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UBC Theses and Dissertations

Prep : a preperation programme designed to minimize the stress of institutional relocation on the elderly Mills, Sandra Ruth


The present study assessed the effectiveness of a preparation programme designed to minimize relocation stress in the elderly by comparing it with an attention placebo condition and an assessment-only condition. The preparation programme was intended to increase predictability of the consequences of moving to an extended care unit (ECU); to enhance personal control over environmental events; and to encourage family support. Seventy-four elderly prospective patients of the University of British Columbia (UBC) ECU initially participated in the study. Patients with severe cognitive, sensory, or communication impairments were not included in the sample. The mean age of the sample was 80.2 years (S.D. = 11.09). Seventy-eight percent were female, and 79.73% were non-ambulatory (i.e., used a wheelchair). Subjects came from private homes and from 41 facilities in the Greater Vancouver area representing four levels of care. Facilities were stratified on the basis of population size; facilities within each size category were assigned to one of three experimental conditions: (1) assessment-only control, (2) attention placebo, and (3) preparation programme. Information relevant to the subjects' social, psychological, and physical functioning was collected at preadmission and three and six months follow-ups. Data were obtained from the subjects themselves, the staff who were caring for subjects, and the interviewers. In addition, behavioural observations were conducted at the two follow-up periods. Subjects in the assessment-only control group participated only in the preadmission and follow-up assessment interviews. In addition to the preadmission assessment interview, subjects in the attention placebo group received three visits by a therapist unfamiliar with the preparation programme, who spent time discussing the subjects' move to the ECU and specific concerns raised by the subject. The preparation programme included three 45 minute sessions in addition to the assessment interview, which were conducted by a therapist two to three weeks prior to relocation. The intervention consisted of three components: (1) an information slide-tape programme, (2) a stress management training slide-tape programme, and (3) sponsor (family) training and involvement. In the first preparation session, the subject was shown a 15 minute slide-tape presentation in which an elderly woman narrator provided accurate information about the ECU in order to create realistic expectancies about hospitalization. In the second and third sessions, the subject was shown two parts of a slide-tape programme in which the same narrator taught stress-management techniques. The techniques included problem-solving, assertiveness, deep breathing, coping self-statements, and positive thinking. The therapist stopped the slide-tape programme at designated points and reviewed the techniques with the subject. Sponsors attended two 2-hour meetings during which time relocation stress, the preparation programme, and the sponsor's role in the relocation process were discussed. Sponsors were also shown the slide-tape programmes, given a tour of the facility and a sponsor's manual. No significant main effects or interactions were observed on any of the dependent measures. However, a significant time effect was observed in mental status scores over the three assessment periods. All groups showed significant improvement in mental status at the six months follow-up. The apparent ineffectiveness of the programme was attributed to the possibility that subjects may not have actually learnt the coping skills; that the content and length of the slide-tape programmes may have been inappropriate; that preparation alone may be insufficient to significantly reduce relocation stress; and that the initial operating conditions of the hospital may have mitigated the effects of the preparation programme. There is a need for future research on the development of effective preparation programmes for relocation in the elderly.

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