Abstract: Purpose: This study provides preliminary evidence for the acceptability, reliability, and validity of the new Alzheimer's Disease Knowledge Scale (ADKS), a content and psychometric update to the Alzheimer's Disease Knowledge Test. Design and Methods: Traditional scale development methods were used to generate items and evaluate their psychometric properties in a variety of subsamples. Results: The final 30-item, true/false scale takes approximately 5–10 min to complete and covers risk factors, assessment and diagnosis, symptoms, course, life impact, caregiving, and treatment and management. Preliminary results suggest that the ADKS has adequate reliability (test–retest and internal consistency) and validity (content, predictive, concurrent, and convergent). Implications: The ADKS is designed for use in both applied and research contexts, capable of assessing knowledge about Alzheimer's disease among laypeople, patients, caregivers, and professionals.

Abstract: Purpose: Building on the disablement process model and the concept of person-environment fit (p-e fit), this review article examines 2 critical questions concerning the role of home environments: (a) What is the recent evidence supporting a relationship between home environments and disability-related outcomes? and (b) What is the recent evidence regarding the effects of home modifications on disability-related outcomes? Design and Methods: Using computerized and manual search, we identified relevant peer-reviewed original publications and review articles published between January 1, 1997, and August 31, 2006. For Research Question 1, 25 original investigations and for Research Question 2, 29 original investigations and 10 review articles were identified. Results: For Research Question 1, evidence for a relationship between home environments and disability-related outcomes for older adults exists but is limited by cross-sectional designs and poor research quality. For Research Question 2, evidence based on randomized controlled trials shows that improving home environments enhances functional ability outcomes but not so much falls-related outcomes. Some evidence also exists that studies using a p-e fit perspective result in more supportive findings than studies that do not use this framework. Implications: Considerable evidence exists that supports the role of home environments in the disablement process, but there are also inconsistencies in findings across studies. Future research should optimize psychometric properties of home environment assessment tools and explore the role of both objective characteristics and perceived attributions of home environments to understand person-environment dynamics and their impact on disability-related outcomes in old age.

Abstract: Purpose: The purpose of this study was to document the benefi ts of volunteering perceived by older adults and to explain variation in these self-perceived benefi ts Design and Methods: This is a quantitative study of 13 volunteer programs and 401 older adults serving in those programs Program directors completed telephone interviews, and older volunteers completed mailed surveys Volunteer-level and programlevel data were merged Results: Older volunteers reported a wide variety of benefi ts to the people they served, themselves, their families, and communities More than 30% reported that they were “ a great deal better off ” because of volunteering, and almost 60% identifi ed a benefi t to their families When considering only individual characteristics, lower-income and lower-educated volunteers reported more benefi t Yet, aspects of the volunteer experience, like amount of involvement, adequacy of training and ongoing support, and stipends, were more important in understanding who benefi ts from volunteering Implications: These fi ndings suggest that characteristics of volunteer programs can be strengthened to maximize the benefi ts of volunteering to older adults These characteristics are more mutable by public policies and organizational procedures than individual characteristics Focusing on the recruitment of lower socioeconomic status older adults may result in an increase in benefi ts from the growth of volunteering

Abstract: Purpose: To validate a survey research measure of subjective income, as measured by perceived income adequacy, in an international context. Design and Methods: The study population comprised persons aged 50 years and older in 12 countries from the Survey of Health, Ageing and Retirement in Europe ( n = 28,939). Perceived diffi culty in making ends meet was regressed on sociodemographic variables, economic indicators, health status measures, and expectations regarding one’s fi nancial future. Country differences were also controlled. Results: The fi ndings confi rm a multidimensional explanation of perceived income adequacy but also point to the primacy of objective economic indicators in predicting household fi nancial distress. Respondents aged 80 years and older report less fi nancial diffi culty. Poor health status and pessimistic fi nancial expectations also predict greater household fi nancial distress but to a lesser degree. Implications: Self-rated economic status is a robust indicator of fi nancial capacity in older age and can be used by practitioners to gain meaningful information. However, practitioners should keep in mind that the oldest-old may underestimate fi nancial diffi culties.

Abstract: Purpose: This study investigated the effectiveness of interventions to improve medication adherence (MA) in older adults. Design and Methods: Metaanalysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Randomeffects models were used to estimate overall mean effect sizes (ESs) for MA, knowledge, health outcomes, and health services utilization. Results: Data were synthesized across 11,827 participants. Interventions signifi cantly improved MA (ES = 0.33), knowledge (ES = 0.48), and diastolic blood pressure (ES = 0.19). Nonsignifi cant effects were found for systolic blood pressure (ES = 0.21), other health outcomes (ES = 0.04), and health services utilization (ES = 0.16). Moderator analyses showed larger adherence ESs for interventions employing special medication packaging, dose modifi cation, participant monitoring of medication effects and side effects, succinct written instructions, and standardized (not tailored) interventions. Larger effects were found when a moderate proportion of participants were women, for participants taking 3 – 5 medications, and when pill count adherence was measured. Implications: The fi ndings document that interventions increase MA in older adults. The considerable heterogeneity in the magnitude of effects across studies and results of the moderator analyses demonstrate the need for additional empirical research to optimize interventions .

Abstract: Purpose: Although participatory action research (PAR) is increasingly viewed as an important complement to traditional investigator-driven research, relatively little PAR has taken place in which older adults have been prominent partners. This article provides a review of the literature on PAR in gerontology, highlighting key studies and their implications. Design and Methods: We searched PubMed, PsycINFO, and ERIC for relevant articles, supplementing our results through the bibliographies of articles identifi ed and consultation with colleagues. This search yielded 75 articles of potential relevance, of which we selected 13 (covering 10 studies) that best adhered to the roles of PAR in gerontology. Results: PAR projects with older adults have utilized a variety of research methodologies in a broad range of social contexts. Each of the 10 studies examined illustrates several core principles of PAR. Furthermore, while suffering from some methodological limitations, each also highlights value added in terms of research quality, elders ’ skill building, and/or action outcomes. Implications: Involving older adults in PAR, while labor intensive and challenging, may offer promise as an underdeveloped resource for the fi eld of social gerontology, as well as for elders themselves.

Abstract: Behavioral symptoms such as resistance to care, shadowing, vocalizations, or physical aggression are common in the 5.2 million individuals living with dementia in the United States (Alzheimer's Association, 2008). Behaviors profoundly affect individuals with dementia and their families, compromising their quality of life and safety, heightening caregiver burden and risk for nursing home placement, and increasing health care costs (Ballard, Lowery, Powell, O’Brien, & James, 2000). Even passive behaviors (withdrawal, apathy) are sources of frustration and sadness to families (Colling, 2004). Behaviors occur across the disease trajectory and dementia types and cannot be attributed to cognitive impairment alone. Emerging conceptual frameworks for understanding behavioral symptoms suggest that behaviors are an outcome of the interaction of individuals and their environments and should be addressed using nonpharmacological approaches. For example, the need-driven dementia-compromised behavior approach views behavior as an expression of an internal or unmet need in the person's environment that can be identified and addressed (Fitzsimmons & Buettner, 2002); the progressively lowered stress threshold views behavior as a response in part to the buildup of environmental stressors that overwhelm the capacity of the individual with dementia (Hall & Buckwalter, 1987); and the Antecedent–Behavior–Consequences approach targets specific triggers prior to and following a behavioral occurrence (Volicer & Hurley, 2003). Finally, the competence–environmental press model (Lawton & Nahemow, 1973) suggests that there are optimal combinations of environmental circumstances or conditions, and personal competencies that result in the highest possible functioning for individuals with compromised cognitive functioning. Obtaining the just-right fit between individual capabilities and external environmental demands results in adaptive positive behaviors; alternately, environments that are too demanding or understimulating result in behavioral symptoms such as agitation or passivity in individuals with dementia. Developing, testing, and translating nonpharmacological approaches to manage disruptive behavioral symptoms are important public health priorities for advancing better care of individuals with dementia (American Psychiatric Association Work Group, 2007; Cohen-Mansfield, 2001, 2005; Lyketsos et al., 2006; Salzman et al., 2008). The focus on nonpharmacological approaches is warranted in light of recent research showing that pharmacological solutions are not available for some of the most distressful behaviors (e.g., wandering, repetitive questioning, shadowing), have only modest benefits, and can pose considerable risk. The latter is particularly the case for the off-label use of atypical antipsychotic drugs commonly used for behavioral symptoms, which now have a Food and Drug Administration black box warning of increased mortality risk among older adults with dementia (Ballard et al., 2009; Salzman et al., 2008; Schneider et al., 2006; Selbaek, Kirkevold, & Engedal, 2007; Sink, Holden, & Yaffee, 2005).

Abstract: Purpose: To examine how cognitive speed of processing training affects driving mobility across a 3-year period among older drivers. Design and Methods: Older drivers with poor Useful Field of View (UFOV) test performance (indicating greater risk for subsequent at-fault crashes and mobility declines) were randomly assigned to either a speed of processing training or a social and computer contact control group. Driving mobility of these 2 groups was compared with a group of older adults who did not score poorly on the UFOV test (reference group) across a 3-year period. Results: Older drivers with poor UFOV test scores who did not receive training experienced greater mobility declines as evidenced by decreased driving exposure and space and increased driving diffi culty at 3 years. Those at risk for mobility decline who received training did not differ across the 3-year period from older adults in the reference group with regard to driving exposure, space, and most aspects of driving diffi culty. Implications: Cognitive speed of processing training can not only improve cognitive performance but also protect against mobility declines among older drivers. Scientifi cally proven cognitive training regimens have the potential to enhance the everyday lives of older adults.

Abstract: Purpose: Creative expression (CE) programs are emerging interventions to improve the quality of care and life of persons with dementia (PWDs) in long-term care settings. However, limited empirical evidence exists to support the effectiveness of these programs. Here, we report the fi ndings from an assessment of the impact of TimeSlips (TS), a group storytelling program that encourages CE among PWDs and those who care for them. Design and Methods: Instruction in TS was provided through a 10-week onsite training. An observational study using an experimental design was conducted in 20 nursing home facilities in 2 states, 10 of which were randomly selected to implement TS. Two weeks after the implementation of TS at the intervention sites, we conducted 4 days of direct observation, using a time-sampling approach, of residents and staff in each facility. Using surveys, we also assessed staff job satisfaction, attitudes toward residents, and burnout. Results: Compared with residents in the control facilities, those in the TS facilities were more engaged and more alert. In TS facilities, there were more frequent staff – resident interactions, social interactions, and social engagement. Also, staff who participated in the TS program had more positive views of residents with dementia and devalued residents less than did the control group staff. There were no differences in staff job satisfaction and burnout among staff in the TS and non-TS facilities. Implications: Implementing the TS program in nursing facilities improves the care environment for PWDs. However, additional studies are needed to offer further insights into the mechanisms by which TS improves both staff and resident outcomes.

Abstract: Purpose: We examined predictors of intrinsic job satisfaction, overall satisfaction, and intention to leave the job among nursing assistants (NAs). Design and Methods: The study focused on NAs who worked 30 or more hours per week in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004 National Nursing Assistant Survey, the fi rst telephone interview survey of NAs nationwide. Regression equations were calculated in which intrinsic satisfaction, overall satisfaction, and intention to leave were dependent variables. NA attributes (e.g., job tenure and education) and extrinsic job factors (e.g., assessment of supervisor behavior, pay satisfaction, and benefi ts) were exogenous variables. Results: A positive assessment of the supervisor ’ s behavior had the strongest association with intrinsic satisfaction. Pay satisfaction had the second strongest association with intrinsic satisfaction. Predictors with the strongest associations with intention to leave were overall and intrinsic satisfaction. Assessment of the supervisor was not associated directly with intention to leave. Assessments of the supervisor and pay may affect overall satisfaction and intention to leave in part through their direct effects on intrinsic satisfaction. Some facility and NA attributes were related to intrinsic satisfaction but not to overall satisfaction, suggesting that intrinsic satisfaction may be an intervening variable in the impact of these attributes on overall satisfaction. Implications: Intrinsic satisfaction and extrinsic job factors amenable to change appear central to NAs ’ overall satisfaction and intention to leave. A facility may be able to improve extrinsic job factors that improve NAs ’ job-related affects, including intrinsic satisfaction.

Abstract: 663 Purpose: Older adults generally have an increased need for health care information. Whereas some use the Internet to look for this information, others use more traditional sources. This study gathered data from older adults to determine their health information needs, the perceived usefulness of sources of health information, and if there are differences in perceptions and use of health information between Internet users and nonusers. Design and Methods: We conducted 9 focus groups — 4 groups of Internet users ( n = 27) and 5 groups of non-Internet users ( n = 26) — to determine reasons for seeking health information, satisfaction with information, and use of the Internet to fulfi ll information needs. Data from focus groups were supplemented with questionnaire data. Results: Those who do not use the Internet were found to be just as satisfi ed with the health information they fi nd as those who search for information online. We also found that nonusers are more likely to make health care decisions based upon information found offl ine than Internet users who have access to more information. Implications: Nonusers may fi nd it quicker to look for information through traditional media sources and stay offl ine, thus limiting their information options. Strategies for encouraging Internet use and programs to teach effective searching skills are needed. Physicians could also direct older patients toward credible health information Web sites.

Abstract: Purpose: To examine the relationship between registered nurse (RN) staffi ng mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999 – 2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state ’ s minimum standard for total nurse staffi ng level over the 5-year period. The other was 210 nursing homes that consistently failed to meet the standard over the period. All facility and market variables were drawn from California ’ s cost report data and state licensing and certifi cation data, as well as 3 other databases. Results: The RN to total nurse staffi ng ratio was negatively related to serious defi ciencies in nursing homes that consistently met the staffi ng standard, whereas the ratio was negatively associated with total defi ciencies in nursing homes that consistently failed to meet the standard over the 5-year period. As the RN to licensed vocational nurse ratios increased, total defi ciencies and serious defi ciencies decreased in both groups of nursing homes. Implications: A higher RN mix is positively related to quality of care, but the relationship is affected by overall nurse staffi ng levels in nursing homes. Further studies are necessary for a better understanding of RNs ’ unique contributions to the quality of care in nursing homes.

Abstract: Purpose: This article investigates how continuing care retirement community (CCRC) residents defi ne transitions between levels of care. Although older adults move to CCRCs to “ age in place, ” moving between levels of care is often stressful. More than half a million older adults live in CCRCs, with numbers continually increasing; yet, no studies address transitions between levels of care in these communities. Design and Methods: I completed 23 months of live-in observation and conducted 35 faceto-face in-depth interviews with CCRC residents across 3 levels of care. I performed a thematic analysis of observation notes and interview transcripts. Results: Residents perceived transitions as both disempowering and fi nal. They discussed decreases in social networks that occurred after such moves. Resident-maintained social boundaries exacerbated these challenges. Implications: Although the transition to institutional living is one of the most important events in older persons ’ lives, transitions within CCRCs also are consequential especially because they are coupled with declining functional ability. These fi ndings may inform policy for retirement facilities on topics such as increasing privacy, challenging social boundaries, and educating residents to prepare them for transitions.

Abstract: Purpose: To estimate the impact of nursing home work practices, specifi cally compensation and working conditions, on job satisfaction of nursing assistants employed in nursing homes. Design and Methods: Data are from the 2004 National Nursing Assistant Survey, responses by the nursing assistants ’ employers to the 2004 National Nursing Home Survey, and county-level data from the Area Resource File. Multinomial logistic regression was used to estimate effects of compensation and working conditions on nursing assistants ’ overall job satisfaction, controlling for personal characteristics and local labor market characteristics. Results: Wages, benefi ts, and job demands, measured by the ratio of nursing assistant hours per resident day, were associated with job satisfaction. Consistent with previous studies, job satisfaction was greater when nursing assistants felt respected and valued by their employers and had good relationships with supervisors. Nursing assistants were more satisfi ed when they had enough time to complete their work, when their work was challenging, when they were not subject to mandatory overtime, and where food was not delivered to residents on trays. Implications: This is the fi rst investigation of nursing assistant job satisfaction using a nationally representative sample of nursing assistants matched to information about their employing nursing homes. The fi ndings corroborate results of previous studies in showing that compensation and working conditions that provide respect, good relationships with supervisors, and better staffi ng levels are important to nursing assistant job satisfaction.

Abstract: Purpose: The purpose of this study was to understand the factors associated with turnover and retention of direct care workers. We hypothesize that a dual-driver model that includes individual factors, onthe-job factors, off-the-job factors, and contextual factors can be used to distinguish between reasons for direct care workforces (DCWs) staying on the job or leaving the job. Design and Methods: We conducted 7 focus groups with 47 participants. We identifi ed key themes they used to describe their experiences focusing on differences between stayers (had been in the same job for at least 3 years) and leavers (had changed jobs within the past 3 years). Results: Five major themes associated with turnover were identifi ed as follows: (a) lack of respect, (b) inadequate management, (c) work or family confl icts, (d) diffi culty of the work, and (e) job openings. Themes associated with retention were as follows: (a) being “ called ” to service, (b) patient advocacy, (c) personal relationships with residents, (d) religion or spirituality, (e) haven from home problems, and (f) fl exibility. Themes associated with turnover were different from those associated with retention. Implications: DCW turnover and retention are complex, multifactorial issues. Efforts to stabilize the DCW must address the issues associated with retention as well as those associated with turnover. Specifi cally, factors that promote retention may be qualitatively different than those that prevent turnover. Treating retention and turnover as simply the obverse of each other may be misleading in addressing the underlying problem of job stability among DCWs.

Abstract: Purpose: Due to population aging, the need for long-term institutional care is increasing. We study the potentially modifi able sociodemographic factors that affect the rate of entry into and exit from longterm care. Design and Methods: A 40% sample from the population registration data of Finns aged 65 and older living in private households at the end of 1997 ( n = 280,722) was followed for fi rst entry into ( n = 35,926) and subsequent exit — due to death or return to the community — from long-term institutional care until the end of 2003. Results: Being female, old, living alone, and of low socioeconomic status increased the risk for entering long-term care. Exit was affected by the same factors, but the associations were weaker and, with the exception of age, in the opposite direction. Women ’ s higher risk for entry was due to older age and greater likelihood of living alone. The effects of living arrangements and socioeconomic factors on entry were stronger among men and were attenuated after adjustment for each other and for health status. The mean duration of care was 1,064 days among women and 686 among men. Implications: Gender, age, living arrangements, and socioeconomic status are major determinants of institutional residence. Women and certain other population groups, e.g., those living alone, are likely to spend a longer time in institutional care because of higher rates of entry and lower rates of exit. These results have implications for the fi nancing of long-term care and for targeting of interventions aimed at delaying it.

Abstract: Purpose : There is wide variability in how spouses providing care respond to their care situations. Few studies focus on the roles of both intra- and interpersonal factors in long-term spousal care, particularly in the context of Parkinson ’ s disease (PD). The current study uses longitudinal data over a 10-year period to examine the roles of optimism, pessimism, mutuality, and spouse gender in predicting role strain in PD spouses. Design and Methods : A longitudinal design was used to study 255 spouses of persons with PD over a 10-year period, with data points at baseline (Year 0), Year 2, and Year 10. A series of multilevel models were used to examine four role strain variables — global strain, strain from worry, strain from feelings of being manipulated, and strain from increased tension. Results : Female spouse gender predicted both higher Year 10 role strain and faster increases in role strain over the 10-year period. In addition, high mutuality and optimism and low pessimism at baseline played important protective roles against increased role strain at Year 10. Implications : This study focused on early-stage spousal care in a primarily physical disability context. Findings suggest that gender differences place wives at greater risk for negative outcomes, even in the absence of dementia. Additionally, clinicians have opportunities to target interventions early in the care trajectory based on intra- and interpersonal risk factors.

Abstract: Purpose: To examine older adults ’ perceptions of the link between physical activity (PA) and nutrition to the maintenance of cognitive health. Design and Methods: Forty-two focus groups (FGs) were conducted with 396 ethnically diverse (White, African American, American Indian, Chinese, Vietnamese, and Hispanic) community-dwelling older adults. FGs were audio recorded, transcribed verbatim, and coded using a constant comparison method. Responses pertaining to PA and nutrition were analyzed. Results: Participants noted a positive link between both PA and dietary practices and brain health, although some participants voiced skepticism regarding diet. Walking was most frequently cited as a recommended PA, but participants did not know the recommended frequency, duration, and intensity. Limiting portion sizes; preparing foods in healthier ways; eating more fi sh, fruits, vegetables, low-fat foods, and chicken; and eating less red meat and chicken with the skin were associated with brain health. Multiple dietary supplements were also discussed. More racial/ethnic differences were noted for PA than for diet. Implications: Interventions and media campaigns may benefi t from explicitly linking PA and dietary habits with brain health and helping older adults understand that cardiovascular risk factors are also dementia risk factors. Emphasizing the total diet (vs. specifi c nutrients) and providing clear messages regarding the frequency, duration, and intensity of recommended PA would also be useful.

Abstract: Background: Nursing aides ’ attitudes condoning elder abuse are a possible risk factor for executing abusive behaviors against elder residents of long-term care facilities but have been studied infrequently. Purpose: The purpose of the study was to assess nursing aides ’ attitudes that condone abusive behaviors toward elderly people, as well as the relationship of these attitudes to demographic variables, work stressors (role confl ict, role ambiguity, and work overload), burnout, and perceived control, based on the theory of planned behavior (Ajzen, 1988, Attitudes, personality and behavior . Milton Keynes: Open University Press) Design and Methods: Two hundred and eight nursing aides from 18 nursing homes in Israel completed demographic, work stressors, burnout, and perceived control questionnaires and a case vignette questionnaire to test attitudes condoning elder abuse. Results: The mean score of the attitudes condoning abusive behaviors was relatively high at 3.24 ( SD = 0.59) on a 1 – 4 scale. Condoning abusive behaviors were closely associated with higher levels of work stressors, burnout, and low income. Multiple regression analyses revealed that demographic variables, work stressors, burnout, and perceived control explained 12% of the variance of condoning abusive behaviors among the nursing aides. Of these, role ambiguity, role confl ict, and burnout were signifi cantly associated with attitudes condoning abusive behaviors. In addition, burnout partially mediated the relationship between work stressors and attitudes condoning elder abuse. Conclusions: As nursing aides ’ attitudes condoning elder abuse may infl uence their actual behaviors, training and supervision programs should be developed to reduce work stressors and burnout and to modify these attitudes.

Abstract: Purpose: The purpose of this study was to examine the associations between nursing home administrator (NHA) leadership style and staff turnover. Design and Methods: We analyzed primary data from a survey of 2,900 NHAs conducted in 2005. The Online Survey Certifi cation and Reporting database and the Area Resource File were utilized to extract organizational and local economic characteristics of the facilities. A general linear model (GLM) was used to estimate the effects of NHA leadership style, organizational characteristics, and local economic characteristics on nursing home staff turnover for registered nurses (RNs), licensed practical nurses (LPNs), and nurse ’ s aides (NAs). Results: The complete model estimates indicate that NHAs who are consensus managers (leaders who solicit, and act upon, the most input from their staff) are associated with the lowest turnover levels, 7% for RNs, 3% for LPNs, and 44% for NAs. Shareholder managers (leaders who neither solicit input when making a decision nor provide their staffs with relevant information for making decisions on their own) are associated with the highest turnover levels, 32% for RNs, 56% for LPNs, and 168% for NAs. Implications: The fi ndings indicate that NHA leadership style is associated with staff turnover, even when the effects of organizational and local economic conditions are held constant. Because leadership strategies are amenable to change, the fi ndings of this study may be used to develop policies for lowering staff turnover.

Abstract: Purpose: This qualitative study assessed the needs of patients and caregivers during the transition from hospital to home. We specifi cally identifi ed unmet needs of ethnic minorities, recent immigrants, and seniors with limited English profi ciency (LEP). Findings are translated into recommendations for improving services to these groups during health care transitions. Design and Methods: This needs assessment included extensive analysis of qualitative data collected from 20 language-, culture-, and ethnic-specifi c focus groups with caregivers who recently assisted a senior after a hospital discharge. Findings from these focus groups were supplemented by 5 in-depth, longitudinal case studies of recently hospitalized seniors and their caregivers. Results: Inadequate information and training at discharge were themes that spanned all groups, despite ethnicity or language. Additional unmet needs were identifi ed for ethnic minorities, those with LEP, and recent immigrants, including lower levels of social support than might be expected, lack of linguistically appropriate information and services, and cultural and fi nancial barriers to using long-term care services. Implications: As ethnic diversity increases among older Americans, it will become increasingly important to design health care services to meet the needs of diverse groups. Recommendations include assessments of informal care, bilingual information and services, partnerships with community agencies providing culturally competent services, and expansion of home- and communitybased services to near-poor seniors.

Abstract: Purpose: Very few studies have examined cognitive decline in caregivers versus noncaregivers, and only 1 study has examined mediators of such decline. We evaluated the relationship between caregiver status and decline on the digit symbol test (DST; a measure of processing speed, attention, cognitive–motor translation, and visual scanning) and whether this relationship was mediated by depressed mood. Design and Methods: Caregivers for spouses with Alzheimer's disease (n = 122) were compared with demographically similar noncaregiver spouses (n = 117) at study entry (Time 1 = T1), T2 (1 year later), and T3 (2 years after T1). Results: Caregivers had lower DST scores and higher Hamilton depression scores at T1, T2, and T3 than noncaregivers (all p < .05). Hierarchical linear modeling revealed that although caregivers started well below noncaregivers, they experienced a more rapid rate of decline than noncaregivers (p = .047). Caregivers declined 4.5 times faster than noncaregivers. Greater depressed mood at T1 (p < .01) and T2 (p < .01) predicted DST decline and mediated DST decline in caregivers vs. noncaregivers. Implications: Depressed mood in caregivers relative to noncaregivers may influence their greater risk for DST decline. This is important because the DST predicts problem solving and everyday functions necessary for independent living and the potential well-being of their care recipients.

Abstract: Purpose: The primary aim of this study was to test the stress process model (SPM; Pearlin, Mullan, Semple, & Skaff, 1990 ) in a racially diverse sample of Alzheimer ’ s caregivers (CGs) using structural equation modeling (SEM) and regression techniques. A secondary aim was to examine race or ethnicity as a moderator of the relation between latent constructs (e.g., subjective stressors and role strain) in the SPM. Sample : Participants included White or Caucasian ( n = 212), Black or African American ( n = 201), and Hispanic or Latino ( n = 196) Alzheimer ’ s CGs from the Resources for Enhancing Alzheimer ’ s Caregiver Health (REACH) II clinical trial. Results: SEM revealed that the Pearlin model obtains a satisfactory fi t across race or ethnicity in the REACH II data, despite signifi cant racial differences in each of the latent constructs. Race or ethnicity moderated the impact of resources on intrapsychic strain, such that CGs reported similar intrapsychic strain across race at lower levels of resources, but White or Caucasian CGs reported more intrapsychic strain than Black or African American or Hispanic or Latino CGs when resources are higher. Implications: Strengths and weaknesses for each race or ethnicity vary considerably, suggesting that interventions must target different aspects of the stress process to provide optimal benefi t for individuals of different cultural or ethnic backgrounds.

Abstract: Purpose: Providing support to an aging parent may pose challenges to adult children but also provide an opportunity to "give back" to loved ones. The current study investigated changes in emotional and instrumental support and quality across a period of 4 years. Additionally, associations between intergenerational support and well-being in adult children over time were investigated. Design and Methods: Data from the first and second waves of the Netherlands Kinship Panel Study (N = 6,062) were analyzed to investigate the relative importance of relationship quality and support exchange and to test the potential buffering role of relationship quality for effects of the changing balance of support on well-being. Results: It was found that provision of instrumental and emotional support to parents increased during a period of 4 years. At the same time, instrumental support children received from parents decreased, whereas emotional support from parents increased. Intergenerational support exchange between children and parents was not associated with well-being in children, whereas the quality of the intergenerational relationship strongly predicted their well-being. Implications: Decreasing relationship quality seems a greater threat to the well-being of caregiving children than increased support and care tasks. Family counseling and public awareness to address this decline in intergenerational relationship quality may be important for well-being of families. © The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

Abstract: Purpose: This cross-sectional study takes a unique look at the association between patterns of walking and cognitive functioning by examining whether older adults with mild cognitive impairment differ in terms of the community settings where they walk and the frequency, intensity, or duration of walking. Design and Methods: The sample was based on interviews with 884 adults aged 65 years and older, residing in 4 locations across the United States: Alameda County, California; Cook County, Illinois; Allegheny County, Pennsylvania; and Durham/ Wake Counties, North Carolina. Cognitive function was assessed using a modifi ed Mini-Mental State Examination (MMSE) and the Mental Alternation Test (MAT). Multiple linear regressions were conducted between self-reported walking activities and cognitive measures, controlling for psychosocial, demographic, health status, functional performance, and neighborhood characteristics. Results: The community setting where people walk and the intensity of walking in their neighborhood were signifi cantly associated with cognitive status. After controlling for individual and neighborhood characteristics, better MAT scores were signifi cantly associated with brisk walking and walking fewer times per week. Compared with the MMSE, the MAT was more likely to be associated with patterns of walking among older adults. Older adults with lower MAT scores were more likely to walk in indoor shopping malls and less in parks, whereas those with higher cognitive function scores on the MMSE were less likely to walk in indoor gyms. Implications: This investigation provides insight into the extent to which walking is associated with preservation of cognitive health, setting the stage for future longitudinal studies and community-based interventions.

Abstract: Purpose: The purpose of this study is to quantify the effect of residential modifi cation on decreasing risk of physical function decline in 2 years. Design: Cohort study using propensity scores method to control for baseline differences between individuals with residential modifi cations and those without residential modifi cations. Participants: Participants ( N = 9,447) were from the Second Longitudinal Study on Aging, a nationally representative sample of the civilian noninstitutionalized population, aged 70 years and older in the United States at the time of baseline interview in 1994 ‐ 1995. Methods: Participants self-reported residential modifi cations at baseline (e.g., railings, bathroom modifi cations). Decline in physical functioning was measured by comparing self-reported activities of daily living at baseline and at 2-year follow-up. Results: Compared with individuals without baseline modifi cations, a higher proportion of those with baseline modifi cations were aged 85 years and older (16% vs. 10%), used special aides (36% vs. 14%), and lived alone (40% vs. 31%). Using a weighted propensity score method, we found a modest decrease in risk of decline at Wave 2 for those with baseline modifi cations (risk difference = 3.1%). Respondents with a baseline residential modifi cation were less likely to experience subsequent decline in functional ability (adjusted odds ratio = 0.88, 95% confi dence interval = 0.79 ‐ 0.97) after adjusting for quintile of propensity score in a survey-weighted regression model. Implications: Baseline modifi cations may be associated with reduced risk of decline among a nationally representative sample of older community-dwelling adults. Widespread adoption of residential modifi cations may reduce the overall population estimates of decline.

Abstract: Purpose : To report the impact on patient and informal caregiver satisfaction, patient empowerment, and health and disability status of a primary care – affi liated disease self-management – health promotion nurse intervention for Medicare benefi ciaries with disabilities and recent signifi cant health services use. Design and Methods : The Medicare Primary and Consumer-Directed Care Demonstration was a 24-month randomized controlled trial that included a nurse intervention. The present study ( N = 766) compares the nurse ( n = 382) and control ( n = 384) groups. Generalized linear models for repeated measures, linear regression, and ordered logit regression were used. Results : The patients whose activities of daily living (ADL) were reported by the same respondent at baseline and 22 months following baseline had signifi cantly fewer dependencies at 22 months than did the control group ( p = .038). This constituted the vast majority of respondents. In addition, patient satisfaction signifi cantly improved for 6 of 7 domains, whereas caregiver satisfaction

Abstract: The use of both quantitative and qualitative strategies to examine a single research question has been a subject of considerable controversy and still remains a largely uncommon practice in the sociology of health and illness. Yet, when seeking to understand the meaning of a chronic disabling condition in later life from a social psychological perspective, a mixed-method approach is likely to provide the most comprehensive picture. This article provides an overview of the usefulness and appropriateness of a mixed-method approach to understanding the stroke experience. I comment on the current state of research on the experience of stroke, including epistemological and ontological orientations. Using real data examples, I address paradigmatic assumptions, methods of integration, as well as challenges and pitfalls in integrating methods. I conclude by considering future directions in this field of research.

Abstract: PURPOSE: Faced with an aging driving population, interest is increasing in the use of restricted licenses or "graduated delicensing" for older drivers to allow them to safely retain a driver's license. The primary purpose of this study was to determine whether restricted licenses are successful at mitigating number of crashes per year and whether they can extend the period of crash-free driving for aging adults. DESIGN AND METHODS: Using a cohort study design, licensing and insurance claims crash records of all drivers aged 66 years and older in British Columbia were examined for the years 1999-2006. Nonparametric and Cox proportional hazards survival analyses were used to compare restricted vs. unrestricted drivers and to estimate crash risks. RESULTS: The risk of causing a crash for restricted drivers was 89% (or 11% lower risk) compared with unrestricted drivers after controlling forage and gender.[corrected]. The most common restriction was a combination of daylight driving only plus a speed maximum of 80 km/hr. Restricted drivers retained a driver's license for a longer period of time than unrestricted drivers and continued to drive crash free longer than unrestricted drivers. There was no difference in severity of collisions, and results suggest a high level of compliance with daylight-only restrictions. IMPLICATIONS: These findings suggest that driving restrictions may be effective for prolonging the crash-free driving of some aging drivers, thus supporting their continued independence and delaying institutionalization. Further studies are needed to determine which drivers are most likely to benefit from restricted licenses. Language: en