Bath VA Medical Center

I worked in a long-term care, for-profit nursing home in New Jersey when I was 14 years old (having lied about my age) and saw some sad things done to residents. Forty years later, I'm the restorative nurse at a long-term care facility in New York. I started the restorative nursing program three years ago, and some of our residents have excelled beyond our initial expectations. We have done exceptionally well in helping residents who haven't done so in a while to walk, and in anticipating a decline in their health, which has prevented falls and accidents as well as helped them to maintain functional levels. Yet I still have to check that the nursing staff is doing enough for each resident—and doing it correctly. This article has reminded me to be an advocate for my patients. I hope it's read by caregivers at all levels. Richard Rygiel, RN Bath, NY

One hundred thirty-seven V.A. patients were randomized to one of three treatment groups to evaluate the efficacy of biphasic calcium phosphate (BCP) ceramic in the treatment of periodontal osseous defects. This material was tested against both autogenous bone implant and open flap curettage procedures. Baseline probing attachment level, Navy plaque index, and gingival index were recorded for all patients. These parameters were monitored for 3 years. At the end of this period, 101 patients had completed the study. Although the plaque and gingival indices steadily increased with time, there were no statistically significant differences among the treatment groups. Patients in the ceramic group had a gain in attachment level of 1.0 mm; those in the curettage group, 0.9 mm; and 0.4 mm for those in the bone implant group. Although the BCP patients had a greater gain, the difference was not statistically significant. In this veteran population, not only did BCP patients fail to outperform those in the control groups, all three treatment groups were similarly ineffective.

ABSTRACTIn the Person-Environment (P-E) Congruence model, psychological well-being is proposed to be a function of the degree of fit between the perceived environment and the important needs of the individual; and, that in more restricted environments, the relationship is stronger. The present study examined, cross-sectionally and longitudinally, the Congruence levels and well-being of elderly veterans (N = 165) in four microenvironments within a single instutition. Congruence was assessed using the multidimensional Environmental Perception, Preference and Importance Scale (EPPIS). Well-being was measured using the PGC Moral Scale, the Life Satisfaction Index A and a semantic differential self-concept scale. There were significant microenvironment differences on three of the 15 EPPIS dimensions; the P-E Congruence scores were predictive of well-being; and, the specific dimensions predictive of well-being varied across microenvironments, criterion of well-being and time. The data reinforces the notion that treatment programs must be individualized and that the P-E model, operationalized in the EPPIS, may serve as a viable clinical tool.

Erikson's theory regarding the existence of an Ego Integrity versus Despair crisis in old age was tested using an interview derived from Whitbourne and Weinstock's application of Marcia's status construct to the ego integrity crisis. Four integrity statuses were defined: integrity achieving, dissonant (in crisis), foreclosed (avoiding crisis), and despairing. These statuses were reliably (80%) identified among forty elderly community-dwelling men and women through the forty-five-minute semistructured interview. Moreover, predicted differences among the four statuses were observed on questionnaire measures assessing reminiscing activity, death attitudes and preparation, psychological well-being, and questionnaire scales of Stages 6 through 8 of Erikson's theory. The pattern of differences suggested that integrity achieving and foreclosed samples differed mainly regarding their degree of introspection regarding the past, but that both appeared to have a high degree of psychological well-being. Dissonant individuals appeared to be unhappy and stressed, but this was seen as a temporary state in contrast to the more chronic nature of the despairing's low sense of psychological well-being. The validity of the integrity status construct and the interview designed to measure it have, therefore, been supported, and provide the basis for suggested refinements within Erikson's description of the Ego Integrity versus Despair stage.

The Person Environment (P-E) Congruence model represents an approach to understanding the impact of the environment on the well-being and adjustment of elderly which may also provide information for the development of intervention programs at individual, group and/or institutional levels. Assessment of P-E congruence, or fit between the person and his/her environment, was operationalized in two studies through the development of the Environmental Perception, Preference and Importance Scale (EPPIS). the EPPIS provides scales to assess environmental perceptions, individual environmental preferences and the important or salience of the environment on 15 empirically derived, commensurate dimensions. In a third study, the four-month test-retest reliability of the overall P-E congruence score of the EPPIS, defined as the absolute difference between the perceived and preferred environment weighted by importance, was .78 while the unweighted model reliability was .76. Also, the 15 dimensions of the EPPIS were observed to be significant predictors of well-being. It was proposed that the EPPIS may be used both to determine areas of intervention which the elderly themselves feel are important and as a means to evaluate the effectiveness of interventions intended to reduce P-E incongruence and increase psychological well-being.

The literature regarding age differences in life satisfaction, locus of control and self-concept reveal seriously conflicting results while that on the relationships among these dependent measures has largely supported Erikson's proposals regarding the psychosocial crisis of ego integrity versus despair. A total of ninety-nine V. A. Domiciliary residents, with thirty-three in each of three age groups (50-59, 60-69 and 70+), completed measures of life satisfaction, locus of control and self-concept. Multivariate analysis of covariance demonstrated a significant age difference with the older veterans, who were less well educated and institutionalized longer, more positive on the composite of the three measures. Univariate analysis, however, resulted in significant age differences in self-concept and life satisfaction but not in locus of control. Based upon these findings and the relationships among the dependent variables, the older veterans appear to have resolved the ego integrity versus despair crisis more adequately in spite of having lived for a longer period of time in what has often been viewed as a sterile, blunting environment. Perhaps, contrary to popular assumptions, an institution may provide an environment that facilitates and nourishes the self-esteem and satisfaction of elderly residents.