Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Psychological Impact of Institutionalization on Older Adults: Community vs. Waiting List, Lecture notes of Human Development

A study examining the psychological effects of institutionalization on older adults, comparing three groups: community-dwelling older adults, older adults on waiting lists for institutionalization, and older adults who have been institutionalized for one to three years. The study found unexpected results, particularly in relation to the waiting list and institutionalized groups.

What you will learn

  • What are the psychological effects of institutionalization on older adults?
  • How does the waiting period impact older adults prior to institutionalization?

Typology: Lecture notes

2021/2022

Uploaded on 09/27/2022

goofy-6
goofy-6 🇬🇧

5

(6)

230 documents

1 / 8

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
A
study
is
reported
on
the
psychological
efects
of
the
waiting
period
on
old
people
awaiting
institutionalization.
The
data
presented
here
indicate
a
need
to
work
with
old
people
during
this
time
to
anticipate
and
prevent
maladaptive
reactions.
EFFECTS
OF
INSTITUTIONALIZATION:
A
COMPARISON
OF
COMMUNITY,
WAITING
LIST,
AND
INSTITUTIONALIZED
AGED
PERSONS
Valencia
N.
Prock,
Ph.D.
THE
aim
of
this
study
was
to
examine
the
psychological
effects
on
ambula-
tory
aged
people,
awaiting
institutionali-
zation,
as
compared
to
those
living
in
an
institution.
Three
groups
of
older
people
were
compared
cross-sectionally:
insti-
tutionalized
aged,
older
persons
living
in
the
community,
and
older
persons
on
waiting
lists
for
institutions.
The
as-
sumption
underlying
this
comparison
was
that
differences
between
the
com-
munity
and
waiting
list
samples
would
reflect
effects
of
pre-institutional
dis-
ruptions,
whereas
differences
between
the
waiting
list
and
institutional
sam-
ples
would
reflect
the
effects
of
institu-
tionalization.
During
the
past
decade,
social
scien-
tists
have
become
increasingly
concerned
about
the
psychological
effects
upon
in-
dividuals
of
all
ages
who
live
in
institu-
tions
for
prolonged
periods
of
time-be
they
orphanges,
boarding
schools,
hos-
pitals,
cloisters,
army
barracks,
old
age
homes,
internment
and
concentration
camps,
or
prisons.
Empirical
evidence
is
available
to
show
that
institutionalized
populations
exhibit
many
differences
from
noninstitutionalized
populations.
The
major
thrust
of
the
evidence
is
that
living
in
an
institution
has
harmful
physical
and
psychological
effects
upon
an
individual,
whether
young
or
old,
and
regardless
of
the
particular
char-
acteristics
of
the
population
or
the
unique
qualities
of
the
total
institution.
A
variety
of
terms
have
been
used
to
describe
the
different
sociopsychologic
effects
of
living
in
institutions.
The
typ-
ically
negative
connotation
of
these
terms
is
conveyed
in
examples
such
as
"mortification
and
curtailment
of
the
self"
(Goffman,
1961);
"institutional
dependency"
(Coser,
1956;
Straus,
1951)
;
"hospitalism"
(Spitz,
1945);
"depersonalization"
(Townsend,
1962);
"institutionalism"
(Martin,
1955)
;
"re-
gressive
pattern
to
infantile
reactions"
(Laverty,
1950);
"an
'apathy'
reaction
including
severe
withdrawal"
(Bettel-
heim,
1943;
Cohen,
1953;
Nardini,
1952;
Strassman,
Thaler,
and
Schein,
1956);
and
"psychological
institutional-
ism"
(Bettelheim
and
Sylvester,
1948).
Observational
Studies
Observational
studies
of
infants
in
in-
stitutions
have
shown
that
lack
of
ade-
quate
object
relationship
may
threaten
the
infant's
life,
may
cause
serious
and
even
irreversible
changes
in
areas
of
maturation
such
as
in
motor
and
lan-
OCTOBER,
19969
1837
pf3
pf4
pf5
pf8

Partial preview of the text

Download Psychological Impact of Institutionalization on Older Adults: Community vs. Waiting List and more Lecture notes Human Development in PDF only on Docsity!

A study is reported on the psychological efects of the waiting period on

old people awaiting institutionalization. The data presented here indicate

a need to work with old people during this time to anticipate and

prevent maladaptive reactions.

EFFECTS OF INSTITUTIONALIZATION: A COMPARISON OF

COMMUNITY, WAITING LIST, AND INSTITUTIONALIZED

AGED PERSONS

Valencia N. Prock, Ph.D.

THE aim of this study was to examine

the psychological effects on ambula-

tory aged people, awaiting institutionali-

zation, as compared to those living in an institution. Three groups of older people were compared cross-sectionally: insti- tutionalized aged, older persons living

in the community, and older persons on

waiting lists for institutions. The (^) as-

sumption underlying this comparison

was that differences (^) between the com- munity and waiting list samples would reflect effects of pre-institutional dis-

ruptions, whereas differences between

the waiting list and institutional sam-

ples would reflect the effects (^) of institu-

tionalization.

During the^ past decade, social scien-

tists have (^) become increasingly concerned

about the psychological effects upon in-

dividuals of all ages who live in institu-

tions for prolonged periods of time-be

they orphanges, boarding schools, hos-

pitals, cloisters, army barracks, old age

homes, internment and concentration

camps, or^ prisons. Empirical evidence is

available to (^) show that institutionalized populations exhibit many differences from (^) noninstitutionalized populations. The major (^) thrust of the (^) evidence is that

living in an institution has harmful

physical and psychological effects upon an individual, whether young or old, and regardless of the particular char- acteristics of the population or the unique qualities of the total institution. A (^) variety of (^) terms have been used to describe the different (^) sociopsychologic effects of living in institutions. The typ- ically negative connotation of these terms is conveyed in examples such as "mortification and curtailment of the self" (Goffman, 1961); (^) "institutional dependency" (Coser, 1956; (^) Straus,

1951) ; "hospitalism" (Spitz, 1945);

"depersonalization" (^) (Townsend, 1962); "institutionalism" (Martin, 1955) ; "re- gressive pattern to infantile reactions" (Laverty, 1950); "an 'apathy' reaction including severe withdrawal" (Bettel- heim, 1943; Cohen, 1953; Nardini,

1952; Strassman,^ Thaler,^ and^ Schein,

1956); and "psychological institutional- ism" (Bettelheim and (^) Sylvester, 1948).

Observational Studies

Observational studies of infants in in- stitutions have shown that (^) lack of ade- quate object (^) relationship may threaten the infant's life, may cause (^) serious and even irreversible changes in areas of maturation such as in motor and lan-

OCTOBER, (^19969 )

guage development, and may create psy-

chosomatic disturbances (Bakwin, 1949;

Bowlby, 1952; Brodbeck and Irwin,

1946; Freud, 1951; Freud and Bur-

lingham, 1943, 1944; Goldfarb, 1945;

Provence and Ritvo, 1961; Ribble,

1943; Spitz, (^) 1945; Spitz (^) and Wolf, 1946).

Cross-sectional studies comparing

populations of institutionalized and

community-living elderly people have

generally shown the institutionalized

groups as less well functioning with im-

paired level of over-all adjustment, a re-

duced capacity for independent thought

and action, depressive mood tone, low

self-esteem as well as other negative at-

tributes (Ames, Learned, Metraux, and

Walker, 1954; Chalfen, 1956; Davidson

and Kruglov, 1952; Davol, 1958; Fink,

1957; Lakin, 1960; Laverty, 1950;

Lieberman and Lakin, 1963; Mason,

1954; Pan, 1948; Pollack, Karp, Kahn,

and Goldfarb, 1962; Scott, 1955; Town-

send, 1962; Tuckman and Lorge, 1952;

Webb, 1959).

The evidence emerging from these

and other studies suggests that living in

an institutional environment may have

harmful effects upon the individual. Re-

search workers have been stimulated to

ask what causes these alleged effects and

whether they affect children or adults.

Studies of institutional structure sug-

gest a reasonable hypothesis that at least

some aspects of the disturbances of in-

dividuals and personality changes are a

part of the functioning of the institu-

tion (^) (Bettelheim, 1950; Freud and Bur-

lingham, 1943; Goffman, 1961; Gold-

farb, 1943; Greenblatt, Levinson, and

Williams, 1957; Spitz, 1945; Stanton

and Schwartz, 1954; Szurek, 1951;

Townsend, 1962). Other investigations

have attributed the differences in psy-

chological functioning to sample selec-

tion (Davol, 1958; Fogel, Swepston,

Zintek, Vernier, Fitzgerald, Marnocha,

and Weschler, 1956; Webb, 1959;

Wolfe and Davis, 1964).

Many control^ samples in^ studies have been (^) inadequate for (^) isolating the (^) effects of (^) institutionalization because (^) they have

been matched to the institutional popu-

lation on (^) demographic and (^) physical variables (^) only. Where the (^) decision for

institutionalization has been unrelated to

a (^) disruption in (^) everyday living, it is reasonable to (^) assume that certain (^) psy- chological variables^ are^ associated^ with the (^) selection of institutional (^) life; con- sequently, control^ samples must be matched for (^) psychological as well as demographic and^ physical character- istics.

Selective attrition within the institu-

tional (^) populations (^) stemming from selec- tive (^) discharge or (^) mortality has been a further source of error. (^) Investigators who have studied (^) aged persons in in- stitutions (^) (Aldrich and (^) Mendkoff, (^) 1963; Camargo and^ Preston, 1945; Miller and Lieberman, (^) 1965; Whittier and Wil- liams, 1956) have (^) suggested that (^) long-

term institutionalized older persons are

a select (^) group of survivors. Another source of error has been the

restricted range of psychological dimen-

sions used to assess the effects of in-

stitutionalization. The present study was

designed to^ circumvent these barriers to (^) differentiating effects associated with becoming an^ institutionalized (^) person

from effects associated with living in an

institution (^) by employing a wide (^) array of psychological variables to (^) compare three samples: a (^) community sample of (^) aged persons who^ would^ be^ likely to seek

care in the homes for the aged if dis-

ruptions (^) occurred; a (^) waiting list (^) sample

who had experienced disruptions that

led them (^) to seek (^) institutionalization (^) ac- tively; and^ aged persons who had been

institutionalized from one to three years.

Subjects

A total of 99 subjects comprised the

three (^) samples: 34 subjects who had lived

from one to three years in either of two

1838 VOL. 59, NO. 10. A.J.P.H.

the community subjects. However, this

expectation was not borne out. On the

contrary, the^ following summary of^ the

major findings highlights the unexpected

results, especially in relation to the wait-

ing list and institutionalized groups:

1. As measured in this study, per-

sonality traits show a wide diversity

within all three groups, suggesting that

a wide range of "personality types" can

be found entering old age homes. This

suggestion is consistent with the find-

ings of other investigators who have

studied institutionalization in the very

aged. For example, Lowenthal (1965)

suggested that any aged person may be-

come an institutionalized aged indi-

vidual if precipitating changes occur in

social support or physical status.

2. Regarding those variables that did

distinguish the three groups, an unex-

pected and striking finding is that indi-

viduals who are waiting to enter an old

age home are psychologically (^) "worse

off"' than those already in the institu-

tion. The^ characteristics that distinguish

the waiting list group from either the

community group or the individuals al-

ready living in the institution include

general anxiety and tension, high emo- tional reactivity, a sense of helplessness and powerlessness, a tone of (^) depression accompanied by low self-esteem, inter- personal patterns suggesting an active

withdrawal from those around them,

and some (^) signs of ego disorganization. A quality of "my (^) life is over" permeates

the waiting list group, a process likened

to a "social (^) death" with concomitant

feelings of mourning.

  1. (^) Important negative effects of long- time periods spent in the institution sig- nificantly differentiate the institutional- ized group from both the community and waiting list groups. Memory im-

pairment increases, orientation to every-

day reality decreases, and preoccupa-

tion with (^) the body and its functioning

is intensified. In sharp contrast to the

community group, the institutionalized

respondents show a radical shift in the

nature of relationships to other human beings. A sense of trustful mutuality is (^) lost; a quality of "there is no one upon whom I can depend" permeates (^) the

group; "distancing" from others and a

lack of true (^) "engagement" with others become characteristic. The cross-sec-

tional design of this study makes it

impossible to determine whether or not these are characteristics actually shaped by the environment.

  1. The variables which significantly

differentiate the community group from

both the (^) waiting list and institutionalized groups are in the areas of ego func-

tioning (ego pathology), and affect

states (including mood tone and (^) ac-

ceptance of past life), affect extension

of self into the future (^) and relations with people.

5. Although the age range of the

respondents is 68-92 years, age does not highly correlate with any of the other variables.

A rigorous method of design was em-

ployed in this study to assure maximum

comparability of^ the^ three^ groups-

community, waiting list, and institu-

tionalized. That a high degree of

homogeneity of the study population

was achieved is demonstrated by the

large number of individual and family characteristics in which the three (^) groups

are similar. In addition, the three groups

were compared on a wide variety of

measures that in most instances were

derived from more than one source of

data.

A major finding in this study is that

the factors that make for institutionali-

zation in an old age home do not seem

to exist as isolated personality traits.

What is clearly evident and heavily

documented by the results is that the

waiting list group shows those charac-

teristics which are most often cited in

the literature as belonging to the in-

stitutionalized group to a far greater de- gree than do the institutionalized resi-

(^1840) VOL. 59, NO. 10, (^) A.J.P.H.

INSTITUTIONALIZATION OF AGED PERSONS

dents. In other words, in this study, where the groups were matched in ad- vance, the waiting list subjects (^) show many of the so-called "effects of insti- tutionalization" before becoming insti- tutionalized (^) persons. In addition, the data do not massively support a hypoth- esis (^) of wide-ranging effects of institu- tional living.

By far the most unexpected or perhaps

most important (^) results in this study in-

volve the characteristics of the waiting

list (^) group compared to the community group. Both are currently living in the community. The critical difference be- tween the two groups is that the wait- ing list group has made a psycholog- ical commitment to go into an old age

home. One also sees a whole cluster of

characteristics which significantly dif-

ferentiates the waiting list group from

the community group. A sense of help-

lessness and powerlessness, low interac-

tion with others, depressed mood, low

self-esteem, little extension of self into

the future, disorganization of experi-

ence, low ego (^) energy, tension and anxi- ety are all (^) factors that distinguish the waiting list group.

For the person on the waiting list,

the thrust of internal organic changes,

psychomotor slowing, perceptual changes

(e.g., decreased vision (^) and hearing), and other (^) perceived, insidious decrepi- tudes from^ aging may arouse a greater than usual degree of anxiety about con- tinued survival, especially when one feels alone and not intimately attached to another human being. The state of anxiety may lead to a (^) disorganization and a disruption in the continued (^) pleas-

ure of mastering "things," such as in

keeping house and in keeping oneself going. A change in self-concept from a person who "did for oneself and others" to a person who now needs things "done to (^) and for one" requires confidence in order to maintain a sense of sameness

and continuity and to believe that. al-

though in^ need, one still has continuity

and meaningfulness for others. Some-

how, the symbolic meaning of the series

of events which lead the person to place

himself on the waiting list for an old

age home^ dramatically fails to uphold

his sense of inner (^) sameness and of con- tinuity and^ belief^ in^ his social roles.

Although family members may be im-

mediately available in the same house-

hold, the waiting list respondent com-

plains: "No one is interested in me, no

one cares if I live or die." This (^) suggests

instability and disturbance in intrafam-

ily relationships and disequilibrium

within the family social structure it-

self. The individual in the waiting list group does not seem to sense any strong support or reinforcement from those

around him in integrating the changes

taking place in his life. Somehow, the

members of the waiting list (^) group seem to have failed (^) or "given up" in creating a (^) supportive, maintaining life situation for themselves in the community at a time when their perceived needs for care, associated with the aging (^) processes, are greatest. The (^) pivotal place of the family in the older (^) person's world (regardless of whether the individual is in an old (^) age home, living under the same roof with family, or living alone in the (^) commu- nity) was poignantly apparent in (^) the interview data. The (^) intimacy and (^) mu- tuality of family ties were decidedly weaker for the institutionalized and waiting list groups than for the com- munity group. Perhaps the quality of "intimacy" with significant people in family and social relations (as (^) men-

tioned also by Lowenthal, 1965) sug-

gests a more powerful set of (^) variables

in research into the "pathway" to in-

stitutions for the older person than (^) per- sonality variables such as (^) "passivity- dependency." The results of this cross-sectional study make it possible to raise questions about

the complex process of institutionaliza-

tion, as well as to point to some inherent

OCTOBER, 1969 1

INSTITUTIONALIZATION OF AGED PERSONS

and (^) Ability Testing (lst ed., 1956; 2nd ed., 1962). Chalfen, L. Leisure-Time Adjustment of the Aged: Part II, (^) Activities and Interests and Some (^) Factors Influencing Choice. J. Genetic Psychol. (^) 88:261-276, 1956. Cohen, E. A. Human Behavior in the (^) Con- centration Camp. New York: Norton, 1953. Coser, R. L. A Home Away From Home. Social Problems 4:3-17, 1956. Davidson, H. H., and Kruglov, L. (^) Personality Characteristics of the (^) Institutionalized Aged. J. Consult. Psychol. 16:5-12, (^) 1952. Davol, S. H. Some Determinants of (^) Socio- metric Relationships and (^) Group Structure in a Veteran's Administration (^) Domiciliary. Unpublished (^) doctoral dissertation, University of Rochester, (^) 1958. Fink, H. The (^) Relationship of Time Perspective to Age, (^) Institutionalization, and Activity. J. Gerontol. 12:414-417, 1957. Fogel, E. J.; Swepston, E. R.; Zintek, S. S.; V'ernier, C. M.; Fitzgerald, J. F.; (^) Marnocha, R. S.; and Weschler, C. H. Problems of the Aging: Conclusions (^) Derived from Two Years of Interdisciplinary (^) Study of Domi- ciliary Members in a (^) Veteran's Administra- tion Center. Am. (^) J. Psychiat. 112:724-730,

Freuid, A. Observations (^) on Child Development. Psychoanalyt. Study (^) of the Child 6:18-30,

Freuid, A., and (^) Burlingham, D. T. Infants With- out (^) Families. New York: International Uni- versities (^) Press, 1944.

. War and Children. Ibid., (^) 1943. Goffnian, E. (^) Asylums: Essays on the Social Situation (^) of Mental Patients and Other In- mates. (^) Garden City, N. Y.: Doubleday, 1961. Goldfarb, W. Effects of Psychological Depriva- tion in (^) Infancy and Subsequent (^) Stimulation. Am. J. Psychiat. 102:18-43, 1945. -. The Effects of (^) Early Institu- tional (^) Care on Adolescent (^) Personality. J. Exper. Educ. 12:106-129, 1943. Greenblatt, M.; Levinson, D. J.; and (^) Williams, R. H. The (^) Patient and the Mental (^) Hospital. Glencoe, Ill.: The Free Press, 1957. Inglis. J. A Paired-Associate Learning (^) Test for Use with Elderly Psychiatric (^) Patients. J. MIent. Sc. 105:440-443, 1959. Kahn, R. (^) L.; Pollack, M.; and Goldfarb, A. I. Factors (^) Related to Individual Differences in Mental (^) Status of Institutionalized Aged. Re- print from (^) Psychopathology of Aging. Paul H. Hoch and (^) Joseph Zubin (eds.). New York: Grune & (^) Stratton, 1961, Chap. 5, pp. 104-113. Lakiin, M. Formal (^) Characteristics of Human Figure Drawings by (^) Institutionalized and

Non-Institutionalized (^) Aged. J. Gerontol. 15: 76-78, 1960. Laverty, R.^ Nonresident^ Aid-Community Ver- sus Institutional Care for (^) Older (^) People. Ibid. 5:370-374, 1950. Lieberman, M.^ A.^ Interpersonal (^) Role-Playing Task. (^) (Unpublished memo.), Committee on Human (^) Development, 1964.

. (^) Relationship of (^) Mortality Rates to Entrance (^) to a Home for the Aged. Geri- atrics (^) 16:515-519, 1961. Lieberman, M. A., and Lakin, M. "On Be- coming an^ Institutionalized Person."' In: Pro- cesses of (^) Aging, Social and (^) Psychological Perspectives, Vol. 1. R. H. (^) W'illiams, C. Tibbits, and W. Donahue (^) (eds.). New York: Atherton (^) Press, 1963, pp. 475-503. Lieberman, M. (^) A., and (^) Rosner, A. (^) Self-Soit Task. (^) (Unpublished memo.) Committee (^) on Human (^) Development, 1964. Lowenthal, M.^ F.^ Social^ and^ Environmental Factors in (^) Maintaining Mental Health. (^) Paper presented at^ the^ 18th Annual Conference on Aging, University of Michigan, (^) July 26,

Martin, D.^ Institutionalization. Lancet 269: 1188-1190. 1955. Mason, E. P. Some Correlates of (^) Self-Judg- ments (^) of the (^) Aged. J. Gerontol. (^) 9:324-337,

Miller. (^) D., and (^) Lieberman, M. A. The (^) Rela- tionship of Affect State (^) Adaptive Capacity to Reactions to Stress. Ibid. (^) 20:492-497, 1965. Murray, H. A. Manual of Thematic (^) Apper- ception Test.^ Cambridge, Mass.: Harvard University Press, 1943. Nardini, J.^ E.^ Survival Factors in American Prisoners of War of the (^) Japanese. Am. J. Psychiat. 109:241-248, 1952. Neugarten, B.^ L.; Havighurst, R. J.; and Tobin, S. S. The^ Measurement of Life Satis- faction. J. Gerontol. (^) 16:134-143, 1961. New York (^) Health Information Foundation (^) (by Ettel (^) Shanas). Family Relationships of Older People-Living Arrangements, Health (^) Status, and (^) Family Ties (^) of Those Aged 65 and (^) Over, as (^) Reported by the Aged, the Persons to Whom They Would Turn in a Health (^) Crisis, and the (^) General Public. (Res. Ser. 20). New York: The (^) Foundation, 1961. Osgood, C.; Suci, G.; and Tannenbaum, P. H. The Measurement (^) of Meaning. Urbana, Ill.: University of^ Illinois Press, 1957. Pan, J. A Study of the (^) Influence of Institu- tionalization on the Social (^) Adjustment of Old (^) People. J. (^) Gerontol. 3:276-280, 1948. Pollack, M.; Karp, E.; Kahn, R. L.; and (^) Gold- farb, A.^ I. Perception of Self in Institu- tionalized (^) Aged Subjects. I: Response Pat- terns to^ Mirror Reflection. Ibid. (^) 17:405-408,

OCTOBER. (^1969 1 )

Provence, S., and Ritvo, S. Effects of Depriva- tion on Institutionalized Infants: Distur- bances in Development of (^) Relationship to Inanimate Objects. Psychoanalyt. (^) Study of the Child (^) 16:189-205, 1961. Reitman, F., and (^) Robertson, J. P. Reitman's Pin-Man Test: A (^) Means of Disclosing Im- paired (^) Conceptual Thinking. J. Nerv. & Ment. Dis. (^) 112:498-510, 1950. Ribble, (^) M. The Rights of Infants: Early Psy- chological Needs and Their Satisfaction. New York: Columbia University Press, 1943. Scott, F. G. Factors in the Personal Adjust- ment of Institutionalized and Non-Institu- tionalized Aged. Am. Sociol. Rev. 20:538-546,

Spitz, R. A. Hospitalism-An Inquiry (^) Into the Genesis of Psychiatric (^) Conditions in Early Childhood. Psychoanalyt. (^) Study of the Child 1:53-74, 1945. Spitz, R. A., and (^) Wolf, K. (^) M. Anaclitic De- pression: An Inquiry Into the (^) Genesis of Psychiatric (^) Conditions in Early Childhood. Ibid. 2:313-342, (^) 1946. Srole, L. (^) Social Integration and Certain Corollaries: An Exploratory Study. Am. Sociol. (^) Rev. 21:709-716, 1956. Stanton, A.^ H., and Schwartz, M. S. The Mental (^) Hospital. New York: Basic Books,

Strassman, H. D.; Thaler, M. B.; and Schein,

E. H. A Prisoner of War (^) Syndrome: Apathy as a Reaction to Severe Stress. (^) Am. J. Psychiat. 112,2:998-1003, 1956. Straus, R. Nonadditive^ Pathological Drinking Patterns of Homeless (^) Men. Quart. J. Stud. Alcohol. (^) 12:601-611, 1951. Szurek, S. S. The Family and the Staff in Hospital Psychiatric Therapy of Children. Am. (^) J. Orthopsychiat. 21:597-611, 1951. Townsend, P. The Last Refuge-A Survey of Residential Institutions and Homes for the Aged in England and Wales. London: Rout- ledge & Kegan (^) Paul, 1962. Tuckman, J., and (^) Lorge, I. The Effect of In- stitutionalization on Attitudes Towards Old People. J.^ Abnorm.^ & Social^ Psychol. 47: 337-344, 1952. Webb, M. A. Longitudinal (^) Sociopsychologic Study of a Randomly Selected Group of In- stitutionalized Veterans. (^) J. Am. Geriatrics Soc. 7:730-740, 1959. Whittier, J. R., and Williams, D. The Coinci- dence of Constancy of Mortality Figures for Aged Psychotic Patients Admitted to State Hospitals. J. Nerv. & Ment. Dis. (^) 124:618-620,

Wolfe, R. N., and Davis, J. A. (^) Intelligence and Central Life Interests in Two Groups of Older Men. (^) Psycholog. Rep. 14:847-852,

Dr. Prock is Professor of Public Health Nursing, University of Wisconsin School of Nursing (1402 University Avenue), Madison, Wis. 53706 This paper was presented before (^) the Public Health Nursing Section of the American Public Health Association (^) at the Ninety-Sixth Annual Meeting in Detroit, Mich., November (^) 14, 1968.

Urgently Needed

The January and March, 1969, issues of the American Journal of Public Health

and the supplement, Medical Care: The Current Scene and Prospects for the Future,

are urgently needed. Members who wish to donate their copies should send them to:

Boyd Printing Company, 49 Sheridan Ave., Albany, N. Y. 12210. Attention:

Mr. H. Quelmalz.

1 844 VOL. 591 NO. 10. A.J.P.H.