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Pygmalion in the Nursing Home The Effects of Caregiver Expectations on Patient Outcomes
Author(s) -
Learman Lee A.,
Avorn Jerry,
Everitt Daniel E.,
Rosenthal Robert
Publication year - 1990
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1990.tb01472.x
Subject(s) - medicine , expectancy theory , life expectancy , psychosocial , activities of daily living , randomized controlled trial , gerontology , nursing homes , family medicine , nursing , psychiatry , psychology , environmental health , social psychology , population , surgery
Several characteristics of nursing home care can diminish rather than enhance the clinical status of older residents. In view of evidence from other settings that “interpersonal expectancy effects” can influence outcomes in a variety of relations, we conducted a randomized controlled trial to test the effects of caregiver expectations on the clinical status of nursing home residents. Within 2 weeks of admission, 63 older residents at six nursing homes were given a comprehensive assessment of cognitive, functional, and emotional status. Residents were then randomly assigned to a “high‐expectancy” or “average‐expectancy” condition. Nurses and aides were told that, in comparison with other residents having similar problems, residents in the high‐expectancy group were predicted to perform above average in their rehabilitation. The assessment was repeated 3 months later; information on the health and psychosocial status of residents was drawn from their medical records covering the same period. Aides reported having higher expectations for treatment group residents. When assessed by a blinded research assistant, residents in the high‐expectancy group experienced greater relief of depressive symptoms but showed greater decrements in functional independence in comparison with control residents. Treatment group residents were admitted significantly less frequently to hospitals despite a comparable number of emergency ward visits, suggesting a lower incidence of severe illness despite comparable medical surveillance. There was also a trend toward improved performance in mental status testing among the high‐expectancy residents compared with controls (P = .08). Additional research is needed to define further the magnitude and mechanisms of expectancy effects in relations between nursing home caregivers and residents.