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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.
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Valencia N. Prock, Ph.D.
zation, as compared to those living in an institution. Three groups of older people were compared cross-sectionally: insti- tutionalized aged, older persons living
waiting lists for institutions. The (^) as-
was that differences (^) between the com- munity and waiting list samples would reflect effects of pre-institutional dis-
ples would reflect the effects (^) of institu-
tists have (^) become increasingly concerned
pitals, cloisters, army barracks, old age
available to (^) show that institutionalized populations exhibit many differences from (^) noninstitutionalized populations. The major (^) thrust of the (^) evidence is that
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,
"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,
1956); and "psychological institutional- ism" (Bettelheim and (^) Sylvester, 1948).
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 )
1943; Spitz, (^) 1945; Spitz (^) and Wolf, 1946).
tion (^) (Bettelheim, 1950; Freud and Bur-
Many control^ samples in^ studies have been (^) inadequate for (^) isolating the (^) effects of (^) institutionalization because (^) they have
lation on (^) demographic and (^) physical variables (^) only. Where the (^) decision for
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.
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-
a select (^) group of survivors. Another source of error has been the
designed to^ circumvent these barriers to (^) differentiating effects associated with becoming an^ institutionalized (^) person
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
ruptions (^) occurred; a (^) waiting list (^) sample
led them (^) to seek (^) institutionalization (^) ac- tively; and^ aged persons who had been
Subjects
three (^) samples: 34 subjects who had lived
ings of other investigators who have
pected and striking finding is that indi-
age home are psychologically (^) "worse
community group or the individuals al-
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
and some (^) signs of ego disorganization. A quality of "my (^) life is over" permeates
to a "social (^) death" with concomitant
tion with (^) the body and its functioning
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
lack of true (^) "engagement" with others become characteristic. The cross-sec-
impossible to determine whether or not these are characteristics actually shaped by the environment.
both the (^) waiting list and institutionalized groups are in the areas of ego func-
states (including mood tone and (^) ac-
of self into the future (^) and relations with people.
respondents is 68-92 years, age does not highly correlate with any of the other variables.
large number of individual and family characteristics in which the three (^) groups
measures that in most instances were
data.
teristics which are most often cited 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.
most important (^) results in this study in-
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
the community group. A sense of help-
ence, low ego (^) energy, tension and anxi- ety are all (^) factors that distinguish the waiting list group.
(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-
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
though in^ need, one still has continuity
his sense of inner (^) sameness and of con- tinuity and^ belief^ in^ his social roles.
one cares if I live or die." This (^) suggests
self. The individual in the waiting list group does not seem to sense any strong support or reinforcement from those
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-
gests a more powerful set of (^) variables
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
tion, as well as to point to some inherent
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,
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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
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