• The effect of diet on mood in the elderly

      Herron, Dorothy Gabell; Baldwin, Beverly Ann, 1941-; Dennis, Karen E. (1994)
      The purpose of this research was to examine the effect of protein and carbohydrate intake on mood state in well, elderly people. There were 28 subjects, three men and 25 women, ages 63 to 83 years, who were free of any disorders which affected food metabolism or mood changes, and who did not take any medications which would have significant effects on these variables. In the first of two components of the study, subjects kept three-day food intake and pre- and post-prandial mood records. No significant relationships were found between the variables. In the experimental component, subjects served as their own controls and, in random order, ate either a high carbohydrate, a high protein, or a control snack. Using two different instruments, mood was measured immediately before and one hour after the snacks were eaten. Although protein did not improve vigor, the carbohydrate snack significantly improved depression and total mood scores. The order in which the snacks were eaten interacted with the type of snack when affecting total mood. The descriptive data were examined and used to group subjects according to carbohydrate intake. Analysis of the data from the upper and lower carbohydrate quartiles did not indicate any differences between the quartiles or between these subjects and the total group, and thus refuted the designation carbohydrate 'cravers' and 'noncravers' in this population. Depressed mood and vigor are two dominant mood themes in older adults. Knowledge of how these and other variables may be related to food intake in these persons could contribute to the development of therapeutic nutritional nursing interventions. Further study is needed, not only on specific nutrients, but also on how food associations, memories, tastes and textures affect human behavior. Interventions devised on these findings could help elderly people self-regulate their mood conditions in an inexpensive and nonpharmacologic manner. Dietary intake and nutritional status have the potential to significantly impact quality of life in this population.
    • Home care following hospitalization of elderly rural patients with chronic diseases: An evaluation of changes in perceived health status on fluctuations in utilization and cost of formal and informal services

      Griggs, Marcella J.; Baldwin, Beverly Ann, 1941- (1995)
      Policy efforts to control costs mean that an appropriate balance between formal and informal caregiving systems must be created, but few studies have examined the costs associated with caring for chronically-ill older adults in their homes. The purpose of this study was to describe changes in perceived health status for patients and caregivers and to evaluate the effects of those changes on the utilization and cost of both formal and informal services in the home. A comparative prospective panel design was used to interview a sample of 21 chronically-ill patients and their 21 primary caregivers on admission to a Medicare-certified home health care agency, at termination of skilled services, and 30 days after discharge. Health status measures included the Sickness Impact Profile, Activities of Daily Living, Instrumental Activities of Daily Living, and Burden of Care. Formal services and costs were evaluated using visits made and charges billed to Medicare and/or Medicaid. Informal services and costs were evaluated using hours of assistance provided with ADLs and IADLs and regional hourly wage rates. The data were analyzed using within-subjects repeated measures analysis of variance procedures. Health status of patients changed significantly across time, with patients who got better showing improved health status but continued difficulty with ADLs and IADLs. Burden of Care did not change statistically over time. Formal service costs were higher for patients who got worse compared to those who got better. Patients received 4.4 mean hours of informal services per day. Intensity of informal services was greater during initial home care services; however, intensity remained the same and did not change for those who got worse. The average cost per patient day was $47 for formal services and $44 for informal services. This study revealed a highly impaired patient group with dedicated informal caregivers spending an average of 31 hours each week helping with ADLs and IADLs in addition to the visits made by formal service providers. The findings from this study have importance for public policy and clinical practice with regard to forging realistic linkages between both the formal and informal support systems as patients move from one provider system to the next.
    • The relationship between the rewards, costs, and coping strategies of black family caregivers

      Picot, Sandra J.; Baldwin, Beverly Ann, 1941-; Rasin, Joyce (1991)
      This study was designed to describe the relationship between perceived rewards, costs, and coping strategies of black family caregivers who provided care to an elderly demented relative. Selection of coping strategies is predicated on a continuous transaction between the caregiver's appraisal of what is at stake for the caregiver in the caregiving situation and her personal resources (Folkman & Lazarus, 1980). However, research studies have suggested the caregiver's ethnicity, household income, relationship to the carereceiver, carereceiver's geographic area of residence, and the caregiving demands may serve as confounding variables. Most caregiver studies have either used predominantly white samples or treated black subjects as a homogeneous group. Therefore, the relationship of rewards, costs, and coping strategy selection with controls for the above confounding variables in an all black sample has not been done. Face-to-face interviews of 83 black female caregivers of elderly demented relatives were conducted. Coping was measured by the Jalowiec Coping Scale, rewards from the Picot Caregiver Rewards Scale, and costs from the Cost of Care Index. The demographics form included caregiver-carereceiver relationship, caregiver household income, and carereceiver geographic area of residence. The Modified Wood's Social Support Questionnaire measured the perceived quality of social support; and the Texas Research Institute of Mental Sciences Behavioral Problem Checklist evaluated caregiving demands. The seven major predictors (together) accounted for a significant amount of the overall variance in selected coping strategies, palliative emotive, confrontive active, positive thinking, problem analysis, and social support use coping. When the influences of all of the variables were removed except rewards and costs, the overall variance in palliative emotive coping, positive thinking, and problem analysis was significantly explained by rewards and costs. Caregiving demands and perceived quality of social support emerged as major predictors of total coping and social support use. Caregiver household income was a major predictor of both confrontive active and palliative emotive coping. Costs, also, predicted palliative emotive coping. Rewards were the most influential predictors of both positive thinking and problem analysis. Neither caregiver-carereceiver relationship nor carereceiver geographic area of residence emerged as significant predictors of either total coping score or individual coping strategies.