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Biomedical subjects

S S Travis

Publications and source records attributed to S S Travis.

At least 19 recordsLinked to original sources
PubMed2001

Hospitalization patterns and palliation in the last year of life among residents in long-term care.

PURPOSE: This study compared patterns of care, including hospitalization, during the last year of life for a group of residents in institutional long-term care. These subjects were either implicitly or explicitly in palliative care modes versus those who remained in active treatment or blended care. DESIGN AND METHODS: The study used a retrospective chart review and both quantitative and qualitative methods of data collection and analysis to examine indepth the end-of-life experiences of 41 nursing home residents who died in the nursing care unit of one large continuing care retirement community during an 18-month period. RESULTS: Most residents die in palliative care modes, but their movement into palliation with comfort care and symptom management is often slowed by indecision or inaction on the part of key decision makers, interrupted by aggressive acute care, or delayed until the last few days of life. IMPLICATIONS: Transitions from active curative care to palliative care are important for residents in permanent long-term care placements. Improved end-of-life care requires more attention to these transitions and to the decisions that residents, their families, and care teams are called upon to make.

Advance Directives↗
PubMed2000

Medication administration hassles reported by family caregivers of dependent elderly persons.

BACKGROUND: Even under the new long-term care mantra for increased home- and community-based care options, attention to and an understanding of the ways that family caregivers are managing complex care for dependent elderly persons, for example, with medication administration, have been slow to materialize. METHODS: Twenty-three family caregivers completed semistructured, face-to-face interviews to capture the shared and idiosyncratic experiences of individuals responsible for all aspects of medication administration regimens for elderly, dependent family members. Data analysis consisted of content analysis of the verbatim interview transcripts. This article reports an emerging typology of caregiver medication administration hassles derived from the interviews. RESULTS: Based on 122 separate accounts, three categories of medication administration hassles were identified. The categories (with the percentage of all accounts represented by the category) include (i) scheduling logistics (29.5%), (ii) administration procedures (31.9%), and (iii) safety issues (38.6%). CONCLUSIONS: Primary care providers must continually reevaluate and simplify medication regimens for dependent elderly persons in the care of family members, and the family caregivers must be given adequate training and access to ongoing information support systems to help them perform safe and effective medication administration responsibilities.

Adult↗
PubMed2000

Family caregivers' use of humor in conveying information about caring for dependent older adults.

Twenty-three family caregivers were interviewed using a semistructured interview format to explore their experiences managing medication administration and providing long-term care to frail elderly family members. Content analysis of the transcripts utilized the arousal-relief theory of humor (Berlyne, 1969) to understand the frequent use of humorous anecdotes found throughout the interviews. For example, caregivers of individuals experiencing dementia often included smiles, jokes, and "punch lines" in their stories of behavioral problems that complicated medication administration schedules. Adult children frequently used humor to describe their role reversal with aged parents and the parents' forgetfulness, incontinence, or inability to dress without assistance. These accounts were placed in a taxonomy of humor response patterns that included categories for cognitive, affective, and behavioral responses. Second-level analysis created subcategories to reflect the function (relief or coping) that the humor served in the interview situation. It appears that humor is a useful communication tool for family caregivers that releases nervous energy about the interview process and the recall of difficult caregiving events. It is the responsibility of the interviewer to recognize the problems and issues embedded in the interview data and follow up humorous anecdotes with appropriate probes for additional information. Based on the results, a meta-humorous interaction theory is offered as an extension of the arousal-relief theory of humor.

Adaptation, Psychological↗
PubMed1999

Preexisting medical conditions in adult day services: an examination of nonmetropolitan and metropolitan admissions.

BACKGROUND: It is not known what health conditions are being managed by day services staff because, to date, there is virtually no research on the types of preexisting medical conditions that clients bring to these community-based settings. Furthermore, it is not known whether or how nonmetropolitan clients differ from their metropolitan counterparts. METHODS: Census data for 1,448 individuals who were admitted to adult day services in Maryland during 1993 were examined. Variables were included for client characteristics, medical diagnoses at admission (based upon ICD-9-CM categories), and adult day center location (metropolitan vs. nonmetropolitan). RESULTS: Persons admitted to nonmetropolitan centers were more likely than those entering metropolitan centers to be diagnosed as having musculoskeletal, respiratory, cardiovascular, and endocrine conditions and as having a malignant neoplasm. Admissions to metropolitan centers were significantly more likely to be diagnosed with Alzheimer's disease. After using multiple logistic regression to control for a number of client characteristics, location of the facility remained significantly associated with all listed admission diagnoses except musculoskeletal conditions. CONCLUSION: Nonmetropolitan centers are caring for a distinctly different type of long-term care client than metropolitan centers, perhaps because few other long-term care options are available to families in sparsely populated settings. The differences in the medical conditions of their clients should affect most aspects of the day services program, including budgets for appropriate professional staff, staff qualifications, resources for client/family education and counseling, and expected outcomes.

Adult↗
PubMed1999

Spousal caregiving when the adult day services center is closed.

Of those spousal caregivers who identified a time when they most needed assistance, morning or afternoon time periods appeared to be most problematic. Spousal caregivers who reported receiving respite time on the weekends identified adult children as the informal support person most often available. However, more than half of the caregivers reported having no respite time during the weekend. Differences in the ways spousal caregivers spent their respite time on the weekends, if available, varied by gender, length of tenure as a caregiver, and age.

Aged↗
PubMed1998

Mentally restorative experiences supporting rehabilitation of high functioning elders recovering from hip surgery.

Because mentally restorative experiences are pivotal in the context of rehabilitation and recovery, a prospective descriptive study was designed to learn more about the opportunities for, locations, and actions taken by, a group of elderly people (n = 8) over the age of 60 (average age = 82.5) that resulted in agreeable or pleasurable states of mind and perceived improvement in their ability to pay attention. Both structured and unstructured interviews were used to describe elderly patients' past and current patterns of and preferences for mentally restorative experiences. Data collection procedures were utilized during complete lengths of stay (range = 14-62 days) in sub-acute care. Results demonstrate that the actions elderly people take to create opportunities for mentally restorative experiences are related to past patterns of restorative activities, opportunities made available by the facility, special circumstances of their care, environmental limitations in the immediate care environment, and the degree to which external factors (such as family visits) are readily available. Implications for designing and managing the care environment are discussed.

Adaptation, Psychological↗
PubMed1997

Chronic subclinical hypothermia: home care alert.

Chronic subclinical hypothermia poses a serious challenge to home health nurses because the condition may negatively impact the plan of care for very old and frail clients. This article provides a review of age-associated changes in thermoregulation, discusses the ways in which these changes may affect an elderly client's response to care, and offers home care interventions for individuals with chronic subclinical hypothermia.

Aged↗
PubMed1996

Formal long-term care networks. Forming a partnership with gerontological nurses.

Faced with overwhelming demands on their time, physical reserves, and emotional energy, contemporary families are depending more and more on formal networks to help them with their elder care responsibilities. In the past, these interactions worked in a somewhat complimentary fashion with each caregiver having identifiable roles and responsibilities. Now, reforms in health and human services are pushing and pulling families into complex caregiving partnerships. These situations have the very real potential for creating stress, strain, tension and conflict among caregivers, as well as opportunities for thriving partnerships in care.

Caregivers↗
PubMed1996

Mall walking. An effective mental health intervention for older adults.

1. Traditional goals of health promotion and disease prevention are actually secondary factors in many walkers' motivations for mall-walking activity. 2. The routine of mall walking and the social relationships they form keep older adults going back to the mall. 3. Successful mall-walking program directors are beginning to understand the need to emphasize the social benefits of participating in a mall-walking group as much, if not more than, the health benefits of regular exercise.

Adaptation, Psychological↗
PubMed1994

The perceived benefits and problems associated with intergenerational exchanges in day care settings.

The universe of current adult day care center administrators (n = 36) and a stratified random sample of child day care center administrators (n = 300) in Virginia were surveyed to gather information about professionals' perceptions of the benefits and problems associated with providing regular intergenerational exchanges in day care settings. Findings of a qualitative analysis revealed that problems attributed to generational differences and organizational/service delivery issues were counterbalanced by sociocultural and organizational benefits.

Administrative Personnel↗
PubMed1992

Hospitalization experiences in the long-term care trajectories of a Medicaid cohort.

Two groups of applicants (859 screened in the community and 607 screened in acute care) for Medicaid-reimbursed long-term care were followed for 1 year from their initial long-term care assessments. The role hospitalizations play in long-term care trajectories was explored. Results reinforce the need for active partnerships between acute care and long-term care multidisciplinary teams for ongoing management of a large number of Medicaid clients and their families.

Demography↗
PubMed1992

Mortality rates within 360 days of admission to Medicaid reimbursed long-term care services.

Current long-term care (LTC) initiatives in many states are aimed at reducing cost by diverting certain members of the long-term care population into more cost effective home and community-based care. To date, very little has been done to monitor the subsequent mortality rates in these care situations. This project reports that approximately 35% of the individuals in a single admission cohort to Medicaid-reimbursed LTC in Virginia died within 360 days of their initial admission. When the data are separated by intermediate versus skilled levels of care and institutional versus community-based care settings, substantial differences in mortality rates between levels of care and care settings can be observed.

Community Health Services↗
PubMed1991

Nursing and medical care of primary dementia patients in a community hospital setting.

A group of 480 hospital discharges systematically drawn from elderly, community hospital discharges were examined in order to describe the hospitalization experiences of individuals with admitting or coexisting diagnoses of primary dementia. Demented patients (7.1% of the sample) were most likely to be among the oldest hospitalized elders. The most frequently recorded patient problem was "alteration in thought processes." Most nursing interventions emphasized safety precautions, often to the exclusion of psychosocial intervention to maximize and support the patient's level of cognitive functioning. Over one fourth of the demented patients had written "no code" prescriptions. Approximately 44% of the elders in the dementia subsample had prescriptions for psychotropic medications.

Aged↗
PubMed1990

Simple counts of the number of basic ADL dependencies for long-term care research and practice.

General acceptance of a patterned progression of dependency in activities of daily living has led to the widespread practice of simply counting the individual's basic ADL dependencies to reflect his or her self-care needs and level of impairment. This method is convenient, and it is practical to the extent that individuals do fit a scaled pattern of dependency that allows some meaningful comparison among individuals and between groups to be made. This research, based on 3,611 Medicaid cases in Virginia, reports that 36 percent of those individuals screened for nursing home admission do not match a commonly accepted pattern of dependency. The analyses include a logistic regression procedure to explain the characteristics of the "ADL divergent" cases and a Guttman scaling procedure on the ADL data for the sample. Results of the analyses indicate that a Guttman scaling procedure does as well as, but not better than, the original Katz ADL scale, with both scales describing approximately two-thirds of the cases in the sample.

Activities of Daily Living↗