Elder mistreatment (EM) is a serious and prevalent syndrome that is estimated to affect between 500,000 to 1.2 million older adults in the United States annually (Pillemer & Finkelhor, 1988). This chapter reviews both the state of the published science and limitations in the knowledge base on the topic. The literature for this review was obtained through computer-assisted searches of PubMed (878 citations), the Cumulative Index of Nursing Research (CINAHL) (593 citations) and Psych-Info databases (443 citations). The search terms used were elder mistreatment, elder neglect, elder abuse, or domestic abuse of the elderly. No limit was placed on the age of publications because of the relative scarcity of research on the subject. Nonnursing articles were included because there are so few nurse researchers addressing this topic. The age limit for subjects in these studies was 65 years and older. Studies were limited to those conducted in the United States, and descriptive studies were included as they form the majority of the research to date. Findings indicate that frail, very old (over 75 years), older adults who have a diagnosis of depression or dementia are more likely to be mistreated (Dyer, Pavlik, Murphy, & Hyman, 2000; Coyne, Reichman, & Berbig, 1993; Fulmer & Gurland, 1996; Lachs & Pillemer, 1995; Lachs et al., 1997; Lachs, Williams, O’Brien, Pillemer, & Charlson, 1998; Lachs & Fulmer, 1993; Lachs, Berkman, Fulmer, & Horwitz, 1994). Those older adults who required assistance with activities of daily living had poor social networks and were at higher risk for EM (Lachs & Pillemer, 1995; Lachs et al., 1997; Lachs et al., 1998; Lachs & Fulmer, 1993; Lachs et al., 1994). Neglect, as a subcategory of EM, accounts for the majority of cases (Fulmer, Paveza, Abraham, & Fairchild, 2000; Pavlik, Hyman, Festa, & Bitondo Dyer, 2001; Fulmer & Gurland, 1996). There is still debate regarding the role of minority status, abuse in childhood, and the persons most likely to mistreat older adults. There is a critical need for replication studies and new research on this important topic. Problems with measurement, funding challenges, and the paucity of investigators conducting research on EM have left the field with several unanswered questions and some conflicting findings. This chapter summarizes the interdisciplinary literature and makes recommendations for future nursing research programs.

This chapter provides a review and synthesis of research on women's sleep and fatigue from a nursing perspective. Most of the research involves four primary issues for women: menstrual cycles, childbearing, chronic mental or physical illness, and oncology. Research with healthy women focused on diurnal fluctuations in fatigue and relationships to sleep, without regard for exercise or level of daytime activity. Research on chronic illness and cancer fatigue focused on general fatigue and its impact on activity, without regard for sleep or therapeutic use of rest and naps. A comparison of these two areas highlights gaps in nursing knowledge about sleep and fatigue. Further research is needed to understand relationships between nonrestorative sleep, fatigue, and symptoms related to poor quality of life. From a synthesis of these studies, nonpharmacologic interventions that could be prove useful in promoting a higher quality of life for those with either acute or chronic fatigue are then proposed.

Family caregivers are the mainstay of long-term care, as they enable chronically ill elders and children to remain at home. The majority of family caregivers are women and historically their caregiving role has been viewed as an extension of their roles as wife and mother. Although numerous studies report the stresses associated with family caregiving and are predictors of burden, less attention has been given to interventions for family caregivers. The objective of this review is to examine reports of interventions to reduce family caregiver burden, to consider their implications for nursing practice, and to identify directions for future nursing research.

Substance abuse often begins in adolescence and is a major factor determining health outcomes for adolescents and adults; thus, it is an important focus for prevention strategies. The use of drugs, especially alcohol, can lead to chronic addiction to substances as well as contribute to a number of common chronic conditions. These conditions include cancer, cardiovascular disease, disability from accidents or violence, and unplanned pregnancy and are major causes of morbidity and mortality among adolescents and adults. As the major social unit responsible for socialization of children and stabilization of adult personalities, the family has been the target of prevention efforts. In this chapter the empirical literature on family interventions to prevent substance use in adolescents is critically reviewed, generalizations and implications for practice identified, and directions for future research projected.

Nonadherence to treatment regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Chronic illness in a general sense and certain chronic diseases in particular have attracted considerable attention from qualitative researchers in nursing as well as in other health and social sciences. This review critically examines the body of available research about the experience of living with a chronic illness from an "insider" perspective. From this foundation the authors interpret the manner in which this large body of writing both contributes to and complicates our theoretical understanding of what it is like to live with a chronic disease. In so doing they illuminate themes within the knowledge that can be gleaned from qualitative inquiry into the chronic illness experience, as well as inherent limitations that must be taken into consideration when applying such knowledge to practice.