HIV/AIDS treatments

Although fewer people are being diagnosed with AIDS in the U.S. and deaths continue to decline, the number of adults age 50 and older who are living with HIV/AIDS is larger than ever. It is likely that older people will continue to comprise an increasingly larger proportion of individuals diagnosed with HIV/AIDS, reflecting both the ineffective prevention efforts targeting older adults and the highly effective antiretroviral therapies that allow many people to live for significantly longer periods of time. These recent trends have created two distinct populations of older persons with HIV/AIDS: those who were infected later in life and those infected earlier and now aging with HIV disease. Aging with HIV/AIDS presents unique psychosocial challenges that may be exacerbated by the aging process. HIV-related stigma, social support and coping issues and evidence-based psychosocial interventions for older adults with HIV/AIDS are reviewed in this paper and suggestions for future research are discussed.     

Successful Aging in the Australian Longitudinal Study of Aging: Applying the MacArthur Model Cross–Nationally

Wide variation in the experience of aging is increasingly recognized and models for identifying groups based on how "successfully" individuals are aging have taken many forms. This study used the criteria developed in the MacArthur studies on successful aging to identify subgroups with higher, intermediate, or lower levels of function, and to compare them across a range of other domains. Data were drawn from the Australian Longitudinal Study of Aging (ALSA) in Adelaide, Australia, which is a population–based, bio–psycho–social study of a cohort of 1947 adults aged 70 years or more. Six waves have been conducted, between 1992 and 2000. At waves 1 and 3, an extensive personal interview and self–complete questionnaires were administered and objective physical and psychological functioning assessed. Eight–year mortality was also examined. Results showed risk and protective effects of successful aging for physical functioning and performance, lifestyle, cognition, affect, and personality. The findings confirm that people age with differing degrees of success and those aging most successfully not only live longer, but also experience a better quality of life. The MacArthur model proved useful for this cross–national comparison of determinants and outcomes of "successful" aging.     

Depression,Hopelessness, and Suicidal Ideation Among the Elderly

Abstract

This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one's own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and depression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment.     

Making sense of HIV/AIDS: Pascal de Duve and the sensitive historian of education1

ABSTRACT

Since the 1990s historians, in general, have increasingly engaged in critical analyses of the emergence and development of what has come to be known as ‘the HIV/AIDS pandemic’. Historians of education have also become interested in the role-played by education in the history of HIV/AIDS. Although the existing educational histories have successfully examined the multiple and far-reaching power structures that helped shape the educational responses to the disease, I will argue that their focus on ideological and geopolitical power structures runs the risk of losing sight of the crucial and often sensorial responses of individuals who have played a part in the educational history of HIV/AIDS. One such individual is the Flemish philosopher Pascal de Duve, who was diagnosed with HIV in 1989. De Duve’s particular approach to the disease clearly illustrate the importance of the senses in how people attributed particular meanings to HIV/AIDS. Knowing that this approach would prove surprising to both his readership and to his wider television audience, de Duve employed sensory experiences and modes of communication (for instance, gesture) to educative ends. I conclude that an intersensorial approach to the past will render historians of education more sensitive to unexpected personal responses towards HIV/AIDS to unexpected personal responses towards HIV/AIDS.     

Older Adults’ Expectations about Mortality,Driving Life and Years Left without Driving

ABSTRACT

People are living and driving longer than ever before, with little preparation for transitioning to being non-drivers. We investigated driving expectations among drivers age 65 and older, including sociodemographic and driving context predictors. Cross-sectional data from 349 older drivers were explored to determine variation in how many years they expected to continue driving. General linear models examined predictors of both expectations. In this predominantly Black/African American sample, 76% of older drivers (mean age = 73 ± 5.7 years) expected a non-driving future, forecasting living an average of 5.75 ± 7.29 years after driving cessation. Regression models on years left of driving life and years left to live post-driving cessation predicted nearly half of the variance in older drivers’ expectations with five significant predictors: income, current age, age expected to live to, self-limiting driving to nearby places and difficulty, visualizing being a non-driver. Many older drivers expect to stop driving before end of life.     

‘Growing Old’ in Shelters and ‘On the Street’: Experiences of Older Homeless People

Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.     

Resilience among older caregivers in rural Namibia: The role of financial status,social support and health

Background: Namibia has one of the highest human immunodeficiency virus (HIV) prevalence rates and one of the highest rates of orphanhood in the world, and older caregivers provide much of the care to Namibians living with HIV and acquired immune deficiency syndrome (AIDS) (UNAIDS, 2014). In this study, the authors explore how financial status, social support, and health were related to the resilience of caregivers caring for people affected by HIV and AIDS in rural northern Namibia, Africa. Method: Data were collected through a structured interview from (N = 147) caregivers from the Zambezi region. Results: Findings from this study show that employment and physical health were significantly associated with increased resilience in older caregivers. Discussion: Our findings point to the need for employment assistance and health services to improve the resilience of caregivers caring for people living with HIV and AIDS. We conclude that there is a need for more vigorous concerted efforts from public and private sector practitioners and policy makers to create more sustained formal employment opportunities and intervention programs aimed at improving the overall health of older HIV caregivers, especially those residing in rural HIV endemic communities in developing countries.     

The effects of socioeconomic inequalities of working life on health: implications for an ageing population

Abstract

This study examines suggestions that inequalities in health related to socioeconomic status (SES) will increase in older age. A representative sample of the New Zealand population aged 55–70 years (N = 6662) responded to a postal questionnaire with measures of health (SF-36), SES, and health-related behaviours. Hierarchical multiple regressions supported predictions that the SES of working life will continue to influence physical and mental health in early old age. The strongest predictor was self-reported economic living standards. This subjective measure of SES is an important construct for future investigations of health and wellbeing among older people in an ageing population.     

Experiences of Stigma and Spirituality of Older Black Men Living with HIV

Abstract

Previous research on HIV stigma and the use of spirituality by people living with HIV/AIDS is scarce. Moreover, the research with older Black men who have sex with men is scant. This study aimed to investigate experiences of HIV stigma and the use of spirituality among older HIV positive Black men who sleep with men. In-depth interviews were conducted with a sample of ten men. Data were analyzed utilizing to the modified van Kaam data analysis method. Three major themes were identified that explores the participants lived experiences with HIV stigma and use of spirituality: experiences of stigma reinforcing the use of spirituality; defining spirituality as a functional concept; and self-empowerment through the use of spirituality. The findings could guide social workers and other helping professionals in developing informed assessments and interventions regarding HIV stigma and the use of spirituality. Future qualitative and quantitative research is needed to achieve generalizable knowledge about the relationship between stigma on the use of spirituality.     

Resilience,Ambiguous Loss,and Older Same-Sex Couples: The Resilience Constellation Model

ABSTRACT

Secondary data analysis examined factors contributing to successful long-term same-sex relationships in older adults. An online survey of couple satisfaction and life factors provided data from 156 participants. Constructivist grounded theory methods were applied to analyze responses to open-ended questions regarding perceived supports and threats and ‘people or things’ contributing to relationship longevity. The resulting Resilience Constellation model identified concepts of: maturity, couple integration, compatibility, complementarity, and ambiguity of external support. This model can be used as a practitioner tool to assess couple resiliency and ambiguity related to societal, social, and intrarelationship stressors. Suggestions for application of the model and further research are explored.     

Sensing Bodies and Digitally Mediated Distress

ABSTRACT

In The Five Senses (2008) Michel Serres shows how the body is not an abstracted, dislocated surface that allows for the objectification of the senses and instead illustrates how it is a process: one of continually infolding sensitivities that translate our bodily feelings into a fluid sense of the world. In this article we explore what it means to be a body in the mediated environments of everyday lives of those who visit social media sites that are designed to help people deal with mental distress. We will discuss the way that “bodies” must tack between oft-competing pressures and draws, which emanate from the performance of sense that is contained within these sites. Attempts to “make” sense of the body in such terrains often require an increasingly sophisticated set of skills and expertise and can, despite our best efforts, result in the body being transported to unexpected places. In order to capture a sense of movement, people must try to transform their offline experiences into a set of actions that can be rendered meaningful in terms of an online domain, which we argue is against the way that people sense. We develop a theory of sensory bodies as subject to continual “movement,” drawing on the work of Serres, Simondon, and Manning, before discussing three examples of social media use in mental health, and the potential implications for people having to learn to sense in and through such online spaces.     

Adults with Down Syndrome and Alzheimer's Disease

Abstract

An increasing number of people with Down syndrome are at risk of dementia resulting from Alzheimer's disease. Many reside in community group homes. When they are affected by dementia, the challenge to agencies providing group homes is how to best provide continued housing and provide effective dementia-related care management. In the general population, long term care is typically provided in nursing facilities, often in special care units (SCUs). This study evaluated select factors found in group homes and SCUs to determine which is able to provide a better quality of life for people with Down syndrome affected by dementia. Interviews, using quality of life indicators, were conducted at 20 sites, equally selected from group homes and SCUs, on the basis of their experience with people with dementia. Results indicate that group homes can provide conditions associated with better quality of life and, additionally, operate with lower staffing costs due to the non-utilization of medical staff.     

Needs and Supports in Transitional Housing for People Living with HIV/AIDS in Ontario,Canada

ABSTRACT

There is a paucity of research on transitional housing for people living with HIV/AIDS (PHA) and even less so within the Canadian context. The present work addresses that gap and reports on the results from the Transitional Housing Study, a province wide community-based research collaboration involving PHA, service providers, and university researchers in Ontario Canada. This article answers the following research questions: What supports do residents in transitional housing for PHA access and what needs do these supports address? Developing from a thematic analysis of in-depth qualitative interviews with 25 residents in one of three transitional housing agencies in Ontario for PHA, the findings reveal that participants benefited from four key supports while in transitional housing: the provision of a safe environment, co-coordination and management of HIV (and other) drug therapies, assistance with appointments, and referrals to health and social services. Until more resources are available to increase availability of transitional housing for PHA, the nonprofit housing sector must fill the gap that exists by offering the types of supports identified in this study in order to address the needs of PHA. Future research may link these supports efficiently with concrete health improvements and permanent housing stability among PHA.     

Too old to test? Prevalence and correlates of HIV testing among sexually active older adults

ABSTRACT

Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008–2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack–cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65–70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.     

Caregiving and Our Inner Elder

Abstract

Dutch Priest Henri Nouwen, who died in 1996, has a large following of devoted readers. Though not formally a gerontologist, he wrote one small book, Aging: The Fulfillment of Life, full of remarkable insights into the meaning of growing old. Two approaches to caring for older people have special resonance. First, a person must appropriate his or her own aging, coming to grips with one's aging self. Secondly, one must allow the old person to enter into one's own life. Incorporating these two principles into service of elders gives it a spiritual value that goes beyond merely routine contact.     

Death Does Not Become Us

Abstract

The social issues of death, dying and bereavement represent important but neglected research areas, and such issues need attention both for practical reform and for deciphering what living with intellectual disability entails. The difficulties which life poses for people with intellectual disabilities may well persist in the times before and after death. As research issues they offer not only potential practical significance, but also a means of determining the social status and value of people with intellectual disabilities. This paper reviews the issues of death and dying from the viewpoint of sociological research and seeks to identify the ways death and dying have been treated within the research literature on living with intellectual disability. It is suggested that these issues have been discounted with some important consequences for the way intellectual disability is perceived. Important areas for research in this area are highlighted.     

Family-Centered Care

Abstract

Recent trends in medicine reflect an attempt to be more patient-centered and while this is progress from the disease- or provider-focused model familiar in healthcare, the experiences and contributions of family as caregivers continue to be overlooked in some settings. The family-centered care model, developed most notably in pediatrics, but emerging in HIV, cancer, and aging, is presented as a resource to increase family involvement at the end of life. In this paper, family-centered care is defined, caregiving trends including support needs of formal and informal caregivers are discussed, and barriers to family-centered services are identified. Reintroducing family into the focus of care at the end of life is the primary goal of this paper. The family-centered model of care offers an appropriate framework for understanding the value of family in end-of-life care and fits well with social work perspectives that understand individuals in the context of their family system and greater environment.     

The Effect of Housing on Perceptions of Quality of Life of Older Adults Participating in a Medicaid Long-Term Care Demonstration Project

Summary

As the nation struggles with the great increase in the numbers of older adults, many questions arise about how to provide housing and long-term care options that will ensure the quality of life of older adults. This study demonstrates that older adults and their families perceive quality of life more positively once moved from a nursing home to an assisted living facility using Medicaid funds. Results of this exploratory study are promising and suggest that having housing options available across the continuum of care with individualized case management offers older     

Utilization of Community-Based Social and Health Services Among Foreign Born Hispanic American Elderly

ABSTRACT

This study examined factors associated with the utilization of community-based social and health services among foreign born elderly Hispanic Americans. The data came from a nationwide probability sample of Hispanic Americans age 65 and older including 296 Mexico-born Mexican Americans, 571 Cuba-born Cuban Americans, and 247 respondents from other Hispanic countries. Being a Cuba-born Cuban American, living alone, having poorer self-rated health and living below poverty level were positively related with the utilization of community-based social services. Cuban Americans with more limitations in activities of daily living (ADL) used more community-based health services. Among Mexico-born Mexican Americans, those who lived alone used more social as well as health services while those who were married used more social services. Those with greater limitations in ADL used more health services. Among other foreign born Hispanic Americans, going to church, living alone and living below poverty status, were positively correlated with the utilization of social services. Respondents with better English language ability were less likely to use community based health services. Elderly men and people who rated their health as poorer or had more ADL limitations were more likely to use these services. Implications of these findings for health and social services are discussed.