Inf. .I. Nurs. Stud. Vol. 16, PP. 169-181. k Pergamon Press Ltd., 1979. Printed in Great Britain
cozo-4878/79/0501-0169$02.00/0
Locus of control, trust, situational control and morale of the elderly* BETTY L. CHANG, R.N., D.N.S.? School of Nursing, Centerfor Health Sciences, lJniversi1.vof California, Los Angeles, California 90024, U.S.A.
The demand for improving the quality of life for institutionalized aged has increased in recent years. Quality of life has been variously defined to include a sense of well-being, high self-esteem, life satisfaction and high morale. Investigations of aging have considered life satisfaction and morale to be important components of successful aging or adaptation (Edwards and Klemmack, 1973; Havighurst, 1961; Neugarten et al., 1961; Palmore and Luikart, 1972; Spretizer and Synder, 1974; Wolk and Telleen, 1976). The present study examines the relationship of selected personality and situational variables to morale of the institutionalized aged. It investigated the relative contributions of generalized expectancies of control and trust, and situational control in predicting morale of the aged within a conceptual framework which considered the congruence between personality characteristics and situations. This information was thought to be useful to care-level personnel by enabling them to tailor situations in such a way as to influence the morale of the institutionalized aged. Institutionalization and the individual Research points to various explanations for the behavior of institutionalized elderly. One explanation suggests that the process of interaction in the environment dehumanized the residents (Goffman, 1961; Coe, 1965; Kahana, 1974). Another argument suggests that characteristics found in the institutionalized are not a result of institutionalization, but of personality characteristics which existed prior to entrance into an institution (Lieberman, 1969). A third explanation suggests that pre-admission effects, independent of selection for admission, are factors causing negative effects of institutionalization. These factors *Based on a doctoral dissertation for the University of California, San Francisco. presented at the 30th Annual Meeting of the Gerontological Society, San Francisco, 1977. The helpful suggestions of Drs. Jeanne C. Hallburg, Majda T. Thurnher, Celeste A. Dye are gratefully acknowledged. Financial support for this study was provided by NIMH Fellowship No. 13621-03 the Graduate Division of the University of California, San Francisco. tAssistant Professor, School of Nursing, Center for the Health Sciences, University 169
A portion of this paper was California, November 18-22, Elizabeth G. Nichols and and Dissertation of California,
Funds
from
Los Angeles.
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are set in motion following the decision to enter, but before actual admission to an institution (Tobin and Lieberman, 1976). A fourth explanation proposes that it is the goodness of fit between environment and person that is conducive to adaptation of the aged in an institutional setting (Kahana, 1974; Lawton, 1970; Marlowe, 1972). None of these studies have identified the relative contributions of personality and situational factors to morale. Expectancy
of locus of control
Expectancy of control has been found to be a significant variable as a correlate of life satisfaction, morale, or adjustment in studies of aging (Fawcett it al., 1976; Felton and Kahana, 1974; Kuypers, 1972; Moran et al., 1975; Palmore and Luikart, 1972; Thurnher and Pierce, 1975). Comprehensive reviews of studies in internal-external (I-E) control generally indicate that a person who believes reinforcements are controlled by internal rather than external forces is likely to make greater attempts at mastering the environment, to be more successful in adjusting to a new environment, to obtain greater satisfaction with present and past life accomplishments, to be more resistant to influence attempts by others but to be more effective in influencing others (Lefcourt, 1966; Rotter, 1966; Joe, 1971). Internality, however, has not been associated with success in the ethnic minorities. Moran et al. (1975) suggest that perhaps for the black population whose real life situation may have low possibility for individual control, having personality characteristics congruent with reality leads to greater competence and better adaptation to the environment. Felton and Kahana (1974) in a study of 124 residents of three homes for the aged found that adjustment in the majority of individuals was higher in individuals who perceived locus of control to be in others. However, Fawcett et al. (1976) reported externality was negatively correlated with life satisfaction in an institutional setting. One explanation for the apparent contradiction may be that indeed different theoretical constructs were being measured by the residents’ responses to hypothetical situations found in a home for the aged in the Felton-Kahana (1974) study, and by Rotter’s I-E scale in the Fawcett et al. (1976) study. In addition to the generalized expectancy of control, generalized expectancy of trust is thought to be related to adjustment of an elderly person in an institutional setting. It is hypothesized to be an important factor in a situation when one’s capacities for self-care are diminished and one must depend on others for the meeting of one’s needs. General expectancies of trust
Trust, a generalized expectancy that the promise or word of another can be relied upon (Rotter, 1967), has been found to be variously correlated with internal-external control. Leon (1974) evaluated a number of personality factors including I-E control, interpersonal trust and academic achievement to study change in two groups of freshman students over the school year. Members of the control group who obtained the higher grades also showed a higher score in interpersonal trust at the end of the college year. Those with more external control showed less interpersonal trust. Contrary to hypothesis, a relationship between interpersonal trust and grade point average did not occur with the disadvantaged group. The disadvantaged students who did better academically showed lower trust at the end of the year than those who did poorly. A search of the literature found no research focusing on the relationship between trust
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and morale in the institutionalized. The expected relationship between trust and morale in white institutionalized aged populations stems from the assumption that trusting persons would accept statements and behavior of others more than less trusting persons and reconcile themselves to the presenting situation. Trust is expected to be a significant factor in a situation when one’s capacities for self-care are diminished and others in the environment are responsible for meeting one’s personal needs. Given the situation of the aged person with diminished capacities and limited alternatives, interpersonal trust would appear to influence morale. Control of situations in instituationalsettings A number of researchers have been concerned with the effect of the control of situations in an institutional setting. Experimental field studies have been done to manipulate the degree of control an elderly nursing home resident could exert over time and duration of student visitors (Schulz, 1976), and the responsibility for caring for a plant (Rodin and Langer, 1977). Results indicated that residents who exerted greater control and were given greater responsibility scored higher on indicators of psychological well-being than those in comparison groups. In a study to examine the association of two levels of constraints with life satisfaction, Wolk and Telleen (1976) found that the higher constraint environment (retirement home) was associated with a lower level of satisfaction than the lower constraint environment (retirement village). Fawcett et al. (1976), in a study of nursing home residents, revealed that perceived institutional constraints (PIG) were the best predictor of life satisfaction. The above studies related to institutional constraints or the amount of control individuals had over selected aspects of life in an institutional setting. They did not examine the residents’ perceived control over their total activities in a setting where many of their activities were related to rehabilitative nursing care. They also neglected for the most part to address the interactive effects of situational and generalized expectancy of control. There is a paucity of literature to guide the care-level staff in assessing whether selfdetermination in situational control of daily activities is associated with high morale for residents of skilled nursing facilities. Issues of who controls the timing, the utilization of space and assistance during these activities constitute specific situations confronting carelevel workers and residents. It is not known for which patients perceived “selfdetermination” in situations contributed to higher morale. This study was undertaken to identify selected personality and situational factors influencing the morale of the institutionalized aged. Framework The general framework is based on adaptation, defined as the interaction of living systems with their environment (Lazarus et al., 1974; Lewin, 1935; Rotter, 1954; Solley and Murphy, 1960; White, 1974). Behavior is viewed in the broad context of the personality and environmental field where perception assumes importance in the conceptualization of personality and adjustment (Lewin, 1935; Solley and Murphy, 1960). The perceptual process is one of apprehending by means of the senses and mind. It is theorized to begin before stimulation with the individual’s expectations (or expectancies, hypotheses) about future perceptions (Solley and Murphy, 1960; Tolman, 1961). Rotter’s (1954) social learning theory emphasizes the expectancy construct in perception
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and behavior changes brought about by reinforcements (stimuli, events) in the situation. Expectancy is conceptualized as the probability held by an individual that a given behavior in a given situation has a certain outcome. These expectancies are dependent upon past experiences and the extent to which generalization of behavior has occurred from related behavior - reinforcement sequences (Rotter, 1954). Individual differences exist in generalized expectancies regarding events in everyday life. Individual differences also exist in the degree to which institutions are perceived as governing the daily lives of the elderly individuals. An aged person’s control of his immediate situation may be viewed as the way in which he manages his daily round of activities (ambulating, dressing, eating, grooming, socializing, toileting) within the institution. His style of management may be influenced by the extent to which he perceives himself in control of the use of basic resources: (A) time, (B) space and (C) assistance. The extent to which he attributes determination of the use of his time, space and assistance to himself or others constitutes one approach to the examination of control or self-determination in immediate situations in an institutional setting. Morale, as one measure of adaptation, of an elderly individual has been hypothesized as a function of congruence between person (needs) and environment (supply) by a number of researchers (e.g. Lawton, 1970; Kahana, 1974). Thomae (1970) has suggested a cognitive theory of aging based on the central postulate that adjustment to aging is a balance between situation as perceived on the one hand and motivational state on the other. In the present framework, the concept is extended to conceptualize morale as a function of congruence between generalized expectancies and perceptions of immediate situations. Successful adaptation as measured by high morale may be viewed as one in which there is a minimum of conflict between generalized expectancies and perceptions of the immediate situation. Specific questions posed by the study were: what is the relative magnitude of the contributions of situational control, generalized expectancies of control and of trust in predicting morale in the institutionalized aged? Is congruence between one’s generalized expectancy of control and one’s perception of situational control in the immediate environment a significant factor in predicting morale in the institutionalized aged? Methodology
Instruments 1. Locus of control (I-E). Levenson’s (1973) internal, powerful other and chance (1 P C) scales were used for the measurement of locus of control. Internal control. A person scoring a predominantly internal orientation was designated ‘internal control’. The internal scale as modified by Levenson (1972) used in the present study corresponds with Rotter’s (1966) internal control. External control. Persons scoring a powerful other or chance orientation on the modified Rotter scale (Levenson, 1972, 1973) constituted the two categories of external control. 2. Self-report trust scale (SRT). This consisted of a IO-item Likert scale consisting of items generated by Kessel (MacDonald et al., 1972) from Rotter’s (1967) sociometric and self-ratings of trust. The SRT is designed to measure individual differences in expectancies that the word or promise of another can be considered reliable. Its internal consistency is high, computed at 0.84 Chronbach alpha coefficient (MacDonald et al., 1972).
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3. Self-rated health. The following question consisting of five alternative answers was used to assess self-rated health. “Would you say your own health in general is excellent; good; fair; poor; or very poor?” It is a question that has been used with success in PTeviOUS research on aging by Wolk and Telleen (1976) and is similar to the scale used by Edwards and Klemmack (1973), and Spreitzer and Synder (1974). Self-rated health has been found to be positively related to physician’s health ratings of the patient (Maddox and Douglass, 1974), and highly correlated with the elderly person’s overall incapacity scores (Shanas et al., 1968). 4. Situational control of daily activities (SCDA). This is a semi-structured interview constructed by the investigator which ascertains the source of control in situations of daily activities from the perspective of the aged person. It consists of semi-structured questions in each of the eight activities bearing on the aged resident’s use of time, space and assistance. The questionnaire includes questions regarding who determines whether the activity should take place and the time, setting, and amount of assistance necessary for the activity.* Examples of questions are: who determines when you get up during the day? Who determines where you go? Responses to the semi-structured interview schedule were recorded in writing by the investigator at the time of the interview. The content of the responses were subsequently coded by the investigator into categories of “self-determined” and “other-determined” for each activity. Every fifth interview was independently coded by two coders. Product-moment correlation coefficients were calculated for the categorization between the two coders and the investigator. The intercoder reliability was + 1 for the overall category of “self” or “other determination of SCDA for each resident. The intercoder reliability of categorization by activities was + 1 for six of the eight activities: ambulating, eating, dressing, socializing in groups, one to one interaction and solitary activity, for the six residents whose coding was checked. For the coding reliability of the remaining two activities, grooming and toileting, the product-moment correlation coefficient for intercoder reliability was computed at 0.9408. Total overall intercoder reliability for categorization by activity for the six residents yielded a correlation coefficient of 0.9852. Congruence. The occurrence of similar categorization for “expectancy of control” and “situational control.” Congruence existed when an individual scored “internal” for expectancy of control and “self-determination” for situational control; or “external” for expectancy of control and “other-determination” in situational control. 5, Revised Philadelphia Geriatric Center (PGC) morale scale. This is a 17-item instrument which measures an individual’s inner state of satisfaction, of having attained something in life, of fitting in with the environment, and the ability to strive appropriately while accepting the inevitable (Lawton, 1972, 1975). Variables other than those above which were found to be associated with morale in the literature (i.e. race, length of institutionalization) were controlled through sample *The SCDA differs from the functional assessments in activities of daily living (ADL) (i.e. Gurel et al., 1972; Katz et al., 1970; Sarno et al., 1973) in that the ADL measures the actual functional ability whereas the SCDA ascertains the resident’s perception of who determines the time, place and assistance given for the activities. The SCDA also differs from the situational constraint (Wolk and Telleen, 1976) in that the general nature of the questions of the latter failed to tap the measure of constraints in a high constraint setting (skilled nursing facility). The perceived Institutional constraints (Fawcett et al., 1976) focused on changes between one’s own home conditions and those in an institution, whereas the SCDA focused on specific perceptions of all activities occuring in the institutional setting.
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selection.
Sample Selection The sample consisted of 30 subjects who met the following criteria for selection. (1) Were age 65 yr or over as of their last birthdate at the time of interview. (2) Had sufficient energy level to participate in the testing procedure. (3) Were able to read and write English in order to understand the language used by the investigator and in each of the instruments in this study. (4) Were cognitively intact: oriented to person, place and able to give informed consent orally and in writing for participation in the study. (5) Had the potential of being involved in the decision-making process as manifested by their being cognitively intact. (It was recognized that residents differ in their degrees of physical disability, the nature of participation in their daily activities, and the range of the decisions they could make. However, the potential for their involvement was constant.) (6) Had a self-rated health of “fair” on a five-alternative scale. (7) Had no previous admission to the same unit in the selected skilled nursing facility. (8) Had been in the same institution on the same unit for a minimum of two weeks and a maximum of six months at the time he was asked about willingness to participate in the study. (The minimum of two weeks was established in order to allow the respondent an opportunity to experience routines of daily activities. The maximum of six months was established in an attempt to limit the total amount of previous experience in the situation which might have affected the
salience of expectancies in predicting behavior.) (9) Were Caucasian, and had lived most of their lives in the United States.
Pre-testing prior to the study A pre-test was conducted by the investigator with 12 residents prior to the study for the purposes of (1) testing the clarity of both the investigator-constructed questions and the items in the standardized questionnaires for the elderly population from which this sample was drawn and (2) determining the best means of administration in terms of refusal rate and resident preferences in test-taking.
The selling The setting for this study consisted of four institutions which qualified as skilled nursing facilities according to the U.S. Department of Health, Education and Welfare’s standards for certification and participation in Medcare and Medicaid programs (Federal Register, 1974). Two of the facilities were free standing and two were geographically connected to acute hospitals. The capacity of the facilities ranged from 100 to 350 beds; and the size of the particular units where data collection took place ranged from 22 to 62 beds. The interviews were administered individually to all who agreed to participate in the study. During the interview, the items in the standardized scales, as well as the investigatorconstructed items, were read aloud by the investigator. The answers given by the respondents were noted by the investigator in writing at the time of the interview. The standardized scales were administered in an identical sequence to all residents. The open-ended questions were administered last.
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Results and Discussion
Description of the sample
The sample included 10 men and 20 women whose mean age was 78.6 yr and mean period of hospitalization was 44.9 days. The predominance of women in the sample reflected a predominance of women among the elderly in society. All of the respondents had been born in the United States. All the respondents were retired, or currently unemployed outside the home. The typical occupations of the men had been as skilled workers or small business men. Women for the most part were housewives or people who had worked at civil service positions. All of the residents were able to state their names, the names of the institutions and to repeat to the investigator their understanding of the purpose of the study. They all had a self-assessed health of “fair” on a five-alternative scale. No direct measure of socioeconomic status was obtained for the residents. This was not, however, to deny a connection between socioeconomic status and a vast array of other variables. Socioeconomic status is one of a number of background demographic variables which influence the development of one’s locus of control, and perception of events in life. However, differences in perceptions of the residents were the foci of interest in this study, not the antecedent factors leading to the development of expectancies and perceptions. The present study focused specifically on resident perceptions of life events in general and of the resident’s perception of self or other determinations in daily activities, regardless of socioeconomic status. A total of 15 respondents were obtained from the two community skilled nursing facilities and 15 from the two hospital connected ones. The intercorrelation matrix in Table 1 shows that the strongest correlation was between SCDA and morale. Residents who perceived themselves in control of situations tended to have higher morale. Although different instruments were used to assess situational control and resident constraint, results ot the present study support the general notion that significant correlates of life satisfaction vary as a function of residential constraint or control of the residents’ daily live!, (Wolk Table 1. Means, standard deviations and correlation Variable
matrix for all variables
Mean
S.D.
8.97 0.57
3.6 0.5
35.80
6.0
0.0782
0.2405
23.50
7.9
-0.3357
-0.2371
0.0214
Chance
25.03
7.7
-0.2849
-0.3227
-0.3213
Orientation
-0.03
0.9
0.2161
0.1893
0.5848*
0.0773
-0.6949*
Trust _.
29.87
5.0 ..___
0.2843
0.1129
0.0047
0.2560
-0.1171
Morale
SCDA
Morale SCDA Internal Powerful
other
._____-___
.__.-___
Correlation
matrix
0.6370:
Internal
0.3905*
Powerful other
Chance
0.1251 Orientation
*P< 0.05.
and Telleen, 1975; Fawcett eta/., Trust was shown to have a suggesting that those who scored morale. Correlations of internal,
1976). weak but positive correlation with morale (r=0.28), high in trust also had a slight tendency to score high on powerful others and chance with morale were relatively
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low. The high correlation of internal powerful others and chance with orientation (0.58 to -0.69) was expected because orientation was derived from the means and standard deviations of each of the three variables for individual respondents, and represented with a dummy value of + 1 for internal, 0 for powerful other, and -1 for chance orientations. The highest contribution was made by SCDA which was significant beyond the 0.05 level. The first question asked: what is the relative magnitude of the contributions of situational control, generalized expectancies of control and trust in predicting morale in the institutionalized aged? To assess the relative contributions of the independent variables to morale, a regression analysis with forced entry of the variables was performed. It is known that the order of entry in a regression analysis may, to some degree, influence the relative magnitude of the contribution of independent variables to the dependent variable. Therefore, the three independent variables in the present study were entered into separate regression equations, rotating the order of entry. As can be seen in Table 2, SCDA was entered first, trust second and orientation third in one equation (order A). In another equation (order B), trust was entered first, orientation second and SCDA third. Table 2. Summary of regression analysis rotating the order of forced entry of situational control of daily activities, orientation and trust upon morale Order of entry Variable
ABC
R-square
A
change
B
--
C
SCDA
I 3
2
0.4057
0.3431
0.36850
Orientation
3 2
I
0.0095
0.0331
0.0467
Trust
2
I
3
0.0418
0.0808
0.0418
0.4570
0.4570
0.4570
Total
Results indicated that SCDA accounted for 34-40% of the variance depending upon the order of entry (P < 0.0001). Trust accounted for 4.2-8% and orientation of locus of control, 4.7-0.9%. Neither trust nor orientation reached significance due to their entries alone. A total of 45.70% of the variance in morale was accounted for by SCDA, trust and orientation. The low contribution of trust may have been due to the relative lack of privacy during test administration, the eagerness of the subjects to respond in a socially acceptable manner, and the greater number of females than males in the study sample. Rotter’s Trust Scale, from which the SRT Scale used in the present study was derived, showed a correlation with the Marlowe-Crowne Social Desirability Scale of 0.21 for male and 0.38 for female (Rotter, 1967). Since 20 out of 30 subjects in the study were female, social desirability may have played a larger role. The finding that locus of control contributed little to predicting morale scores stands in contrast to previously reported results (Fawcett ef al., 1976; Felton and Kahana, 1974) in which internality or externality was variously correlated with adjustment,.life satisfaction and morale. There may have been many reasons for this: (1) the samples may not have been comparable, (2) predictive validity of the locus of control construct was low when the dependent variable was highly specific (Rotter, 1975), (3) the measurement of locus of control used was different from the ones used in other studies and (4) chance locus of control may have been a temporary state rather than a more enduring personality trait. This
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supports findings of Bielby and Siegler’s (1977) longitudinal study which investigated the stability of locus of control. The range for locus of control stability over time reported for men and women was 0.47-0.65, with the female subsample manifesting less stability than the male subsample. Thus, locus of control was identified as a state-like construct for both men and women (Bielby and Siegler, 1977). The second question examined in greater detail the contributions of the interactive effects of specific factors. The question asked: is congruence between one’s generalized expectancy of control and one’s perception of situational control in the immediate environment a significant factor in predicting morale in the institutionalized aged? First, given an internal orientation, will self-determination in situational control result in higher morale than other-determination situations? A 2 x 2 (I-E by SCDA) analysis of variance was performed to answer this question. As can be seen in Table 3, the morale mean in internal orientation for locus of control, under the condition of “self-determined” situations, was 10.0, and under the condition of “other-determined” the morale mean was 7.286. Although the mean was higher under “self-determined”, the interactikon between orientation and situational control of daily activities did not reach 0.05 level of significance. What did reach significance were the differences between cells for SCDA (“self” and “other determined”), regardless of orientation of locus of control P < 0.00016 as illustrated in Table 4. This may have been a reflection of the elderly in which control in a world-view sense may have been lost, but control of daily activities may have assumed greater significance. Another explanation is that the elderly may have lost a sense of internal control, and developed a chance orientation as a reaction to an illness which resulted in their hospitalization. This notion is further elaborated upon below. Table 3. Morale
means for locus of control (internal, by situational control
external)
Locus of control
Situational
External orientation
Internal orientation
control
Self-determined
(6)*
I I.454 (11)
7.286
5.333
10.000
Other-determined
(6)
(7) *Sample cell size in parentheses.
Table 4. Analysis of variance table of the influence of locus of control (internal, external) by situational control on morale Source of variance
df
Within cells
26
7.826
I
Situational
control
Locus of control Situational
control
I.ocus of control N = 30.
F
Significance
152.949
19.542
0.00016
I
0.061
0.000
0.930
I
20.468
2.615
0.118
Mean square
X
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Next, given an external orientation, will other-determination in situational control result in higher morale than in self-determination situations? In order to address this question, powerful other and chance orientations were collapsed, and called external orientation. Inspection of the morale means in Table 4 indicated that given an external orientation, other-determined SCDA resulted in a score of 11.45. It was obvious that given an external orientation, morale under other-determination conditions did not result in higher morale than under self-determination conditions. On the contrary, self-determination on the average resulted in higher morale for both internal and external orientations of locus of control, as illustrated in Tables 3 and 4. The finding that external (chance) orientation under the condition of perceived selfdetermination of SCDA, or in other words, that incongruence between orientation and SCDA, resulted in higher morale than congruence must be regarded with caution for the following reasons: (1) the sample size and cell sizes were small, therefore, the finding may have been a reflection of characteristics of the particular sample; (2) the finding may have been a reflection of the residents’ reaction to a specific event, such as an accident or illness as being attributed to chance, rather than personal responsibility. That is, the locus of control, particularly the chance dimension, may have been a temporary state rather than a more enduring personality trait. Although locus of control was conceptualized as a fairly enduring personality characteristic derived from a composite of experiences throughout life, a recent study, as mentioned, has indicated that the locus of control may indeed be a state. The residents scoring chance orientation in the present ctudy may have been responding to their specific life situations, such as an accident or illness, as being caused by chance, rather than expressing their world view. Of those who scored a chance orientation, all eight who scored high morale referred to a sudden dramatic event (stroke, accident) which precipitated their hospitalization and subsequent stay in the skilled nursing facility. The dramatic nature of the onset of illness may have emphasized the ‘hand of fate’ or chance factor in determining these residents’ destinies. Three of these respondents stated during the interview, that until the time of the accident (or stroke), they thought they were in control of their lives. Some in the chance group may also have been defensive externals. This would provide further support to the suggestion made over the years (Rotter, 1966; Davis and Davis, 1972; Lloyd and Chang, 1978) that a subgroup of externals exists. Members of this subgroup do not genuinely subscribe to an external belief system, but tend to verbalize an external orientation for its defensive functions. By attributing their illness to chance, individuals may avoid the threat that they may otherwise experience when presented with the idea of an illness (or failure to remain healthy). Conclusion
There has been an increasing demand to improve the quality of life for residents of nursing homes in the United States. The quality of life has been variously defined to include the maintenance of dignity, self-esteem and morale of the residents. Research in aging has found situational Icontrol to be a factor in influencing measures of well being in the institutionalized elderly. Personality factors, such as locus of control, have been found to influence the adaptation of persons in community settings. Its influence on institutionalized elderly, however, has been inconclusive. Trust was examined as a contributing factor to morale in institutional settings. A conceptual framework synthesized
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from existing theories was developed for the examination of selected personality and situational variables affecting morale of the institutionalized aged. A study of 30 residents indicated that situational control of daily activities emerged as the strongest contributor to morale. The results lend support to the notion that selfdetermination in daily activities plays an important role in the morale of institutionalized aged residents. Trust and locus of controi contributed little to the variance in morale, failing to reach the 0.05 significance level. Congruence between locus of control and SCDA did not result in higher morale. This may have been in part due to the chance orientation being subject to change related to the dramatic nature of the residents’ illnesses. With the concept of chance in this population, one needs to separate out that which may be a personality characteristic from that which may be a defense mechanism to explain the occurrence of a specific illness. Further investigations are needed to do this. Further studies are also needed to explore the effect of resident control in aspects of daily care of the institutionalized elderly person. Tentative results from this study suggest that care which allows resident determination of his daily care and activities is the strongest contributor to morale. A resident’s control of his daily activities may be enhanced by creating a more resident-oriented environment and by having increased options for decision making. Care in an institutional setting could be directed toward a consideration of the resident’s wishes and goals in carrying out the activities inherent in a skilled nursing facility. The potentials of the interview guide developed in this study may be explored as one means of assessment in ascertaining an elderly person’s perception of control of his daily activities in skilled nursing and other long term care facilities. It is crucial that research be undertaken to further investigate how the quality of life can be improved for the elderly person requiring long term care. With an increasing number of elderly persons in our society, the improvement of the quality of life for those requiring long term care is essential. Researchers, policy makers, health care professionals and consumers must work together so that long term care will be that which enhances an individual’s morale, sense of dignity, and self-worth. References Bielby, D. D. and Sigler, 1. C. (1977). Internal-external locus of control in middle and late life: the search for construct validation. Paper presented at the 30th annual meeting of the Gerontological Society, San Francisco, California. Coe, R. M. (1965). Self conception and institutionalization. Chapter 15 in A. Rose (ed.), OlderPeople and Their World. F. A. Davis, Philadelphia. Davis, W. L. and Davis, D. E. (1972). Internal-external control and attribution of responsibility for success and failure. J. Personality 40, 123-126. Edwards, J. N. and Klemmack, D. L. (1973). Correlates of life satisfaction: a reexamination. J. Geront. 28, 497-502. Fawcett, G., Stonner, D. and Zepelin, H. (1976). Locus of control perceived, constraint, and morale among institutionalized aged. Paperpresented at the 29th Annual Meeting of the Gerontological Society, New York, New York. Federal Register (1974). Skilled Nursing Facilities: Standards for Certification and Participation in Medicare and Medicaid Programs. Department of Health, Education and Welfare, Social and Rehabilitation Service, Social Security Administration, Washington, D.C., 39 (12), January 17. Felton, B. and Kahana, E. (1974). Adjustment and situationally-bound locus of control among institutionalized aged. J. Geront. 29,295301. Goffman, E. (1961). Asylums. Anchor Books, Double Day, Garden City. Gurel, L., Linn, N. W. and Linn, B. S. (1972). Physical and mental impairment of function evaluation in the aged: the PAMIE scale. J. Geront. 27(l), 83-90.
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Havighurst, R. J. (1961). Successful Ageing. Gerontologist 1,8-13. Joe, V. C. (1971). Review of the internal-external control construct as a personality variable. Psychol. Rep. 28, 619640. Kahana, E. (1974). Matching environments to needs of the aged: a conceptual scheme. Chapter 9 in J. F. Gubrium (ed.), Late Life: Communities and Environmental Policy, Charles C. Thomas, Springfield, Illinois. Katz, S., Downs, T. D., Cash, H. R. and Grotz, R. C. (1970). Progress in development of the index of ADL. Gerontologist. Spring, Part 1,20-30. Kuypers, J. (1972). internal-external locus of control, ego functioning, and personality characteristics in old age. Gerontologist. Summer, Part I, 168-173. Lawton, M. P. (1979). Assessment, integration and environments for older people. Gerontologist 10,38-46. Lawton, M. P. (1972). The dimensions of morale. in Research Planning andAction for the Elderly: The Power and New Potential of Social Science. D. P. Kent, R. Kastenbaum and S. Sherwood (eds.), Behavioral Publications, York. Lawton, M. P. (1975). The Philadelphia Geratric Center morale scale: a revision. J. Geront. 30,35-89. Lazarus, R. S., Avriil, J. R. and Opton, E. M., Jr. (1974). The psychology of coping: issues of research and assessment, in Coping and Adaptation. G. V. Coelho, D. A. Humburg and J. E. Adams (eds.), Basic Books, inc., New York. Lefcourt, H. M. (1966). internal versus external control of reinforcements: a review. Psychol. Bull. 65,206-220. Leon, G. R. (1974). Personality change in the specially admitted disadvantaged student after one year in college. J. clin. Psychol. 30,522.528. Levenson, H. (1972). Distinctions within the concept of internal-external control: development of a new scale. Proceedings of the American PsychologicalAssoc. 80th Annual Convention, 261-262. Levenson, H. (1973). Multidimensional locus of control in psychiatric patients. J. consult. Clin. Psychol. 41, 397404. Lewin, K. (1935). A Dynamic Theory of Personality: Selected Papers of Kurt Lewin. (Translated by K. D. Adams and K. E. Zener). McGraw-Hill, New York. Lieberman, M. A. (1969). institutionalization of the aged: effects on behavior. J. Geront. 24,330-339. Lloyd, C. and Chang, A. F. (1978). The usefulness of distinguishing between a defensive and a non-defensive external locus of control. J. Rex Personal., in press. MacDonald, A. P., Jr., Kessel, V. S. and Fuller, J. B. (1972). Self-disclosure and two kinds of trust. Psycho/. Rep. 30, 143-148. Maddox, G. L. and Douglass, E. B. (1974). Self-assessment of health. in Normal Aging, Vol. 2. E. Paimore (ed.), Duke University Press, Durham, North Carolina. Marlow, R. A. (1972). The Modesto Relocation Project: The Social Psychological Consequences of Relocation on Geriatric State Hospital Patients. Unpublished Final Report to Department of Mental Hygiene, State of California, Project No. l-60 (MOD), August. Moran, J. A., Gatz, M. and Tyler, F. B. (1975). Lifespan spunk! Psychosocial competence in active and inactive senior citizens. Paper presented at the 28th Annual Meeting of the Gerontological Society, Loisviile, Kentucky. Neugarten, B. L., Havighurst, R. J. and Tobin, S. S. (1961). The measurement of life satisfaction. J. Geront. 16, 134-143. Palmore, E. and Luikhart, C. (1972). Health and social factors related to life and staisfaction. J. Hlth. Sot. Behavior. 13,68-80. Rodin, J. and Langer, E. J. (1977). Long-term effects of a control-relevant intervention with the institutionalized aged. J. Personal. Sot. Psychol. 35(12), 897902. Rotter, J. B. (1954). SocialLearning and Clinical Psychology. Prentice-Hall, Englewood Cliffs, New Jersey. Rotter, J. B. (1966). Generalized expectancies for internal versus external control of reinforcement. Psychol. Monogr. 80 (1, Whole No. 609). Rotter, J. B. (1967). A new scale for the measurement of the interpersonal trust. J. Personal. 35,651-665. Sarno, J. E., Sarno, M. T. and Levita, E. (1973). The functional life scale. Archs. phys. Med. Rehabil. 54,214-220. Schulz, R. (1976). Effects of control and predictability on the physical and psychological well-being of the institutionalized aged. J. Personal. Sot. Psychol. 33(5), 563-573. Shanas, E., Townsend, P., Wedderburn, D., Friis, H., Milhoj, P. and Stehouver, J. (1968). The psychology of health. Chapter 23 in Middle Age and Aging, B. L. Neugarten (ed.), The University of Chicago Press, Chicago. Solley, C. M. and Murphy, G. (1960). Development of the Perceptual World. Basic Books, New York. Spreitzer, E. and Sunder, E. E. (1974). Correlates of life satisfaction among the aged. J. Geront. 29,454-458. Subcommittee on Long-Term Care of the Special Committee on Ageing, U. S. Senate (1974. Nursing Home Care in the United States: Failure in Public Policy. Introductory Report. U.S. Government Printing Office, Washington, D. C., November-December. Thomae, H. (1970). Theory of aging and cognitive theory of personality. Hum. Dev. 13, i-16. Thurnher, M. and Pierce, R. (1975). Dimensions of locus of control among young and old adults. Presented at
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the 28th Annual Scientific Meeting of the Gerontological Society, Louisville, Kentucky. Tobin, S. and Lieberman, M. (1976). Lasf Homefor theAged. Jossey-Bass, San Francisco. Tolman, E. C. (1961). Behavior and Psychological Man: Essays in Motivation and Learning. University of California Press, Berkeley. White, R. W. (1974). Strategies of adaptation: An attempt at systematic description. Chapter 4 in Coping and Adaptation, G. V. Coelho, D. A. Hamburg and J. E. Adams (eds.), Basic Books, New York. Wolk, S. and Telleen, S. (1976). Psychological and social correlates of life satisfaction as a function of residential constraint. J. Geront. 31,89-98. (Received 26 September 1978; acceptedforpublication
2 October 1978)
cozo-4878/79/0501-0169$02.00/0
Locus of control, trust, situational control and morale of the elderly* BETTY L. CHANG, R.N., D.N.S.? School of Nursing, Centerfor Health Sciences, lJniversi1.vof California, Los Angeles, California 90024, U.S.A.
The demand for improving the quality of life for institutionalized aged has increased in recent years. Quality of life has been variously defined to include a sense of well-being, high self-esteem, life satisfaction and high morale. Investigations of aging have considered life satisfaction and morale to be important components of successful aging or adaptation (Edwards and Klemmack, 1973; Havighurst, 1961; Neugarten et al., 1961; Palmore and Luikart, 1972; Spretizer and Synder, 1974; Wolk and Telleen, 1976). The present study examines the relationship of selected personality and situational variables to morale of the institutionalized aged. It investigated the relative contributions of generalized expectancies of control and trust, and situational control in predicting morale of the aged within a conceptual framework which considered the congruence between personality characteristics and situations. This information was thought to be useful to care-level personnel by enabling them to tailor situations in such a way as to influence the morale of the institutionalized aged. Institutionalization and the individual Research points to various explanations for the behavior of institutionalized elderly. One explanation suggests that the process of interaction in the environment dehumanized the residents (Goffman, 1961; Coe, 1965; Kahana, 1974). Another argument suggests that characteristics found in the institutionalized are not a result of institutionalization, but of personality characteristics which existed prior to entrance into an institution (Lieberman, 1969). A third explanation suggests that pre-admission effects, independent of selection for admission, are factors causing negative effects of institutionalization. These factors *Based on a doctoral dissertation for the University of California, San Francisco. presented at the 30th Annual Meeting of the Gerontological Society, San Francisco, 1977. The helpful suggestions of Drs. Jeanne C. Hallburg, Majda T. Thurnher, Celeste A. Dye are gratefully acknowledged. Financial support for this study was provided by NIMH Fellowship No. 13621-03 the Graduate Division of the University of California, San Francisco. tAssistant Professor, School of Nursing, Center for the Health Sciences, University 169
A portion of this paper was California, November 18-22, Elizabeth G. Nichols and and Dissertation of California,
Funds
from
Los Angeles.
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are set in motion following the decision to enter, but before actual admission to an institution (Tobin and Lieberman, 1976). A fourth explanation proposes that it is the goodness of fit between environment and person that is conducive to adaptation of the aged in an institutional setting (Kahana, 1974; Lawton, 1970; Marlowe, 1972). None of these studies have identified the relative contributions of personality and situational factors to morale. Expectancy
of locus of control
Expectancy of control has been found to be a significant variable as a correlate of life satisfaction, morale, or adjustment in studies of aging (Fawcett it al., 1976; Felton and Kahana, 1974; Kuypers, 1972; Moran et al., 1975; Palmore and Luikart, 1972; Thurnher and Pierce, 1975). Comprehensive reviews of studies in internal-external (I-E) control generally indicate that a person who believes reinforcements are controlled by internal rather than external forces is likely to make greater attempts at mastering the environment, to be more successful in adjusting to a new environment, to obtain greater satisfaction with present and past life accomplishments, to be more resistant to influence attempts by others but to be more effective in influencing others (Lefcourt, 1966; Rotter, 1966; Joe, 1971). Internality, however, has not been associated with success in the ethnic minorities. Moran et al. (1975) suggest that perhaps for the black population whose real life situation may have low possibility for individual control, having personality characteristics congruent with reality leads to greater competence and better adaptation to the environment. Felton and Kahana (1974) in a study of 124 residents of three homes for the aged found that adjustment in the majority of individuals was higher in individuals who perceived locus of control to be in others. However, Fawcett et al. (1976) reported externality was negatively correlated with life satisfaction in an institutional setting. One explanation for the apparent contradiction may be that indeed different theoretical constructs were being measured by the residents’ responses to hypothetical situations found in a home for the aged in the Felton-Kahana (1974) study, and by Rotter’s I-E scale in the Fawcett et al. (1976) study. In addition to the generalized expectancy of control, generalized expectancy of trust is thought to be related to adjustment of an elderly person in an institutional setting. It is hypothesized to be an important factor in a situation when one’s capacities for self-care are diminished and one must depend on others for the meeting of one’s needs. General expectancies of trust
Trust, a generalized expectancy that the promise or word of another can be relied upon (Rotter, 1967), has been found to be variously correlated with internal-external control. Leon (1974) evaluated a number of personality factors including I-E control, interpersonal trust and academic achievement to study change in two groups of freshman students over the school year. Members of the control group who obtained the higher grades also showed a higher score in interpersonal trust at the end of the college year. Those with more external control showed less interpersonal trust. Contrary to hypothesis, a relationship between interpersonal trust and grade point average did not occur with the disadvantaged group. The disadvantaged students who did better academically showed lower trust at the end of the year than those who did poorly. A search of the literature found no research focusing on the relationship between trust
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and morale in the institutionalized. The expected relationship between trust and morale in white institutionalized aged populations stems from the assumption that trusting persons would accept statements and behavior of others more than less trusting persons and reconcile themselves to the presenting situation. Trust is expected to be a significant factor in a situation when one’s capacities for self-care are diminished and others in the environment are responsible for meeting one’s personal needs. Given the situation of the aged person with diminished capacities and limited alternatives, interpersonal trust would appear to influence morale. Control of situations in instituationalsettings A number of researchers have been concerned with the effect of the control of situations in an institutional setting. Experimental field studies have been done to manipulate the degree of control an elderly nursing home resident could exert over time and duration of student visitors (Schulz, 1976), and the responsibility for caring for a plant (Rodin and Langer, 1977). Results indicated that residents who exerted greater control and were given greater responsibility scored higher on indicators of psychological well-being than those in comparison groups. In a study to examine the association of two levels of constraints with life satisfaction, Wolk and Telleen (1976) found that the higher constraint environment (retirement home) was associated with a lower level of satisfaction than the lower constraint environment (retirement village). Fawcett et al. (1976), in a study of nursing home residents, revealed that perceived institutional constraints (PIG) were the best predictor of life satisfaction. The above studies related to institutional constraints or the amount of control individuals had over selected aspects of life in an institutional setting. They did not examine the residents’ perceived control over their total activities in a setting where many of their activities were related to rehabilitative nursing care. They also neglected for the most part to address the interactive effects of situational and generalized expectancy of control. There is a paucity of literature to guide the care-level staff in assessing whether selfdetermination in situational control of daily activities is associated with high morale for residents of skilled nursing facilities. Issues of who controls the timing, the utilization of space and assistance during these activities constitute specific situations confronting carelevel workers and residents. It is not known for which patients perceived “selfdetermination” in situations contributed to higher morale. This study was undertaken to identify selected personality and situational factors influencing the morale of the institutionalized aged. Framework The general framework is based on adaptation, defined as the interaction of living systems with their environment (Lazarus et al., 1974; Lewin, 1935; Rotter, 1954; Solley and Murphy, 1960; White, 1974). Behavior is viewed in the broad context of the personality and environmental field where perception assumes importance in the conceptualization of personality and adjustment (Lewin, 1935; Solley and Murphy, 1960). The perceptual process is one of apprehending by means of the senses and mind. It is theorized to begin before stimulation with the individual’s expectations (or expectancies, hypotheses) about future perceptions (Solley and Murphy, 1960; Tolman, 1961). Rotter’s (1954) social learning theory emphasizes the expectancy construct in perception
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and behavior changes brought about by reinforcements (stimuli, events) in the situation. Expectancy is conceptualized as the probability held by an individual that a given behavior in a given situation has a certain outcome. These expectancies are dependent upon past experiences and the extent to which generalization of behavior has occurred from related behavior - reinforcement sequences (Rotter, 1954). Individual differences exist in generalized expectancies regarding events in everyday life. Individual differences also exist in the degree to which institutions are perceived as governing the daily lives of the elderly individuals. An aged person’s control of his immediate situation may be viewed as the way in which he manages his daily round of activities (ambulating, dressing, eating, grooming, socializing, toileting) within the institution. His style of management may be influenced by the extent to which he perceives himself in control of the use of basic resources: (A) time, (B) space and (C) assistance. The extent to which he attributes determination of the use of his time, space and assistance to himself or others constitutes one approach to the examination of control or self-determination in immediate situations in an institutional setting. Morale, as one measure of adaptation, of an elderly individual has been hypothesized as a function of congruence between person (needs) and environment (supply) by a number of researchers (e.g. Lawton, 1970; Kahana, 1974). Thomae (1970) has suggested a cognitive theory of aging based on the central postulate that adjustment to aging is a balance between situation as perceived on the one hand and motivational state on the other. In the present framework, the concept is extended to conceptualize morale as a function of congruence between generalized expectancies and perceptions of immediate situations. Successful adaptation as measured by high morale may be viewed as one in which there is a minimum of conflict between generalized expectancies and perceptions of the immediate situation. Specific questions posed by the study were: what is the relative magnitude of the contributions of situational control, generalized expectancies of control and of trust in predicting morale in the institutionalized aged? Is congruence between one’s generalized expectancy of control and one’s perception of situational control in the immediate environment a significant factor in predicting morale in the institutionalized aged? Methodology
Instruments 1. Locus of control (I-E). Levenson’s (1973) internal, powerful other and chance (1 P C) scales were used for the measurement of locus of control. Internal control. A person scoring a predominantly internal orientation was designated ‘internal control’. The internal scale as modified by Levenson (1972) used in the present study corresponds with Rotter’s (1966) internal control. External control. Persons scoring a powerful other or chance orientation on the modified Rotter scale (Levenson, 1972, 1973) constituted the two categories of external control. 2. Self-report trust scale (SRT). This consisted of a IO-item Likert scale consisting of items generated by Kessel (MacDonald et al., 1972) from Rotter’s (1967) sociometric and self-ratings of trust. The SRT is designed to measure individual differences in expectancies that the word or promise of another can be considered reliable. Its internal consistency is high, computed at 0.84 Chronbach alpha coefficient (MacDonald et al., 1972).
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3. Self-rated health. The following question consisting of five alternative answers was used to assess self-rated health. “Would you say your own health in general is excellent; good; fair; poor; or very poor?” It is a question that has been used with success in PTeviOUS research on aging by Wolk and Telleen (1976) and is similar to the scale used by Edwards and Klemmack (1973), and Spreitzer and Synder (1974). Self-rated health has been found to be positively related to physician’s health ratings of the patient (Maddox and Douglass, 1974), and highly correlated with the elderly person’s overall incapacity scores (Shanas et al., 1968). 4. Situational control of daily activities (SCDA). This is a semi-structured interview constructed by the investigator which ascertains the source of control in situations of daily activities from the perspective of the aged person. It consists of semi-structured questions in each of the eight activities bearing on the aged resident’s use of time, space and assistance. The questionnaire includes questions regarding who determines whether the activity should take place and the time, setting, and amount of assistance necessary for the activity.* Examples of questions are: who determines when you get up during the day? Who determines where you go? Responses to the semi-structured interview schedule were recorded in writing by the investigator at the time of the interview. The content of the responses were subsequently coded by the investigator into categories of “self-determined” and “other-determined” for each activity. Every fifth interview was independently coded by two coders. Product-moment correlation coefficients were calculated for the categorization between the two coders and the investigator. The intercoder reliability was + 1 for the overall category of “self” or “other determination of SCDA for each resident. The intercoder reliability of categorization by activities was + 1 for six of the eight activities: ambulating, eating, dressing, socializing in groups, one to one interaction and solitary activity, for the six residents whose coding was checked. For the coding reliability of the remaining two activities, grooming and toileting, the product-moment correlation coefficient for intercoder reliability was computed at 0.9408. Total overall intercoder reliability for categorization by activity for the six residents yielded a correlation coefficient of 0.9852. Congruence. The occurrence of similar categorization for “expectancy of control” and “situational control.” Congruence existed when an individual scored “internal” for expectancy of control and “self-determination” for situational control; or “external” for expectancy of control and “other-determination” in situational control. 5, Revised Philadelphia Geriatric Center (PGC) morale scale. This is a 17-item instrument which measures an individual’s inner state of satisfaction, of having attained something in life, of fitting in with the environment, and the ability to strive appropriately while accepting the inevitable (Lawton, 1972, 1975). Variables other than those above which were found to be associated with morale in the literature (i.e. race, length of institutionalization) were controlled through sample *The SCDA differs from the functional assessments in activities of daily living (ADL) (i.e. Gurel et al., 1972; Katz et al., 1970; Sarno et al., 1973) in that the ADL measures the actual functional ability whereas the SCDA ascertains the resident’s perception of who determines the time, place and assistance given for the activities. The SCDA also differs from the situational constraint (Wolk and Telleen, 1976) in that the general nature of the questions of the latter failed to tap the measure of constraints in a high constraint setting (skilled nursing facility). The perceived Institutional constraints (Fawcett et al., 1976) focused on changes between one’s own home conditions and those in an institution, whereas the SCDA focused on specific perceptions of all activities occuring in the institutional setting.
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selection.
Sample Selection The sample consisted of 30 subjects who met the following criteria for selection. (1) Were age 65 yr or over as of their last birthdate at the time of interview. (2) Had sufficient energy level to participate in the testing procedure. (3) Were able to read and write English in order to understand the language used by the investigator and in each of the instruments in this study. (4) Were cognitively intact: oriented to person, place and able to give informed consent orally and in writing for participation in the study. (5) Had the potential of being involved in the decision-making process as manifested by their being cognitively intact. (It was recognized that residents differ in their degrees of physical disability, the nature of participation in their daily activities, and the range of the decisions they could make. However, the potential for their involvement was constant.) (6) Had a self-rated health of “fair” on a five-alternative scale. (7) Had no previous admission to the same unit in the selected skilled nursing facility. (8) Had been in the same institution on the same unit for a minimum of two weeks and a maximum of six months at the time he was asked about willingness to participate in the study. (The minimum of two weeks was established in order to allow the respondent an opportunity to experience routines of daily activities. The maximum of six months was established in an attempt to limit the total amount of previous experience in the situation which might have affected the
salience of expectancies in predicting behavior.) (9) Were Caucasian, and had lived most of their lives in the United States.
Pre-testing prior to the study A pre-test was conducted by the investigator with 12 residents prior to the study for the purposes of (1) testing the clarity of both the investigator-constructed questions and the items in the standardized questionnaires for the elderly population from which this sample was drawn and (2) determining the best means of administration in terms of refusal rate and resident preferences in test-taking.
The selling The setting for this study consisted of four institutions which qualified as skilled nursing facilities according to the U.S. Department of Health, Education and Welfare’s standards for certification and participation in Medcare and Medicaid programs (Federal Register, 1974). Two of the facilities were free standing and two were geographically connected to acute hospitals. The capacity of the facilities ranged from 100 to 350 beds; and the size of the particular units where data collection took place ranged from 22 to 62 beds. The interviews were administered individually to all who agreed to participate in the study. During the interview, the items in the standardized scales, as well as the investigatorconstructed items, were read aloud by the investigator. The answers given by the respondents were noted by the investigator in writing at the time of the interview. The standardized scales were administered in an identical sequence to all residents. The open-ended questions were administered last.
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Results and Discussion
Description of the sample
The sample included 10 men and 20 women whose mean age was 78.6 yr and mean period of hospitalization was 44.9 days. The predominance of women in the sample reflected a predominance of women among the elderly in society. All of the respondents had been born in the United States. All the respondents were retired, or currently unemployed outside the home. The typical occupations of the men had been as skilled workers or small business men. Women for the most part were housewives or people who had worked at civil service positions. All of the residents were able to state their names, the names of the institutions and to repeat to the investigator their understanding of the purpose of the study. They all had a self-assessed health of “fair” on a five-alternative scale. No direct measure of socioeconomic status was obtained for the residents. This was not, however, to deny a connection between socioeconomic status and a vast array of other variables. Socioeconomic status is one of a number of background demographic variables which influence the development of one’s locus of control, and perception of events in life. However, differences in perceptions of the residents were the foci of interest in this study, not the antecedent factors leading to the development of expectancies and perceptions. The present study focused specifically on resident perceptions of life events in general and of the resident’s perception of self or other determinations in daily activities, regardless of socioeconomic status. A total of 15 respondents were obtained from the two community skilled nursing facilities and 15 from the two hospital connected ones. The intercorrelation matrix in Table 1 shows that the strongest correlation was between SCDA and morale. Residents who perceived themselves in control of situations tended to have higher morale. Although different instruments were used to assess situational control and resident constraint, results ot the present study support the general notion that significant correlates of life satisfaction vary as a function of residential constraint or control of the residents’ daily live!, (Wolk Table 1. Means, standard deviations and correlation Variable
matrix for all variables
Mean
S.D.
8.97 0.57
3.6 0.5
35.80
6.0
0.0782
0.2405
23.50
7.9
-0.3357
-0.2371
0.0214
Chance
25.03
7.7
-0.2849
-0.3227
-0.3213
Orientation
-0.03
0.9
0.2161
0.1893
0.5848*
0.0773
-0.6949*
Trust _.
29.87
5.0 ..___
0.2843
0.1129
0.0047
0.2560
-0.1171
Morale
SCDA
Morale SCDA Internal Powerful
other
._____-___
.__.-___
Correlation
matrix
0.6370:
Internal
0.3905*
Powerful other
Chance
0.1251 Orientation
*P< 0.05.
and Telleen, 1975; Fawcett eta/., Trust was shown to have a suggesting that those who scored morale. Correlations of internal,
1976). weak but positive correlation with morale (r=0.28), high in trust also had a slight tendency to score high on powerful others and chance with morale were relatively
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low. The high correlation of internal powerful others and chance with orientation (0.58 to -0.69) was expected because orientation was derived from the means and standard deviations of each of the three variables for individual respondents, and represented with a dummy value of + 1 for internal, 0 for powerful other, and -1 for chance orientations. The highest contribution was made by SCDA which was significant beyond the 0.05 level. The first question asked: what is the relative magnitude of the contributions of situational control, generalized expectancies of control and trust in predicting morale in the institutionalized aged? To assess the relative contributions of the independent variables to morale, a regression analysis with forced entry of the variables was performed. It is known that the order of entry in a regression analysis may, to some degree, influence the relative magnitude of the contribution of independent variables to the dependent variable. Therefore, the three independent variables in the present study were entered into separate regression equations, rotating the order of entry. As can be seen in Table 2, SCDA was entered first, trust second and orientation third in one equation (order A). In another equation (order B), trust was entered first, orientation second and SCDA third. Table 2. Summary of regression analysis rotating the order of forced entry of situational control of daily activities, orientation and trust upon morale Order of entry Variable
ABC
R-square
A
change
B
--
C
SCDA
I 3
2
0.4057
0.3431
0.36850
Orientation
3 2
I
0.0095
0.0331
0.0467
Trust
2
I
3
0.0418
0.0808
0.0418
0.4570
0.4570
0.4570
Total
Results indicated that SCDA accounted for 34-40% of the variance depending upon the order of entry (P < 0.0001). Trust accounted for 4.2-8% and orientation of locus of control, 4.7-0.9%. Neither trust nor orientation reached significance due to their entries alone. A total of 45.70% of the variance in morale was accounted for by SCDA, trust and orientation. The low contribution of trust may have been due to the relative lack of privacy during test administration, the eagerness of the subjects to respond in a socially acceptable manner, and the greater number of females than males in the study sample. Rotter’s Trust Scale, from which the SRT Scale used in the present study was derived, showed a correlation with the Marlowe-Crowne Social Desirability Scale of 0.21 for male and 0.38 for female (Rotter, 1967). Since 20 out of 30 subjects in the study were female, social desirability may have played a larger role. The finding that locus of control contributed little to predicting morale scores stands in contrast to previously reported results (Fawcett ef al., 1976; Felton and Kahana, 1974) in which internality or externality was variously correlated with adjustment,.life satisfaction and morale. There may have been many reasons for this: (1) the samples may not have been comparable, (2) predictive validity of the locus of control construct was low when the dependent variable was highly specific (Rotter, 1975), (3) the measurement of locus of control used was different from the ones used in other studies and (4) chance locus of control may have been a temporary state rather than a more enduring personality trait. This
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supports findings of Bielby and Siegler’s (1977) longitudinal study which investigated the stability of locus of control. The range for locus of control stability over time reported for men and women was 0.47-0.65, with the female subsample manifesting less stability than the male subsample. Thus, locus of control was identified as a state-like construct for both men and women (Bielby and Siegler, 1977). The second question examined in greater detail the contributions of the interactive effects of specific factors. The question asked: is congruence between one’s generalized expectancy of control and one’s perception of situational control in the immediate environment a significant factor in predicting morale in the institutionalized aged? First, given an internal orientation, will self-determination in situational control result in higher morale than other-determination situations? A 2 x 2 (I-E by SCDA) analysis of variance was performed to answer this question. As can be seen in Table 3, the morale mean in internal orientation for locus of control, under the condition of “self-determined” situations, was 10.0, and under the condition of “other-determined” the morale mean was 7.286. Although the mean was higher under “self-determined”, the interactikon between orientation and situational control of daily activities did not reach 0.05 level of significance. What did reach significance were the differences between cells for SCDA (“self” and “other determined”), regardless of orientation of locus of control P < 0.00016 as illustrated in Table 4. This may have been a reflection of the elderly in which control in a world-view sense may have been lost, but control of daily activities may have assumed greater significance. Another explanation is that the elderly may have lost a sense of internal control, and developed a chance orientation as a reaction to an illness which resulted in their hospitalization. This notion is further elaborated upon below. Table 3. Morale
means for locus of control (internal, by situational control
external)
Locus of control
Situational
External orientation
Internal orientation
control
Self-determined
(6)*
I I.454 (11)
7.286
5.333
10.000
Other-determined
(6)
(7) *Sample cell size in parentheses.
Table 4. Analysis of variance table of the influence of locus of control (internal, external) by situational control on morale Source of variance
df
Within cells
26
7.826
I
Situational
control
Locus of control Situational
control
I.ocus of control N = 30.
F
Significance
152.949
19.542
0.00016
I
0.061
0.000
0.930
I
20.468
2.615
0.118
Mean square
X
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Next, given an external orientation, will other-determination in situational control result in higher morale than in self-determination situations? In order to address this question, powerful other and chance orientations were collapsed, and called external orientation. Inspection of the morale means in Table 4 indicated that given an external orientation, other-determined SCDA resulted in a score of 11.45. It was obvious that given an external orientation, morale under other-determination conditions did not result in higher morale than under self-determination conditions. On the contrary, self-determination on the average resulted in higher morale for both internal and external orientations of locus of control, as illustrated in Tables 3 and 4. The finding that external (chance) orientation under the condition of perceived selfdetermination of SCDA, or in other words, that incongruence between orientation and SCDA, resulted in higher morale than congruence must be regarded with caution for the following reasons: (1) the sample size and cell sizes were small, therefore, the finding may have been a reflection of characteristics of the particular sample; (2) the finding may have been a reflection of the residents’ reaction to a specific event, such as an accident or illness as being attributed to chance, rather than personal responsibility. That is, the locus of control, particularly the chance dimension, may have been a temporary state rather than a more enduring personality trait. Although locus of control was conceptualized as a fairly enduring personality characteristic derived from a composite of experiences throughout life, a recent study, as mentioned, has indicated that the locus of control may indeed be a state. The residents scoring chance orientation in the present ctudy may have been responding to their specific life situations, such as an accident or illness, as being caused by chance, rather than expressing their world view. Of those who scored a chance orientation, all eight who scored high morale referred to a sudden dramatic event (stroke, accident) which precipitated their hospitalization and subsequent stay in the skilled nursing facility. The dramatic nature of the onset of illness may have emphasized the ‘hand of fate’ or chance factor in determining these residents’ destinies. Three of these respondents stated during the interview, that until the time of the accident (or stroke), they thought they were in control of their lives. Some in the chance group may also have been defensive externals. This would provide further support to the suggestion made over the years (Rotter, 1966; Davis and Davis, 1972; Lloyd and Chang, 1978) that a subgroup of externals exists. Members of this subgroup do not genuinely subscribe to an external belief system, but tend to verbalize an external orientation for its defensive functions. By attributing their illness to chance, individuals may avoid the threat that they may otherwise experience when presented with the idea of an illness (or failure to remain healthy). Conclusion
There has been an increasing demand to improve the quality of life for residents of nursing homes in the United States. The quality of life has been variously defined to include the maintenance of dignity, self-esteem and morale of the residents. Research in aging has found situational Icontrol to be a factor in influencing measures of well being in the institutionalized elderly. Personality factors, such as locus of control, have been found to influence the adaptation of persons in community settings. Its influence on institutionalized elderly, however, has been inconclusive. Trust was examined as a contributing factor to morale in institutional settings. A conceptual framework synthesized
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from existing theories was developed for the examination of selected personality and situational variables affecting morale of the institutionalized aged. A study of 30 residents indicated that situational control of daily activities emerged as the strongest contributor to morale. The results lend support to the notion that selfdetermination in daily activities plays an important role in the morale of institutionalized aged residents. Trust and locus of controi contributed little to the variance in morale, failing to reach the 0.05 significance level. Congruence between locus of control and SCDA did not result in higher morale. This may have been in part due to the chance orientation being subject to change related to the dramatic nature of the residents’ illnesses. With the concept of chance in this population, one needs to separate out that which may be a personality characteristic from that which may be a defense mechanism to explain the occurrence of a specific illness. Further investigations are needed to do this. Further studies are also needed to explore the effect of resident control in aspects of daily care of the institutionalized elderly person. Tentative results from this study suggest that care which allows resident determination of his daily care and activities is the strongest contributor to morale. A resident’s control of his daily activities may be enhanced by creating a more resident-oriented environment and by having increased options for decision making. Care in an institutional setting could be directed toward a consideration of the resident’s wishes and goals in carrying out the activities inherent in a skilled nursing facility. The potentials of the interview guide developed in this study may be explored as one means of assessment in ascertaining an elderly person’s perception of control of his daily activities in skilled nursing and other long term care facilities. It is crucial that research be undertaken to further investigate how the quality of life can be improved for the elderly person requiring long term care. With an increasing number of elderly persons in our society, the improvement of the quality of life for those requiring long term care is essential. Researchers, policy makers, health care professionals and consumers must work together so that long term care will be that which enhances an individual’s morale, sense of dignity, and self-worth. References Bielby, D. D. and Sigler, 1. C. (1977). Internal-external locus of control in middle and late life: the search for construct validation. Paper presented at the 30th annual meeting of the Gerontological Society, San Francisco, California. Coe, R. M. (1965). Self conception and institutionalization. Chapter 15 in A. Rose (ed.), OlderPeople and Their World. F. A. Davis, Philadelphia. Davis, W. L. and Davis, D. E. (1972). Internal-external control and attribution of responsibility for success and failure. J. Personality 40, 123-126. Edwards, J. N. and Klemmack, D. L. (1973). Correlates of life satisfaction: a reexamination. J. Geront. 28, 497-502. Fawcett, G., Stonner, D. and Zepelin, H. (1976). Locus of control perceived, constraint, and morale among institutionalized aged. Paperpresented at the 29th Annual Meeting of the Gerontological Society, New York, New York. Federal Register (1974). Skilled Nursing Facilities: Standards for Certification and Participation in Medicare and Medicaid Programs. Department of Health, Education and Welfare, Social and Rehabilitation Service, Social Security Administration, Washington, D.C., 39 (12), January 17. Felton, B. and Kahana, E. (1974). Adjustment and situationally-bound locus of control among institutionalized aged. J. Geront. 29,295301. Goffman, E. (1961). Asylums. Anchor Books, Double Day, Garden City. Gurel, L., Linn, N. W. and Linn, B. S. (1972). Physical and mental impairment of function evaluation in the aged: the PAMIE scale. J. Geront. 27(l), 83-90.
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2 October 1978)
