This study will examine how sixty-five older adults who experienced their first stroke develop a new self care manager role, and the impact of this role development process on ability to remain in the home, with or without assistance, over time. Using a transactional definition, the construct of role is conceptualized as the management of an interrelated set of behaviors into a routine that can be adapted in response to environmental expectations and resources, and individual identity and beliefs of self efficacy. The essential activities of the self care manager role include coordination and control of medical management, health promotion, basic activities of daily living (ADLs), related instrumental ADLs, and system/information coordination. Prior studies have not examined the adaptive process older adults experience as they learn how to coordinate the new set of activities, resources, and coping strategies needed to stay in the home despite acute and chronic conditions, functional limitations and other personal and environmental threats. Underlying this study is the argument that this adaptation process involves taking on a new self care manager role and integrating this role with other life roles. This role development process is hypothesized to involve a series of phases through which older adults may progress, regress or maintain status. Phases include role loss, emotional or physical reaction precluding action, acknowledgement, exploration of isolated behaviors, role competence and habit formation, and flexible adaptation in response to ongoing threats and challenges. Quantitative and qualitative methods will be used to study the role development process and related outcomes. A general estimated equation design (n=65) will be used to study the factors (fixed and time-varying) contributing to self care manager role development at six time points prior to and after stroke (through 8 months post discharge home), and specific change patterns (progress, maintain, regress) over time. This design also will be used to examine the contribution of role development and previously identified factors to the outcome of remaining in the home over time, including future placement trajectories (e.g., home vs. nursing home). A qualitative study will be conducted with a subgroup of ten subjects and their primary caregivers to describe their role repertoires (matrix of roles in which they engage), role interactions and strains around the disability experience, and coping strategy development following return home. In summary, this study tests a transactional conceptualization of role development for older adults as they experience disability, and learn how to manage their self care and remain in the home over time. This model will be applied within future studies to examine self care management role and coping strategy development among diverse older adults transitioning across health and community systems, and the continuum of living situations and care settings.
