Aging gradually increases vulnerability to chronic illness, and approximately 80% of the aged population have at least one chronic condition. Older adults whose health and functioning are compromised by chronic illness are at great risk for anxiety, depression, and further declines in physical functioning. Thus, there is a growing need to promote their resourcefulness in achieving optimal physical and psychological health. Resourcefulness involves both the ability to use internal resources to perform daily tasks independently (learned resourcefulness) and to use external resources by seeking help from others when unable to function independently (help-seeking behavior). Research shows that elders who are resourceful in both of these ways have better physical and psychological health than those who use either internal or external resources alone. In addition, when taught resourcefulness, community- dwelling elders with greater numbers of chronic illness symptoms showed the most improvement in physical and psychological health. Hence, teaching learned resourcefulness and help-seeking behavior to chronically ill elderly residents of assisted living facilities has great potential for improving or sustaining their physical and psychological health. A clinical trial will test the effects of two interventions to 200 randomly selected elders in assisted living facilities: learned resourcefulness training (LRT) and help-seeking behavior training (HSBT). The study will also examine the additive effects of combining the two (LRT + HSBT). Since all three interventions use reminiscence, a reminiscence-only group (REM) will separate effects due to reminiscence and to determine content specificity of the interventions, a diversional activity group (DIV) will be used. Subjects will be randomly assigned to one of five treatment groups (LRT, HSBT, LRT + HSBT, REM or DIV) and will participate in one pre- intervention and three post-intervention face-to-face interviews. A priori planned comparisons will be used to compare: 1) LRT, HSBT, and LRT + HSBT to DIV; 2) LRT, HSBT, and LRT + HSBT to REM; 3) (LRT + HSBT) to LRT (combined) to LRT and HSBT alone; and 4) LRT to HSBT. The comparisons will be repeated while controlling for demographics and chronic and episodic conditions to determine if the effects still hold. The effects of the treatments will be examined for immediate and 6 week lagged, and 3 month extended effects. This study is unique in comparing the separate and additive effects over time of two interventions, LRT and HSBT, on physical and psychological health in functionally impaired elders.
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