1
|
Fields NL, Dabelko-Schoeny H, Murphy IE, Highfill C, Cao Q, White K, Sheldon M, Jennings C, Kunz-Lomelin A. Social Cognitive Theory, Driving Cessation, and Alternative Transportation in Later Life. J Appl Gerontol 2023; 42:2252-2260. [PMID: 37230489 PMCID: PMC10583478 DOI: 10.1177/07334648231177215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Having viable alternative transportation options could help individuals stop driving when appropriate. This study employs the Social Cognitive Theory (SCT) to understand the barriers and facilitators of alternative transportation among a sample of adults aged 55 and older (N = 32). Using a daily transportation data collection app, MyAmble, the research team asked participants questions structured around environmental, individual, and behavioral factors as outlined in the SCT framework. Responses were analyzed using directed content analysis. Findings suggest a substantial reliance on motor vehicles and it was evident that many participants had never seriously considered what they would do if they could no longer drive. We posit that SCT principles may be applied to help older adults build self-efficacy to transition to driving cessation when needed.
Collapse
Affiliation(s)
- Noelle L. Fields
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | | | - Ian E. Murphy
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Christine Highfill
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Qiuchang Cao
- Pepper Institute on Aging and Public Policy& Claude Pepper Center, Florida State University, Tallahassee, FL, USA, USA
| | - Katie White
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Marisa Sheldon
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | | | - Alan Kunz-Lomelin
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| |
Collapse
|
2
|
Wilkins JM, Locascio JJ, Gomez-Isla T, Hyman BT, Blacker D, Forester BP, Okereke OI. Potential impact of the COVID-19 pandemic on everyday preferences for persons with cognitive impairment. Int Psychogeriatr 2023:1-6. [PMID: 37622323 PMCID: PMC10894308 DOI: 10.1017/s1041610223000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The COVID-19 pandemic and subsequent social distancing guidelines and restrictions brought on changes in the everyday experiences of older adults. It is not clear, however, to what extent the pandemic has impacted the importance of everyday preferences for persons with cognitive impairment (CI) or the proxy ratings of those preferences. The sample of this study included 27 dyads of persons with CI and their care partners. The Preferences for Everyday Living Inventory was used to assess importance of preferences among persons with CI; care partners completed concurrent proxy assessments. Mixed random and fixed effects longitudinal models were used to evaluate changes in ratings and concordance levels between persons with CI and care partners prior to and during the COVID-19 pandemic. Persons with CI rated autonomous choice preferences as significantly more important during the COVID-19 pandemic than before; there was no association between the COVID-19 pandemic and change in other everyday preferences domains or discrepancy in proxy assessments of everyday preferences. Identifying avenues to support and provide for autonomy in the decision-making of older adults with CI may offer a way forward in mitigating the psychological and behavioral impacts of the COVID-19 pandemic in this population.
Collapse
Affiliation(s)
- James M. Wilkins
- McLean Hospital, Belmont, MA; Harvard Medical School, Boston, MA
| | - Joseph J. Locascio
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
- Harvard Catalyst Biostatistical Consulting, Harvard Catalyst/CTSA; Harvard Medical School, Boston, MA
| | - Teresa Gomez-Isla
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Bradley T. Hyman
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Deborah Blacker
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Olivia I. Okereke
- Massachusetts Alzheimer’s Disease Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Fanaki C, Fortin J, Sirois MJ, Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A. Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults. Can Geriatr J 2023; 26:227-238. [PMID: 37265986 PMCID: PMC10198677 DOI: 10.5770/cgj.26.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Introduction To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. Methods In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the Consolidated Framework for Implementation Research and then adding emergent subthemes. Results We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. Conclusions These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
Collapse
Affiliation(s)
- Chaimaa Fanaki
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
| | - Julie Fortin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| | - Marie-Josée Sirois
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Research Centre of the CHU de Québec, Quebec, QC
- Department of Readaptation, Université Laval, Quebec, QC
| | - Edeltraut Kröger
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Faculty of Pharmacy, Université Laval, Quebec, QC
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - Susie Gregg
- Canadian Mental Health Association Waterloo Wellington Dufferin, Waterloo, ON
| | - Joanie Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anik Giguere
- VITAM—Research Centre On Sustainable Health, Quebec, QC
- Quebec Centre for Excellence on Aging, Quebec, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC
| |
Collapse
|
4
|
Wilkins JM, Locascio JJ, Gomez-Isla T, Hyman BT, Blacker D, Forester BP, Okereke OI. Projection of Care Partners' Preferences in the Proxy Assessments of Everyday Preferences for Persons With Cognitive Impairment. Am J Geriatr Psychiatry 2023; 31:254-263. [PMID: 36609056 PMCID: PMC10023418 DOI: 10.1016/j.jagp.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Bias in surrogate decision-making can occur when proxy decision-makers overestimate the degree to which their preferences are shared by others, resulting in a projection of their beliefs onto others. The purpose of this study is to assess projection of care partners' preferences onto surrogate assessments of everyday preferences for persons with cognitive impairment (CI) and to address clinical and demographic factors as predictors of projection. METHODS The sample included 116 dyads of persons with CI (Clinical Dementia Rating Scale score ≥ 0.5) and their care partners. The Preferences for Everyday Living Inventory (PELI) was used to assess importance of preferences among persons with CI. Care partners completed two separate PELI assessments: one from the perspective of the persons with CI (i.e., acting as a surrogate decision-maker) and one from their own perspective. To assess for projection of care partners' preferences onto surrogate assessments of preferences for persons with CI, two-step regression with multivariable-adjusted general linear models was used. RESULTS Significant projection was noted within the PELI domains of autonomous choice, personal growth, and keeping a routine (p < 0.005). More significant cognitive impairment was associated with increased projection within the PELI domains of autonomous choice and personal growth (p < 0.05). CONCLUSION The results of this study suggest that projection of care partners' own preferences may be a significant source of bias in proxy decision-making regarding everyday preferences for persons with CI, particularly for those with more significant CI.
Collapse
Affiliation(s)
- James M Wilkins
- McLean Hospital (JMW, BPF), Belmont, MA; Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA.
| | - Joseph J Locascio
- Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA; Department of Neurology (JJL, TGI, BTH, DB, OIO), Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA; Harvard Catalyst Biostatistical Consulting (JJL), Harvard Catalyst/CTSA, Boston, MA
| | - Teresa Gomez-Isla
- Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA; Department of Neurology (JJL, TGI, BTH, DB, OIO), Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA
| | - Bradley T Hyman
- Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA; Department of Neurology (JJL, TGI, BTH, DB, OIO), Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA
| | - Deborah Blacker
- Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA; Department of Neurology (JJL, TGI, BTH, DB, OIO), Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA; Department of Psychiatry (DB, OIO), Massachusetts General Hospital, Boston, MA
| | - Brent P Forester
- McLean Hospital (JMW, BPF), Belmont, MA; Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA
| | - Olivia I Okereke
- Harvard Medical School (JMW, JJL, TGI, BTH, DB, BPF, OIO), Boston, MA; Department of Neurology (JJL, TGI, BTH, DB, OIO), Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, MA; Department of Psychiatry (DB, OIO), Massachusetts General Hospital, Boston, MA
| |
Collapse
|
5
|
McCabe M, Byers J, Busija L, Mellor D, Bennett M, Beattie E. How Important Are Choice, Autonomy, and Relationships in Predicting the Quality of Life of Nursing Home Residents? J Appl Gerontol 2021; 40:1743-1750. [PMID: 33402014 DOI: 10.1177/0733464820983972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Older people face major challenges when they move into nursing homes, particularly in relation to independence and their ability to influence their activities of daily living (ADLs). This study evaluated the contribution of resident choice, as well as the staff-resident relationship, to promoting resident quality of life (QoL). A total of 604 residents from 33 nursing homes in Australia completed measures of QoL, perceived levels of choice in various ADLs, and the staff-resident relationship. A hierarchical regression demonstrated that the predictor variables accounted for 25% of the variance in QoL. Two of the four predictor variables (resident choice over socializing and the staff-resident relationship) significantly contributed to resident QoL. These findings reinforce the important contribution of autonomy and social relationships to resident QoL. Nursing home staff have a key role to play in supporting resident autonomy as a means of building residents' chosen social connections, and thereby promoting QoL.
Collapse
Affiliation(s)
- Marita McCabe
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jessica Byers
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Lucy Busija
- Monash University, Melbourne, Victoria, Australia
| | | | - Michelle Bennett
- Australian Catholic University, North Sydney, New South Wales, Australia
| | | |
Collapse
|
6
|
Fabius CD, Brown E, Robison JT. Racial Differences in Choice and Control Among Older Adults: Results From Connecticut's Money Follows the Person Rebalancing Demonstration. J Aging Soc Policy 2019; 32:172-187. [PMID: 30935294 DOI: 10.1080/08959420.2019.1589887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We examined racial differences in determinants of choice and control in daily activities and service coordination for a sample of White and Black participants in the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration. Within-group analyses were conducted to understand factors that contribute to choice and control among participants. While no disparities were found in the odds of reporting choice and control, our findings show that White participants with mental health challenges, who lived with family, and had more functional impairments and Black participants with engagement transition challenges were less likely to have choice and control over daily activities. Determinants varied by race for choice in service coordination. Findings indicate a need for initiatives to target different factors for White and Black MFP participants to optimize opportunities for choice and control after returning to community living.
Collapse
Affiliation(s)
- Chanee D Fabius
- Center for Gerontology and Healthcare Research, Brown University School of Public Health,Providence, Rhode Island, USA.,College of Liberal Arts and Sciences, Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Edna Brown
- College of Liberal Arts and Sciences, Department of Human Development and Family Studies, University of Connecticut, Storrs, Connecticut, USA
| | - Julie T Robison
- Center on Aging, UConn Health School of Medicine, Farmington, Connecticut, USA
| |
Collapse
|