Brian D. Individualizing care for older persons depends on knowing about a care recipient's psychosocial preferences. Currently, however, no comprehensive, empirically derived instruments exist to assess these preferences. As part of an effort to develop such an instrument, this pilot study examined the content and structure of psychosocial preferences in older adults using the statistical technique known as concept mapping. Both the dimensions and the content domains provide valuable information for the construction of psychosocial preference instruments.
Trochim has created a computer software package that facilitates the entire concept mapping process, from item generation through reporting, although the statistical procedures themselves are available in most standard statistics packages, including SPSS, which was used here. A Good Lie? This final cluster is named Caregivers and Care. Published Next, participants are instructed to sort items into groups based on their perceived similarity. Figure 3. Stress values for multidimensional scaling solutions of different dimensions. The sorting is done independently by each individual, without consultation with other participants. Autosuggest Results. Morgan E Levine.
Destroyer escort wilmar. LEARNING OBJECTIVES
The jaw may be clenched. Erikson and colleagues already reported that successful balancing of a development stage assists in facilitating the axults stage Psycuo 60 ]. Joan Erikson showed that all the eight stages "are relevant and recurring in the ninth stage". The Health Self Rating was used to measure self-perceived health status. Norton, Therefore, it is important to investigate the recognition process Implanted cd healthy aging and identify the influential factors in healthy Psycho social and older adults at each stage of life. Erikson does note that the time of Identity crisis for persons of genius Psycyo frequently prolonged. The final developmental task is retrospection: people look back on their lives Psycho social and older adults accomplishments. We work with individuals, couples and families to establish a sustainable plan that supports the best interests of each person. Erikson EH.
This study investigates education differences in levels and change in sense of control and hopelessness among older adults.
- Healthy aging includes physical, psychological, social, and spiritual well-being in later years.
- Northern Virginia Older Adult Counseling OAC is a professional health care practice that strives to provide excellent and affordable counseling services to older adults in our community.
- Erik Erikson was an ego psychologist who developed one of the most popular and influential theories of development.
- Describe mental health disorders that may occur in older adults.
If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. This chapter addresses the following Geriatric Fellowship Curriculum Milestones: 1 , 6 , 23 , and Learning Objectives Apply the life course perspective to the aging process to show how the experience of aging depends on cultural factors, such as the conceptualization of the lifespan, as well as lifespan changes in affective experience.
Identify core psychosocial factors and the mechanisms by which they affect health and well-being in older adults. Examine the significance of resilience, the process by which older individuals adapt to challenges associated with disability and declining health. Recognize current trends in common old-age transitions such as retirement, widowhood, and caregiving. Key Clinical Points Lack of support social isolation and loneliness has a negative effect, and social engagement volunteering, lifelong learning, and involvement in intergenerational programs has a positive effect, on health and well-being in old age.
Social environments that promote aging in place support psychosocial health. The aging services network is important in promoting engagement across diverse domains. Hospice supports the psychosocial health of caregivers who provide end-of-life care. As people age they experience changes in physical and cognitive capacities, such as gait speed and reaction time, and also changes in emotional experience and social interests.
Cultures impose an order on this continuum of change in widely shared understandings of the life course, which partition the lifespan into different stages.
The Samia people of Kenya describe old age as a pleasant time to sit before the fire and be fed. Such differences in thinking about the life course remind us that psychosocial aging is governed both by biological and sociocultural elements. A major focus of developmental approaches to psychosocial aging is to distinguish between invariant biological change and cultural constructions that selectively emphasize particular transitions in this continuum of change. For example, in the United States, establishment of the Social Security system linked old age to age This definition of old age is more a product of social perceptions and economic necessity than anything else.
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Sign in via OpenAthens. Sign in via Shibboleth. AccessBiomedical Science. AccessEmergency Medicine. Case Files Collection. Clinical Sports Medicine Collection. Davis AT Collection. Davis PT Collection. Murtagh Collection. About Search. Enable Autosuggest. Previous Chapter. Next Chapter. Albert S. Psychosocial Aspects of Aging. Halter J. Jeffrey B.
Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. Antenatal Cognitive development of infants Positive youth development Young adult Positive adult development Maturity. Published online Mar 7. As in other stages, bio-psycho-social forces are at work. American Journal of Geriatric Psychiatry, 18 4 , — Erikson believes we are sometimes isolated due to intimacy. Factors associated with healthy aging: the cardiovascular healthy study.
Psycho social and older adults. Background
Do you usually take a drink to relax or calm your nerves? Do you drink to take your mind off your problems? Have you ever increased your drinking after experiencing a loss in your life?
Do you sometimes drive when you have had too much to drink? Has a doctor or nurse ever said he or she was worried or concerned about your drinking? Have you ever made rules to manage your drinking? When you feel lonely, does having a drink help? Scoring: A score of 3 points or less is considered to indicate no alcoholism; a score of 4 points is suggestive of alcoholism; a score of 5 points or more indicates alcoholism. From Menninger , J. Assessment and treatment of alcoholism and substance-related disorders in the elderly.
Bulletin of the Menninger Clinic, 66 2 , — The older person who misuses alcohol displays symptoms of confusion, malnutrition, self-neglect, weight loss, depression, and falls. Diarrhea, urinary incontinence, decreased functional status, failure to thrive, and dementia may also be present. Alcohol-induced dementia is caused by long-term excessive alcohol abuse. It typically presents with impaired executive function and significant lack of insight.
This is in contrast to the memory or language problems of dementia. Moos and colleagues conducted a study where participants were followed over a year span.
Indicators of excessive use were past drinking history, reliance on substances for stress reduction, and support of peers in drinking behavior. There is evidence that older adults respond to treatment as well as, if not better than, younger adults. Intentional brief intervention by a health care provider or participation in a group setting can impact older adults to decrease alcohol consumption. Group therapy along with self-help groups like Alcoholics Anonymous can be effective. It is important that health care providers recognize this recovery potential.
Pain is common among older adults and affects their sense of well-being and quality of life. These conditions include arthritis, peripheral vascular disease, and diabetic neuropathy. Pain is also associated with depression. Jann and Slade describe three categories of depressive symptoms: emotional mood, motivation, apathy, anxiety , cognitive concentration, memory , and physical insomnia, fatigue, headache, and stomach, back, and neck pain. Pain can lead to increased stress, delayed healing, decreased mobility, disturbances in sleep, decreased appetite, and agitation with accompanying aggressive behaviors.
Chronic pain can cause depression, low self-esteem, social isolation, and feelings of hopelessness Wynne et al.
There is mounting evidence that treatment of pain improves mood and treatment of mood improves pain. The appropriate assessment and treatment of pain in older adults may have complications. They may believe that pain is a punishment for past behaviors, an inevitable part of aging, indicative of pending death, related to serious illness, expensive to test and diagnose, or a sign of weakness.
External obstacles include inadequate assessment by health professionals, complicated clinical presentation, assumptions by health care professionals that pain is part of aging, and communication deficits due to cognitive impairment. McDonald and colleagues demonstrated that the phrasing of pain-related questions with older adults influenced their report. Changes in behavior may indicate pain and should be assessed, especially in patients who have language impairment e.
Unlike younger adults, older adults may understate pain using milder words such as discomfort, hurting , or aching. Multiple painful problems may occur together, making differentiation of new pain from preexisting pain difficult. Sensory impairments, memory loss, dementia, and depression can add to the difficulty of obtaining an accurate pain assessment.
Interviews with family members, caregivers, or friends may be helpful. When pain is suspected, the nurse begins with a physical assessment for medical origins of the pain and assesses the level of pain.
Respondents are asked to choose the face that depicts the pain they feel. The Pain Assessment in Advanced Dementia PAINAD scale is used to evaluate the presence and severity of pain in patients with advanced dementia who no longer have the ability to communicate verbally Figure The scale evaluates five domains: breathing, negative vocalization, facial expression, body language, and consolability Box The score guides the caregiver in the appropriate pain intervention.
Normal breathing is effortless breathing characterized by quiet, rhythmic respirations. Occasional labored breathing is characterized by episodic bursts of harsh, difficult, or wearing respirations. Short period of hyperventilation is characterized by intervals of rapid, deep breaths lasting a short period of time. Long period of hyperventilation is characterized by excessive rate and depth of respirations lasting a considerable time. Cheyne-Stokes respirations are characterized by rhythmic waxing and waning of breathing from very deep to shallow respirations with periods of apnea.
None is characterized by speech or vocalization that has a neutral or pleasant quality. Occasional moan or groan : Occasional moaning is characterized by mournful or murmuring sounds, wails, or laments.
Occasional groaning is characterized by louder than usual inarticulate involuntary sounds, often abruptly beginning and ending. Low-level speech with negative or disapproving quality is characterized by muttering, mumbling, whining, grumbling, or swearing in a low volume with a complaining, sarcastic, or caustic tone.
Repeated, troubled calling out is characterized by phrases or words being used over and over in a tone that suggests anxiety, uneasiness, or distress. Loud moaning or groaning : Loud moaning is characterized by mournful or murmuring sounds, wails, or laments in a much-louder-than-usual volume. Loud groaning is characterized by louder-than-usual inarticulate involuntary sounds, often abruptly beginning and ending.
Crying is characterized by an utterance of emotion accompanied by tears. There may be sobbing or quiet weeping. Smiling or inexpressiveness: Smiling is characterized by upturned corners of the mouth, brightening of the eyes, and a look of pleasure or contentment.
Inexpressive refers to a neutral, at ease, relaxed, or blank look. Sad is characterized by an unhappy, lonesome, sorrowful, or dejected look. Eyes may be teary. Frightened is characterized by a look of fear, alarm, or heightened anxiety. Eyes may appear wide open. Frown is characterized by a downward turn of the corners of the mouth. Increased facial wrinkling in the forehead and around the corners of the mouth may appear. Facial grimacing is characterized by a distorted, distressed look.
The brow is more wrinkled, as is the area around the mouth. Eyes may be squeezed shut. Relaxed is characterized by a calm, restful, mellow appearance.
The person seems to be taking it easy. Tense is characterized by a strained, apprehensive, or worried appearance. The jaw may be clenched. Distressed pacing is characterized by activity that seems unsettled. There may be a fearful, worried, or disturbed element present.
The rate may be faster or slower. Fidgeting is characterized by restless movement. Squirming about or wiggling in the chair may occur. The person might be hitching a chair across the room. Repetitive touching, tugging, or rubbing body parts can also be observed.
Rigid is characterized by stiffening of the body. The trunk may appear straight and unyielding exclude contractures. Fists clenched are characterized by tightly closed hands. They may be opened and closed repeatedly or held tightly shut.
Knees pulled up is characterized by flexing the legs and drawing the knees upward toward the chest exclude contractures. Pulling or pushing away is characterized by resistiveness upon approach or to care. The person is trying to escape by yanking or wrenching himself or herself free or by shoving you away. Striking out is characterized by hitting, kicking, grabbing, punching, biting, or other forms of personal assault.
No need to console is characterized by a sense of well-being. The person appears content. Distracted or reassured by voice or touch is characterized by a disruption in the behavior when the person is spoken to or touched. The behavior stops during the period of interaction, with no indication that the person is at all distressed. Unable to console, distract, or reassure is characterized by the inability to soothe the person or stop a behavior with words or actions.
No amount of verbal or physical comforting will alleviate the behavior. Scoring: See Figure on p. From Lane, P. Home Healthcare Nurse, 21 1 , Pharmacological pain management relies on the use of prescriptive and nonprescriptive medications, frequently based on the recommendation of the health care provider. The treatment of acute pain is different from the approach for chronic pain. Acute pain can be helped with analgesics, such as opioids, nonsteroidal antiinflammatory drugs NSAIDs , COX-2 inhibitors, and non-narcotic agents, such as tramadol.
Consultation with a pain-management specialist is often helpful with chronic pain syndromes. Some considerations in pharmacological pain management in older adults are listed in Box The current trend is to not utilize opioids for non—cancer-related chronic pain due to strong evidence that the risks are significant, including increased risk of fractures, hospitalization, and mortality. Prescribers also reported concern about abuse of opioids by family and friends.
Compensate for this. Start with one fourth to one half the adult dose and titrate up carefully. Confusion in postoperative patients has been found to be associated with unrelieved pain rather than with opiate use.
Although there is an increased risk of end-stage renal disease with long-term use, it does not produce the gastrointestinal bleeding seen with nonsteroidal antiinflammatory drugs NSAIDs. NSAIDs can have the same effect during their initial period of administration. Avoid the use of meperidine , whose active metabolite may stimulate the central nervous system and lead to confusion, seizures, and mood alterations. If this drug is selected, do not use it for more than 48 hours.
Avoid intramuscular administration because of tissue irritation and poor absorption. Morphine is a safer choice than meperidine because its duration of action is longer, so a smaller overall dose is required.
Psychosocial needs of the older adult. Objectives 1. Discuss facts and myths about aging. Mental health issues related to aging Late-life mental illness Older adults who develop late-life mental illness are less likely than young adults to be accurately diagnosed and receive mental health treatment.
Depression Depression is not a normal part of aging and is often under-identified because of comorbid medical conditions. From Centers for Disease Control. Retrieved from www. Delirium Delirium is a medical condition caused by physiological changes due to underlying pathology. Alcohol abuse Although heavy drinking tends to decline with age, it continues to be a serious problem that can create particular problems for older adults. Problem We know that suicide rates increase dramatically in the white male geriatric population.
Methods Study data were collected from 20 primary care practices in New York City, Philadelphia, and Pittsburgh over a 5-year period. Implications for nursing practice Although elderly patients may not be depressed, assessing for a wish-to-die is an important intervention.
Pain Pain is common among older adults and affects their sense of well-being and quality of life. Barriers to accurate pain assessment The appropriate assessment and treatment of pain in older adults may have complications. Assessment tools When pain is suspected, the nurse begins with a physical assessment for medical origins of the pain and assesses the level of pain.
From Hockenberry , M. Louis, MO: Mosby. We work with individuals, couples and families to establish a sustainable plan that supports the best interests of each person. OAC therapists have experience working with local Community resources and offer informed referrals for services to support older adults where they live. OAC also offers special seminars and classes for groups interested in learning more about quality longevity through cognitive health awareness.
It will change in the fall season of its life cycle and while remaining beautiful, it will also become more fragile — just as older adults in our community will inevitably experience new challenges as they advance in years. Phone: Email: shirley novaolderadultcounseling. Compassionate Northern Virginia Older Adult Counseling OAC is a professional health care practice that strives to provide excellent and affordable counseling services to older adults in our community.
Counseling Mental health psychotherapy is offered for older adults suffering from emotional distress associated with medical and psycho-social challenges in the aging experience. Care Planning OAC specializes in a team approach to Care Planning for older adults and their personal support network.
Resources OAC therapists have experience working with local Community resources and offer informed referrals for services to support older adults where they live.
Cognitive Health Assessments Seminars and Programs. Contact Phone: Email: shirley novaolderadultcounseling.
Brian D. Individualizing care for older persons depends on knowing about a care recipient's psychosocial preferences. Currently, however, no comprehensive, empirically derived instruments exist to assess these preferences. As part of an effort to develop such an instrument, this pilot study examined the content and structure of psychosocial preferences in older adults using the statistical technique known as concept mapping.
Both the dimensions and the content domains provide valuable information for the construction of psychosocial preference instruments. They also might assist formal and informal caregivers in tailoring their interventions to provide individualized care that enhances quality of life for older adults.
Older people with functional limitations often require assistance with a variety of tasks ranging from traditional activities of daily living e. Depending on the nature and extent of their impairment, each individual has a unique pattern of care needs.
So too does each individual have different thoughts and feelings about how those care needs should be met. For example, two people may require a comparable amount of assistance getting dressed, but they may have different thoughts about what time to get dressed, who they want present when they get dressed, and what they prefer to wear.
A recent emphasis in gerontology has been on promoting the perspective of the individual, the care recipient, in the design and execution of personal care e. Indeed, in advocating improvement in nursing home quality, the Omnibus Budget Reconciliation Act OBRA gave a prominent position to resident preferences as a guide to care. Acknowledging that people have unique notions about their care reflects a respect for the individual, an awareness of individual differences, and a sensitivity to the continued importance of choice and autonomy in late life Rodin and Langer Allowing individuals to exercise control in their environment and integrating personal preference into their care are ways to enhance consumer satisfaction and quality of life Kane ; Kane and Kane ; Kearney and McKnight ; Rader and Tornquist One area in which the importance of personal preference has been recognized for some time is in the case of advance directives e.
Senate Special Committee on Aging Advance directives offer individuals the opportunity to plan the kind or degree of medical intervention they would like if at some point they are unable to express their wishes. While the value of documenting aspirations for medical care has been widely acknowledged, relatively little theoretical or empirical work has been done regarding the assessment and implementation of preferences in the area of psychosocial care for notable exceptions see the work of Froberg and Kane ; Kane ; and Kane and Degenholtz Just as people have unique wishes about the medical care they receive, they may have unique wishes about the personal care they receive as they become more dependent on others.
It may be useful to document psychosocial preferences while an individual is capable of expressing them in order to use that information if they are incapable of expressing preferences in the future. Currently, however, few empirically derived instruments exist to help caregivers assess psychosocial preferences or broad qualities of a person that might be important to how care is planned or delivered.
Without such a tool, care decisions often are based on a best guess about what an individual might like, particularly if they are unable to express their preferences directly. Or, more often, care is provided using a "cookie cutter" approach in which two or three standard service plans are used regardless of personal preferences Kane Previous assessments of preferences in older adults have been limited to important but brief appraisals of personal values e. Brennan, Moos, and Lemke developed a questionnaire to assess preferences for policies and services in group residential settings, but questions on the instrument were framed in terms of broad communal policy e.
The authors did suggest, however, that the instrument could be used to compare current policies with residents' preferences when deciding whether a particular care setting was appropriate for a resident.
A comprehensive, person-specific assessment is necessary in order to individualize care in all the realms in which it might be needed. With little yet known about how to make such an assessment, significant conceptual issues exist.
One consideration in the assessment of psychosocial preferences is whether there are overarching domains or content areas in which preferences are organized. For example, preferences regarding social activities might be distinct and qualitatively different from opinions about more solitary leisure activities. Similarly, individuals might have a collection of opinions that focus on family involvement in caregiving, which could be distinct from their preferences regarding professional caregivers such as physicians, home health aides, or nursing home staff.
Currently, little is known about the breadth of people's preferences and whether those preferences fall into cohesive categories.
Knowledge about categories of preferences could help guide the construction of preference instruments and the implementation of program and care plans. A second consideration concerns the specificity of preferences. In their study of community-dwelling elders, Degenholtz and colleagues identified broad domains of preferences related to care e. Domains of preferences could be arranged, of course, in almost infinite detail.
Preferences regarding apparel, for instance, could be divided into preferred clothing for warm weather and preferred clothing for cool weather.
Warm weather clothing, in turn, could be divided into preferred clothing for casual occasions and preferred clothing for special occasions, and so on. There is clearly a limit to the specificity that is feasible in an assessment, just as there are limitations in terms of the accommodation to preferences in actual care settings. Theoretically, one could sketch out preferences regarding every aspect of every minute of the day, but the burden of documenting that detail would be great, and the reality of most caregiving environments would prohibit its implementation.
A third issue is whether some preferences are more important than others. Holmes and colleagues asked nursing home clinical staff, administrative staff, and families of residents with Alzheimer's disease to rate the importance of attributes of special care units.
They found a limited range but definite hierarchy of what people thought was important in special care units. In a study of community-dwelling elders receiving case management services Degenholtz et al. Here, too, a definite hierarchy emerged. These results suggest that personal significance might vary across domains of preferences e.
All items in an assessment of preferences may have some worth, but certain items may have higher priority. Importance rankings could be useful in prioritizing care planning and guiding interactions between care providers and care recipients. The current study grew from the idea that knowing psychosocial preferences is an essential component in providing respectful, individualized personal care. Because little is known about the breadth or organization of preferences, we sought to explore aspects of everyday life that older people consider important and how those aspects are organized.
The statistical approach known as concept mapping was used as a data-gathering and analytic technique to investigate, in a preliminary manner, the structure and pattern of psychosocial preferences.
What follows is a brief review of concept mapping. For additional details readers are referred to works by Trochim and Linton and Trochim a. As its name suggests, concept mapping is a data analytic approach that produces a pictorial representation—literally a map—of items, ideas, or concepts.
Like a traditional geographical map, a concept map portrays how close i. Items that are close to one another on the map were rated as similar, and those far from one another were rated as dissimilar. The value of this type of analysis is that it allows investigators to explore interrelationships among items and thereby refine a theory, with the assistance of a picture.
Concept mapping has been used to address a wide range of issues including social service planning and implementation Galvin , mental health programming Trochim, Cook, and Setze , articulation of the facets of special care units Holmes et al.
Concept mapping involves a series of data gathering steps that yield a number of products. Item generation can occur through a brainstorming process, a literature review, or even a qualitative analysis of transcripts. Next, participants are instructed to sort items into groups based on their perceived similarity. The sorting is done independently by each individual, without consultation with other participants.
No explicit guidelines are provided about the strategy they should use for sorting; participants can create any number of groups and can place any number of items in each group.
The only definitive instructions are that each item must appear in a group, and each item can appear in only one group. The purpose here is to provide a relatively open-ended task that enables participants to impose on the items the structure that is intuitive to them.
In this way investigators can learn how people naturally organize items into conceptual categories. Next, each item is rated, usually on a Likert-type scale, in terms of its importance to the concept under consideration. Finally, as an optional step, participants name each group to indicate what the group represents to them. In the matrix, a 1 is entered when two items have been sorted by the participant into the same group, 0 if the two items were sorted into different groups.
A total similarity matrix for all participants is constructed by summing the values in each individual matrix. In the total similarity matrix, where M equals the total number of participants, the value of any cell can range from 0 two items were sorted together by none of the participants to M two items were sorted together by all of the participants.
The total similarity matrix provides the data for subsequent statistical analyses. The first step in the statistical analysis is a nonmetric multidimensional scaling MDS of the total similarity matrix. This analysis generates a concept map that is a visual representation of similarity: Items that were sorted together frequently appear closer to one another on the map, whereas items sorted together less frequently appear farther from one another on the map.
Qualitative interpretation of the concept map involves a examining the content of items and their relative positions on the map to determine if there is some underlying thematic organization to the items, and b exploring opposite sides of the map to detect unifying dimensions that may describe the basis of item similarity. Next, the two-dimensional concept map itself provides xy coordinates that are the input for a hierarchical cluster analysis.
In this analysis items are grouped into non-overlapping clusters, which are interpreted for conceptual significance. Finally, importance ratings for the items are reviewed. The purpose of this pilot study was to use concept mapping to derive an empirical structure for the psychosocial preferences of older adults. Knowing more about domains of preferences and their ranked importance would a help guide how to structure assessments of preferences, and b provide preliminary information relevant to clinical intervention.
For this study, items for concept mapping were generated from a number of sources. First, an extensive literature review was conducted to identify scales and theories that described areas in which preferences might exist. Second, focus groups were held with older individuals at three senior centers, two assisted living facilities, and one nursing home to generate additional areas of preference that older individuals felt were important for the satisfaction of their everyday needs and the maintenance of a good quality of life.
Because the ultimate goal was to apply preference measurement to frail elders, item content excluded preferences regarding activities that demand full physical vigor or those identified strongly with the interests of young cohorts. These efforts yielded approximately items; see Note 2, B. In the case of medical directives, a number of authors have emphasized that an assessment of broad values may be useful in addition to an investigation of preferences in specific situations Cox and Sachs ; Lambert, Gibson, and Nathanson Consequently, using level of specificity as a demarcation, questions were divided into two categories: broad items that explored a general area, and nested items that addressed precise preferences within a general area.
An example of a broad item was, "I enjoy reading," and one of its nested items was, "At what times of day do you enjoy reading? Those 80 items served as the items for concept mapping. The nested items of them were not analyzed in this study but were retained for use in another pilot project. Twenty-eight individuals were contacted to participate in this pilot study.
All were over age 60 with established records of research and service in the area of gerontology. Older gerontologists were sought for participation because of their simultaneous perspectives as older individuals and scientific experts.
Although the participants in this pilot study represented a select group of individuals and therefore a limited perspective on elder preferences, they were thought to have personal insight into late life as well as professional experience with the issues of importance to elders. Of the 28 individuals contacted, 20 11 men and 9 women provided completed protocols.
This sample size is comparable to those used in other studies employing concept mapping see Trochim b. Participants were mailed an introductory letter and instructions for the concept mapping procedure. Along with the instructions were 80 index cards, and on each was printed one of the 80 broad preference items. Participants were instructed to sort the items into groups that reflected areas of preferences for everyday living.