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The will-to-live scale: development, validation, and significance for elderly people
- Author:
- CARMEL Sara
- Journal article citation:
- Aging and Mental Health, 21(3), 2017, pp.289-296.
- Publisher:
- Taylor and Francis
Objectives: In old age, the will-to-live (WTL) is one of the most important indicators of subjective well-being (SWB). However, few studies to date have focused on WTL. In these studies, WTL has mainly been evaluated via indirect questions concerning factors that may influence peoples’ WTL, or by measures directed to patients with specific diseases. The current study describes the development and psychometric properties of a new WTL scale. Method: The five-item WTL scale was developed on the basis of previous qualitative and quantitative research, and was evaluated in a longitudinal study of a random sample of 868 adults, aged 75+. Results: Confirmatory factor analytic (CFA) models were computed showing that each of the five items contributed significantly to measurement of a single WTL latent factor. Goodness-of-fit statistics were in ideal parameters for these CFA models at each point of data collection. Moreover, temporal analyses indicated that the relative contribution to measurement for each item was equivalent across time, attesting to reliability of measurement and the construct validity of WTL measurement. Concurrent validity was supported by significant positive correlations between WTL and life satisfaction, happiness, self-rated health, morale, self-rated aging, and, as expected, by inverse associations of WTL with depression and loneliness. Conclusion: The results of these analyses indicate that the WTL scale is a valid and reliable instrument. Considering the importance of the WTL concept in late life, and the psychometric properties of the WTL scale, the authors recommend it for use in research and practice related to older adults’ SWB and end-of-life care. (Edited publisher abstract)
Life-sustaining treatment decisions: health care social workers' attitudes and their correlates
- Authors:
- WERNER Perla, CARMEL Sara
- Journal article citation:
- Journal of Gerontological Social Work, 35(1), 2001, pp.19-32.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study is the first to examine social workers' attitudes to life-sustaining treatment (LST) and the correlates associated to these attitudes. A convenience sample of 63 Israeli social workers participated in a mail survey. Results indicate that social workers would use CPR significantly less than artificial feeding or mechanical ventilation. Additionally they would use significantly less LST for patients in a metastatic condition than in mental health and severe physical conditions. Social workers' attitudes to the use of LST were more associated to beliefs regarding life and death than to socio-demographic variables. Research examining the attitudes of social workers involved in medical decision-making processes, should be expanded.
Subjective well-being of visually impaired older adults living in the community
- Authors:
- RAFAELY Liran, CARMEL Sara, BACHNER Yaacov G.
- Journal article citation:
- Aging and Mental Health, 22(9), 2018, pp.1223-1231.
- Publisher:
- Taylor and Francis
Objectives: Vision impairment is one of the most common disabilities among older adults, and it has a substantial impact on well-being. The present study constructs an integrative model to identify which variables derived from four dimensions of life (physical/functional, social, psychological and environmental) combined with sociodemographic variables explain the overall subjective well-being (SWB) visually impaired older adults living in the community. Method: A total of 121 severe visually impaired persons, aged 60 and over (M = 77.4, range 60–95), participated in the study. Personal, face-to-face interviews were conducted with participants at social centres or at their homes. Research tools consisted of valid and reliable questionnaires. Results: Five variables explained the older adults' variability in SWB: self-rated health, sense of meaning in life, functional independence in activity of daily living (ADL), sense of control of one's environment (Mastery) and the participant's age. The explained variance percentage was found to be high (61%). In contrast to expectations, social-environmental variables proved to be only of secondary significance in explaining SWB variability. Discussion: Variables derived from the psychological dimension appear more significant than the social-environmental variables in explaining SWB among visually impaired older adults. These variables should be considered when developing intervention programmes intended to increase SWB within this unique population group. (Edited publisher abstract)
The will-to-live and survival at old age: gender differences
- Authors:
- CARMEL Sara, BARON-EPEL Orna, SHEMY Galia
- Journal article citation:
- Social Science and Medicine, 65(3), August 2007, pp.518-523.
- Publisher:
- Elsevier
In previous studies, the will-to-live (WTL) was presented as a parsimonious and easy to use indicator of well-being, perceived differently by men and women. This study evaluates the role of WTL in long-term survival of elderly men and women. In 1994, socio-demographic, psychosocial, and health characteristics were collected from a sample of 1138 Israeli elderly persons (70+) by structured interviews. Data regarding survival were gathered 7.5 years later. Results indicated that WTL was significantly related to survival in univariate analyses. However, in multivariate Cox analyses, conducted separately on men and women, the will-to-live predicted survival only among women after adjusting for age, self-rated health (SRH) and psychosocial variables, so that the stronger the WTL, the higher the chances of survival for women. Age, WTL and SRH were the only statistically significant predictors of survival in women. Survival of men was predicted by age, daily functioning, SRH, working outside home or volunteering, and self-esteem. Findings show that the WTL predicts long-term survival among elderly women, and therefore has a prognostic value. This strengthens its previously presented importance as a generalized indicator of well-being. These findings have practical implications for formal and informal caregivers.
Nurses' and social workers' attitudes and beliefs about and involvement in life-sustaining treatment decisions
- Authors:
- WERNER Perla, CARMEL Sara, ZIEDENBURG Hanna
- Journal article citation:
- Health and Social Work, 29(1), February 2004, pp.27-35.
- Publisher:
- Oxford University Press
Data were collected from 213 nurses and 61 social workers at major hospitals across Israel. Whereas nurses reported being more involved in the daily care of terminally ill patients, social workers reported being more involved in discussions with patients and family members. Nurses were more willing than social workers to use artificial feeding and less willing to use mechanical ventilation and CPR for all conditions. Social workers expressed stronger beliefs about their involvement in end-of-life issues. These findings, which reflect the differences in the professional values and experiences of both groups, encourage the use of interdisciplinary teams to improve end-of-life decision making.