Positive dying and resiliency in later life: A qualitative study

This article examines resiliency factors and processes of older adults who experienced positive dying from their perspectives. A qualitative study was conducted based on interviews with 16 hospice patients and their primary caregivers. Core resiliency factors identified included empowering relationships with significant others, spiritual beliefs and practices, ability to skillfully confront mortality, and a stable caregiving environment. These older adults' psychological processes were characterized by a dialectical tension of surrender and resistance, and a creation of life-affirming narratives through which they derived meaning of death and dying. Aspects of personal growth and psychosocial and spiritual well-being were interrelated in these dying older adults' experience of life fulfillment. The examples of resilient older adults suggest that greater attention should be devoted to the interrelatedness of spiritual and psychosocial well-being and human development. Developing an understanding of the positive potential at the end of life is essential to form new ideas in end-of-life care.     

Assessing capacity in the setting of self-neglect: development of a novel screening tool for decision-making capacity

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self-care and protection in elders who self-neglect.     

Assessing Capacity in the Setting of Self-Neglect: Development of a Novel Screening Tool for Decision-Making Capacity

ABSTRACT

Compared with older adults with disabilities and those who autonomously choose to live in squalor, self-neglect syndrome arises from a predicate state of vulnerability in frail older adults. This state of vulnerability is characteristically associated with a decline in decision-making capacity regarding the ability to care for and protect oneself. We developed the COMP Screen to evaluate vulnerable older adults to identify potential gaps in decision-making capacity using a screening tool. A total of 182 older adults were evaluated and consistent declines in cognitive ability and decision-making processes were present in this population. However, there were no significant differences between elders referred for self-neglect and matched older adults. These findings suggest that declines in decision-making processes are not uncommon in vulnerable older adults but traditional conceptualizations of decision-making capacity may be inadequate for differentiating the capacity for self-care and protection in elders who self-neglect.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

Resiliency in older Hong Kong Chinese: Using the grounded theory approach to reveal social and spiritual conditions

Resiliency refers to the personal disposition favoring resilience, which is a state of adjustment in the face of adversity. As the nature and origin of resiliency are unclear, especially in older Hong Kong Chinese, the present study adopts a qualitative, grounded theory approach to elucidate resiliency. Findings from the study are notable because they contrast with existing knowledge. The study conducted personal interviews with 15 older Hong Kong Chinese identified by elderly service workers as resilient to recent adversities. Consequently, the study identifies a grounded, social–spiritual dialectic theory that relates resiliency to its contributors in early living conditions, family socialization, and religious faith. According to qualitative data, resiliency, which is characterized by self-reliance, openness, and relaxation, turns out to be a result of isolation in living conditions and family socialization. Isolation can also lead to religious faith, which is another contributor to resiliency. These findings are different from existing knowledge that social support is a basis for resiliency. They imply the possibility of converting negative experiences into impetus for generating resiliency.     

Graduate Social Work Students' Interest in Working with Older Adults

This study examined Master's in Social Work students' (N = 304) interest in working with older adults following the use of case studies to infuse aging content into the foundation social work curriculum. Faculty members were provided with extensive materials to support their use of the cases with aging content in class. Compared to an earlier study, students were significantly more interested in working with older adults after they were exposed to the cases. Factors that predicted students' interest include age and attitude towards aging, specifically seeing older adults as having vitality. Implications of these findings are discussed.     

Family risk and resiliency factors, substance use, and the drug resistance process in adolescence

Recent approaches to drug prevention have emphasized risk and resiliency factors. Two models have been developed to explain these factors, one which posits that separate elements make up each set and the other which posits that a single factor can be either a risk or a resiliency factor depending on, for example, if it is present (resiliency) or absent (risk). This study tested these models and attempted to compare the effects of risk and resiliency across gender and ethnicity. Results support the model in which risk and resiliency are discrete sets of factors and demonstrate that overall resiliency factors play a larger role than risk factors in substance use and drug resistance processes. However, gender proved to be an important moderator of these effects. For adolescent males, resiliency has an indirect effect on overall substance use through age of first use, while risk has a direct effect on overall substance use. For adolescent females, resiliency has a direct effect on overall substance use and risk has an indirect effect through age of first use. This indicates that while early interventions are important for both genders, resiliency factors must be dealt with before initiation of substance use for males. Findings did not differ substantially across ethnicity, although the small African-American sample size may have limited power to detect differences.     

Developmental Recapitulation in Adaptation to Vision Loss Among Middle-Age and Older Adults

Abstract

Previous research has suggested that a recapitulation of developmental stages occurs during periods of readjustment in situations involving significant contextual or environmental change. The purpose of this paper is to examine if evidence exists for developmental recapitulation among middle-age and older adults adapting to recent vision impairment. Psychosocial development was operationalized in accordance with Erikson's stage theory (Erikson, 1963, 1980) and measured using the Inventory of Psychosocial Balance (Domino & Affonso, 1990). Data were obtained from 99 middle-age and 96 older adult vision rehabilitation service applicants and compared with normative scale data for these age groups. Results found significantly lower Trust, Initiative, Industry, and Intimacy scores for middle-age adults and lower Initiative and Industry scores for older adults. Unexpectedly, middle-age adults who were visually impaired had significantly higher Integrity scores compared to the normative group. Findings provide preliminary evidence for developmental recapitulation of psychosocial stages in the process of adaptation to vision loss in middle age and older adults. Implications of these findings are discussed in terms of social work practice with this population and future research.     

The Psychological Effects of Considering a Move into Residential Care: An Age-Related Study

This study employed a cross-sectional design to examine the psychological effects of considering a move into supported housing. It sought to explore the wistful “prefactual/counterfactual” evaluation of “if only” scenarios. A Time, Environment, Motivation, Personality, and Outcome (TEMPO) model was applied to investigate whether individuals moving closer in time to a prefactual scenario (a hypothetical vignette about two older adults facing a move toward residential care) expressed increased prefactual/counterfactual statements. Additional hypotheses explored the impact of personality and outcome. Thirty-three older adults (65 and older) and 33 adults (aged 18 to 64) were asked to write what could be better or worse about each scenario. The older-adult group generated a significantly higher number of counterfactual/prefactual statements. Effect sizes were medium-large. The implications of these findings, particularly concerning the emotional impact, were explored.     

The effect of aging and tennis playing on coincidence-timing accuracy

This study examined the effect of tennis playing on the coincidence timing (CT) of older adults. Young, younger-old and older-old (20-30, 60-69, and 70-79 years old, respectively) tennis players and nonplayers were asked to synchronize a simple response (pressing a button) with the arrival of a moving stimulus at a target. Results showed that the older tennis players responded with a slight bias similar to that of the young players. Two experiments were conducted to determine whether the elimination of age effects through tennis playing was a result of maintaining basic perceptuomotor and perceptual processes or of some possible compensation strategy. The results revealed that the age-related increase in the visuomotor delay was significantly correlated with CT performance in older nonplayers but not in older tennis players. These results suggest that playing tennis is beneficial to older adults, insofar as they remained as accurate as younger ones despite less efficient perceptuomotor processes. This supports the compensation hypothesis.     

Casino Gambling Among Older Adults in North Dakota: A Policy Analysis

This article examined social issues surrounding casino gambling among older adults both nationally and in the state of North Dakota. An exploratory review of gambling trends among older adults and an examination of policies to protect older gamblers revealed that older adults are targeted by the gaming industry as a lucrative market (Singh et al. J Retail Leisure Property 2007, 6(1):61–68). The authors used the national literature to frame their qualitative study, which explored gambling issues among older adults in North Dakota from the perspective of six counselors trained in gambling addiction who provide treatment services in the state. Findings indicated that relatively few policies existed at the state and national levels to protect older, more vulnerable adults who gamble. Further, the six casinos in North Dakota were viewed as very effective in marketing their casino gaming opportunities to older citizens by the gambling treatment providers interviewed. Additionally, barriers to gambling addiction treatment involved lack of available services and distance to receive services in this rural state. Based on the findings of this study, social policy changes which could lead to increased protection for older adult gamblers in the state were included.     

Resistive training and long-term function in older adults

The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers- 25 women and 5 men; 25 comparisons- 16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.     

The social and policy predictors of driving mobility among older adults

This research was designed to identify the impact of state driver's license renewal requirements on the driving mobility (i.e., the reduction or cessation of driving) of older (70 years or older) drivers in the United States. Nationally representative data from four waves (1993-2000) of the Asset and Health Dynamics of the Oldest Old study were linked to state policies on relicensing and used in a longitudinal logistic regression analysis. The author assessed the driving behaviors of a sample of 9,638 men and women. The findings demonstrate that the driving mobility of older people is influenced by state relicensing policies. The analysis indicates that five policies--accelerated renewal, mental testing, peripheral vision testing, renewal in person at age 70+ (as opposed to renewal by mail or online), and restricted licensing--have a significant effect on an older driver's decision to reduce or cease driving. The driving patterns of older adults are influenced not only by their health and socioeconomic backgrounds, but also by state relicensing policies. In terms of public policy, this result shows that there is a mechanism for extending the years of independent mobility for older people: restricted licensing.     

Dimensions of subjective well-being and effects of physical activity in Chinese older adults

Subjective well-being (SWB) and its relationship with physical activity have not been systematically investigated in older Chinese people. This study explored these issues using qualitative interviews with a purposive sample of 23 community-dwelling Chinese older adults (age 55-78 y, 12 women); 16 were physically active and 7 physically inactive. Using cross-case analyses, 7 dimensions of SWB emerged: physical, psychological, developmental, material, spiritual, sociopolitical, and social. Although elements of SWB may be shared across cultures, specific distinctions were identified. Active respondents reported the unique contributions of physical activity to the physical, psychological, developmental, and social elements of SWB. The findings suggest that physical activity could enhance the quality of life in Chinese older adults.     

The Social and Policy Predictors of Driving Mobility Among Older Adults

This research was designed to identify the impact of state driver's license renewal requirements on the driving mobility (i.e., the reduction or cessation of driving) of older (70 years or older) drivers in the United States. Nationally representative data from four waves (1993–2000) of the Asset and Health Dynamics of the Oldest Old study were linked to state policies on relicensing and used in a longitudinal logistic regression analysis. The author assessed the driving behaviors of a sample of 9,638 men and women. The findings demonstrate that the driving mobility of older people is influenced by state relicensing policies. The analysis indicates that five policies—accelerated renewal, mental testing, peripheral vision testing, renewal in person at age 70+ (as opposed to renewal by mail or online), and restricted licensing—have a significant effect on an older driver's decision to reduce or cease driving. The driving patterns of older adults are influenced not only by their health and socioeconomic backgrounds, but also by state relicensing policies. In terms of public policy, this result shows that there is a mechanism for extending the years of independent mobility for older people: restricted licensing.     

Exercise behavior in older adults: a test of the transtheoretical model

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 +/- 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales--self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)--were generally reliable (all>.78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.     

Seniors and technology, ergonomic needs and design considerations

This work is based on the ergonomic approach and the principles of universal design, with the aim of establishing the cognitive design features that interfaces must comply, for older adults achieve a good performance during their interaction with technological aids. Describes the analysis of exploratory experiences with a group of 17 older adults was aimed first to establish the main barriers to implementation that arise during these activities, and secondly to set the variables to be addressed and the procedure required to develop depth study, where the relationship establish between the quality of the stimuli and the level of performance achieved in the implementation of older adults with interfaces, observing each of the cognitive functions that promote independence, attention, motivation, memory these processes. The study in depth, looking for describe gaps and mismatches encountered during execution, which hamper the harmonious interaction processes through participatory methodological approach that allows to specify requirements for the creation of stimulating interfaces for cognitive skills and committed with the levels of autonomy of the elderly.     

“I don't know where I would be right now if it wasn't for them”: Emancipated foster care youth and their important non-parental adults

Research has identified the benefits of having non-parental adults for older youth in foster care, but less is known about the characteristics of these relationships, as well as the processes that support the foster youth as they transition from care to independence. The present study included a diverse group of 99 young adults, who recently emancipated from care in a major U.S. city. These young adults reported having a very important non-parental adult (VIP) and 63 of these VIPs were also included in this study. The youth participated in a two-hour in-person interview followed by a survey, and the VIPs underwent a phone interview; all of these interviews were later transcribed and qualitatively coded using thematic analysis. Overall, this study aimed to: 1) identify the characteristics of these VIPs, and 2) elucidate how the VIPs support youth during the transition from care. Prominent characteristics of the youth and VIP relationship identified in this study include the relationship being “parent-like”, respectful, and reciprocal with regards to communication. Moreover, it was found that both the youth and the VIPs viewed these relationships to be important in reducing negative outcomes for the youth. These results call for the foster care system to take steps in helping foster care youth find and build relationships with the non-parental adults in their lives — VIPs can serve as important sources of support to aid foster youth in their adaptation to young adulthood.     

Late Life Gambling: The Attitudes and Behaviors of Older Adults

For a significant number of retired older adults (aged 65+), gambling has become a new form of recreation and entertainment. While prevalence studies have examined the incidence of problem gambling in other age groups, little research attention has been paid to the impact of gambling on older adults since the increase in availability and accessibility of legalized gambling within the last ten years. This study investigated the prevalence of problem gambling behaviors (SOGS-R), depression (GDS-15), levels of life satisfaction (SWLS), and motivations for gambling among older adults. A total of 315 older adults completed the study questionnaire and were grouped and analyzed according to those sampled from gambling venues and those from within the community. Results of the study found the most frequent accession and spending on several types of gambling occurred among older adults who were sampled at gambling venues. Older adults who were sampled at gambling venues were also found more likely to have higher levels of disordered gambling than older adults from the community, as measured by the SOGS-R. Relaxation, boredom, passing time, and getting away for the day were also the most likely reported motivations for the older adults who were gamblingpatrons. These findings provide an initial profile of older adults and their attitudes, motivations and gambling behaviors.     

‘Chocolate … makes you autism’: impairment,disability and childhood identities

This paper discusses perceptions and experiences of impairment and disability from the perspectives of learning disabled children, their parents and their social workers. The author reports on findings from her doctoral study that adults often fail to take into account the views and experiences of learning disabled children. As a result, these children developed their own interpretations of impairment and disability based on their experiences and interactions with others. Whilst this indicates that they are active social interpreters, it also suggests that adults should make greater efforts to inform and consult learning disabled children. The author concludes by reflecting on the relevance of these findings to contemporary theories of disability and childhood.