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. Author manuscript; available in PMC: 2021 May 1.
Published in final edited form as: Clin Gerontol. 2019 Aug 27;43(3):340–349. doi: 10.1080/07317115.2019.1656696

Reliability and Validity of the Adult Hope Scale among Nursing Home Residents with and without Cognitive Impairment

Diana DiGasbarro a,*, Allison Midden b, Kimberly VanHaitsma c, Suzanne Meeks a, Benjamin Mast a
PMCID: PMC7133019  NIHMSID: NIHMS1540096  PMID: 31453758

Abstract

Objectives:

The current study aims to examine the reliability and validity of the Adult Hope Scale among older adults with and without cognitive impairment who were recently admitted to a nursing home.

Methods:

Sixty-four recently admitted nursing home residents, 32 of whom had cognitive impairment, were administered the Adult Hope Scale and measures of concurrent and divergent validity.

Results:

In this sample the Adult Hope Scale demonstrated good to excellent reliability. The Adult Hope Scale also correlated as expected with measures of concurrent and divergent validity, thus supporting the validity of the scale to measure hope in older adults despite level of cognitive functioning.

Conclusions:

This study shows that the Adult Hope Scale is a reliable and valid measure of hope in this sample of older adults with and without cognitive impairment who were recently admitted to a nursing home. Given the small sample size, additional research on the psychometrics properties of the utility of the Adult Hope Scale in older adults with and without cognitive impairment is warranted.

Clinical Implications:

These preliminary findings allow future researchers and clinicians to consider administration of the Adult Hope Scale to individuals with and without cognitive impairment living in long-term care facilities. Gathering additional data on the psychometrics of this measure will enable new directions in research involving self-report measures for older adults with cognitive impairment, and in the development of interventions involving hope to improve physical and mental health in long-term care residents.

Keywords: hope, older adult, cognitive impairment, long-term care

Introduction

Hope is a construct that has received increased attention in recent decades alongside growing interest in the relationship between health and psychological well-being. In 1991, Snyder et al. proposed one of the most widely studied conceptualizations of hope. Snyder’s (1991) theory is a cognitive model of hope as a stable trait centered on goal pursuit and built upon two components: pathways and agency. The pathways component describes the ability to produce a plan to achieve a goal, while the agency component describes an individual’s perception that they are capable of achieving their goals. Snyder’s model of hope has been compared to theories of optimism, self-efficacy, self-esteem, and problem solving, although it is distinct from each of these constructs (Snyder, 2002). In research, hope has been found to correlate positively with optimism, positive affect, self-esteem, and problem-solving confidence. It has negative associations with negative affect, depression, and psychopathology (Snyder et al., 1991). Hope is thus a construct that encompasses the ability to create and strive towards goals, a positive outlook for the future, and belief in one’s own abilities to achieve their goals.

In conjunction with this theory of hope, Snyder created a self-report measure of hope, the Adult Hope Scale (AHS) (Snyder et al., 1991). The AHS is a reliable and valid measure of hope as a stable trait in the general adult population (Snyder et al., 1991; Snyder, 2002). It has been used in studies examining academic outcomes, psychopathology, pain, lung cancer symptoms, visual impairment, marital status, normal aging, suicidal ideation, and more (Bailey & Snyder, 2007; Berendes et al., 2010; Jackson, Taylor, Palmatier, Elliott, & Elliott, 1998; Snyder, 2002; Wrobleski & Snyder, 2005). Many of these studies examined the association of hope with factors that include symptoms endorsed by patients, health and functional outcomes, and well-being. Measuring hope may thus shed light on reasons for individual differences in domains like health, psychological and social well-being, and mental health. Research into hope’s relationship with health-related outcomes especially may inform interventions that utilize or target hope in order to improve physical and mental health in patients (Snyder, Lehman, Kluck, & Monsson, 2006). For example, Luo et al. (2016) found that increasing hope, especially the agency construct within Snyder’s model of hope, may bolster protection against suicidal ideation, as hope was correlated negatively with suicidal ideation and positively with reasons for living. It is therefore crucial that a reliable and valid measure of hope, such as the AHS, exists.

Snyder’s theory and the AHS have been used with community-dwelling older adults to examine hope and its relationship to several variables including physical and mental health outcomes, the directionality with positive and negative affect, depressive symptoms and functional impairment, and medical burdens and obstacles (Barnett, 2014; Ferguson, Taylor, & McMahon, 2017; Hirsch, Sirois, & Lyness, 2011; Wrobleski & Snyder, 2005). For example, Hirsch, Sirois & Lyness (2011) found that hope mediates the relationship between functional impairment and depression in older adults. In terms of interventions targeting hope in older adults, several smaller studies have found that interventions to increase hope through brief training sessions are effective in increasing hope and quality of life (Staats, 1991; Herth, 2000; Duggleby et al., 2007).

However, no studies to date have examined the AHS among older adults living in long-term care. Due to the major changes and adjustments that accompany moving to a nursing home, hope is a potentially rich area of study and intervention for older adults living in nursing homes. Given that many older adults living in nursing homes may have functional impairment, medical illness, and are at higher risk of depression, better understanding of how trait-level hope interacts with physical and psychological health can lead to the development of interventions designed to target hope in a long-term care setting (Thakur and Blazer, 2008). With over 1.3 million nursing home residents in the United States, there is a need for research on the reliability and validity of hope scales such as the AHS in older adults living in nursing homes (National Center for Health Statistics, 2017).

The AHS has not been studied in older adults with cognitive impairment despite growing interest in person-centered care and the development of self-report measures that can be completed by older adults with cognitive impairment. While in the past it was assumed that people living with dementia, for example, were not reliable sources of information, more recent studies have found that important information may be overlooked when the person with dementia’s perspective is not assessed (Mast, Shouse, & Camp, 2015; Reamy, Kim, Zarit, & Whitlatch, 2011). Although patient self-report, caregiver, and clinician ratings often differ, there is also evidence that some self-report measures completed by people living with dementia match clinician ratings (Arlt, Hornung, Eichenlaub, Jahn, Bullinger, & Petersen, 2008). These more recent findings indicate that self-report measures can be clinically useful, reliable, and valid in older adults with cognitive impairment. It is important to determine the reliability and validity of self-report measures in people with cognitive impairment so that researchers and clinicians know which self-report measures are appropriate for use with older adults with cognitive impairment. Specifically, the ability to measure hope in older adults with cognitive impairment is necessary for researchers to understand if hope interacts with functional impairment, depression, and health outcomes in older adults with cognitive impairment in the same way it does in older adults without cognitive impairment.

While there are other conceptualizations and measures of hope, such as the Herth Hope Scale (Herth, 1991), the current study focuses on assessing Snyder’s conceptualization and measurement of hope using the AHS. The first aim of this study was to assess the reliability and validity of the AHS in older adults recently admitted to a nursing home. The second aim was to assess the reliability and validity of the AHS in older adults with varying levels of cognitive functioning. This study also explored if level of cognitive functioning affects hope in older adults recently admitted to a nursing home.

We expected the AHS to be a reliable measure of hope in older adults recently admitted to a nursing home despite cognitive impairment. Additionally, we expected that the AHS would demonstrate concurrent validity as a measure of hope in this population as indicated by moderate to high correlations with constructs associated with hope: affect, optimism, and quality of life. While hope may be influenced by medical burden and cognitive functioning, it is a theoretically unrelated construct. Thus, we predicted that the AHS would demonstrate divergent validity by showing lower correlations with medical burden and cognitive functioning.

Methods

Sample

The methodology and sample of this study have been described previously (Meeks et al., 2016) and here we highlight key features. The sample, recruited for a prospective study of newly admitted long term care residents, was from 13 nursing homes in the Louisville, KY metropolitan area; nursing home social services departments provided the researchers with a list of all new admissions, along with health information relevant to inclusion/exclusion criteria. Research assistants approached the residents for consent within 30 days of admission if they met inclusion and exclusion criteria. The sample included 66 participants who were (1) being age 55 or older and (2) admitted for a long-term stay or transferred from acute rehabilitation to a long-term stay within the previous 30 days. Exclusion criteria consisted of English proficiency, hearing, or verbal response capabilities being too limited for an in-person interview, if residents were unable to answer study questionnaires due to severe cognitive impairment, or if they had unstable or terminal medical conditions.

Measures

Adult Hope Scale (Snyder, 2002; Snyder et al., 1991) was designed to measure dispositional hope. The scale consists of eight self-rated items falling on two empirically validated subscales, Agency Thinking and Pathway Thinking (4 items each, score 1–4 each). In a prior study with adults, the internal consistency ranging from .63 to .86; full-scale alphas ranged from .74 to .88 (Snyder, 2002). The full AHS and its scoring instructions can be found in Snyder, 1991 and is freely available online.

Several measures were used to help establish the concurrent validity AHS in this sample:

The Quality of Life-AD scale (Qol-AD; Logsdon, Gibbons, McCurry, & Teri, 2002) is a 13-item self -report instrument designed for persons with cognitive impairment. Scores range from 13 to 52, with higher scores indicating better quality of life. Responses are structured in a four-choice format (poor to excellent). The scale demonstrated good internal consistency (alpha = .88), test–retest reliability (ICC = .76), and good validity as indicated by lower correlations with depression, and higher correlations with day-to-day functioning and activity levels (Logsdon et al., 2002).

Dispositional optimism was measured with the Life Orientation Test – Revised (Scheier, Carver, & Bridges, 1994). The LOT-R consists of six items rated on a 5-point scale. It can be coded as an overall optimism scale, or scored in two subscales, optimism and pessimism, which is how we treated it in this study. Each scale range was 3–15. The LOT-R has been used extensively in social psychology and health psychology research and correlates with a host of positive and negative mental health indicators, even controlling for neuroticism, trait anxiety, self-mastery and self-esteem (Scheier et al., 1994).

Positive and negative affect were measured with the Philadelphia Positive and Negative Affect Rating Scale, which is a modification of the Philadelphia Geriatric Center Positive and Negative Affect Rating Scale (ARS; Lawton, Kleban, Dean, Rajagopal, & Parmelee, 1992). This scale contains five ratings for positive affect (energetic, interested, warmhearted, happy, and content) and five ratings for negative affect (depressed, sad, worried, annoyed, and irritated). Items are rated from 1 (not at all) to 5 (very strongly) in response to the probe “how are you feeling right now?” An examiner read the items aloud and presented them visually at the same time (Lawton, Van Haitsma, & Klapper, 1996).

Cognitive impairment was evaluated using the Mattis Dementia Rating Scale −2 (Jurica, Leitten, & Mattis, 2001), which is a broad measure of cognitive functioning for use among patients with dementia. The MDRS has good clinical utility for detecting cognitive impairment in frail geriatric patients (Mast, MacNeill & Lichtenberg, 2000; Shay, Duke, Conboy, & Harrell, 1991; Vitaliano et al., 1984). Higher scores indicate better overall cognitive functioning. In the current sample, those with a MOANS age-scaled score below 6 were considered cognitively impaired and those with scores of 6 or higher were considered not impaired. MOANS scaled scores less than 6 reflect performance at or below the 5th percentile for their respective age group and greater than 1.5 standard deviations below age group means, both of which are often used as an indicator of clinically significant impairment (Jurica et al., 2001).

Medical illness was assessed via the Cumulative Illness Rating Scale for Geriatrics (CIRS-G; Miller & Towers, 1991), a widely used clinician-rated scale of health status among frail older adults. The CIRS has been shown to correlate with medication use and disability, and to predict mortality, hospitalization, and disability (e.g., Borson, Scanlan, Lessig, & DeMers, 2010; Parmelee, Thuras, Katz, & Lawton, 1995). In our study, a licensed registered nurse with training and supervision from a study physician completed the CIRS-G. We used a severity score calculated by dividing the total score by the number of categories scored greater than 0.

Procedures

The Institutional Review Board of the University of Louisville reviewed and approved all procedures, protocols, and forms. Residents were referred for recruitment by the social service departments at the facilities. Research staff approached eligible residents to ask them to participate. After being tested for ability to give consent, residents consented, declined, or assented to having their responsible party provide consent by proxy when they were deemed too impaired to provide their own consent. The baseline assessment began within one week of consent.

Statistical analysis

Reliability and validity analyses were conducted using SPSS 25. Internal consistency was measured for the full AHS and the subscales using Cronbach’s alpha. Validity of the AHS as a measure of hope in older adults with and without cognitive impairment was examined with Pearson’s r correlations between the AHS and QoL-AD, LOT-R, and ARS. Divergent validity predictions were low correlation between AHS and CIRS. Item level analysis was conducted using the graded response model. The graded response model (GRM; Samejima, 1969) was selected as an IRT analysis technique because it is specifically designed for use with polytomous items; it is a two-parameter model that estimates both difficulty and discrimination parameters. All GRM analyses were conducted in Mplus, Version 7 (Muthén & Muthén, 1998-2012). For each item, discrimination parameters and difficulty parameters were analyzed to examine item properties and identify the most useful items reliably measuring the trait of hope. The parameter estimates were based on a logit link, the latent scales were identified with a mean of 0 and a variance of 1, and the MLR estimator was used.

A high discrimination value means that the probability of endorsing an item increases more rapidly as the latent trait increases. Baker (2001) suggested ranges to evaluate discrimination parameters: 0.01 to 0.24 as very low, 0.25 to 0.64 as low, 0.65 to 1.34 as moderate, 1.35 to 1.69 as high, and greater than 1.70 as very high. Though there is no gold standard, we considered those items with very high or high discrimination values as those most effective at measuring hope.

Difficulty parameters in GRM are comparable to the difficulty parameter in IRT analyses of dichotomously scored items; an item’s difficulty parameter in GRM is equal to a threshold divided by the discrimination parameter. The number of difficulty parameters (bj) per item is equal to one less than the number of response options. Thus, since each AHS item has four response options, there are three difficulty parameters per item. GRM difficulty parameters reflect the trait level at which an individual has a 50/50 chance of moving from a less frequent response option (e.g., “3. Slightly True”) to a more frequent response option (e.g., “4. Mostly True”). The higher the difficulty of a response option, the higher on the trait level the person must be to endorse that option.

Results

Two participants did not complete the Adult Hope Scale, leaving a final sample of 64 older adults. The mean age of participants was 74.45 years old (SD=10.49) with ages ranging from 54 to 91 years old. The mean number of years of education in this sample was 11.45 (SD=2.70). Of the 64 participants, 43 were female. Fifteen African American older adults participated in the study, while the remaining 49 participants were white. MDRS Total Scaled Scores were available for 61 participants; of those 61 older adults, 32 had impaired cognitive functioning as defined by a total scaled score below 6 on the MDRS. Participants were considered to have no impairment if their scaled score on the MDRS was above 6.

An independent samples t-test examined whether hope differed between participants with and without cognitive impairment. There was no significant difference (t(54.901)=1.794, p=.078) between mean scores on the AHS between older adults with and without cognitive impairment.

Reliability

The internal consistency of the full AHS was excellent when administered to older adults recently admitted to a nursing home (see Table 1). The two subscales of the AHS had good internal consistency. Analysis showed that the AHS had good reliability among older adults without cognitive impairment and excellent reliability among older adults with cognitive impairment. The pathways and agency subscales also had excellent internal consistency in the group with cognitive impairment, but only moderate internal consistency in the group without cognitive impairment.

Table 1.

Descriptive Statistics and Internal Consistency of the Adult Hope Scale in Older Adults Recently Admitted to a Nursing Home.

Full Sample (N=64) No Impairment (n=29) Cognitive Impairment (n=32)
Total Scale
M 24.75 25.76 23.34
SD 5.45 4.21 6.19
Cronbach’s α .853 .739 .885
Agency Subscale
M 12.36 12.59 11.88
SD 3.14 2.75 3.47
Cronbach’s α .777 .611 .854
Pathways Subscale
M 12.37 13.10 11.47
SD 2.84 2.04 3.28
Cronbach’s α .776 .635 .797
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Note. There was no significant difference between mean AHS scores when comparing older adults with no impairment to those with cognitive impairment (t(54.90)=1.794, p=.078).

Validity

In the full sample of recent nursing home residents, the AHS demonstrated a significant positive association with positive affect. The AHS showed a significant negative association with the LOT-R, which is scored so that lower scores indicate greater levels of optimism. Thus, this correlation shows that higher levels of hope were associated with higher levels of optimism. Quality of life was also significantly positively correlated with the AHS.

For older adults without cognitive impairment, a non-significant, moderate, positive correlation was detected between positive affect and the AHS. The AHS and the LOT-R were significantly negatively correlated, meaning that higher levels of optimism were associated with higher levels of hope. There was also a significant, positive correlation between quality of life and the AHS.

The correlations between measures of psychological well-being and the AHS in the sample of older adults with cognitive impairment were similar to those found in the sample of older adults without cognitive impairment. There were positive but non-significant correlations between the AHS and positive and negative affect. Optimism and quality of life were both significantly correlated to AHS, with greater levels optimism and higher quality of life associated with greater levels of hope.

Divergent validity was tested by comparing measures of medical burden and cognitive impairment to the AHS in samples of older adults with and without cognitive impairments. In the full sample, all correlations between the AHS and measures of medical burden and cognitive functioning were small and non-significant.

Among participants without cognitive impairment, medical burden had a small, non-significant correlations with the AHS. Cognitive impairment as measured by the MDRS Total Scaled Score had a small, non-significant, negative correlation with the AHS.

In this sample of older adults with cognitive impairment, associations between the AHS and medical burden and cognitive functioning were small and non-significant.

Item Level Analysis

One discrimination parameter (a) was determined for each item. The discrimination parameter describes how well an item can distinguish between individuals with different levels of hope. Items 2, 3, 5, and 8 achieved very high discrimination (a ≥ 1.839) and items 1, 4, 6, and 7 achieved high discrimination (1.369 ≤ a ≤ 1.572; see Table 3).

Table 3.

Item Response Theory Calibration for Adult Hope Scale (AHS) Items

AHS Item Discrimination a Difficulty b1 Difficulty b2 Difficulty b3
Item 1—many ways out of a jam* 1.57 −2.65 −1.61 0.81
Item 2—energetically pursue goals** 2.04 −2.45 −1.44 1.04
Item 3—lots of ways around a problem** 1.84 −3.90 −2.06 0.01
Item 4—many ways to get important things* 1.37 −3.15 −1.69 1.10
Item 5—when others are discouraged, I can solve problems** 2.45 −4.76 −2.30 1.05
Item 6—past experiences prepared me well for future* 1.49 −2.89 −1.72 −0.06
Item 7—been pretty successful in life* 1.54 −3.30 −2.25 −0.34
Item 8—meet goals set for myself* 2.16 −3.00 −1.59 1.17
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Note. N=64.

*

denotes items with high discrimination

**

denotes items with very high discrimination according to Baker’s (2001) criteria.

The difficulty parameters of all items were reviewed at each response level to identify the range of hope each item measured. The difficulty parameters for each of the 8 AHS items increase in the expected direction (i.e., more hope is required to endorse each advanced response option along the Likert scale) and address a range of hope levels (4.764 ≤ b ≤ 1.096), though lower hope seems to be better measured than higher hope (see Table 3).

Discussion

The first aim of this study was to assess the reliability and validity of the Adult Hope Scale among older adults recently admitted to a nursing home. The second aim of this study was to assess the reliability and validity of the scale among older adults with cognitive impairment. The internal consistencies of the full scale and the pathways and agency subscales among the full sample were high, indicating excellent reliability. The internal consistency values found in this sample are similar to previously reported internal consistencies of the scale and subscales among the general population (Snyder et al., 1991) and community-residing older adults (Hirsch et al., 2011; Barnett, 2014; Ferguson et al., 2017). The results of the IRT analysis found that the AHS demonstrated expected discrimination and difficulty parameters for a scale that is purported to measure hope, with higher scores indicating greater levels of hope. The reliability and IRT analyses indicate that the AHS is in fact a reliable measure of hope in older adults who are admitted to long term care facilities.

The correlations between the AHS and measures of psychological well-being supported the concurrent validity of the AHS as a measure of hope despite cognitive impairment of participants in this sample. Positive affect had a significant positive correlation with the AHS in the full sample. Previous research has reported correlations of similar magnitudes between measures of positive affect and the AHS (Snyder et al., 1991). Negative affect had a small, non-significant correlation with hope, which also replicates previous findings (Snyder et al., 1991); previous research suggests that hope is related to both positive and negative affect but is a separate construct, and our findings support this pattern of validity for older adults who are in long term care.

In further support of the concurrent validity of the AHS, optimism and quality of life were significantly associated with hope in the full sample. The correlation between the AHS and the LOT-R optimism scale is similar in magnitude to that reported by Snyder and colleagues (1991) in their original validation of the scale among younger adults, specifically college students and people receiving inpatient and outpatient psychological treatment. Hope and optimism are theoretically related, and scores on measures of hope and optimism should be correlated (Snyder, 2002). However, hope is distinct from optimism. Snyder’s (2002) theory of hope emphasizes pathways and agency equally, while optimism may focus more on agency. That hope was moderately associated with optimism in this sample supports the validity of the AHS as a measure of something related to—but distinct from—optimism for older adults who reside in nursing homes.

This study also found that greater quality of life was associated with higher levels of hope. Hope and quality of life have previously been linked as related but not identical constructs (Bailey, Eng, Frisch, & Snyder, 2007). The results of the current study support these findings and provide further evidence of concurrent validity of the AHS.

Conversely, the correlations between the AHS and measures chosen to demonstrate divergent validity—medical burden and cognitive functioning—were generally low in the full sample. Cognitive functioning was also not associated with the AHS. These results support the divergent validity of the AHS, as we did not expect there to be strong relationships between medical burden, cognitive functioning, and hope. Overall, the AHS demonstrated the expected pattern of correlations with other measures, supporting the assertion that the AHS may be used to assess hope in individuals newly admitted to nursing homes.

The reliability and validity of the AHS in participants with and without cognitive impairment were very similar. The full scale and pathways and agency subscales demonstrated moderate to good reliability for the sample of older adults without cognitive impairment, and good to excellent reliability in the sample of older adults with cognitive impairment. The patterns of correlations found between AHS and other study measures were also similar to those found in the full sample of recent nursing home residents. The correlations between positive affect and the AHS in the sub-sample analyses did not reach significance, but this may be attributable to small sample sizes; the magnitude of the correlations was similar to those found in previous research (Snyder et al., 1991). As in the full sample, the strongest sub-group analysis correlations were between the AHS and a measure of optimism, and a measure of quality of life; relationships between the AHS and measures of medical burden and cognitive functioning were all small and non-significant. The AHS correlated as expected with these unrelated measures, meaning that the AHS measures a specific trait and is not so sensitive as to correlate with any scale completed by older adults with cognitive impairment. These findings all support validity of the AHS as a measure of hope in older adults regardless of cognitive impairment, albeit sample sizes of older adults with cognitive impairment and without cognitive impairment in this study were small. These results suggest that the AHS shows promise as a reliable and valid measure of hope in older adults with cognitive impairment, which is relevant to growing interest in research on hope and dementia (Wolverson, Cooke, and Moniz-Cooke, 2010; Stoner et al., 2017).

Limitations

It should be noted that the AHS used in this study was administered according to the original development of the scale, where response options are on a 4-point Likert scale. Some of the research conducted on the AHS has used a version with an 8-point Likert scale response frame. The 4-point Likert scale response frame was deemed more appropriate for use in this study on older adults with and without cognitive impairment, and while not necessarily a limitation, the current findings on reliability and validity may not be the same when researchers or clinicians use the 8-point Likert scale version of the AHS.

A major limitation of this study is the small sample size and thus the generalizability of these findings. Analysis of the full sample included only 64 participants, while analyses divided by presence of cognitive impairment reduced the sample size even further. Additionally, not all participants included in the study completed the positive and negative affect measures; twenty older adults without cognitive impairment and thirteen older adults with cognitive impairment completed these measures. Despite the small sample size, reliability coefficients and tests of validity were similar to those reported in larger studies examining the psychometrics of the AHS in the general adult population. While this study cannot definitively conclude that the reliability and validity of the AHS found in this sample will apply to all older adults residing in long-term care, it does provide promising results regarding the use of this measure and encourages further research on the AHS in older adults in long-term care despite cognitive impairment status.

A second limitation and topic of further research is the reliability and validity of the AHS as a measure of hope in a more diverse population of older adults in long-term care. A requirement of the current study was that participants had the ability to provide responses during a lengthy verbal interview, which necessarily excluded those individuals with severe cognitive impairment and resulted in a sample that is not fully representative of the range of cognitive impairment experienced by older adults. Future research should determine at what level of cognitive impairment the AHS is no longer a reliable and valid measure of hope. Furthermore, all participants resided in nursing homes in the Louisville area, and White older adults were overrepresented in the sample. To ensure the AHS is a reliable and valid measure of hope among all older adults, analysis of the psychometrics of this measure administered to a more diverse sample is necessary.

In conclusion, the Adult Hope Scale was found to be a reliable and valid measure of hope in this sample of older adults recently admitted to a nursing home. This study also showed promising evidence that the Adult Hope Scale can be used to assess hope among older adults with cognitive impairment. Assessment of hope in this population may provide clinicians working with older adults in long-term care with an additional target of intervention when attempting to improve quality of life and protect against depression and suicidal ideation. In the context of increasing interest in self-report measures for older adults with cognitive impairment, the results of this study offer evidence that older adults with cognitive impairment can provide reliable and valid information about their own levels of hope when given the Adult Hope Scale by clinicians or researchers. The ability to accurately measure hope in older adults who have recently moved into a nursing home, despite their cognitive functioning, is important in tracking well-being and planning interventions for physical and mental health, and for learning more about how hope interacts with the experiences of older adults living in nursing homes.

Table 2.

Correlations between Adult Hope Scale and Measures of Concurrent and Divergent Validity

Adult Hope Scale
Full Sample (N=64) No Impairment (n=29) Cognitive Impairment (n=32)
Concurrent Validity
Positive Affect .393* .376 .371
Negative Affect .146 .344 .047
Optimism −.548** −.433* −.555**
Quality of Life .552** .477* .615**
Divergent Validity
Medical Burden −.109 −.082 −.181
DRS-2 Total Scaled Score .168 −.010 −.007
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Note. Full sample n=33 for positive and negative affect correlations. For participants with no cognitive impairment, n=20 for positive and negative affect correlations. For participants with cognitive impairment, n=13 for positive and negative affect.

*

p<.05

**

p<.01

Clinical Implications.

  • Researchers can consider use of the Adult Hope Scale to measure hope in recent nursing home residents, including individuals with cognitive impairment. This would allow for additional research on the reliability and validity of the AHS as a measure of hope, which in turn would make way for reliable and valid measurement of hope in interventions for recent nursing home residents that may target well-being.

  • Clinicians can consider use of the Adult Hope Scale to measure hope, via self-report, in older adults with cognitive impairment. This contributes to the growing literature on the use of self-report measures with older adults with dementia. The ability to measure hope in recent nursing home residents, despite cognitive impairment status, may inform care planning and interventions.

Acknowledgments

Disclosure Statement

This work was supported by the National Institute of Mental Health, Suzanne Meeks [grant number R01 MH092317]. The authors report no conflict of interest.

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