to those of younger individuals (18–64). We used a representative sample of individuals with a SMI who accessed community mental health services in northwestern Ontario (n = 532). Older adults differed from their younger counterparts on several measures. Twenty-nine percent of clients over 65 were diagnosed with an organic disorder as compared to only 4% of younger clients (p =.001). The majority in the older group had an additional medical diagnosis (59%) and was prescribed psychotropic medication(s) (84%). Older clients were more likely to be non-ambulatory (p =.001), and have a hearing (p =.001) or vision (p =.017) impairment. Furthermore, staff indicated significantly greater problem severity for older adults in areas such as basic needs (p =.021), antisocial behavior (p =.019), family issues (p =.001) and medical illnesses (p =.001). When compared to younger clients, they required significantly more support regarding medication management, physical health care, self-care, and other activities of daily living and support to the client's family/caregiver. Older adults have complex psychiatric problems that cannot be treated effectively without addressing comorbid conditions. The differences between older and younger users of community mental health programs point out the necessity of ensuring that treatment plans are tailored to clients' needs across the lifespan.

Paper: Assessment of Dementia and Depression (CM)

The Feeling-Tone Questionnaire (FTQ) Psychometric Properties of a Screening Instrument for Depressive Symptoms in Cases of Dementia in Institutional Settings, J. Toner, J. Teresi, B. Gurland, F. Tirumalasetti, Columbia University Stroud Center in the Faculty of Medicine, New York, NY, E. Middleearsky, Teachers College Columbia University, New York, NY.

This research was aimed at developing a means of getting in touch with the subjective inner life of persons who are seriously limited in their ability to communicate feelings of distress due to symptoms of depression. The purpose of these analyses was to further develop a reliable and valid measure of affective disorder in communication-impaired elderly demented patients. The Feeling-Tone Questionnaire (FTQ), consisting of 16 questions and 16 corresponding observation ratings of affect, was the focus of these efforts. The FTQ augments the field of assessment of depression in dementia by combining a direct assessment focus and clinical observation method and adding behaviorally anchored ratings of affect, or feeling-tone. It was specifically designed for use with the communication-impaired demented patient and uses standardized questions with simple wording. The total sample size was 764 respondents from four samples of respondents in New York City and upstate New York nursing homes and psychiatric hospital. The mean age of the combined sample was 84. The FTQ evidenced good reliability and validity across all four samples. Internal consistency reliability and interrater reliability were good, as was test-retest reliability. Concurrent convergent construct validity and discriminant validity coefficients were generally high in each of the four samples. Criterion-related validity was provided in two samples utilizing DSM ratings by geriatric psychiatrists. These findings provide support for the view that the FTQ works well as a method of facilitating the recognition of depressive signs in the more severely communication-impaired group of demented.

Observable Indicators of Elderly Depression, C. Hendrix, Duke University School of Nursing, Durham, NC.

Objective: To determine patterns of observable indicators of elderly depression in institutionalized settings using the MDS 2.0. This mode for assessing depression is useful for nursing home staff since limited verbal communication and physical endurance is common among institutionalized elderly. This mode of assessment also bypasses threats of imperfect recall and socially desirable responses.

Design: Descriptive study

Setting: Three nursing homes in the southeastern part of the country.

Participants: Residents who were aged 65 and above. Those who were comatose or in constant vegetative state, conditions that precluded the use of observable indicators, were excluded.

Measurements: The indicators of depression, anxiety and sad mood in the MDS 2.0 were used to determine observable depressive patterns. The Cornell Scale for Depression in Dementia was utilized to validate findings on the MDS indicators. Consensus analysis, a method that allows information on rater's bias, rater's ability, and item difficulty, was used for data analysis.

Results: No depressive patterns were detected on the MDS indicators. In the CSDD, distinct depressive patterns were identified: anxiety, sadness, lack of reaction to pleasant events, irritability, agitation, multiple physical complaints, loss of interest, appetite loss, and lack of energy.

Conclusion: The current trend of allowing non-direct caregivers in completing the MDS may have contributed to the result of not detecting any depressive patterns. The findings on the CSDD reflect that mood-related signs, and behavioral disturbance are most consistently associated with depression.

Delirium Recognition and Prevention: A Screening Algorithm and Care Protocols, D. Brown-Farrell, Sunnybrook & Women's College Health Sciences Centre, Toronto, Canada.

Delirium is a common and often unrecognized source of morbidity for older hospitalized patients. Additionally, caring for patients who present with the features of delirium can be an extremely challenging experience. Through an extensive literature review and thorough interdisciplinary discussions, a delirium algorithm and five research-based care protocols were developed to assist health care professionals in caring for these patients. The Delirium Algorithm identifies risk factors and clinical features of delirium. Additionally, screening processes are outlined and appropriate baseline investigations are suggested. The five care protocols: Sleep Enhancement; Mobility Enhancement; Fluid Enhancement; Perceptual and Cognitive Enhancement and Addressing Psychomotor Agitation, provide patient-focused approaches to care in the prevention and/or treatment of delirium. The delirium algorithm and care protocols can be a valuable resource for interdisciplinary health care professions in hospital and community settings.

The Saint Louis University Mental Status (SLUMS) Examination for Detecting Dementia—A New Screening Tool, S. Tariq, N. Tumosa, H. Perry, Saint Louis University School of Medicine & the GRECC VAMC St. Louis, Saint Louis, MO, R. Baudenistel, GRECC VAMC Saint Louis, Saint Louis, MO, J. Morley, Saint Louis University School of Medicine & the GRECC VAMC St. Louis, Saint Louis, MO.

Background: Various screening tools in addition DSM-IV, are currently used to detect mild neurocognitive disorder (MND) and to stages of dementia. The SLUMS is a new 30-point screening questionnaire that tests for orientation, memory, attention and executive functions. Objectives: To test the hypothesis that the SLUMS exam is more sensitive than MMSE (Mini-mental States Examination) in detecting MND.

Methods: Two hundred male veterans attending the Saint Louis Veterans Administration's Geriatric Research, Education and Clinical Center were consented and administered MMSE and SLUMS exam.

Results: The mean age was 76+/– 5.9 yrs, 77 % of the veterans had high school or higher education and 23% had less than high school education. The mean score on SLUMS was 23+/–6.2 and MMSE was 26.9+/–4.6. Age was associated with both SLUMS (r = 0.4, p < 0.001), MMSE (r = 0.33, p < 0.001). There was significant correlation between SLUMS and MMSE (r = 0.799, p < 0.001). Men who scored between 18–24 on the MMSE averaged 14.9+/–0.9 on SLUMS. No one scored higher on the SLUMS then the MMSE.

Conclusion: These results suggest that the SLUMS may detect mild neurocognitive disorder better then the MMSE, which needs to be further validated.

Poster: Successful Aging and Transportation Issues Participant(s):

Successful Aging Factors Influencing the Use of Alcohol Among Older Adults (OAs), K. Lenzi, K. Kopera-Frye, S. Harris, E. Starbuck, University of Nevada-Reno, Reno, NV.

One serious challenge for the field of gerontology is understanding the processes behind aging successfully. Successful aging is defined as decreasing risk of disease/disease-related disability, increasing physical/mental functioning, and active social engagement. One indicator of healthy lifestyle behavior according to this model involves decreasing the risk of disability. Alcohol abuse among OAs is reported to range from 1.4 to 4.9% in epidemiological studies to over 5% in survey studies. The largest problem with alcohol use among OAs is the potentially negative interactions alcohol may have with prescription medications. Other risks associated with OAs drinking include: higher perceived life stress, decreased mental and physical health, limited social support, use of ineffective coping strategies, and lower self-concept. Few health promotional interventions have been targeted for OAs and alcohol use (e.g. Pratt et al., 1992). These crucial areas need attention when focusing on at-risk OAs: low level of alcohol use knowledge among alcohol consuming adults, especially the lower-income segment. The sample consisted of 99 healthy, lower income OAs (M age = 75.5 years), who were interviewed on alcohol/prescription use, knowledge of alcohol among OAs, social integration, coping strategies use, and family history. Significant correlates of alcohol use included: younger age, less effective coping, less perceived stress, and lower awareness of alcohol effects. Multiple regression results indicated knowledge level and medication use accounted for 35% of the variance in explaining alcohol use. These findings suggest that alcohol education is key to promoting successful aging. These results are promising for future intervention programs.

The Interplay of Intraindividual Variability in Subjective Well-Being and Cognitive Performance in Old Age, C. Roecke, D. Gerstorf, J. Smith, Max Planck Institute for Human Development, Berlin, Germany. – Moved to Tuesday, November 25, 8:00 AM–9:30 AM, Board 30

Subjective well-being and cognitive functioning are central aspects of successful aging. Despite a revived interest in the dynamics of emotional well-being and cognitive performance, relatively little is known about intraindividual fluctuations in positive and negative affect as characteristics of normal aging, or about the linkages of such fluctuations to cognition. The present study used 4-wave longitudinal data from the Berlin Aging Study (N = 82, M = 85.82 years; Baltes & Mayer, 1999) to investigate the interplay between patterns of intraindividual variability in subjective well-being and performance on tasks measuring fluid and crystallized intelligence. Hierarchical linear modeling analyses indicated that greater fluctuation in each domain was related to impaired average functioning in the other. Specifically, intraindividual variability of positive and negative affect was significantly related to lower cognitive performance over time, particularly in the pragmatics of intelligence (i.e., knowledge). Interestingly, intraindividual variability in knowledge was negatively associated with levels of positive affect over time, but not with negative affect. Hierarchical regression analyses suggested that intraindividual variability in well-being, over and above mean levels of well-being, accounted for significant amounts of variance in average levels of cognition. Similar patterns were obtained for the prediction of mean levels of well-being from intraindividual variability in intelligence performance. Some cross-domain linkages differed between cohorts of young old and oldest old adults. The findings speak to the usefulness of investigating the unfolding and interaction of processes in different domains of psychological functioning in old age over time rather than narrowing down on single snapshots.

The Role of Controllability in Predicting Older Individuals' Feelings of Vulnerability to Health Crises, J. Volk, Health, Leisure, and Human Performance Research Institute, Winnipeg, Canada, J. Ruthig, Department of Psychology, Canada, J. Chipperfield, Health, Leisure, and Human Performance Research Institute, Canada.

Perceived vulnerability to health crises has become a popular topic among health researchers. As individuals age their vulnerability to certain health crises (i.e. stroke, hip fracture) increases. The main objective of this study was to explore the reasons for elderly adults' perceptions of vulnerability. A sample of 189 community dwelling elderly individuals rated their likelihood of experiencing a hip fracture (i.e. 0–100% chance). They were subsequently asked about their reasons for their vulnerability rating. Because perceived control has been found to play a role in health coping, these reasons were grouped on a perceived controllability dimension. An example of a "controllable" response to the perceived likelihood of suffering a hip fracture is "Because I walk carefully" (n = 63) whereas an "uncontrollable" response is "What will happen, will happen" (n = 126). Demographics including age, education, marital status, and gender were examined as predictors of controllability in a logistic regression. Results revealed that education, Wald(1) = 3.91; marital status, Wald(1) = 2.96; and gender, Wald(1) = 3.57, significantly predicted whether vulnerability was perceived as controllable or uncontrollable: having more education, being married, or being female were predictive of controllable responses. A linear regression was then conducted to predict vulnerability ratings. Significant predictors were marital status, t(5) = 1.95, and controllability responses, t(5) = 7.47, where being married or providing controllable reasons predicted lower vulnerability. These findings suggest that perceptions of control play an important role in determining feelings of vulnerability to future health crises among aging individuals.

Perception of Resources and Their Relationship to Subjective Well-Being: Exploring Age Differences, D. Jopp, B. Leipold, Free University of Berlin, Berlin, Germany.

The perception of resources is considered as one important determinant of subjective well-being. According to Hobfoll's (1998) Conservation of Resources Theory, resource changes are of specific importance. Several studies involving young and middle-aged persons have shown that resource loss is positively related to depression and low subjective well-being. It also has been found that resource gains are essential in phases of resource loss to counteract to loss spirals. Given that old adults are confronted with low resources, we hypothesized that in old age, resource gain is more relevant for well-being than in younger ages. In this study, the relationship between resource perception and well-being was examined by comparing a sample of 40 young persons (20–40 years) with a subsample of 42 old persons (70–90 years) of the ALLEE-Study (M. Baltes & Lang, BA902/11-2). Young and old persons did not differ with respect to perceived resource status, importance, loss and gain. In both age groups, resource status was positively related to life satisfaction and satisfaction with aging. The correlation pattern differed with respect to resource changes. As expected, resource loss was negatively associated with life and aging satisfaction in the young group, but resource gain was not. In the old group, resource gain was positively correlated to aging satisfaction, but resource loss was unrelated to the outcomes. Results demonstrate that the importance of resource loss and gain changes in old age. Further examinations are needed to understand why perceived resource loss has no impact on well-being in the elderly.

Personal Meaning Orientations and Psychosocial Adjustment in the Elderly, G. Reker, Department of Psychology, Trent University, Peterborough, Ontario, Canada.

This study examined how different patterns of sources of meaning in life impact on the psychosocial adjustment of older adults. One hundred and twenty (62 women and 58 men) community-residing older adults completed self-report measures of sources of meaning in life, physical health, life satisfaction, depression, personality, existential regrets, attitudes toward aging, and attitudes toward life. Cluster analysis of sources of meaning revealed four distinct meaning orientations: self-transcendent (N = 32); collectivistic (N = 24); individualistic (N = 34); and self-serving (N = 30). MANCOVA analysis of the four groups, controlling for age, marital status, education, and financial satisfaction, showed that older adults who derive meaning from self-transcendent sources are more extraverted, open to experience, agreeable, and conscientious; enjoy higher levels of physical health; perceive greater purpose and coherence in life; are less depressed; feel more in control in directing their life; and express a stronger desire to get more out of life compared to those who derive meaning through pursuing self-serving interests without any real commitment to personal, interpersonal, or societal development. No statistically significant gender nor gender x meaning orientation interaction effects were found. The implications of our findings for successful aging are discussed.

Planning for Long-Term Care: Concept, Definition, and Measurement, M. Friedemann, F. Newman, L. Seff, B. Dunlop, Florida International University, School of Nursing, Center on Aging, North Miami, FL.

An instrument to measure long-term care planning (LTCP) was developed and differences in readiness to plan were explored for Hispanics, African Americans/black, and non-Hispanic white residents of Miami/Dade, Florida. LTCP signifies the actions of preparation for a future time when help with ACL may be needed. The planning framework drew from open systems theory and the idea of McGrew and Friedemann that balance between control and acceptance response styles is key to distinguishing ethnic orientation and understanding the planning process. Items included acceptance and control in three types of planning: financial, wellness/functional ability, and social/environmental. Two focus groups provided feedback about the relevance of items and the overall construct. A telephone survey involved 150 randomly-selected individuals age 55 to 69. Responses underwent exploratory and confirmatory factor analyses and reliability testing. Results indicated that the long-term care planning instrument of 23 items had five reliable (á >.70) sub-scales (social/environmental, wellness, and financial control, acceptance in terms of readiness to accept help in all types of LTCP, and unwillingness to do so). The comparative fit index (CFI) was.987 and RMSEA.050. Planning was found to imply being in control and taking action. An accepting attitude in anticipation of future needs appeared essential for planning. There were no differences in planning between males and females. Hispanics reported greatest readiness to use family help and non-Whites were most likely to have planned for future living arrangements. Breaking through people's denial of needing help from others is a major challenge for professionals.

Participation in Meaningful Activities and Successful Aging: Quantitative and Qualitative Analyses, S. Clancy Dollinger, M. Garber, M. Hanson, Southern Illinois University, Carbondale, IL, L. Harris, Murray State University, Murray, KY.

One of the goals for the study of successful aging is to identity factors related to optimal functioning in old age. This study examined the relations between the type and frequency of activities, and self-reported health quality over the last year, as well as verbal and cognitive measures of intellectual functioning (e.g., WAIS-III). Semi-structured one-hour interviews were conducted with 142 well educated middle-aged and older adults (age range 55–90 yrs) living in a rural area. Quantitative measures of perceived health quality and cognitive functioning were administered. Qualitative data on type and frequency of activities were also obtained from the participants. Qualitative data were coded and analyzed by three well-trained members of the lab staff. An external audit was conducted by an experienced qualitative researcher to assess reliability. Grounded Theory Method (Strauss & Corbin, 1998, 1990) was used to analyze the qualitative data, resulting in 23 open coding level activity categories. Axial coding results were consistent with qualitative results obtained by Silverstein and Parker (2002). Activity type and frequency was examined in relation to measures of successful aging (e.g., health, activity level). Participation in a broader range of activities across categories, increasing numbers of activities, and higher frequency of participation were associated with indicators of successful aging as defined in the present study. Research implications of using both qualitative and quantitative methods to examine successful aging are discussed. Practical implications for professionals working with older adults are also addressed.

Attitudes and Beliefs of Older Drivers, H. Tuokko, University of Victoria, Centre on Aging, Victoria, Canada, P. McGee, University of Victoria, Victoria, Canada.

With a rapidly aging population, concern for older driver safety is mounting. Strategies for improving driver safety are beginning to emerge that focus on driving behaviors and knowledge. Few studies have examined attitudes of older adults toward driving. To gain insight into these issues, data on the beliefs, attitudes, and perceptions of 86 older drivers were collected. Even though 85% of the respondents indicated experiencing one or more driving situations as stressful, they did not perceive themselves to be at an increased risk for accident involvement compared to others their age or younger adults. Sixty percent indicated that changing when and where they drive is possible. The remaining 40% could not change because public transportation was not convenient or their lifestyle required the use of a motor vehicle. More men (30%) than women (7%) reported that changing the way they drive would take too much thought. A significantly higher percentage of women (71%) than men (31%) indicated that they do not drink and drive. Men (12%) but not women (0%) reported being able to handle driving after drinking and equal percentages of men and women felt that driving under the influence of alcohol was appropriate if the distance driven was not too far. These findings suggest that driving interventions such as those addressing stressful driving situations, use of alternative modes of transportation, and factors influencing driver performance (e.g., alcohol consumption) may need to take into consideration older adults' prevailing attitudes and beliefs about driving and be gender-specific in their orientation.

Training in Everyday Problem Solving Increases Self-Efficacy and Everyday Problem Solving Performance Among Older Adults, D. Artistico, University of Illinois at Chicago, Chicago, IL, L. Pezzuti, University of Rome "La Sapienza," Italy.

This work examined the effect of a novel training procedure on perceived self-efficacy and everyday problem solving performance among older adults. Solving daily problems is crucial in later life, yet procedures to enhance this ability are not well developed. Two studies addressed this issue. In study 1, we developed two parallel sets of everyday problems (Forms A/B), employing a daily diary procedure and construct validity phases. Results indicated that both forms were identical on key criteria: number of solutions, effective ways to solve problems, and conditions, that is, the ability to find conditions that may hinder or help solution generation. In study 2, we examined the impact of training on problem solving ability among 56 older adults (pre-selected from a larger sample, N = 104), with equal performance on solutions, conditions and self-efficacy for problems contained in Form A. Half this sample was administered in a one-hour training consisting of a colloquium aimed at facilitating the exploration of problems contained in Form A, by drawing upon problem solutions and conditions provided by participants in study 1. Training enhanced performance. The 28 trained older people provided more solutions and conditions than 28 non-trained older people for problems contained in Form B, that is, the parallel version of Form A. Training also improved people's self-efficacy for everyday problem solving, which in turn partly mediated the relationship between the training and number of solutions. Knowledge gained here is discussed within a social-cognitive framework for promoting well-being among older people.

Primary and Secondary Control in Older Adults With Serious Health Problems: Gender-Specific Implications for Mortality, Health, and Well-being, N. Hall, A. Swift, J. Chipperfield, R. Perry, University of Manitoba, Winnipeg, Canada.

The present 5-year longitudinal study examined the implications of primary- (PC) and secondary-control strategies (SC) among older adults reporting serious, restrictive health conditions (i.e., heart attack/stroke, heart disease, arthritis). Regression analyses were conducted separately for 66 males and 118 females (M = 80 years) with background variables in Step 1 (i.e., linear: age, income, education, marital status, baseline; logistic: functional independence, baseline), PC (proactive) and SC (interpretive) main effects in Step 2, and a PC x SC interaction in Step 3. For males, PC corresponded to lower home care needs (B = –.23) and mortality (B = –.38), whereas SC led to lower perceived health (Beta = –.35) and control (health: Beta = –.58; overall: Beta = –.37). Significant interaction effects for males showed high or low levels on both strategies related to fewer observable difficulties (Beta = –.63), greater perceived responsibility (Beta = –.51), and exercise (B =.05) with low-PC/low-SC males reporting the most exercise and least pain (B = –.03) and high-PC/low-SC males showing having more observable difficulties, self-reported pain, and feeling least responsible. For females, PC was related to lower life satisfaction (Beta = –.32), more observable difficulties (Beta =.30), fewer leisure activities (Beta = –.31), and greater mortality (B =.21). Significant interaction effects showed low-PC/low-SC females experiencing greater well-being (perceived health: Beta =.21; happiness: Beta =.24; activity: Beta =.38), and high-PC/low-SC females to be most unhappy and inactive. These findings suggest that PC and SC strategies may be differentially effective for males and females facing serious health conditions in terms of health, well-being, and survival.

Driving Habits of Older Men With Glaucoma, G. Adler, University of South Carolina, Columbia, SC, S. Rottunda, M. Bauer, GRECC, Minneapolis, MN.

In our society, driving an automobile plays an important role in mobility. Glaucoma, an eye disorder that gradually decreases peripheral vision, affects millions of older drivers. Research has shown that vision problems can contribute to unsafe driving behaviors as well as influence older adults' driving habits and decisions about driving cessation. We surveyed older male drivers with glaucoma (n = 52) and a comparison group (n = 147) to learn more about their driving history, habits, and expectations about driving cessation. Average age of the glaucoma drivers was 72.7 years and 70.8 years for the comparison group. Both groups averaged over 50 years driving experience. Glaucoma group members had a 4.8 year median history of the disease; 98% had open-angle glaucoma. Logistic regression analysis was used to assess group differences. Compared to the control group, significantly more drivers with glaucoma changed their driving habits with regard to driving at night (p = 0.003), on freeways (p = 0.05), and in unfamiliar areas (p = 0.01). Drivers with glaucoma were also significantly more likely to report family concern about their driving (p = 0.01). Drivers with glaucoma were no more likely than controls to have made plans for driving cessation (p = 0.49) and significantly less likely to have made financial plans (p = 0.03) or completed advance directives (p < 0.001). Both groups reported that driving was important to their quality of life. This exploratory study provides a beginning understanding of the driving behaviors and future plans of older drivers with glaucoma.

Use of Genetic Algorithms and Cox Regression (CoRGA) for Identifying Risk Factors for Mortality Among Older People, R. Ahmad, P. Bath, University of Sheffield, Sheffield, United Kingdom.

A variety of risk factors for mortality among older people have been identified in numerous research studies, including health- and medical-related factors, factors relating to physical, social and behavioral activity. However, limitations in the numbers of variables that can be included in regression models have restricted exploration of putative risk factors for mortality. The aim of this study was to develop a model to select the best combination of risk factors for mortality from all the available data. A genetic algorithm, an evolutionary computational tool based on the Darwinian principles of natural selection, was used for variable selection in combination with Cox proportional hazard regression models. The resulting CoRGA program was used to analyze baseline data from a longitudinal study of 1042 older people living in Nottingham, UK (NLSAA), to identify the best combination of risk factors for eight-year all-cause mortality. CoRGA evolved the best combination of 10 risk factors for mortality. The selected risk factors were access to telephone, visits by social worker, financial difficulty, depression score, handgrip strength, perceived level of physical activity, pain in joints, age, chest pains and time since cessation of smoking. Assessment of the Hazard Ratios for these risk factors in adjusted and unadjusted models containing these variables confirmed their importance in predicting mortality in older people. The study demonstrated the potential of CoRGA for identifying risk factors for mortality and predictors of successful aging: it confirmed previously reported risk factors as being important, but also identified previously unknown risk factors.

Quality of Life: A Conceptual Model, J. Sellers, Northern Arizona University, Flagstaff, AZ.

The sphere of interest in quality of life originates in philosophy and encompasses all areas of human experience. It is a perception formulated from an individual's current and past life experiences and is multidimensional with subjective and objective components. To date, although generating a huge amount of research, no model has been proposed to systematically examine the multiple factors found related to quality of life. Additionally, while considered subjective, few researchers measure quality of life using individual perception. The purpose of this poster is to present a comprehensive conceptual model of the construct quality of life that can be used for future research. The model consists of quality of life, and two broad constructs that categorize the multiple measurable concepts identified by research as being associated with quality of life. The first broad construct, Inner Peace, is defined using self-transcendence, spirituality, the confidant relationship, and the person's attitude toward his/her own aging. The second construct, Wellness, is defined by factors associated with health (number of illnesses, medications, level of function), psychological factors (depression, morale) and social factors (number and type of interactions, and activities). It is believed that these factors individually or in combination contribute to a person's perception and self-rated quality of life. The poster will include the model, proposed relationships, instruments to measure the variables, and examples of research using the model. It is hoped that this presentation will lead to discussion and collaboration among researchers to systematically examine the multidimensionality and individuality of quality of life.

A Measure of Motivation for Productive Aging, F. Caro, Gerontology Institute, Boston, MA, L. Bruner-Canhoto, J. Burr, J. Mutchler, Gerontology Institute, UMass Boston, Boston, MA.

This project seeks to develop a measure that can be used in large-scale survey research to examine the extent to which the desire to be productive explains the extent of overall productive activity among older people. Some previous research has examined motivation for some specific forms of productive activity but has generally failed to consider motivation for a broad range of activities. For this study, an item pool was developed based upon a literature search and focus group interviews with older people. Following this effort, a questionnaire was developed which included items to measure a global concept of motivation for productive activity. Also included were questions linking global motivation items to a set of specific activities (both productive and nonproductive)—items used in previous research to measure motivation for volunteering, paid employment, and caregiving—and questions about actual productive activity behavior. The questionnaire was administered to 200 elders in eastern Massachusetts. Based on the analysis of these data, the paper will report on the extent of association among the items in the question pool, the extent to which there is evidence that some of the items can be combined to represent a uni-dimensional scale, and the extent to which there is evidence that they represent multiple dimensions. We report on the measurement qualities of the measures of motivation (reliability and validity). The associations between the global measure of motivation for productive activity and motivation for specific forms of productive activity and actual productive activity behavior will also be reported.

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