Philadelphia Geriatric Centre Morale Scale Research Articles

Self Perceptions of Stress in Caregiving Moderate Associations of Within and Between Caregivers’ Physical Health Symptoms

AbstractBackgroundThe success of dementia care requires the full support from the caregivers with the goal of delaying the disease’s progress. Studies over decades have reinforced that the knowledge, attitude, and skills of caregivers are crucial parameters of the success of in‐community care for dementia. Nevertheless, studies have identified that many caregivers, across different culture and ethicity, are not well prepared emotionally or practically to be the caregivers and this will result in stress, particularly when their stress are ignored by medical professionals during this long journey of care.MethodThis is a mixed‐method research to examine how self‐perceptions of aging (SPA) moderated within‐ and between‐caregivers Self‐perceived stress (SPS) associations with physiological health symptoms (PHS) and daily physical health symptoms (DPHS). SPA was measured by the Philadelphia Geriatric Centre Morale scale. SPS was measured by Zarit Burden Interview Scale and Revised Memory and Behaviour Problem Checklist. DPHS was measured daily through an adapted symptom checklist.ResultA pilot study of 20 caregivers reported significantly more physical health symptoms compared to individuals with lower perceived stress on average (p < .05). SPA significantly moderated associations between both within‐ and between‐persons perceived stress (SPS) and physiological health symptoms (PHS) (ps < .05).ConclusionMore positive SPA significantly dampened the impact of perceived stress, suggesting the importance of SPA as an individual characteristic within stress processes. Future work should examine how daily changes in SPA may exacerbate or mitigate the impacts of daily stress processes and health outcomes.

Can Informal Caregiving be Perceived as Rejuvenating? Changes in Perceptions of Ageing at Onset and End of Informal Caregiving during Different Stages of Life

Introduction: Perceptions of ageing are a central predictor of health, wellbeing, and longevity. This study analyses the association between the onset and end of informal caregiving and perceptions of ageing in different stages of life. Methods: Data from the German Aging Survey (2014, 2017) were used; a longitudinal dataset that is representative of community-dwelling individuals aged ≥40 years in Germany. Adjusted asymmetric fixed effects regression analyses were conducted to analyse the associations in three age groups (40 to <60, 60 to <80, and ≥80). Perceptions of ageing were measured in terms of attitude towards one’s own ageing (Philadelphia Geriatric Centre Morale Scale), subjective age (felt age), and onset of old age (when someone is considered to be old). Results: Significant changes in the perceptions of ageing were found only among individuals aged ≥80 years. In this group, the onset of informal caregiving was significantly associated with improved attitude towards one’s own ageing and the end of informal caregiving was significantly associated with increased subjective age and earlier onset of old age. Conclusion: The perceptions of ageing improved with the onset and worsened with end of caregiving – but only among oldest old individuals. Thus, informal caregiving seems to be a significant predictor for perceptions of ageing in old age.

Questionnaire measures of self-directed ageing stereotype in older adults: a systematic review of measurement properties.

The population is ageing, but while average life expectancy continues to increase, healthy life expectancy has not necessarily matched this and negative ageing stereotypes remain prevalent. Self-directed ageing stereotypes are hypothesised to play an important role in older adults' health and well-being; however, a wide variety of terms and measures are used to explore this construct meaning there is a lack of clarity within the literature. A review was conducted to identify tools used to measure self-directed ageing stereotype in older adults and evaluate their quality. Searches identified 109 papers incorporating 40 different measures. Most common were the Philadelphia Geriatric Centre Morale Scale Attitude Towards Own Ageing (ATOA) subscale, Ageing Perceptions Questionnaire (APQ) and Attitudes to Ageing Questionnaire. Despite being most frequently used, the ATOA was developed to measure morale in older adults rather than self-directed ageing stereotypes. Over 25 terms were used to describe the concept, and it is suggested that for consistency the term "self-directed ageing stereotype" be adopted universally. Across measures, poor reporting of psychometric properties made it difficult to assess scale quality and more research is needed to fully assess measures before conclusions can be drawn as to the best tool; however, the Brief-APQ appears to hold most promise. Future research must address this issue before interventions to reduce negative self-directed ageing stereotypes can be developed and fully evaluated.

P478: Psychometric properties of Philadelphia Geriatric Centre Morale Scale in Iranian elderly

P478: Psychometric properties of Philadelphia Geriatric Centre Morale Scale in Iranian elderly

The relationship between characteristics of supported housing and the quality of life of older adults with severe mental illness

This study examined whether group living (as opposed to single living), staff availability and degree of personal freedom are associated with the quality of life of older adults with severe mental illness. A cross-sectional study was carried out in 18 supported living programmes in residential homes for the elderly that differed in terms of these three characteristics. The study included 35 patients with a psychotic disorder and 38 with an anxiety or mood disorder. Quality of life was assessed with the Philadelphia Geriatric Centre Morale Scale (PGCMS) and the Manchester Short Assessment of Quality of Life (MANSA). No association was found between group living and quality of life. Availability of psychiatrically trained staff was associated with life quality only for patients with a psychotic disorder, and perceived amount of personal freedom was associated with life quality only for patients with a non-psychotic disorder. Both differences were seen only on the PGCMS Agitation subscale. Older people with psychotic disorders appear to have relatively high needs for professional psychiatric support, and those with non-psychotic disorders for control over their daily lives. Further research is needed in other settings for older people with severe mental illness, preferably using longitudinal designs.

Bienestar subjetivo en prejubilados de Andalucía occidental

Introduction job loss or discontinuing paid professional activity is stressful for individuals, their families and people in their social network, and the impact is greater when retirement is definitive, early, or unexpected, as in the case of early retirement. The aim of this study was to describe the sociodemographic characteristics and the degree of subjective well-being (SW) among a group of early retirees in western Andalusia (Spain). Interviewed participants consisted of 165 early retirees included in the latest early retirement plan of the company Telefónica SAU, who were members of the Telefónica Elders’ Association in Huelva and of the Association of Telefónica early retirees of Seville. Material and method the instruments used were a specifically designed sociodemographic questionnaire, the Life Satisfaction Index- Form A (Neugarten, Tobin and Havighurst, 1961), and the Philadelphia Geriatric Centre Morale Scale (Lawton, 1975). Successive samplings with groups of different participants were performed at two time points separated by a 5-month interval, using the postal mail survey method. Results the profile of the retiree is a man, married, with a middle education level, and whose partner does not work, all job categories being equally affected. Most subjects feel happy and satisfied with their new life, although an important rate shows a low mood and poor life satisfaction. Variations in Subjective Well-being are minimal within a 5-month period. Also, a strong correlation between mood and life satisfaction was found. Conclusions age seems to be the only indicator to be affected by an early retirement plan. Minimal variations in SW could be explained by time interval and Atchely’s honeymoon stage. In general, most participants were satisfied with their new life situation. The correlation between mood and life satisfaction would show the existence of the SW construct. The validity of SW instruments used in populations aged 50 to 60 years old should be emphasized.

Down and drowsy? Do apathetic nursing home residents experience low quality of life?

This cross-sectional study investigated the relationship between apathy and quality of life (QOL) in nursing home residents (n = 227). In all, 92 residents could be assessed with the Mini Mental State Examination (MMSE), the Geriatric Depression Scale (GDS) and the Philadelphia Geriatric Centre Morale Scale (PGCMS), and were able to answer a question about overall subjective QOL. Apathetic behaviour and consciousness disorders were measured with the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). Linear regression analysis was first applied to study the association of cognition, depression and consciousness with apathy. It was then used to study the relationship between apathy and QOL, controlling for the constructs that were associated with apathy. The relationship between apathy and QOL appeared to vary with the cognitive functioning of the residents: In residents with a low level of cognitive functioning, apathetic behaviour was associated with high QOL; in residents with a higher level of cognitive functioning, apathetic behaviour was associated with low QOL. The necessity and nature of interventions aimed at stimulating apathetic residents may depend on the level of cognitive functioning of the residents. Further research is needed to determine if and when apathy interventions are appropriate.

Repeatability of standardized tests of functional impairment and well-being in older people in a rehabilitation setting

Purpose : The aim of this study was to establish the repeatability of standardized tests of vision (Snellen chart testing), hearing (whispered voice test), communication (Frenchay aphasia screening test), loneliness (UCLA loneliness scale), morale (Philadelphia geriatric centre morale scale), and a multidimensional instrument (EASY-care) when used in a rehabilitation setting. Method : The tests were administered by a research nurse to 50 older subjects attending a day rehabilitation unit, with repeat administration one or two weeks later by a nurse on the unit. Kappa statistics were used for level of agreement for categorized data and interclass correlation coefficient were used for data based on scores. Results : Moderate repeatability for Snellen chart testing, whispered voice test; good to excellent for the FAST, UCLA loneliness scale and Philadelphia geriatric centre morale scale. Moderate to very good repeatability for all EASY-care items except communication, feeding, use of telephone and cognitive impairment, which had poor spread of data. Conclusions : Poor repeatability for commonly used tests of vision and hearing is worrying, whereas the positive results for the other tests will increase confidence in using them more in routine practice.

A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples’ Homes

Background: Falls are a major cause of morbidity in old age. A small number of fall prevention trials in cognitively intact community-dwelling older people have been effective. This study set out to examine the preventability of falls in older people living in institutional care. Objective: To evaluate the effectiveness of falls risk factor assessment/modification and seated balance exercise training in reducing falls among elderly people living in residential care. Methods: 133 residents with a mean age of 84± (SD) 6.8 years were allocated at random by home to receive either a 6-month falls risk factor assessment/modification and seated balance exercise training programme (n = 77) or 6 months of reminiscence therapy (n = 56). The risk factors targeted were postural hypotension, polypharmacy, visual acuity, and ambient lighting levels. Falls risk factor assessments and recommendation for modifications were performed at baseline in the intervention group and assessments repeated at 6 months. Functional reach, reaction time, timed up-and- go, grip strength, spinal flexibility, and Philadelphia Geriatric Centre Morale Scale and Mini-Mental State Examination scores were determined at baseline and at 6 months by a ‘blind’ observer. Falls and fractures were then monitored in both groups during a 7- to 12-month falls-monitoring follow-up period. Results: Only 90 of 133 (67.7%) residents completed the 6-month intervention period, and 84 (63.2%) completed the 7- to 12-month falls-monitoring follow-up period. Both prevalence of postural hypotension (p = 0.0005) and poor visual acuity (p = 0.04) were reduced in the intervention group. There was no difference between the groups in the number of falls sustained, the risk of falling [odds ratio 0.45 (95% CI 0.19–1.14)], or in the risk of recurrent falling [odds ratio 1.07 (95% CI 0.40–2.97)]. No significant differences were found between the groups with regard to change in other outcome measures. Conclusions: The high drop-out rate reduced the power of this study to detect any effect of the interventions used. It is possible that either the exercises were not sufficiently vigorous or that to improve balance exercises must be performed standing. Further research is required to identify effective fall prevention strategies for elderly people in residential settings.

Hospital discharge into nursing home care: Psychological reactions and contributing factors

Two groups of older people were investigated within a hospital setting, a 'care' group (N = 32) to be discharged into nursing home care and a 'home' group (N = 20) discharged to their own home. The groups completed a series of standardized assessments and a semi-structured interview. The factors which most significantly predicted going into 'care' were lower levels of emotional support, being without a spouse and older, and having a lower level of functional ability. Compared to community norms, both groups demonstrated higher scores on the Hospital Anxiety and Depression Scale and lower scores on the Philadelphia Geriatric Centre Morale Scale. There was some evidence to suggest that the 'care' group was more clinically depressed and had lower morale. Interview data were categorized into six types of acceptance of the decision to go into care. These were associated with whether or not a person themselves initiated the idea to go into care and level of emotional support received. Descriptive data regarding the most frequent concerns associated with discharge into nursing home care were also obtained. Overall, the results were discussed with respect to the factors relating to the decision to enter care and how this acceptance might be facilitated.

Mobility, social support, loneliness and well-being amongst two groups of older adults

This study was designed to investigate factors relating to loneliness in older adults. The Mobility Scale (MS); UCLA Loneliness Scale (LS); Revised Philadelphia Geriatric Centre Morale Scale (PGC); Life Satisfaction Index (LSI) and the Social Network List (SNL) were administered to 36 subjects, aged 67–97 years. 16 of the subjects were occupying their own homes in the community and 20 were living in residential homes. Neither age nor place of residence were related to loneliness. Greater loneliness was related to increased physical impairment, the lack of confidantes, low morale and low life satisfaction. Implications of the results for service provision are discussed.

Hope, morale and adaptation in patients with chronic heart failure.

Clinical observation of a population of patients with chronic heart failure suggested that some patients adapt to their disease more effectively than others. This difference in response appeared to be more related to psychosocial variables, including a positive future orientation, than to variation in severity of disease. The purpose of this study was to investigate the relationship among the psychosocial variables of hope and morale, the level of function of the individual, and the physiological status of that individual. The sample for this descriptive study was patients who met inclusion criteria and who attended the Heart Failure Clinic at St Joseph's Hospital, Hamilton, Ontario, Canada (n = 23). Data were collected at one point in time. Population characteristics were obtained by chart extraction and patient interview. The Beck Hopelessness Scale, the Philadelphia Geriatric Centre Morale Scale, and an adapted version of the McMaster Health Status Index were administered. Physiological status was determined by clinical signs and symptoms in accordance with a scale devised by Lee. Patients who scored higher on the scales assessing hope and morale also scored higher on social function. There was very little relationship between these psychosocial variables and the physical variables of physiological status and physical function. These findings suggest that patients who are more hopeful maintain their involvement in life regardless of physical limitations imposed by their heart failure. Nursing interventions must continue to include the enhancement of hope for the future and active participation with others.