Organizational Culture Affects Staff Attitudes

Using self-reported surveys completed by 316 staff members in 61 assisted living facilities in Maryland, this study focused on staff perceptions of organizational culture and their work-related attitudes. Staff who had more favorable perceptions of organizational culture reported greater job satisfaction, co-worker satisfaction, and organizational commitment. Perceptions of teamwork had the strongest influence on satisfaction with co-workers, and perceptions of organizational morale had the strongest influence on job satisfaction.

Higher Turnover, Low Staffing, & For-Profit Ownership

Researchers explored the association between turnover rates at 854 facilities in six states and eight organizational characteristics, including staffing levels, top-management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census. Key characteristics of the organization, such as ownership, facility quality, and staffing levels, dramatically affect staff turnover rates. Higher turnover rates for certified nurse aides, licensed practical nurses, and registered nurses are consistently associated with lower staffing levels, lower quality of care, and for-profit ownership.

Loneliness Soothed More By Dogs Than People

Studies have linked pet ownership to less stress and depression. In this study, residents of three nursing homes in St. Louis, Missouri, were given time alone with a specially trained dog and asked to compare that time with time spent with other residents. Everyone got the same amount of time with the dog: 30 minutes per week for six weeks. Participants, most of whom were Caucasian women around 80 years old, also completed before-and-after loneliness surveys. Residents visited by a dog reported less loneliness than those who took part in a group with two or three other residents.

Rethinking Long-Term Care

The Commonwealth Fund (December 2005)

"The Baby Boomer generation may be an 'earthquake' that will shake the foundation of the long-term care system."

In this commentary, Edward King, Executive Director at the National Senior Citizens Law Center, writes about recent successes in long-term care quality as well as areas for improvement. The aging Baby Boomer generation has been described as a coming “earthquake” that will shake the foundation of the long-term care system. In the face of such a challenge, serious long-term care reform is needed. To read more of King’s comments, visit http://www.cmwf.org/publications/publications_

show.htm?doc_id=331767.

Long-Term Care Tutorial

This new narrated slide tutorial by Risa Elias of the Kaiser Commission on Medicaid and the Uninsured provides an overview of the financing of long-term care in the U.S. and explains issues related to the cost of long-term care, how families pay for long-term care services, and the role of Medicare and Medicaid programs. This web-based program, and others offered at KaiserEDU.org, are designed to provide easy access to the latest data, research, analysis, and developments in health policy. The information is free and available to students, faculty, and others interested in learning about health policy. The site includes background reference libraries and modules addressing current topics and policy debates. To learn more, visit http://www.kaiseredu.org/tutorials_index.asp#Financing.

Less Fat May Not Lower Cancer Risk

Eating less fat late in life failed to lower the risk of cancer and heart disease among older women. This is disappointing news for those who expected greater benefits from a healthy diet. The results stem from the Women’s Health Initiative, a landmark government project involving tens of thousands of postmenopausal American women. The eight-year study showed no difference in the rate of breast cancer, colon cancer, and heart disease among those who ate lower-fat diets.  Researchers suggest that the women in the long-running study (average age: 62), may have started their healthy eating too late. They also didn’t reduce fats as much as the diet demanded, and most remained overweight, a major risk factor for cancer and heart problems.

More Whole Grain a Day Keeps the Doctor Away

Eating whole grains may help prevent risk factors that could lead to heart attacks and strokes in older adults. In a study of 535 adults between ages 60 and 98, those who ate more whole grain foods were less likely to develop metabolic syndrome or die of cardiovascular disease over the next 12 or 15 years. Metabolic syndrome refers to a group of conditions that include high blood pressure, high cholesterol, high blood sugar levels, and abdominal obesity. These conditions elevate the risk of heart disease, stroke, and  kidney damage. Among various foods, whole grains can be found in high-fiber cereals, cooked oatmeal, and certain breads.

Exercise Quickens the Healing Process

"The finding is of interest to older adults who tend to have an increased risk of infection with minor wounds." In addition to the widely accepted benefits of regular exercise, quicker recovery time from wounds is also possible, according to results of this study. Researchers inflicted a small wound, one-eighth-inch deep and wide, in 28 healthy people ages 55 to 77. Thirteen of the participants exercised three times a week for three months, while the other 15 participants were sedentary. Individuals who exercised regularly on average experienced healing 10 days quicker than their sedentary counterparts did. The results are significant because the quicker a wound heals, the less likely an individual is to develop an infection. This finding is of particular interest to older adults who tend to have an increased risk of infection with minor wounds.

Lower Risk & Postponing Onset of Dementia

According to a Group Health Cooperative/University of Washington study, regular exercise is associated with a delay in the onset of dementia and Alzheimer’s disease. The study followed 1,740 people ages 65 and older over a six-year period. The researchers contacted the participants every two years to assess factors potentially affecting dementia, including exercise frequency, cognitive function, physical function, symptoms of depression, and lifestyle characteristics. People who exercised three or more times a week had a 30% to 40% lower risk of developing dementia, compared with those who exercised fewer than three times a week.

Twin Study Finds Alzheimer's Highly Inherited

The largest study to date of twins and Alzheimer’s disease indicates that inheritance may play a role in nearly 80% of cases. The report was based on a study of 392 pairs of twins in Sweden. The participating twins, ages 65 and older, had at least one whom had been diagnosed with Alzheimer’s. They were compared to a similar group of twins who were free of the disease. The study found that genetic factors accounted for 58% to 79% of the risk of developing late-onset Alzheimer’s. The rest of the risk (21% to 42%) could be chalked up to other factors, such as unhealthy lifestyles or another disease such as atherosclerosis.

Progress Report on Alzheimer's Disease

This annual report summarizes recent research conducted or supported by the National Institute on Aging (NIA) on the causes and risk factors of Alzheimer’s, its diagnosis, and treatment/caregiving issues associated with the brain-degenerating disease. The report includes a section called “Outlook for the Future” that examines some Alzheimer’s research initiatives designed to accelerate laboratory and clinical research and collaboration across the government and in association with the private sector so that research findings can be translated quickly into real advances for patients and families. The 88-page report is available in print or in PDF format at http://www.alzheimers.org/pr04-05/index.asp.

More Facilities and Agencies Providing Dementia Care

"More than a third of assisted living facilities had separate dementia units and most charged nothing extra for care services." Nearly two out of three assisted living facilities in the U.S. provide specialized care for those with dementia, with half charging extra for the service.  Of those with additional costs, rates ranged considerably from $50 to $3,000 per month, with the majority reporting added costs of $1,000 per month. Of nursing homes surveyed, more than a third had separate dementia units and most charged nothing extra.  Seventy-one percent of home care agencies provide their staff with training specific to caring for someone with dementia.  The summary of Alzheimer’s Care: Supplemental Findings to the 2005 Metlife Market Surveys of Nursing Home/Home Care and Assisted Living Costs is available at http://www.maturemarketinstitute.com/ under “What’s New.”

Newsletter for People With Dementia

Perspectives: A Newsletter for Individuals with Alzheimer’s or a Related Disorder is edited by Lisa Snyder, LCSW, of the Shiley-Marcos Alzheimer’s Disease Research Center at the University of California, San Diego. The quarterly newsletter is now available for free by e-mail or for $20 a year by mail. Requests for print subscriptions can be mailed to Lisa Snyder, Shiley-Marcos Alzheimer’s Disease Research Center, 9500 Gilman Drive-0948, La Jolla, California 92093-0948. Ms. Snyder can be reached at (858) 622-5800; fax: (858) 622-1012. Requests for free subscriptions by e-mail can be sent to lsnyder@ucsd.edu.

Web-Based Help For Family Caregivers

The Gerontologist (December 2005)

A web-based multimedia caregiver support program, Caregiver’s Friend: Dealing with Dementia, was found to be an effective intervention with employed family caregivers. The program consisted of text material and videos, and the evaluation involved 299 caregivers participating in a pre-test/post-test randomized clinical trial with a 30-day follow-up and a waitlist control condition. When compared to the control group, the treatment group had significantly reduced depression, anxiety, and strain levels. The program may be a low-cost, convenient, and effective way to offer support services to working family caregivers. To learn more, contact Natasha Beauchamp at nbeauchamp@orcasinc.com. To read the abstract, visit http://gerontologist.gerontologyjournals.org/cgi/content/abstract/45/6/793.

Spouse's Hospitalization Increases Partner's Risk of Death

"Hospitalization of a spouse for a serious illness increases his or her partner's risk of death." Most people have heard stories about an older adult who “dies of a broken heart” shortly after his or her partner’s death. A new study found that hospitalization of a spouse for a serious illness also increases his or her partner’s risk of death. Furthermore, the risk is greater with certain diagnoses, such as dementia, stroke, and hip fracture. Researchers studied more than half a million couples over the ages of 65 who were enrolled in Medicare from 1993 through 2001. Over that period, the study found that overall, having a sick spouse is about one-fourth as bad for a partner’s health as having a spouse actually die. Some spousal diseases were nearly as bad for partners as it would be if the spouse actually died.  The period of greatest risk is over the short run, within 30 days of a spouse’s hospitalization or death.

Caregiving and Hospice

Researchers studied 354 family caregivers of patients in a community hospice, dividing the caregivers and their patients into three groups. The first group received standard hospice care; the second group received standard care and three visits from a nurse and home health aide for emotional support; and the last group received standard care and three visits in which they were taught coping skills, including how to assess and manage their family members’ symptoms. Caregivers who were taught coping skills reported greater improvements in their quality of life than did caregivers in the other two groups. Caregivers taught coping skills also were less stressed by their family members’ pain, shortness of breath, or other symptoms, and were less stressed by caregiving tasks.  Furthermore, the results revealed that the coping intervention was more beneficial than the mere provision of emotional support.

Improving End-of-Life Care

Some leading experts were invited to explore the significance of changes in end-of-life care. The final report, Improving End-of-Life Care: Why Has It Been So Difficult?, features essays on subjects ranging from disability rights to public policy and asks readers to consider what they believe to be true about end-of-life care, to consider what is actually true, and to envision a different approach to concerns, such as personal autonomy, advance directives, disability rights, and the legal system. To view and download the free 68-page report, go to http://www.thehastingscenter.org/research/healthcarepolicy8.asp.

Aspirin's Heart Benefits May Vary By Sex

According to a review of six studies involving more than 95,000 participants, the benefits of taking aspirin regularly differ between men and women – it reduces the risk of heart attacks in men while it reduces the risk of strokes in women.  Researchers found that aspirin use lowered women’s risk of suffering a stroke by 17% compared with nonusers, while not having any effect on their chances of having a heart attack or dying from cardiovascular disease. Aspirin’s benefit for men was to reduce their chances of a heart attack by 32%, while having no impact on their risk of stroke or cardiovascular death. Overall, women who took low doses of aspirin had a 12% lower risk of suffering a heart attack or stroke or death due to cardiovascular disease, compared with those who did not take it. Aspirin conferred a 14% lower risk of these diseases in men.

A Little Help Goes a Long Way

Journal of the American Geriatrics Society (February 6,2006)

To examine what effect living with unmet needs had on the use of medical services, researchers studied 2,943 frail older adults enrolled at 13 sites in the Program of All-Inclusive Care for the Elderly (PACE).  PACE provides medical and social services 

that also meet the daily living needs of those eligible for nursing homes. After a few weeks of help with daily tasks such as bathing, dressing, and preparing food, however, the need for health care dropped off, implying that a little help with the basics goes a long way. Older adults who do not have help for daily tasks, such as dressing and bathing, are much more likely to be hospitalized for acute illness than older adults who receive the help they need.

The New Retirement Mindscape

This study explored people’s attitudes, worries, behaviors, ambitions, and needs in retirement. Results show that retirement is not a single event that takes place in a day or even in a single year. Instead, the study reveals that people migrate through distinct and predictable stages of retirement, each with its own complex emotions and needs. As people migrate through these stages, each stage has an impact on every other aspect of their lives.  The stages noted below are described in the 14-page report found at http://www.ameriprise.com/amp/global/sitelets/dreambook/docs/mindscape-study-0106.pdf.