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[edit] Importance of Communication, Self-Efficacy, and Perceived Control in Relocation of the Aged

Perceptions of control are important predictors of behavior and social behaviour[1]. This is no different in the aged. When moving an aging relative into a more care intensive environment, such as a Nursing home or long term care facility, the issues of self efficacy and perceived control are particularly important factors in both preparing and facilitating the transition. Understanding an aging relative must begin with spending more quality time with him or her. Quality time may include communicating and doing activities they suggest or enjoy, while making sure they do not feel overwhelmed or feel as if the activities are turning into chores. Being able to effectively communicate in the difficult time leading up to relocation will make the process easier and lead to better outcomes.

[edit] Relocation

Community based relocation or nursing home based relocation are the primary possibilities when an aging relative's needs change. Relocation is a process that includes not only the actual moving but also the decision to move, the circumstances surrounding the move, and the adjustment period following the move[2]. Therefore, having an open mind to potential relocation possibilities is important since each may cater to different needs of the aging relative/patient. Some aging adults recognize their cognitive and physical limitations, explore their options, and actively participate in the decision to relocate[2]. The expectations of relocation may also change as the aging relatives perceived health also changes; however, patterns show that this may only be the case within a certain type of moves[3].

[edit] Community- based relocation

The expectation of a Community-based relocation in an aging relative confirmed that many older adults do indeed anticipate community-based moves. A global measure of expectations to move was a significant predictor of a community-based move within 2 years but was not a predictor of relocation to a nursing facility[3].

[edit] Nursing- facility relocation

The expectation of a Nursing-Facility relocation in an aging relative was not predictable and found that, when a sample of those aged 70+ was taken, there was an over estimation in the expectation and actual relocation of being relocated to a Nursing- facility in 5 years. Therefore, this overestimation could be due to a stereotype of the elderly getting sent away once they get to be a certain age[3].

[edit] Communication

Conversing, playing an activity, listening and silence are all important forms of communication. The aging brain suffers multiple losses in everyday functioning and therefore how the aged does something one day may gradually change in process[4]. Understanding and noticing these changes are crucial in keeping their self-esteem up while they adapt to their aging brain and body. The importance of communication cannot be overlooked when it comes to understanding the next steps (i.e. possible relocation) as well as how they are feeling on a day to day basis. Communication with an aging relative will likely be situational, meaning there will likely be different conflicts or problems; therefore, it is important to try to remember it is "Not about Me" and to not get frustrated, "Be There"[5] During these times it is also very important to keep an open mind. Having an open mind towards an aging relatives desires, goals and needs will help to provide more enjoyable final years of their life as well as a smoother transition in a relocation of residence if the aging relative can no longer take care of themselves.

[edit] Factors Inhibiting Quality Communication

Stereotyping is very common when speaking to the elderly and is commonly subconsciously done. The ideas of over-parenting or an over emphasis on the efficient accomplishment of tasks can be counter productive and result in a lowering of the self esteem which will lead to lose of self efficacy and perceived control[6]. Additionally, Western culture historically tends to stigmatize both illness and dying. This ignorance of dying may be harmful to the quality of communication[5].

[edit] Self-Efficacy

Self efficacy[1] is an individual’s belief about how well they can perform a specific task [1]. If an individual is confident, it can improve their ability to complete a specific task. The opposite is true for individuals with a low level of confidence. Interestingly, social stereotypes can affect a person’s view of self efficacy; for example, negative stereotypes decrease self efficacy[7].

[edit] The Risks of Stereotypes

One of the major reasons for relocation in the aged is a change in health status[8]. With old age, health often becomes less predictable and can produce rapid declines in autonomy. Personal experiences are often defined in terms of common stereotypes when a decrease in autonomy occurs[7][9]. The current stereotypes associated with old age tend to be negative and, therefore, place a greater emphasis on decline than actually exists[7]. The negative nature of these stereotypes lower an individual’s self efficacy.

[edit] Stereotype Threat and the Effects of Labeling

Research has shown that the aged tend to be placed in situations that may lead to ‘stereotype threat’[7][2]. Stereotype threat refers to an experience of anxiety that occurs when one is placed into a situation where a stereotype can be confirmed. When put into situations where there is potential to confirm people’s expectations, the person who is stereotyped is more likely to attribute any failure to the stereotype. When discussing the old age stereotype of senility, Rodin and Langer (1980) believe "every time a mistake is made or a thought is forgotten, older people may question whether their mental capacities are diminishing[10]. Therefore, the idea of labeling an individual also changes the way they are likely to perceive their successes or failures which ultimately results in an internalization of the stereotype[10].

[edit] How to Prevent Stereotype from Influencing Self-Efficacy

Fortunately, the process that is used to attribute success or failures can be altered by changing the way a person looks at a situation. Researchers conducted an experiment in which new nursing home residents were told that the declines they were experiencing were a direct result of “age-environment interaction” problems. Essentially, the residents were given another means of explaining the reason for how they were feeling and performing. The experiment demonstrated that this group showed a "greatly improved behavior, including an increase in active participation and sociability[10].

[edit] Perceived Control

Perceived control[3] is the degree to which an individual feels they are responsible for factors surrounding them[1]. When it comes to the aged, perceived control plays a large role in day to day life which can be influenced by the possibility of major life changes in health and living arrangements. According to researchers, perceived control is one of the "critical determinants of the aged’s physical and psychological well-being"[9].

[edit] Perceived Control in Day to Day Living

Another factor that is important to consider is the role that age plays in terms of perceived control. Age influences sense of control, health maintenance, and when the individual will seek medical attention[10]. This will not only affect the degree to which the aged try to take responsibility for their own care, but also affects their overall life expectancy. This can be seen in an experiment conducted by Langer and Rodin. When the amount of responsibility given to residents of a nursing home was increased, the researchers found that residents were more social, happy, and experienced an increase in life expectancy compared to the control group[10]. Schulz and Hanusa later reported that it is the relative increase in control, rather than the finite amount of control, that is important[9].

[edit] How to Improve Outcomes for Relocation

Concerning relocation, better outcomes have been found in situations where greater perceived control and a more predictable environment were present. Due to the nature of health in old age it has been found that many individuals actually anticipate a relocation before it takes place [8]. Since the aged already anticipate relocation, that opens up an avenue for communication regarding the move. Research has determined that when the aged were involved in the decision to relocate, it often made the transition easier[8]. There has also been research showing that if the environment that the individual is being moved to is more predictable, the move is expected and the setting is more calculable, it greatly reduces negative effects of the move[9][10].

--Jm11ad 14:51, 27 November 2011 (EST) --Dm10vs 05:35, 27 November 2011 (EST)

[edit] Notes and References

  1. 1.0 1.1 1.2 Rodgers, W.M., Conner, M., & Murray, T.C., (2008). Distinguishing among perceived control, perceived difficulty, and self-efficacy as determinants of intentions and behaviours. British Journal of Social Psychology, 47, 607-630
  2. 2.0 2.1 Keister, K, (2006). Predictors of Self Assessed Health, Anxiety, and Depressive symptoms in Nursing Home residents at Week 1 Postrelocation. Journal of Aging and Health, 18(5), 722-742
  3. 3.0 3.1 3.2 Sergeant, J., Ekerdt, D., Chapin, R, (2010). Older Adults Expectation to Move: Do they Predict Actual community based or nursing facility move within 2years. Journal of Aging and Health. 22(7), 1025-1055
  4. Brandstadler,J., Wentura, D., Greve W, (1993). Adaptive Resources of Aging Self: Outline of an Emergent Perspective. International Journal of Behavioural Development, 16(2), 323-349
  5. Cite error 8; No text given.
  6. Ryan, E,. Hummert, M,. Boich, L, (1995). Communication Predicaments of Aging- Patronizing behavior towards older Adults. Journal of Language and Social Psychology, 14(1-2), 144-166
  7. 7.0 7.1 7.2 7.3 Rodin, J., & Langer, E, (1980). Aging labels: the decline of control and the fall of self-esteem. Journal of Social Issues, 36(2), 12-29
  8. 8.0 8.1 8.2 Stoeckel, K.J., & Porell, F. (2010). Do older adults anticipate relocation? The relationship between housing relocation expectations and falls. Journal of Applied Gerontology, 29(2), 231-250
  9. 9.0 9.1 9.2 9.3 Schulz, R. & Hanusa, B.H., (1980). Experimental social gerontology: a social psychological perspective. Journal of Social Issues, 36(2), 30- 46
  10. 10.0 10.1 10.2 10.3 10.4 10.5 Rodin, J., (1986). Aging and health: effects of the sense of control. Science, 233(4770), 1271-1276
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