Improvement in resident quality of life may be achieved by improved training and deployment of staff.

Differences in process of care and resident characteristics by facility type highlight the importance of considering: (1) the adequacy of existing process measures for evaluating smaller facilities; (2) resident case-mix when comparing facility types and outcomes; and (3) the complexity of understanding the implication of the process of care, given the importance of person-environment fit. Work is continuing to clarify the role of RC/AL vis-à-vis NHs in our nation's system of residential long-term care.

No single component defines "good" AL care. Predictors and outcomes are inconsistent, and effect sizes are small. Therefore, practice and policy should not focus narrowly on any one area or restrict the type of care-this being welcome news that supports diversity to accommodate individual preferences.

Earlier studies on attachment and substance use disorders using the Hazan and Shaver (1987) self-report mainly indicate a link with "avoidant" attachment styles. Studies working with the Adult Attachment Interview (Main & Goldwyn, 1998) have produced inconsistent results. The present study used the Bartholomew (1990) interview coding system to assess attachment in a sample of 71 German opiate using, drug dependent adolescents (DDAs, age 14 - 25) and 39 non-clinical controls. Fearful attachment was predominant in DDAs, while controls were predominantly secure. Severity of drug use, as assessed with the European Addiction Severity Index (Gsellhofer, Fahrner, & Platt, 1994) and urinalyses, was positively correlated with fearful attachment, but negatively correlated with dismissing attachment. The presence of comorbid psychiatric disorders was associated with fearful attachment but not with addiction severity.

Purpose This study explored aspects of stigmatization for older adults who live in residential care or assisted living (RC–AL) communities and what these settings have done to address stigma. Design and recognition of resident preferences and strengths, rather than their limitations. Methods We used ethnography and other qualitative data-gathering and analytic techniques to gather data from 309 participants (residents, family and staff) from six RC–AL settings in Maryland. We entered the transcript data into Atlas.ti 5.0. We analyzed the data by using grounded theory techniques for emergent themes. Results Four themes emerged that relate to stigma in RC–AL: (a) ageism in long-term care; (b) stigma as related to disease and illness; (c) sociocultural aspects of stigma; and (d) RC–AL as a stigmatizing setting. Some strategies used in RC–AL settings to combat stigma include family member advocacy on behalf of stigmatized residents, assertion of resident autonomy, and administrator awareness of potential stigmatization. Implications: Findings suggest that changes could be made to the structure as well as the process of care delivery to minimize the occurrence of stigma in RC–AL settings. Structural changes include an examination of how best, given the resident case mix, to accommodate care for persons with dementia (e.g., separate units or integrated care); processes of care include staff

ABSTRACT. Preferences for long-term care alternatives include both place of care and persons to provide care. In this analysis, these elements are separated for mature adults (N-1503, ages 40-70) regarding future care needs. Most adults preferred care in home/community settings by kin or non-kin, with few deeming nursing homes acceptable. Demographics and personal knowledge, experience, and expectations were marginally likely to influence preferences; males were more likely to prefer care in paid/

In NHs and RC/AL, dying residents have high rates of physical symptoms and need for more-effective palliation of symptoms near the end of life.

BACKGROUND Catatonia was first described by Kahlbaum as a psychomotor disease with motor, behavioral, and affective symptoms. In keeping with this concept, we developed a rating scale for catatonia (Northoff Catatonia Scale [NCS]) with three different categories of symptoms (i.e., motor, behavioral, affective). Furthermore, the question of the relationship among catatonic symptoms, extrapyramidal motor symptoms, and neuroleptics was addressed in the present study. METHOD 34 acute catatonic patients and 68 age‐, sex‐, diagnosis‐, and medication‐matched psychiatric control subjects were investigated on days 0, 1, 3, 7, and 21 with the NCS, with other already validated catatonia rating scales by Rosebush, Bush (BFCRS), and Rogers (MRS), as well as with scales for hypokinetic (SEPS) and dyskinetic (AIMS) extrapyramidal motor features. Validity and reliability of the new scale, factor analysis, correlational analysis, and differences between catatonic patients and psychiatric control subjects were statistically calculated. RESULTS NCS showed high validity (i.e., significant positive correlations [p <0.0001] with the other scales, significant differences between catatonic and control subjects), high intra‐ and interrater reliabilities (r = 0.80–0.96), and high affective subscores. Factor analysis revealed four factors best characterized as affective, hypoactive, hyperactive, and behavioral. Catatonic scores in NCS correlated significantly with AIMS on day 0 and SEPS on days 7 and 21. There were no significant differences in catatonic (i.e., NCS, MRS, BFCRS) and extrapyramidal (i.e., AIMS, SEPS) scores between neuroleptically treated and untreated catatonic subjects. CONCLUSIONS The following conclusions were drawn: (1) the NCS has to be considered as a valid and reliable rating instrument for catatonia; (2) catatonia can be characterized by psychomotor symptoms encompassing motor, affective, and behavioral alterations; and (3) extrapyramidal hyperkinesias like dyskinesias are apparently closely related to catatonic symptoms which, in general, seem to be relatively independent of previous neuroleptic medication.