RESUMEN
The heterogeneity of schizophrenia has been acknowledged for decades because of the diverse presentation of symptoms, illness course, and treatment response noted between individuals diagnosed with the disorder. Cluster analysis has been used as a statistical method to determine whether schizophrenia subgroups might be identified based on symptom heterogeneity. However, there is very limited research examining whether heterogeneity in negative symptoms might be useful in establishing schizophrenia subtypes, particularly research examining newer models of negative symptoms based on five latent constructs including anhedonia, asociality, avolition, blunted affect, and alogia. The Brief Negative Symptom Scale was used to assess the five negative symptoms domains in a sample of 220 outpatients diagnosed with schizophrenia or schizoaffective disorder. Cluster analysis supported a four-cluster solution, comprising clusters of subjects with low negative symptoms (LNS), severe negative symptoms (SNS), and two clusters with moderate negative symptoms, one with predominantly elevated blunted affect (BA) and one with elevated avolition (AV). The LNS, SNS, BA, and AV clusters significantly differed on external validators including clinical characteristics, neurocognition, and functional outcome. Findings suggest that schizophrenia heterogeneity can be parsed according to negative symptom subtypes that have distinct clinical and neuropsychological profiles. Implications for diagnosis and treatment are discussed.
Asunto(s)
Trastornos Psicóticos , Esquizofrenia , Anhedonia , Análisis por Conglomerados , Humanos , Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Psicología del EsquizofrénicoRESUMEN
BACKGROUND AND OBJECTIVES: The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States. RESEARCH DESIGN AND METHODS: The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)'s supplemental module (Health Behaviors) and the RAND version of the HRS fat file. RESULTS: Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p < .05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p < .05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p < .05). DISCUSSION AND IMPLICATIONS: While more research is needed to clarify the purposes (e.g., prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults.
Asunto(s)
Etnicidad , Grupos Minoritarios , Anciano , Estudios Transversales , Hispánicos o Latinos , Humanos , Aceptación de la Atención de Salud , Grupos Raciales , Estados UnidosRESUMEN
Volunteering is beneficial not only for individuals' well-being but also for society's well-being; yet only a fraction of U.S. citizens regularly engage in volunteer activities. This study examined how underlying motivations are associated with interest in volunteering for individuals in three major life phases: early, middle, and later adulthood. Data were collected from 1,046 adults who volunteered through nonprofit organizations in Nevada (USA). Exploratory factor analysis revealed that community service, career advancement, and well-being were common underlying motivations for individuals across life stages. However, generativity among the later adulthood group, and social networking among the early and middle adulthood groups were unique motivations for volunteering. Regression analysis showed that the community service motivation was significantly associated with individuals' interest in volunteering among all life stages. Simultaneously, generativity for the later adulthood group, and career advancement for the early adulthood group were unique motivations linked to their actual interest in volunteering.
Asunto(s)
Envejecimiento/psicología , Motivación , Voluntarios/psicología , Adulto , Anciano , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Nevada , Organizaciones sin Fines de Lucro , Satisfacción Personal , Autoimagen , Conducta Social , Apoyo Social , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The Family Evaluation of Hospice Care (FEHC) survey is widely employed by hospices, and several studies have examined this information to help inform and enhance end-of-life services. However, these studies have largely focused on examining relatively straightforward associations between variables and have not tested larger models that could reveal more complex effects. The present study aimed to examine the direct and mediating (i.e., via information/education, patient care, and family support) effects of demographic factors, length of stay, timing of referral, patient symptom severity, location of services, and relationship to caregiver on two outcome variables: overall satisfaction and caregiver confidence. METHOD: Surveys were collected from 3226 participants who had lost a loved one who received hospice services. Structural equation modeling was employed to examine the direct and mediating effects of the independent variables on the two outcomes of interest. RESULTS: Participants reporting on racial minority patients, patients with more symptoms, and those referred too late or too early were the most likely to express some discontentment with hospice services. The information/education these individuals received was the only mediating factor significantly associated with caregiver confidence. More positive perceptions of patient care and information/education were both significantly related to greater overall satisfaction. SIGNIFICANCE OF RESULTS: These findings help to (1) pinpoint those most at risk for being less satisfied with hospice, (2) identify which aspects of care may be most strongly related to overall outcomes, and (3) provide a model for examining complex associations among FEHC variables that may be employed by other researchers.
Asunto(s)
Estudios de Evaluación como Asunto , Familia , Cuidados Paliativos al Final de la Vida/normas , Neoplasias/terapia , Satisfacción Personal , Aflicción , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
The Hispanic older adult population is increasing rapidly and past research suggests that this demographic group underutilizes hospice services, highlighting the need to improve our understanding of their needs in end of life. This study relied upon information from the family evaluation of hospice care survey provided by 2980 caregivers, 152 of whom cared for a Hispanic patient and 2828 who cared for a non-Hispanic patient. Caregivers of Hispanic patients were more likely to report that hospice was inconsistent with the patient's wishes, and that they received more attention than desired for emotional issues. Caregivers of Hispanic patients were also more likely to express that emotional/spiritual forms of support were insufficient. Similar levels of satisfaction were reported for caregivers of Hispanics and non-Hispanics regarding dignity/respect, information received, care coordination, and overall satisfaction.
Asunto(s)
Cuidadores/psicología , Familia/psicología , Hispánicos o Latinos/psicología , Cuidados Paliativos al Final de la Vida/psicología , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Factores Sexuales , Factores SocioeconómicosRESUMEN
BACKGROUND: Although many veterans are progressing into older adulthood and a substantive subset of people who die each year in the United States served in the military, there is limited evidence on the role of military service at the end of life. OBJECTIVE: The objective of the study was to examine differences in caregivers' perceptions of sadness and anxiety at the end of life between veteran and nonveteran patients and levels of contentment with the emotional support provided to the patient and family by hospice staff. METHODS: This cross-sectional study used clinical information from the Family Evaluation of Hospice Care (FEHC) survey administered to caregivers of a patient who received hospice services. The sample in this study included 560 individuals who completed the FEHC survey (from December 2007 to April 2013) after receiving services at a large hospice in an urban southwestern U.S. city. Caregivers responded to questions on the FEHC survey about demographic information, perceptions of the patient's level of sadness/anxiety, and the emotional support the patient and family received from hospice staff. In addition, information regarding veteran status was obtained from patients' medical records. RESULTS: Caregivers of veterans were significantly more likely to report that the patient experienced sadness/anxiety at the end of life, as well as a desire for more emotional support for the family from hospice staff after the death. CONCLUSIONS: Results provide preliminary evidence for veteran status being a risk factor for emotional distress at the end of life, highlighting the possible need for augmented support services for veterans and their families in hospice and palliative care.
Asunto(s)
Ansiedad , Cuidadores/psicología , Familia/psicología , Pesar , Cuidados Paliativos al Final de la Vida/psicología , Apoyo Social , Veteranos/psicología , Anciano , Comportamiento del Consumidor , Estudios Transversales , Estudios de Evaluación como Asunto , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Relaciones Profesional-Familia , Relaciones Profesional-Paciente , Sudoeste de Estados Unidos , Estados UnidosRESUMEN
We use data from the 2006 American Community Survey to examine race and ethnic differences in the effects of marital status and co-residence of the middle generation on the likelihood of poverty among grandfathers who have primary responsibility for co-resident grandchildren (N = 3,379). Logistic regression results indicate that race/ethnicity and household composition are significant predictors of poverty for grandfather caregivers: non-Hispanic white grandfathers, those who are married, and those with a co-resident middle generation are the least likely to be poor. The effects of race/ethnicity, marital status, and the presence of a middle generation are, however, contingent upon one another. Specifically, the negative effect of being married is lower among grandfathers who are Hispanic, African American, non-Hispanic, and non-Hispanics of other race/ethnic groups compared to whites. In addition, having a middle generation in the home has a larger negative effect on poverty for race/ethnic minority grandfathers than for non-Hispanic whites. Finally, the combined effects of marriage and a middle generation vary across race/ethnic group and are associated with lower chances of poverty among some groups compared with others. We use the theory of cumulative disadvantage to interpret these findings and suggest that race/ethnicity and household composition are synergistically related to economic resources for grandfather caregivers.