Understanding the cognitive processes of problem detection and decision making among assisted living caregivers
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It is estimated that by 2050 the proportion of older adults in the U.S. will reach 20% (U.S. Census Bureau, 2008). This increase in the elderly population will likely be associated with a greater need for supportive services in various sectors, including healthcare and housing, such as assisted living communities. Many older adults choose to reside in assisted living communities due to increased difficulty managing health conditions or performing activities of daily living (e.g., bathing, toileting, walking). A primary goal of assisted living communities is to help residents maintain their health and well-being. However, little is known about how caregiving staff detect and interpret relevant cues, and what behaviors are taken to address concerns about residents. In addition to investigating these questions, the role of experience in the job was examined by comparing workers with a relatively low level of experience (1 month-16 months) to those with a relatively high level of experience (3+ years). These questions were addressed using a Critical Incident Interview and a Scenario-based Interview. The cues discussed by participants were categorized as Cognitive, Physical, or Emotional in nature. Participants reacted with concern to most of the scenarios, although the ratings they assigned to indicate their level of concern showed a high level of variability across participants. The explanations participants generated for the various scenarios were classified as either general or specific, with the majority of explanations coded as specific. Specific explanations were primarily that the situation was the result of a Cognitive/Emotional/Social issue or a Physical health issue. Of the actions participants described taking to handle the scenarios, gathering and using information was discussed far more than any other action. Participants discussed needing information related to the resident, such as their health, current and recent state, and personal history, as well as elaboration of the cues that initiated the concern in the first place, such as how long the symptom had been present. Participants also discussed various types of knowledge that they used in their decision making process. The most frequently discussed type of knowledge was health conditions and symptoms. Lastly, the data from the current study did not generally reveal differences between the two levels of experience that were examined. A revised model of caregiver decision making and practical contributions are discussed.