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A coping and communication support intervention tailored to older patients diagnosed with late-stage cancer

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      As our society ages, increasing numbers of older Americans will be diagnosed and eventually will die of cancer. To date, psycho-oncology interventions for advanced cancer patients have been more successful in reaching younger adult age groups and generally have not been designed to respond to the unique needs and preferences of older patients. Theories and research on successful aging (Baltes and Baltes 1990; Baltes 1997), health information processing style (Miller 1995; Miller et al 2001) and non-directive client-centered therapy (Rogers 1951, 1967), have guided the development of a coping and communication support (CCS) intervention. Key components of this age-sensitive and tailored intervention are described, including problem domains addressed, intervention strategies used and the role of the CCS practitioner. Age group comparisons in frequency of contact, problems raised and intervention strategies used during the first six weeks of follow up indicate that older patients were similar to middle-aged patients in their level of engagement, problems faced and intervention strategies used. Middle-aged patients were more likely to have problems communicating with family members at intervention start up and practical problems as well in follow up contacts. This is the first intervention study specifically designed to be age sensitive and to examine age differences in engagement from the early treatment phase for late-stage cancer through end of life. This tailored intervention is expected to positively affect patients’ quality of care and quality of life over time.

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        On the incomplete architecture of human ontogeny. Selection, optimization, and compensation as foundation of developmental theory.

         P B Baltes (1997)
        Drawing on both evolutionary and ontogenetic perspectives, the basic biological-genetic and social-cultural architecture of human development is outlined. Three principles are involved. First, evolutionary selection pressure predicts a negative age correlation, and therefore, genome-based plasticity and biological potential decrease with age. Second, for growth aspects of human development to extend further into the life span, culture-based resources are required at ever-increasing levels. Third, because of age-related losses in biological plasticity, the efficiency of culture is reduced as life span development unfolds. Joint application of these principles suggests that the life span architecture becomes more and more incomplete with age. Degree of completeness can be defined as the ratio between gains and losses in functioning. Two examples illustrate the implications of the life span architecture proposed. The first is a general theory of development involving the orchestration of 3 component processes: selection, optimization, and compensation. The second considers the task of completing the life course in the sense of achieving a positive balance between gains and losses for all age levels. This goal is increasingly more difficult to attain as human development is extended into advanced old age.
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          The prevalence of psychological distress by cancer site.

          The goal of this project was to determine the prevalence of psychological distress among a large sample of cancer patients (n=4496). In addition, variations in distress among 14 cancer diagnoses were examined. The sample was extracted from a database that consists of 9000 patients who completed the Brief Symptom Inventory as a component of comprehensive cancer care. Relevant data points for each case included age, diagnosis, gender, insurance status, marital status, race and zip code. Simple frequencies, percentages, measures of central tendency and variability were calculated. In addition, a univariate and multiple regression analysis was used to examine the relationships of these relevant variables to psychological distress. The overall prevalence rate of distress for this sample was 35.1%. The rate varied form 43.4% for lung cancer to 29.6% for gynecological cancers. While some rates were significantly different, diagnoses with a poorer prognosis and greater patient burden produced similar rates of distress. Pancreatic cancer patients produced the highest mean scores for symptoms such as anxiety and depression, while Hodgkin's patients exhibited the highest mean scores for hostility. These results offer vital support for the need to identify high-risk patients through psychosocial screening in order to provide early intervention. To simply perceive cancer patients as a homogeneous group is an erroneous assumption. Failure to detect and treat elevated levels of distress jeopardizes the outcomes of cancer therapies, decreases patients' quality of life, and increases health care costs. Copyright 2001 John Wiley & Sons, Ltd.

            Author and article information

            [1 ]simpleCase Western Reserve University School of Medicine Cleveland, OH, USA
            [2 ]simpleLouis Stokes Cleveland VAMC-GRECC Cleveland, OH, USA
            [3 ]simpleCenter for Health Care Research and Policy, Case at MetroHealth Medical Center Cleveland, OH, USA
            [4 ]simpleDepartment of Nursing, MetroHealth Medical Center Cleveland, OH, USA
            [5 ]simpleDepartment of Sociology, Case Western Reserve University Cleveland, OH, USA
            Author notes
            Corresponence: Julia Hannum Rose Department of Medicine – Geriatrics and Palliative Care, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA Tel +1 216 778 2303 Fax +1 216 778 4935 Email julia.rose@
            Clin Interv Aging
            Clinical Interventions in Aging
            Clinical Interventions in Aging
            Dove Medical Press
            March 2008
            March 2008
            : 3
            : 1
            : 77-95
            © 2008 Dove Medical Press Limited. All rights reserved


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