Research in Gerontological Nursing

Empirical Research 

Story-Sharing Intervention to Improve Depression and Well-Being in Older Adults Transitioning to Long-Term Care

Gail J. Sullivan, PhD, MSN, APRN-BC, CCRN; Debra J. Hain, PhD, APRN, AGPCNP-BC, FAANP, FNKF; Christine Williams, DNSc, RN, PMHCNS-BC; David Newman, PhD, MA, MS

Abstract

Older adults frequently experience depression and reduced well-being when transitioning to long-term care (LTC) that can lead to increased risk for mortality. In the current randomized controlled trial, older adults (N = 93) who were transitioning to LTC facilities in Southeast Florida were enlisted. It was hypothesized that when transitioning to LTC (a) story sharing (i.e., sharing stories in groups) could lead to reduced depression and improved well-being, and (b) baseline sociodemographic characteristics could predict depression and well-being. Baseline results revealed that participants were not depressed and had moderate well-being, and postintervention results indicated that there were no significant improvements in depression (p = 0.35) and well-being (p = 0.41). Some baseline sociodemographic characteristics predicted depression (p = 0.04) and well-being (p = 0.03). Future research should incorporate moderate depression as an inclusion criterion and more weeks of story-sharing sessions.

Targets: Adults age 65 and older transitioning to LTC.

Intervention Description: Two to three participants met as a group to share five stories over 3 weeks.

Mechanisms of Action: Story sharing will improve well-being.

Outcomes: Participant level of well-being will improve, and sociodemographic characteristics and factors related to the move will predict risk for depression and reduced well-being.

[Res Gerontol Nurs. 2019; 12(2):81–90.]

Abstract

Older adults frequently experience depression and reduced well-being when transitioning to long-term care (LTC) that can lead to increased risk for mortality. In the current randomized controlled trial, older adults (N = 93) who were transitioning to LTC facilities in Southeast Florida were enlisted. It was hypothesized that when transitioning to LTC (a) story sharing (i.e., sharing stories in groups) could lead to reduced depression and improved well-being, and (b) baseline sociodemographic characteristics could predict depression and well-being. Baseline results revealed that participants were not depressed and had moderate well-being, and postintervention results indicated that there were no significant improvements in depression (p = 0.35) and well-being (p = 0.41). Some baseline sociodemographic characteristics predicted depression (p = 0.04) and well-being (p = 0.03). Future research should incorporate moderate depression as an inclusion criterion and more weeks of story-sharing sessions.

Targets: Adults age 65 and older transitioning to LTC.

Intervention Description: Two to three participants met as a group to share five stories over 3 weeks.

Mechanisms of Action: Story sharing will improve well-being.

Outcomes: Participant level of well-being will improve, and sociodemographic characteristics and factors related to the move will predict risk for depression and reduced well-being.

[Res Gerontol Nurs. 2019; 12(2):81–90.]

By 2030, 74 million Americans will be age 65 and older (Federal Interagency Forum on Aging Related Statistics, 2016). Older adults frequently experience functional decline that often leads to transitions to long-term care (LTC) and depression (Azeem & Naz, 2015; Drageset, Eide, & Ranhoff, 2013; Fraher & Coffey, 2011; Hutchinson, Hersch, Davidson, Yee-Mei Chu, & Mastel-Smith, 2011; Neufeld, Freeman, Joling, & Hirdes, 2014; World Health Organization, 2018). There is insufficient evidence to support healthy transitions to LTC for this population. The purpose of the current study was to examine the effects of a story-sharing intervention delivered in LTC over 3 weeks on depression and well-being of older adults transitioning to LTC. Sociodemographic factors and conditions of transition (i.e., choice and duration of time in LTC) were examined to determine whether they predicted reduced depression and improved well-being. Two hypotheses were developed to address the purpose of the study:

  • Hypothesis 1—Story sharing in a group will lead to reduced depression and improved well-being; and

  • Hypothesis 2—Sociodemographic characteristics and conditions of transition will predict level of depression and well-being.

Story sharing has been found to be a useful intervention to help reduce depression (Chuang, Kao, Lee, & Chang, 2018; Korte, Bohlmeijer, Cappeliez, Smit, & Westerhof, 2012) and improve well-being (Chiang, Lu, Chu, Chang, & Chou, 2008; Haslam et al., 2010; Westerhof & Bohlmeijer, 2014). Accounts of one's life can be told through a story—a natural way to communicate and pass on societal behavioral norms (Mitchell, 2006). Story sharing is described as a “prehistoric and historic thread of human awareness” (Livo & Rietz, 1986, p. 2), the oldest form of knowing, and where knowing is an epistemology (Bradt, 1997). Multiple research findings have shown story sharing is an effective way to improve coping skills (Richardson, 2015), increase self-identity (Hull & Katz, 2006), provide empathy and empowerment (DiFulvio, Gubrium, Fiddian-Green, Lowe, & Del Toro-Mejias, 2016), reduce depression (Chuang et al., 2018; Korte et al., 2012), and improve well-being (Westerhof & Bohlmeijer, 2014). To the current authors' knowledge, there have been no studies on the impact of story sharing on symptoms of depression and well-being in older adults transitioning to LTC.

Theoretical Framework

The frameworks of the current study were Meleis' middle-range theory of transitions (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000) and Schumacher, Jones, and Meleis' (1999) “Helping elderly persons in transition.” Transitions begin with external triggers such as a financial, social, mental, physical, or geographical change (Meleis et al., 2000). The trigger brings awareness that things will no longer be the same and a confusing or neutral period ensues. Over time, the confusing period shifts to the process of creating new beginnings (Bridges, 1980), which signals the end of the transition. Schumacher et al.'s (1999) extensive work on older adults transitioning to LTC describes this process as a bridging of the confusing period to either a stable, healthy end or an unstable, unhealthy end. Meleis et al. (2000) further identify process indicators of healthy transition as subjective sense of well-being, mastery of new behaviors, and well-being of interpersonal relationships. Well-being is an indicator used to measure an individual's ability to bridge to a stable, healthy transition end (Meleis et al., 2000). In the current study, participants' ability to bridge to a stable, healthy end was examined by analyzing baseline and 3-week postintervention levels of depression and well-being.

Method

In this two-group randomized controlled trial (RCT), participants were randomly assigned to groups using the Research Randomizer (access https://www.randomizer.org). They were assigned as individuals rather than assigning facilities as a whole. The intervention group (n = 41) received the story-sharing intervention and standard care (daily LTC activities), and the control group (n = 52) received standard care.

Eleven urban LTC facilities in Southeast Florida that provide 24-hour/7-days per week nursing care participated as sites for the study. Of the 11 LTC facilities, all were for-profit except two, which were not-for-profit. All sites reported having ≥100 beds, and all facilities except one accepted Medicaid and Medicare. All facilities were considered long-term assisted care except for one facility that was identified as a continuum care facility. All participants required some assistance from LTC facility staff to complete daily care activities. The LTC directors of nursing (DONs) provided a list of residents who they believed might meet the inclusion criteria of willing to share stories in a group with others, age 65 and older, English speaking, a score of ≥3 on the Mini-Cog™ (i.e., suggesting no dementia), and transitioning to a LTC facility within the past 2 years. The literature indicated a transition to LTC can range anywhere between 3 months and 7 years (Brandburg, 2007; Hammer, 1999; Nay, 1995). For the purpose of the current study, the timeframe for transition to LTC was limited to 2 years.

Measures

Sociodemographic Data and Characteristics of the Move. A researcher-created questionnaire was administered to collect data on age, marital status, gender, ethnicity, level of education, months living in LTC, choice to move to LTC, and if there was a health reason for the move (Table 1).

Sociodemographic Characteristics of the Study Sample

Table 1:

Sociodemographic Characteristics of the Study Sample

Mini-Cog. Level of cognitive impairment in older adults was measured using the Mini-Cog, which has three items (3-item registration, clock drawing, and 3-item recall) to gauge the cognitive ability of older adults. Participants with a total score ≥3 are described as screening positive for dementia (Borson, Scanlan, Brush, Vitaliano, & Dokmak, 2000); these individuals were excluded from the study.

Depression Inventory 8b (DI). Level of depression was measured using the 8-item DI from the Patient Reported Outcomes Measurement Information System (PROMIS®) (National Institutes of Health, 2015). The DI rates respondent's level of depression on a 5-point Likert-type scale, with 1 = never, 2 = rarely, 3 = sometimes, 4 = often, and 5 = always. Total scores range between 8 (never depressed) and 40 (always depressed).

Level of Well-Being. Well-being was defined as thoughts and feelings about life that remain stable and consistent over time (Diener, 2009). To capture an individual's engagement, interest, optimism, feelings of being respected, and contributions to the happiness of others (Diener, Emmons, Larson, & Griffin, 1985), three self-report measures were used:

Psychological Well-Being (PWB). Well-being was measured using the 8-item PWB (Diener & Biswas-Diener, 2009), which evaluates the positive and negative affective components of well-being relating to relationships, competence, and meaning and purpose (Diener, 2009; Diener & Emmons, 1985). The PWB uses a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Total scores range between 8 and 56, with higher scores indicating positive views of self.

Satisfaction With Life Scale (SWLS). Well-being was measured using the 5-item SWLS (Diener et al., 1985), which evaluates the judgmental component of an individual's emotional well-being (Diener et al., 1985; Pavot & Diener, 2008). The SWLS uses a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Total scores range between 5 and 35, with higher scores interpreted as highly satisfied.

Scale of Positive and Negative Experience (SPANE). Well-being was measured using the 12-item SPANE (Diener & Biswas-Diener, 2009), which evaluates optimal human function (Diener, 2009). The SPANE uses a 5-point Likert-type scale ranging from 1 (very rarely or never) to 5 (very often or always). Scores are added for negative feeling items (e.g., negative, bad, unpleasant, sad, afraid, angry) and positive feeling items (e.g., positive, good, pleasant, happy, joyful, contented) separately. Negative feeling scores are subtracted from positive feeling scores, with a possible total score range between −24 (unhappiest possible) and 24 (highest affect balance possible).

Story-Sharing Intervention. The investigators defined story sharing as a respectful space where one tells and listens to stories of others (Heliker, 2009) while in a group and being guided by another (in this study, the lead author [G.S.]). Five story topics were chosen focusing on ordinary experiences, including a pleasant childhood or children's story; a profession or vocation story; a wish list or ambition story; a funny or strange story; and a heartwarming tale or love story. Table 2 includes the parameters and topics used to guide each story-sharing session. Each session lasted approximately 30 minutes and included two or three participants in a group who each took a turn sharing a story. The purpose of story sharing was to offer meaning, enhance relationships, and improve well-being.

Story-Sharing Guidelines and Topics

Table 2:

Story-Sharing Guidelines and Topics

Procedures

Upon approval by the University Institutional Review Board, the investigator (G.S.) met with the LTC DONs to request a list of residents who may meet study inclusion criteria. Following introductions to potential participants who expressed interest in the study, the investigator administered the Mini-Cog. If potential participants scored ≥3, they were asked to sign the study consent. Consenting participants completed the sociodemographic questionnaire and baseline measures, including the DI, PWB, SWLS, and SPANE. Control group participants were instructed to continue with their daily LTC activities (standard care) and 3 weeks later were asked to complete the DI, PWB, SWLS, and SPANE.

The story-sharing sessions were led by the investigator and held at each LTC facility twice per week for approximately 3 consecutive weeks. To prevent participant fatigue, each session was limited to 30 minutes. Two or three participants from the same facility and in the same story-sharing session were assisted by the investigator to an assigned comfortable and private area of the institution. Participant chairs faced one another and introductions were given. The story-sharing guidelines and the story topic for each session (Table 2) were read aloud by the investigator at the beginning of every session. The investigator reminded everyone that there were no recorded sessions and stories and comments would remain confidential. The investigator requested a volunteer to begin sharing a story; if there were no volunteers, the investigator selected a participant to begin. All participants in the intervention group engaged in five story-sharing sessions. Three weeks postintervention, once all five topics were discussed by each participant, intervention group members were asked to complete the DI, PWB, SWLS, and SPANE.

Data Analysis

Descriptive statistics, including means, frequencies, and standard deviations, were used to analyze sociodemographic data. A dependent t test and repeated measures analysis of variance were used to analyze changes in depression (measured by DI) and well-being (measured by PWB, SWLS, and SPANE) from baseline to 3-week postintervention. Generalized linear modeling was used to determine whether sociodemographic factors (e.g., age, gender, ethnicity, level of education) and conditions of the transition (e.g., choice to move, duration of time in LTC) predicted depression and well-being.

Results

Mean participant age was between 81 and 82 years, mean time in LTC was between 11 and 12 months, and the majority of participants were White non-Hispanic women (Table 1). Results indicated 50% of participants had no choice in the move to LTC. Of the total study sample, only 11 participants were admitted to LTC for reasons other than health. Attrition (7%) reduced the sample to 93 participants, with 52 participants in the control group and 41 participants in the intervention group. Attrition occurred after the baseline instruments were completed and prior to the first story-sharing intervention session. Attrition was attributed to hospitalization (n = 3), fatigue (n = 1), an episode of delirium (n = 1), and having no participant to share stories with (n = 2). Participants who were unable to be in the study due to absence of a partner for story sharing, an essential component of the intervention, instead shared stories with the investigator, but their data were not included in the analysis.

There were no statistically significant differences between groups for age or length of stay (t [91] = 0.345, p = 0.731 and t [91] = 1.087, p = 0.280, respectively). All participants had minimal depression and moderate well-being at baseline. There was a slight decrease in depression scores in the control group from baseline (mean = 17.37, SD = −7.59) to posttest (mean = 16.17, SD = −6.66) and in the intervention group from baseline (mean = 15.92, SD = 7.41) to posttest (mean = 15.85, SD = −6.16); however, the changes were not significant.

Hypothesis 1

The interaction between the intervention and time (i.e., 3 weeks) for depression was not significant (F [1, 91] = 0.90, p = 0.35, η2 = 0.01)], and the interaction between the intervention and time was not significant for any measures of well-being: PWB (F [1, 91] = 0.66, p = 0.41, η2 = 0.01), SWLS (F [1, 91] = 0.13, p = 0.72, η2 = 0.00), and SPANE (F [1, 91] = 0.50, p = 0.48, η2 = 0.01). These findings suggest that compared to individuals in the control group, story sharing did not improve depression or well-being.

Hypothesis 2

Although most sociodemographic characteristics and conditions of the move were not related to depression, compared to other categories, 2 years of college education was a significant predictor of greater depression (β = 4.20, χ2 [1] = 4.31, p = 0.04). Further, as seen in Table 3, most sociodemographic characteristics and conditions of the move did not predict well-being (PWB); however, a high school level of education (p = 0.01) and Hispanic ethnicity (β = −13.36, χ2 [1] = 5.80, p = 0.02) predicted lower well-being. Likewise, participants who indicated that they had no choice in the move reported lower well-being (p = 0.05), whereas those living in LTC longer had greater well-being (p = 0.04).

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Psychological Well-Being Tool

Table 3:

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Psychological Well-Being Tool

Sociodemographic factors and conditions of the move as a whole predicted well-being (SWLS) (p = 0.03). Two years of college education (p = 0.01) and high school education (p = 0.05) were significant predictors of lower well-being, and more months in the LTC predicted greater well-being (p = 0.05) (Table 4). Most sociodemographic characteristics and conditions of the move did not predict well-being (SPANE); however, high school level of education predicted lower well-being (p = 0.04). Likewise, more months in LTC predicted greater well-being (p = 0.03) (Table 5).

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Satisfaction With Life Scale

Table 4:

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Satisfaction With Life Scale

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Scale of Positive and Negative Experience

Table 5:

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Scale of Positive and Negative Experience

Discussion

The findings from this RCT demonstrate that a story-sharing intervention did not reduce depression and well-being in older adults transitioning to LTC. This finding was surprising because other researchers found reduced depression and improved well-being following story sharing (Chiang et al., 2008; Chuang et al., 2018; Jones, 2003; Korte et al., 2012). Korte et al.'s (2012) RCT examined the effects of narrative therapy and life review on older adults with moderate depressive symptomatology. Participants (intervention group) had significant reductions in depression (p < 0.001) compared to the control group (care as usual). Measuring change in depression and well-being in the current study was hampered by the unexpected baseline depression and well-being scores that indicated minimal depression and average well-being. These findings differed from Hutchinson et al.'s (2011) results indicating transitioning to LTC may lead to depression and reduced well-being. Seo, Jeon, Chong, and An (2015) reported participants in their study who had minimal depression had average well-being, and those with few social interactions had more depression and less well-being. Story sharing is a social interaction that may help reduce depression and improve well-being (Seo et al., 2015; Vitorino, Paskulin, & Vianna, 2013).

Other study findings support the benefits of using story sharing for lengthier periods of time (Chueh & Chang, 2014; Haslam et al., 2010; Karimi et al., 2010). More story-sharing sessions could lead to reduced depression and greater well-being if depression and reduced well-being are present. Additional story-sharing sessions extended over a longer period of time may be beneficial.

In the current study, although most participants had some college education, 2 years of college predicted depression whereas 4 years of college did not predict depression. According to a cross-sectional study by Mess, Witkowicz, Ornat, Sielski, and Klaszczyk (2018), participants with higher levels of education had significantly greater symptoms of depression. A systematic review by Brown et al. (2017) showed that less education indicated greater depression. In the current study, level of education (i.e., high school and 2 years of college) predicted lower well-being. Kobau, Sniezek, Zack, Lucas, and Burns (2010) examined well-being scales and used stratified analysis in a sample of community-dwelling adults (N = 5,399) ages 18 to 65. The findings showed improved well-being was associated with higher levels of education, higher income, and older age. The current study's curvilinear relationship between level of education and various components of well-being (as measured by the PWB, SWLS, and SPANE) and depression merits future research.

Although individuals of Hispanic ethnicity represented a small portion of the current sample, Hispanic ethnicity was linked to reduced well-being, and reduced well-being has been associated with depression (Diener & Biswas-Diener, 2009; Frey & Stutzer, 2002). The National Institute of Mental Health reports that ethnic minorities are less likely to be diagnosed and treated for depression than non-Hispanic White or African American individuals (Akincigil et al., 2011). Interestingly, according to the Federal Interagency Forum on Aging Related Statistics (2016), Hispanic individuals comprise 8% of the national population of older adults. Of this group, 54% completed only high school (Federal Interagency Forum on Aging Related Statistics, 2016). The current study findings linked two characteristics—individuals of Hispanic ethnicity and participants with only high school education had lower well-being, whereas participants with 2 years of college had higher depression. Additional studies with multicultural populations may offer new insights into the role of ethnicity and level of education as predictors of depression and well-being.

Some factors related to the move predicted well-being. Time (i.e., more months in LTC) predicted higher well-being. Other study findings suggest an increase length of stay in LTC improves well-being (Cotter, Harrop-Stein, Fortner, & Gendron, 2015; Vitorino et al., 2013). Having no choice in the move to LTC predicted lower well-being. Autonomy to choose is a human need, and self-determination (autonomy to choose) may improve well-being (Ryan & Deci, 2000). These findings indicate that time in LTC and having choice in the move to LTC are factors that warrant further study.

Anecdotally, participants in the intervention group seemed eager to share their stories and often expressed laughter during sessions. Some participants acknowledged they had seen other participants in the facility; however, they had not spoken to them prior to their first story-sharing session. Some participants told the investigator that they are now friends with the individuals in their story-sharing group. During a story session, two participants discovered that they lived on the same street when they were young. In one story-sharing group, two participants discussed plans to start courting each other. Overall, participants in the intervention group seemed pleased to meet and share their stories with others. These anecdotal findings support the need for further examination of the effects of story sharing on relationships, depression, and well-being in adults transitioning to LTC.

Limitations

The current study had multiple limitations. The sample comprised mainly White non-Hispanic individuals; greater diversity might have offered unique findings to increase generalizability. Because depression was not an inclusion criterion and baseline findings indicated participants were not depressed, a ceiling effect occurred in the measurement of depression and well-being. Individuals who were not depressed may have been more likely to volunteer for this study. Three weeks of story sharing may not have been long enough to produce changes in depression and well-being. All seven participants who dropped out of the study were from the intervention group. Fatigue, bereavement, and unexpected illness, including hospitalization, were reasons given for withdrawal. Measures of covariates such as pain, fatigue, and bereavement may have offered new results.

Implications

Older adults' transition to LTC facilities is relevant to nursing because nurses are charged with overseeing their care. Sharing with others could uncover the many stories older adults have acquired and may result in new relationships and meaning. Creating meaning by story sharing, a caring practice, could lead to well-being and a healthy transition end. Findings of the current study show that sociodemographic factors—particularly level of education, time in LTC, choice to move, and ethnicity—are risks for depression and decreased well-being. Health professionals can use this information to identify older adults at risk for unhealthy transitions. Measurement of pain, decline in health, presence of subclinical depression, and the inclusion of a diverse sample using added story sessions over an extended time may offer new insights to healthy transition outcomes for this population.

Conclusion

Sharing stories is a way humans communicate and relate. In the current study, a story-sharing intervention was not effective in reducing depression or improving well-being in adults transitioning to LTC. Some sociodemo-graphic characteristics may help identify individuals who are at risk for depression and reduced well-being. Further studies using story sharing with older adults who are depressed and report reduced well-being while transitioning to LTC may offer new insights.

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Sociodemographic Characteristics of the Study Sample

Variablen (%)
Control (n = 52)Enrolled in the Intervention (n = 48)Completed the Intervention (n = 41)
Gender
  Female34 (65.4)30 (62.5)26 (63.4)
  Male18 (34.6)18 (37.5)15 (36.6)
Ethnicity
  Hispanic3 (5.8)
  White non-Hispanic40 (76.9)34 (70.8)30 (73.2)
  African American5 (9.6)5 (10.4)4 (9.8)
  Afro-Caribbean3 (5.8)5 (10.4)3 (7.3)
  Other1 (1.9)4 (8.3)4 (9.8)
Marital status
  Married10 (19.2)11 (22.9)10(24.4)
  Widow25 (48.1)14 (29.2)11 (26.8)
  Widower4 (7.7)5 (10.4)5 (12.2)
  Single5 (9.6)8 (16.7)6 (14.6)
  Divorced8 (15.4)10 (20.8)9 (22)
Level of education
  Elementary school3 (5.8)5 (10.4)3 (7.3)
  Middle school3 (5.8)1 (2.1)1 (2.4)
  High school24 (46.2)14 (29.2)12 (29.3)
  Junior college (2 years)17 (32.7)14 (29.2)11 (26.8)
  College (4 years)5 (9.6)14 (29.2)14 (34.1)
Participant's choice to move
  Yes26 (50)24 (50)20 (48.8)
  No26 (50)24 (50)21 (51.2)
Health problem
  Yes47 (90.4)42 (87.5)35 (85.4)
  No5 (9.6)6 (12.5)6 (14.6)

Story-Sharing Guidelines and Topics

Guidelines
1. Share what you are comfortable sharing
2. Fiction and non-fiction stories are acceptable
3. Be courteous to the storyteller and listeners
4. You may stop or break at any time
5. Please keep others' story information confidential
Session/Topics
1. Pleasant childhood or children's story
2. Profession or vocation story
3. Wish list or ambition story
4. Funny or strange story
5. Heartwarming tale or love story

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Psychological Well-Being Tool

VariableβSE95% Wald CIWald χ2(1)p Value
Gender
  (Intercept)48.407.24[34.22, 62.59]44.72<0.001
  Female1.551.88[−2.12, 5.23]0.690.41
  Male0
Ethnicity
  Hispanic−13.365.55[−24.23, −2.49]5.800.02
  White non-Hispanic−6.503.51[−13.38, 0.37]3.440.06
  African American−1.243.80[−8.69, 6.21]0.110.74
  Afro-Caribbean−2.074.28[−10.45, 6.31]0.230.69
  Other0
Marital status
  Married−0.562.42[−5.31, 4.19]0.050.82
  Widow−0.352.37[−5.00, 4.31]0.020.89
  Widower0.373.18[−5.86, 6.61]0.010.91
  Single2.002.68[−3.25, 7.25]0.560.46
  Divorced0
Level of education
  Elementary school−4.443.30[−10.91, 2.02]1.820.18
  Middle school−5.964.39[−14.56, 2.65]1.840.18
  High school−5.572.05[−9.59, −1.56]7.390.01
  Junior college (2 years)−1.792.04[−5.78, 2.20]0.770.38
  College (4 years)0
Participant's choice to move
  No−2.591.54[−5.61, 0.43]2.820.05
  Yes0
Health problems
  No2.502.46[−2.32, 7.32]1.030.31
  Yes0
Age−0.070.09[−0.25, 0.10]0.690.41
Months living in LTC0.230.11[0.01, 0.46]4.100.04

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Satisfaction With Life Scale

VariableβSE95% Wald CIWald χ2(1)p Value
Gender
  (Intercept)20.926.62[7.94, 33.91]9.98<0.001
  Female1.251.72[−2.12, 4.61]0.530.47
  Male0
Ethnicity
  Hispanic−4.325.08[−14.27, 5.63]0.730.40
  White Non-Hispanic−1.623.21[−7.91, 4.67]0.260.61
  African American−1.353.48[−8.17, 5.47]0.150.70
  Afro-Caribbean1.593.91[−6.08, 9.26]0.170.68
  Other0
Marital status
  Married6.632.22[2.28, 10.98]8.93<0.001
  Widow5.142.17[0.88, 9.40]5.600.02
  Widower7.462.91[1.75, 13.17]6.550.01
  Single7.812.45[3.01, 12.62]10.16<0.001
  Divorced0
Level of education
  Elementary school−2.883.02[−8.79, 3.04]0.910.34
  Middle school−4.474.02[−12.34, 3.41]1.240.27
  High school−3.631.88[−7.30, 0.05]3.740.05
  Junior college (2 years)−5.251.86[−8.91, −1.60]7.930.01
  College (4 years)0
Participant's choice to move
  No−1.251.41[−4.01, 1.52]0.780.38
  Yes0
Health problems
  No1.362.25[−3.05, 5.77]0.370.55
  Yes0
Age−0.020.08[−0.18, 0.14]0.050.82
Months living in LTC0.170.10[−0.03, 0.38]2.730.05

Generalized Linear Model Parameter Estimates of the Social Demographic Variables Predicting Well-Being According to the Scale of Positive and Negative Experience

VariableβSE95% Wald CIWald χ2(1)p Value
Gender
  (Intercept)20.775.08[10.81, 30.74]16.69<0.001
  Female−0.671.32[−3.25,1.91]0.260.61
  Male0
Ethnicity
  Hispanic−1.363.90[−9.00, 6.28]0.120.73
  White non-Hispanic−0.492.46[−5.31, 4.34]0.040.84
  African American−1.732.67[−6.96, 3.50]0.420.52
  Afro-Caribbean1.053.00[−4.84, 6.93]0.120.73
  Other0
Marital status
  Married1.841.70[−1.50, 5.18]1.170.28
  Widow2.421.67[−0.84, 5.69]2.110.15
  Widower1.672.24[−2.72, 6.05]0.560.46
  Single3.771.88[0.08, 7.45]4.010.05
  Divorced0
Level of education
  Elementary school−2.652.32[−7.19, 1.89]1.300.25
  Middle school−1.513.08[−7.55, 4.54]0.240.63
  High school−3.031.44[−5.85, −0.20]4.420.04
  Junior college (2 years)−1.791.43[−4.59, 1.02]1.560.21
  College (4 years)0
Participant's choice to move
  No−0.461.08[−2.58, 1.67]0.180.67
  Yes0
Health problems
  No0.061.73[−3.32, 3.45]<0.0010.97
  Yes0
Age−0.010.06[−0.13, 0.11]0.030.86
Months living in LTC0.160.08[0.00, 0.31]3.780.03
Authors

Dr. Sullivan is Visiting Assistant Professor, Dr. Hain is MSN Coordinator: AGNP Concentration, Blake Distinguished Professor, Dr. Williams is Professor and PhD Nursing Program Director, and Dr. Newman is Associate Professor and Statistician, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Gail J. Sullivan, PhD, MSN, APRN-BC, CCRN, Visiting Assistant Professor, Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, NU 354, Boca Raton, FL 33431; e-mail: Gsulliv6@health.fau.edu.

Received: August 03, 2018
Accepted: December 12, 2018
Posted Online: January 31, 2019

10.3928/19404921-20190124-01

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