The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS) through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition) were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19). The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care.

These data were used to identify strategies and messages to enhance adherence to nutrition and activity recommendations for persons with type 2 diabetes and accompanying cardiovascular risk factors.

Providing care to clients who come from different countries is a challenge for the American health care providers as they traverse the issues of cultural health beliefs and practices and language and knowledge deficits. It is just as difficult for the clients as they face new cultural customs, language barriers, and unfamiliar health care systems and medical management plans. Both parties face acculturation and adherence challenges. This article intends to address these issues as they pertain to clients of Mexican origin and to identify key points to be considered by providers when working with this population.

Older adults prefer to age in place (AIP), and there are psychological, physiological, and economic benefits in doing so. However, it is especially challenging to AIP in rural communities. AIP models have been tested in urban settings and age-segregated communities, but they are not appropriate for rural communities. This paper presents rural AIP variables identified in the literature as well as those described by 39 older adults in five focus groups.Older adults prefer to stay in their familiar homes and communities (i.e., age in place). Despite their intentions, older adults move for various reasons such as diminishing health status, economic hardships, poor housing quality, and lack of support services and care giving. Rural elderly have a particularly strong ''attachment to place''

Successful adjustment to a chronic illness such as diabetes mellitus is influenced by a variety of psychosocial factors. The purpose of this study was to examine the extent to which social support, personal resources, coping styles, and psychosocial adjustment to illness differ among women with diabetes living in different types of household structure and to explore the influence of social support, personal resources, coping styles, and household structure on the psychosocial adjustment of women with diabetes. Data were collected in 1995. The convenience sample included 115 diabetic women with an average age of 48 years. Mean length of time from diagnosis was 10 years. Instruments included a demographic data form, a measure of social support, a personal resource scale, the Jalowiec Coping Scale, the Psychosocial Adjustment to Illness Scale-Self-Report, and a self-report item for assessing household structure. Multiple analysis of variance showed that women in various types of households differed in personal resources and coping. Higher levels of social support and more adequate personal resources were associated with more effective coping and better psychosocial adjustment. The effective use of confrontive, optimistic, supportant and self-reliant coping was associated with better psychosocial adjustment, while evasive and emotive coping styles were associated with more adjustment problems. Multiple regression showed that 47% of the variance in adjustment was explained by personal resources and social support. Findings indicated that women in various types of households differed in the adequacy of their resources and in the ways that they cope with diabetes. Findings further indicated that greater social support, more adequate personal resources, and more effective coping are associated with better adjustment.