Chapter Five Person-Environment Transactions Relevant to Control And Helplessness in Institutional Settings

Abstract

This chapter presents a review of prevalent conceptualization about the impact of long term care institutionalization on personal control and well-being of the elderly. Alternative formulations which focus on learned helplessness, environmentally- induced deficits and dependency are presented in accounting for adverse psychosocial influences on residents. In an effort to extend existing formulations to also account for potentially favorable post-institutional outcomes a congruence model of personal and environmental control and dependency is presented and integrated with existing models. Physical environmental features, institutional policies and staff attitudes are proposed as salient influences which are mediated through staff behaviors to exert their effects on residents. It is proposed that congruence between patient needs and staff behavior along dimensions of control and dependency are major determinants of well-being and competence of frail elderly after institutionalization. Lack of congruence between these factors may be diminished through coping efforts of residents in environments where staff response is contingent on resident behaviors. Secondary dependency may represent a useful coping response in such environments. Where there is no contingency between staff responses and resident behaviors lack of person-environment fit cannot be altered by successful coping efforts. Consequently adverse post-institutional outcomes are likely to ensue resulting in learned helplessness, depression and other environmentally induced deficits. A brief review of intervention strategies based on alternative conceptualizations of control is provided and direction for future research in the area of person-environment transactions relevant to control and helplessness is noted.