Philadelphia Geriatric Center Morale Research Articles

Abstract P4-11-09: A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners

Abstract Background: Health-related quality of life (HRQoL) is one of the important outcomes in cancer control trials and has increasingly become the one of the primary foci. Obtaining informed consent from participants is essential for participation in randomized controlled trials (RCTs), but the participation in these RCTs may directly influence HRQoL, because treatment options are determined according to the allocation schedule. To date, only a few studies have compared HRQoL between clinical trial participants and decliners. Patients and Method: The National Surgical Adjuvant Study of Breast Cancer 07 (N-SAS BC 07) is a randomized controlled trial in women with HER2-positive primary breast cancer who are over 70 years of age. The primary aim was to investigate the benefit of trastuzumab monotherapy compared with combination therapy using trastuzumab and chemotherapy. The study concept and design were published in concept paper (Sawaki M. et al., Jpn J Clin Oncol. 2011). In this study, patients were randomized to receive either trastuzumab plus chemotherapy or trastuzumab monotherapy. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival, relapse-free survival, safety, HRQoL, comprehensive geriatric assessment (CGA) and cost effectiveness (protocol ID; NCT01104935). HRQoL and CGA were assessed at registration (baseline), 2 month, 1 year, and 3 years after the start of protocol treatments using the Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression Scale (HADS), EuroQol 5 Dimension (EQ-5D), Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, and the Philadelphia Geriatric Center (PGC) Morale Scale. The patients who declined to participate in N-SAS BC 07 were registered in a cohort study to prospectively evaluate the subsequent treatment options and prognosis (07-Cohort). The same questionnaire that was used in N-SAS BC 07 was used in 07-Cohort to evaluate HRQoL and CGA at entry. Results: Patients were enrolled from October 2012 to October 2016. During this period, 275 and 123 patients were registered in N-SAS BC 07 and 07-Cohort, respectively. The mean age at entry of the patients in the N-SAS BC 07 and 07-Cohort groups was 73.9 and 74.6 years, respectively. The questionnaire response rates at baseline in the patients in N-SAS BC 07 and 07-Cohort groups were 89% and 82%, respectively. There were no significant differences in FACT-G, HADS, EQ-5D, or TMIG index of competence at baseline between the groups, but the mean (standard deviation) scores of PGC Morale Scale in N-SAS BC 07 and 07-Cohort groups were 10.8 (3.3) and 9.9 (3.7), respectively, with the scores being significantly greater in the N-SAS BC 07 group (p=0.020, t-test). Conclusion: The PGC Morale Scale provides a multidimensional approach to assess the psychological state of older people. This study indicated that participation in the RCT did not affect the baseline QoL of elderly patients but suggested that the baseline QoL of the RCT participants was better than decliners. Citation Format: Saito T, Sawaki M, Hozumi Y, Sagawa N, Iwata H, Kashiwaba M, Kawashima H, Kobayashi K, Taira N, Takashima T, Takahashi M, Tsuneizumi M, Nakayama T, Baba S, Bando H, Mizuno T, Yamaguchi M, Yamamoto Y, Uemura Y, Ohashi Y, Mukai H. A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-09.

Self Perception of Community Dwelling Elderly Toward Aging in Shubra El Khima City

Background: Elderly with positive self-perception of aging tend to engage in additional health behaviors related to prevention and report better functional health and live longer. Objectives: The aim of the study is to assess the self-image of community dwelling elderly toward aging in shubra el khima city. Design: A cross sectional study. Participants: Four Hundred of community dwelling elderly. Settings: shubra el khima city. Measurements: Minimental status examination (MMSE-30), Geriatric Depression scale (GDS-15), Direct interview by researcher to fulfill a structured battery of questionnaire formed of several subscales from seven different questionnaires investigating self perception of aging by participating individual:Age Stereotypes Scale, Quality of Life Scale, Satisfaction with Life Scale (SWLS), Positive and Negative Affect Schedule (PANAS), Lawton’s Philadelphia Geriatric Center (PGC) Morale Scale, Subjective Age Scale, Ryff'sPsychological Well Being Scales. Results: Older people feel younger than they actually are generally are satisfied with their aging, have high levels of positive affect and low level of negative affect and have higher morale, have positive age stereotype, have positive self-acceptance (good psychological well-being) and positive purpose in life. The three most important things for a good quality of life among studied participants were in order: good health followed by having good pension and good relationship with family members or friends. Conclusion: elderly in shubra el khima city have positive self-perception of aging.

Coping With Late-Life Challenges: Development and Validation of the Care-Receiver Efficacy Scale

Measures are lacking that address the challenges that people think they face in their roles as elderly care receivers. However, the development of a sense of efficacy in this role by mentally competent care receivers is critical to successful partnerships between caregivers and care receivers. The purpose of this article is to report the development and psychometric analysis of the Care-Receiver Efficacy Scale (CRES). Content validity, internal consistency reliability, factor structure, and convergent validity were assessed through a pilot study, expert review, and field administration with 177 participants. Results suggest that the CRES comprises five subscales, with strong reliability evidenced for three subscales but marginal reliability for the remaining two. Strong support was found for content validity from expert review and moderate support from the relationship between empirical and expert judgment of item location. Support for validity also was found from correlation with the Geriatric Depression Scale-Short Form and the Philadelphia Geriatric Center Morale Scale. The CRES may be useful as an outcome measure for psycho-socio-behavioral interventions aimed at increasing the capacity of care receivers to direct and improve their own care. Future measure revision and validation are important to optimize its utility.

Depression among the oldest old: the Umeå 85+ study

To investigate the prevalence of depression among the oldest old and to analyze factors associated with depression. A cross-sectional, population-based study was undertaken in Umeå, Sweden. Out of 319 eligible participants aged 85, 90 and 95 years and older, it was possible to evaluate 242 people (75.9%) for depression. Data were collected from structured interviews and assessments in the participants' homes, and from medical charts, relatives and caregivers. Depression was screened for using the Geriatric Depression Scale-15 and further assessed with the Montgomery-Asberg Depression Rating Scale. Cognition was assessed using the Mini-mental State Examination, activities of daily living (ADL) using the Barthel ADL Index, nutrition using the Mini Nutritional Assessment and well-being using the Philadelphia Geriatric Center Morale Scale. The 85-year-olds had a significantly lower prevalence of depression than the 90- and 95-year-olds (16.8% vs. 34.1% and 32.3%). No sex differences were found. One-third of those with depression had no treatment and among those with ongoing treatment 59% were still depressed. Persons diagnosed with depression had a poorer well-being and a higher 1-year mortality. Logistic regression analyses showed that depression was independently associated with living in institutions and number of medications. Depression among the oldest old is common, underdiagnosed and inadequately treated, and causes poor well-being and increased mortality. More knowledge about depression is essential to improve the assessment and treatment of depression among the oldest old.

Altruistic Activity and Older Adults in Long Term Care Facilities

The purpose of this study was to investigate the effect of different types of activity on older adults in long term care facilities. Twenty-six female occupational therapy students visited older adults residing in local nursing facilities. Older adults were paired with student volunteers and participated in an altruistic activity, a non-altruistic activity, or weekly conversation with no activity. Responses to the dependent measures were also gathered from participants of a regularly scheduled group activity whose members did not interact with students. The dependent measures included the participants' scores on the revised Philadelphia Geriatric Center (PGC) Morale Scale, participants' scores on the Patient Description Scale, completed by each participant's student visitor, and the participants' rating of the activity using Osgood's Semantic Differential. Scores on the PGC Morale Scale indicated a significantly more positive attitude toward aging among individuals in the altruistic condition compared to ...

Achievement motivation, achieving styles, and morale in the elderly.

This research extends the literature on variables predictive of morale from the often-researched demographic, physical, and social factors to the psychological variables of achievement motivation and achieving styles. A sample of 115 older adults completed the Work and Family Orientation Questionnaire, the L-BLA Achieving Styles Inventory, and the PGC (Philadelphia Geriatric Center) Morale Scale. Regression analysis indicated that five variables were predictive of morale: (a) direct achieving style, (b) instrumental achieving style, (c) health, (d) social participation, and (e) age. The instrumental achieving style and age were inversely related to morale, although the direct and instrumental achieving styles were the two best predictors of morale.