An Ethnographic Approach to Understanding Service Use Among Ethnically Diverse Low Income Families

Poverty is linked to disparity in families access to basic human services and an incapacity to fulfill basic needs. The study described in this paper uses a qualitative research design to address the ecology of service use in the family within the broader social and physical environment. While the focus of this paper relates to the methodology of the study, some substantive results are used for illustrative purposes. Through an in-depth study of families in the contexts of their neighborhoods, our task is to search for patterns and their meanings. This process may uncover the motives and beliefs underlying service use and access among the families in our study.     

Homelessness Among Older Adults with Severe Mental Illness

ABSTRACT

This article tackles a problem that is often overlooked in the literature-the plight of homeless elders with severe mental disabilities. Drawing on his personal experience working with sheltered homeless persons who were mentally ill, the author argues for a focus not on self-sufficiency but on closely supervised care for this vulnerable population.     

Preventing Economic Hardship Among Chinese Elderly in Hong Kong

Abstract

Over the next 20 years, Hong Kong will face a rapidly aging population as the number of older adults aged 65 or above increases to approximately 1.4 million by 2021, that is, 17% of the total population. In 2001, there were 1.2 million adults aged 45-59. To assess the differences between these middle-aged adults and the current cohort of older adults, we identified the challenges that Hong Kong society will face in meeting the financial needs of older adults in the coming two decades. In this paper, we examine the retirement economic status of three groups of older adults: those who are financially independent, those who are financially supported by their adult children or children-in-law, and those who are receiving welfare assistance. We describe the current situations of these groups, prevailing social policy, future trends, and recommend policies for tackling problem areas.     

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.     

Problem and Probable Pathological Gambling Among Older Adults Assessed by the SOGS-R

This study had three main objectives: to examine the prevalence of gambling and problem gambling among older adults, to examine the socio-demographic and gambling patterns of people with various South Oaks Gambling Screen Revised (SOGS-R) scores, and to examine endorsement of the SOGS-R items. The data were drawn from telephone interviews conducted with a sample of 1000 older adults, 60 years and older, throughout the province of Manitoba. Problem gambling was determined from scores on the SOGS-R (Lesieur, H., & Blume, S. (1987). American Journal of Psychiatry, 144, 1184–1188; Lesieur, H., & Blume, S. (1993). Journal of Gambling Studies, 9, 213–219). The results showed gambling to be a fairly common activity among older adults, with 74.7% of participants having gambled in the year prior to the study. Of the total sample, 1.6% were gambling at problem levels, and a further 1.2% were gambling at probable pathological levels in the past year. Inspection of gambling patterns by SOGS-R score failed to reveal a clear and consistent distinction between problem gambling and probable pathological gambling. Finally, examination of item distribution revealed consistent trends of both over and under endorsement of certain items. These results suggest the need for either refinement of the SOGS-R for use with older adults, or the development of a new measure specific to older adults.     

Presence and Visibility of Outdoor and Indoor Physical Activity Features and Participation in Physical Activity Among Older Adults in Retirement Communities

Abstract

In this paper we examine how the presence and visibility of outdoor and indoor physical activity resources (e.g., walking path/ trail, outdoor tennis courts, gardens, etc.) influences participation in physical activity among elderly residents in non-profit continuing care retirement communities and other senior housing communities. This paper reports findings from a survey of 800 such communities. A social ecological model was used to study the relationships between the environment and physical activity behavior. A fifty-two percent response rate (n = 398) was obtained. Campuses with more attractive outdoor and indoor physical activity facilities had more residents participating in different types of physical activity.     

Post-Stroke Depression Among African-American Elders

ABSTRACT

In the United States, the expanding 65 and older population comprises 13% of the total population (U.S. Census, 2000, population estimates; projections). African-Americans will be the largest segment of Non-Caucasians 65 and older (Administration on Aging, [AoA], statistics, 2005). Post-stroke depression (PSD), is a common post-stroke consequence (May et al., 2002; American Stroke Association [ASA], 2005, behavior changes). Existent research on PSD focuses predominantly on Caucasian Americans. To my knowledge, no singular study examines the effects of PSD among African-American older persons. This article provides information that reveals the need to examine African-American elders in relation to PSD.     

Resource Accessibility and Walkability Among Older Adults in Extended-Stay Hotels

Older adults represent a large and growing population group in the United States. This population cohort is projected to grow to 72.1 million, or 19% of the total population, by 2030, up from 40 million in 2010 (Administration on Aging, 2011; Federal Interagency Forum on Aging-Related Statistics, 2012). Despite reported decreases in the proportion of older adults living in poverty in recent years, inequities prevail. Approximately 40% of older American households reported housing cost burdens¹Cost burdens are expenditures on housing and utilities that exceed 30% of household income. (Federal Interagency Forum on Aging-Related Statistics, 2012). Many of these low-income older adults live in socially and economically marginalized positions, and housing them remains a major challenge complicated by (a) limited affordable housing options and (b) chronic health conditions that seriously undermine long-term health and mobility. In a study on the impacts of public housing transformation in Atlanta, Oakley, Reid, & Ruel (2011) reported that 26% of seniors entered public housing because of a health condition or disability. According to Smith (2006), seniors in public housing are in worse health than other older Americans, even other poor older Americans suffering from such chronic health conditions as hypertension, diabetes, arthritis, and asthma. Despite these realities, Ball (2012) has noted that older adults receive little attention in comprehensive development planning beyond specialized age-segregated retirement and care communities. Salkin (2009) echoes similar concerns about the tendency toward housing initiatives and designs for more affluent older adults. She commented that most states have focused attention on programs that are best suited for seniors who do not have the same income limitations as those who are truly on fixed incomes and living close to the poverty level (Salkin, 2009). While public housing remains the predominant affordable housing option for low-income older adults, such housing is out of reach for many low-income older adults who find themselves displaced and homeless. As a result, some of these adults move into extended-stay hotels to remain sheltered.     

Role of Marital Quality in Explaining Depressive Symptoms After Marital Termination Among Older Adults

This study assesses whether prior marital quality moderates the impact of divorce or widowhood on subsequent depression. Poor marital quality may buffer depression associated with divorce/widowhood; conversely, the effect of divorce/widowhood on depression could be exacerbated by previous marital quality. Three waves from the National Survey of Families and Households based on respondents, ages 50 and older, (N?=?2,570) included eight marital quality measures. We find limited evidence suggesting higher marital quality elevates, while lower marital quality decreases, depression after divorce. No moderating effects were found for widowhood. Additionally, health condition is more important than current marital status for elders’ well-being after divorce or widowhood. Heterogeneity in the context of the marriage before divorce should be considered when examining marital termination effects on elders’ depression.     

Volunteer Behavior and Factors that Influence Volunteering Among Residents in Continuing Care Retirement Communities

The purpose of this survey was to explore volunteer preferences, perceived benefits and barriers, and the factors that influence volunteering among older adults living in a continuing care retirement community. This was a single group, one-time survey completed via a face-to-face interview. The sample included 127 older adults who were eligible and completed the survey. The majority were women (78%) and White (98%), with an average age of 88.0 (SD = 6.5) years. Engagement in volunteer activities ranged from 0 to 7, with a mean of .94 (SD = 1.30). Just under half (47%) of the participants were engaged in volunteer work, with the majority (87%) volunteering within the facility. Perceived benefits and barriers to volunteering were described. Chronic illness, age, time spent exercising, and resilience accounted for 25% of the variance in volunteer activity. Those who had fewer chronic illnesses, were younger, spent more time exercising, and were more resilient were more likely to volunteer. Findings from this study suggest that there are advantages to offering volunteer activities within senior living facilities. Ongoing study is needed to develop and implement successful facility-specific volunteer programs.     

The Effect of Long-Term Care Insurance on Home Care Use Among the Disabled Elders

Using the 1998?C2004 Health and Retirement Study, this study uses Cox??s model to explore the effects of private long-term care insurance ownership on first home care use among the disabled elderly. Results show that long-term care insurance ownership and Medicaid eligibility did not significantly increase the likelihood of using home care services, while income and homeownership lowered this likelihood. Functional limitation was the key determinant of home care use and those who lived with children were less likely to use home care services. Based on the findings, this study provides foundations for long-term care policies and long-term care planning programs.     

Gambling Involvement and Drug Use Among Adolescents

The literature on youth gambling often notes the relationship of gambling involvement to drug use. The extent of this association and its importance toward advancing knowledge about the origins and course of adolescent gambling are discussed. The authors contend that (a) adolescent gambling, like drug use, may be a normal part of adolescence from a statistical perspective, (b) claims that the prevalence rate of problem/pathological gambling is comparable or higher than the rate of substance use disorders are not supportable at this time given the weaker methodological studies in the gambling area, (c) while research suggests that similar risk factors may be important determinants for both behavior domains, prospective studies of adolescent development are needed to further clarify which factors are unique and common to adolescent gambling, and (d) greater documentation of the harm associated with adolescent gambling is a major barrier to garnering more prevention and treatment resources for this issue.     

Snowball sampling: a cautionary tale involving a study of older drug users

Snowball sampling is generally seen as a highly effective sampling technique that allows for the study of difficult to reach or ‘hidden’ populations. It is also seen as a valuable tool for the study of particularly sensitive or private matters. As a result, it was chosen as the sampling method for a research study into illegal drug users over the age of 40 who are not in contact with the criminal justice authorities or treatment agencies regarding their use. However, there proved to be great difficulty in locating and interviewing potential participants using snowball sampling. Four reasons for this are proposed, and it is suggested that snowball sampling is prone to failure in particular circumstances. Thus, caution should be exercised when considering its adoption as a sample-building technique.     

Stress,Depression, and Drug Use Among Aging Mexican American Men Living in the Barrio

Residing in Mexican American barrios might place individuals at heightened risk for chronic financial and acute stress, which are associated with adverse mental health outcomes. Stressors could be exacerbated for substance users. This research explores relations between chronic financial stress, acute stress, and depressive symptomatology among aging Mexican American heroin and other drug-using men. A prospective cohort study and field-intensive outreach methodology were used to recruit 227 men for in-depth interviews. Participants were categorized into depressed and nondepressed groups based on symptomatology measured by the Center for Epidemiological Studies Depression Scale. Chronic financial stress (i.e., poverty) and acute stress (i.e., Life Events Questionnaire) associated with depressive symptomatology were tested using logistic regression. Findings suggest scores of depressive symptoms among substance users are highly related to chronic financial stress. Community-level interventions targeting chronic stressors present in the barrio could be especially salient in improving the mental health of Latino drug users.     

Service Delivery Issues in Early Termination of Latino Clients

Abstract

This paper explores the nature and meaning of the early termination experience from outpatient counseling among Latinos. A theoretically grounded perspective is forwarded to explain the nuances of minority group interface with human services (Green, 1995), and the early termination phenomenon among this population. The authors offer an explanatory model, referred to as the repelled client, which undergirds their central argument concerning the need to reexamine important aspects of cross-cultural counseling practice.     

Caregiving and Care Receiving Among Older Lesbian,Gay, and Bisexual Adults

Abstract

A survey research design was used to examine caregiving, care receiving, and the willingness to provide caregiving among lesbian, gay, and bisexual (LGB) older adults recruited from community groups. More than one-third reported receiving care from people other than healthcare providers in the last five years; more than two thirds provided care to other LGB adults. Those who had given care were more likely than non-caregivers to give care in the future. The gender and sexual orientation of recipients of future help affected participants' willingness to provide care, as did their education level and style of coping. Participants willing to provide care to older LGB adults perceived such experiences to be less burdensome and more personally rewarding than those who were un-willing to provide care.     

Development of a Spiritual Support Scale for Use with Older Adults

SUMMARY

This study reports the development and empirical test of a measure of spiritual supports used by older adults in managing life challenge. The Spiritual Strategies Scale (SSS) consists of 18 items. Cronbach's coefficient alpha reliability for the measure was .86. The sample, gathered from interviews at four sites, consisted of 79 older adults who were predominantly Jewish European American and African American. Concurrent validity analyses suggest that this measure warrants further testing. This scale also has potential for clinical use in social work practice by counselors for older adults.     

Lift Every Voice: Voices of African-American Lesbian Elders

Old lesbians of African descent have experienced racism, heterosexism, homophobia, and ageism. This article explores the topics of aging, ageism, heterosexism, and minority stress among older African-American lesbians. The narratives and subsequent analysis offer significant contributions to the dialogue regarding Black aging lesbians in the aging and lesbian, gay, bisexual, and transgender (LGBT) communities generally and in the African-American and African-American lesbian communities specifically.     

Social Relationships of African American and Hispanic Older Assisted Living Residents: Exploring the Role of Race and Ethnicity

African American and Hispanic older adults are underrepresented in assisted living communities, so little is known about how they experience social relationships in these settings. The purpose of the study was to explore resident-to-resident and resident-to-staff relationships experienced and perceived by African American and Hispanic older residents in assisted living settings. In-depth interviews with 15 African American and 15 Hispanic older adults were conducted in seven assisted living communities in Central Florida. Three salient themes emerged using a grounded theory approach: formation of relationships: emotional vs. instrumental support; language as a facilitator or barrier; and avoidance of inter-racial relationships. Implications for providing culturally competent services in assisted living communities with diverse populations are discussed.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.