Ability,Disability, and the Oldest Old

Abstract

A measure of range of ability is used to profile the 85-years-old-and-older (oldest old) population, including the highly disabled institutional population. This new measure uses two new questions available in the 1990 Decennial Census concerning a selfcare limitation and a mobility limitation as well as the usual question concerning a work limitation. In addition to examining the extent of disability among the oldest old, the article examines the extent of care potentially available in the household as well as the economic characteristics of this age group. It is also profiled in terms of relevant personal characteristics, including age, gender, marital status, race, ethnicity, rural residence, education, and employment. A key question addressed is the need for help or care among the oldest old and how various long-term care proposals would meet such needs. A careful analysis of this unique and growing population is necessary to both allay fears of the cost of care or help as well as to dispel stereotypes of this age group as frail and dependent, and in need of institutional care.     

Understanding Very Old Age: Looking Back and Thinking Forward

ABSTRACT

Understanding human development among the oldest old is a sequential building process taking into account building-block data, theories, and models from childhood, adulthood, and old age toward a new territory of oldest-old survivors who have lived way beyond the average life-span. A central question is whether the oldest-old survivors have developed specific survival techniques and/or protective environments that nurture survival. Or are the oldest old statistical outliers who by happenstance continue to survive further into old age? This commentary provides a historical framework on the papers in this series that describe challenges confronted by the oldest-old survivors in order to advance our understanding of survival of the oldest old. A clear understanding of the contributors to longevity could guide public policies toward well-being and life satisfaction among our oldest-old citizens.     

The effects of environmental stressors on the mortality of the oldest old male population in Hong Kong, 1977–2006

Although age–sex-specific mortality rates were decreasing over the years, such a trend was not observed for the male population aged 85 or above (the oldest old) in Hong Kong. Despite literature suggesting that environmental stressors were associated with higher mortality, the adverse effects of socioeconomic and political events were seldom included. Hence, this study explored the relationship between environmental stressors covering adverse weather conditions as well as key socioeconomic and political events and fluctuations in the oldest old mortality rates in Hong Kong during the period 1977 to 2006. The oldest old mortality rates in Hong Kong were observed to have a likelihood of being associated with these environmental stressors. Furthermore, men appeared to be more susceptible to these risk factors than did women. More care and attention should be given to the oldest old men, in particular, during periods of socioeconomic or political upheavals. A cohort study would be useful to study these stressors in greater detail.     

Distress,Need for Help,and Positive Feelings Derived from Participation in Sex Research: Findings of a Population Study in the Netherlands

To inform cost-benefit analyses of potential harms and benefits for participants in sex research, the current study investigated potential effects of completing a self-report sex survey. The data stem from a sexual health study in a population sample in the Netherlands (N = 8,064; 15 to 70 years old). Three measures assessed potential effects of participation: distress, need for help, and positive feelings related to research participation. Analyses showed that levels of experienced distress and need for help resulting from participation in a self-report sex survey were low, while participants reported positive feelings to a considerable extent. Only few participants reported levels of positive experiences that were lower than the levels of distress (4.8%) or need for help (1.7%) they experienced. Although differences were found according to sociodemographic characteristics and sexual experiences, the proportion of variance explained by these variables was generally small. While the findings of this study show that the balance between potential harm and positive outcomes seems disturbed for few participants, researchers should provide participants with the details of care providers in case they experience any distress or need for help.     

Turning vinegar into wine: Humorous self-presentations among older GLBTQ online daters

This study investigates humorous and self-mocking comments about age and age-related appearance among older gay, lesbian, bisexual, transsexual and queer advertisers in two Swedish Internet dating forums. Using a perspective where age is regarded as an accomplishment, humor was investigated as a way of relating to restrictive norms concerning age and sexuality. It was concluded that self-mocking comments, although sometimes subverting norms of age-appropriate behavior, contributed to allocating ambiguous problematic status to old age. According to this analysis, humor appeared as a form of age-salient maneuvering. If we change analytical focus and regard self-presentations as performances of marketability, the study illustrated that self-mocking comments on old age, being overweight, impotence and other age-related changes were in fact part of a repertoire that displayed marketable characteristics such as humor, self-distance and honesty among advertisers. The last part of the paper discusses these findings in terms of a need to focus on aspects that are relevant to the local context where the enactment is taking place, and the need to take care not to construct age and aging as the only objects of knowledge within aging research.     

Perception of quality of life in an elderly Angolan sample / Percepción de calidad de vida en una muestra de ancianos angoleños

Increased life expectancy and the ageing of the population have made it particularly important to distinguish between the old (usually 60–79 years, or the ‘young old’) and the oldest old (80 years or more, or the ‘fourth age’). This study explores the effects of age, gender and institutionalization on perceived health and life satisfaction in 1003 elderly people from Luanda, Angola. A multivariate analysis of variance (MANOVA) was estimated to test for these effects. Results provide evidence of lower scores on life satisfaction and perceived health for the oldest old and the institutionalized. However, the higher life satisfaction among the non-institutionalized disappeared when they reach the fourth age. No differences were found by gender, although there was a slight drop in the life satisfaction of women over the age of 80.     

Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge

ABSTRACT

Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the very old; the balance between formal and informal care; and the development of suitable places for living. Besides more specific measures, we propose that policies promoting the social integration of very old adults in their communities would be particularly helpful, as these may benefit not only the very old and their families but also individuals of all ages. We conclude that the development of suitable policies addressing the needs of the very old will benefit from future investigation of cross-cultural similarities and differences in centenarians’ characteristics, available services, as well as life conditions they encounter in communities and institutional contexts.     

The experience of quality of life among older people

Although quality of life has been in the focus of attention for over a decade there are few studies available investigating, how the old and the oldest old experience their quality of life or what quality of life actually means for them? To illuminate this, eleven in-depth interviews were conducted with six women and five men (80+) living in their home. An interpretative hermeneutic phenomenological analysis revealed that quality of life in old age meant a preserved self and meaning in existence. Maintained self-image meant that the older people experienced a coherent life with an intact meaning. How quality of life was valued depended on the meaning the old people attached to the areas of importance as well as how they were evaluated. Additionally, areas not generally included when measuring quality of life became discernible. The meaning of home, how life was viewed, thoughts about death and dying, and telling ones story proved to be areas of importance for their perception of quality of life. Thus, indicating that older people's view of quality of life is more complex than some of today's most commonly used quality of life instruments capture and that quality of life assessment tools needs to measure beyond pure health indices. For nursing care the use of life review in everyday care, and an open way towards existential topics as well as a family oriented care along with preventive work helping people to remain in their own homes may enhance their experience of quality of life.     

Adoption and feasibility of a communication app to enhance social connectedness amongst frail institutionalized oldest old: an embedded case study

The risks of social isolation and loneliness are becoming emergent issues for older adults (aged 65+) in industrialized countries, particularly for oldest old people (80+) who are frail and institutionalized. Socially isolated and lonely older people are more likely to experience depression, social disengagement, cognitive and physical decline, morbidity, and early mortality. In response to these significant negative health and socioeconomic costs, research suggests using new technologies to enhance opportunities for social connectedness as a strategy to help alleviate both social isolation and loneliness. In this context, following a participatory design method, we developed an accessible communication app with and for frail institutionalized older adults. To test the adoption of this innovative technology and its feasibility to address social isolation and loneliness, we conducted a two-month deployment of the app in a long-term care home with five oldest old and their relatives. Due to access, recruitment, and ethical challenges, the oldest old are a specially understudied group. Using an embedded case study (based on interviews, psychometric scales, field observations, and usability and accessibility testing) and a recursive approach to technology studies, our findings show that technology adoption is based on a complex set of interrelated factors: social, attitudinal, physical, digital literacy, and usability. We also discuss the feasibility of the app to enhance perceived social connectedness amongst our target population, provided that at least one strong tie is involved and communication norms and expectations across generations are considered.     

“Old age” as a social location: Theorizing institutional processes,cultural expectations,and interactional practices

The graying of societies and growing inequality call for increased attention to age relations and their implications for power, status, and constraint in late life. In this paper, I argue old age is a distinct—and devalued—social location that exists amid intersecting relations of inequality. Using an integrative approach, I synthesize selected sociological research on the institutional processes, cultural expectations, and interactional practices underlying the social construction of old age. I then review research in the areas of family care work and employment to illustrate some empirical contexts where age relations intersect with gender, class, race, and ethnicity to structure divergent opportunities and constraints among older people. This paper maps out significant theoretical and substantive signposts in the sociology of old age to build connections across levels of analysis, and to provide a nuanced, comprehensive approach to patterned inequalities in late life.     

Medical Innovations: Their Diffusion,Adoption, and Critical Interrogation

The 1950s and 1960s were a ‘golden age’ of medical progress: an era of high expectations, widespread faith, and life‐saving innovations. In the 1970s, as it gradually became clear that medicine's technological advance also contributed to the rising costs of health care, policy makers began to question the ways in which new technologies diffused. Sociologists soon found that professional and institutional interests, the search for competitive advantage, and processes of ‘institutional isomorphism’ played major roles. By the end of the millennium, as a result of growing patient (and ‘health care consumer’) activism, and of globalization, the context in which new technologies were developed, introduced, and used had become politicized, and technologies had become more heterogeneous. The patient perspective offered a new vantage point from which to study medical technology in use, and one which fitted many sociologists' normative and methodological commitments. Many recent sociological studies highlight failures, contradictions, and the (often concealed) interests involved in the promotion of new drugs and other medical technologies. However, resources for studies aligned with dominant interests, perspectives, and claims are more readily available.     

Immigrants in the Old‐Age Pension System: The Case of Sweden

The article investigates incomes and especially state pensions 2008 among elderly immigrants who arrived in Sweden before 1970. At age 70 and above, the level of state old‐age pension for immigrant men was nearly the same and for immigrant women somewhat higher than for natives with similar characteristics. At age 65–66 the state pension was lower for immigrants than for their native counterparts. The differences in pensions for immigrants of different ages are probably due to changed rules in the Swedish state old‐age pension system from 2003. The new rules have hit different age groups in different ways. The gaps are partially levelled out when other incomes are included. The extent to which levelling occurs varies greatly between different immigrant groups. For immigrants who have arrived during the last decades, the future state old‐age pension outcomes are expected to be worse.

Policy Implications

• The Swedish Pensions Agency should set up a register of pensions from abroad. This will tell us to what extent old‐age pensions from the home country compensate for low old‐age pensions from the Swedish system.
• Better integration on the labour market is a powerful measure for reducing the risk of future low pensions among immigrants. This is a challenge for Swedish integration policy.
• To what extent can other parts of the Swedish welfare system in the future compensate individuals with low old‐age pensions?

     

Public Policy and Poverty Among the Oldest Old

In neglecting to acknowledge the heterogeneity of our aging population, we encourage policies that meet the needs of the majority of older people but discount the needs of those characterized by lifelong poverty. The overall economic well-being of the "oldest old," historically the poorer cohort among the age%: is anticipated to improve over the next 50 years. This improvement will increase the economic gap between the majority of the aged and a minority who will carry their existing poverty into old age. Economic protection for the "always-poor" can be improved and intergenerational stress reduced if we identify now those with a high probability of poverty in old age and develop policies in the 1990s aimed at meeting their future needs.     

The politics of care for elderly people in Scandinavia

Most of the European countries struggle with a lack of public resources for the care of elderly people. Several comparative studies have shown that the ‘social democratic’ welfare regime of Scandinavia offers more public services to older people than any other regime. This is true both for institutional care and home care. The national averages, however, hide some serious problems. The responsibility for the care of elderly people has been transferred to the municipalities. This is threatening one of the cornerstones of the Scandinavian welfare state, equality. Access to care is increasingly becoming a question of which municipality you happen to grow old in. While inequality seems to be the problem when comparing elderly living in different municipalities, too egalitarian a policy seems to be a problem within the municipalities. In a situation where every old person is entitled to get help, the number of old people is growing and the economic resources are restricted, the cheapest form of care, ‘thinly spread’, often seems to be the only solution. It is argued that this leads to unnecessary institutionalisation. Whether there are other solutions, and what consequences they have, is also discussed. Empirical findings from a study of the care of older people in five municipalities in Denmark, Finland, Iceland, Norway and Sweden from 1991 to 1995, will be used as examples.     

城市社区居家养老服务的发展思路与对策

随着老龄化时代的到来,需要照料的失能、半失能、失独老人总量不断增加,在当前传统家庭的养老功能不断弱化、机构养老服务能力滞后的形势下,居家养老服务模式成为解决养老问题的重大战略抉择。但目前居家养老服务总体而言尚处于起步和试点示范阶段,在居家养老服务资源凝聚、开拓,居家养老服务运作和软硬环境营造等方面,面临不少问题和困境,建议从资金、人力、设施、运作环境等方面来解决居家养老服务的发展问题。     

Landscape ecology and countryside planning: Vision,theory and practice

Landscape planners are beginning to recognise the need for a strategic response to countryside change, but lack an appropriate theoretical framework. Landscape ecology is proposed as a basis for planning at a variety of scales. A number of key concerns of landscape ecology are identified, which help to explain the functioning of present and future ecosystems. These centre upon population dynamics, characteristics of habitat patches, movements between patches, visual cohesion and hydrological structures. Despite the complex relationships between biophysical and socio-economic systems, some broad principles are emerging which can be used to underpin landscape plans. Several implementational mechanisms are available which might help to convert these plans into reality. A set of strategic landscape planning principles is proposed, as a basis for further discussion.     

Relocation to a long-term care facility: working with patients and families before, during, and after

Permanent relocation of a dependent older adult to a long-term care facility can occur for a number of reasons, including the need for postacute care or a higher level of care than can be provided in a less-restrictive environment, and/or the inability of family members or others to care for the individual in a noninstitutional setting. Outcomes of institutional placement may be either negative, such as the older adult experiencing relocation stress syndrome, or positive, such as improved management of chronic illnesses and reversal of functional decline. This article offers a review of the factors that predict when and where older adults will relocate for institutional long-term care, an overview of individual transitions to institutional care, and suggestions for seamless transitions during the preinstitutionalization, transitional, and postinstitutionalization phases of relocation, which are guided by a transactionist approach to stress and coping.     

Work-related upper extremity injuries: prevalence,cost and risk factors in military and civilian populations

Persons with musculoskeletal-related disorders represent a prevalent source of outpatient visits, lost work time and disability in the military; however, research concerning the extent of work-related upper extremity disorders (WRUEDs) within this population is lacking. This literature review examined studies in civilian and military settings to ascertain the prevalence, cost and risk factors associated with WRUEDs. The results indicated that the prevalence and cost of WRUEDs in the civilian workforce are significant, justifying the need to research the military population. The literature also outlined physical, individual and psychosocial factors associated with WRUEDs that will help identify potential risk factors within military occupations.     

Exercise, health, and aging

The aims of this study were to examine the level of exercise among elderly people with regard to the current Norwegian recommendations, demographic correlates of exercise, and the relationship between exercise and subjective health among elderly men and women. A representative sample of 3,770 Norwegian men and women between 65 and 97 years of age (mean 75 years) completed a questionnaire. The response rate was 83.4 %. Results showed that 6 % of the participants exercise at the level recommended. The oldest old (>80 years), those who have an illness and use medication, and individuals with lower levels of education and income are the least active segments of the sample. After adjusting for age, marital status, income, and education, results showed that exercise at moderate intensity 3-4 days per week is a significant predictor for positive subjective health.     

Children in Need in the South of Italy: Features and Distortions in the Deinstitutionalisation of Care

Despite the shift in emphasis from institutional to foster family care, in the south of Italy children in need are mainly looked after by residential services. These are required to provide family‐style care and to place children on a short‐term basis. Using data from research on a 100% sample of day units, residential services and children in care in the Calabria region, this article investigates the functioning of the system of care for vulnerable children at the sub‐national level, describes looked‐after children’s characteristics and life conditions and questions the extent to which a real deinstitutionalisation process has occurred in this area. Finally, some deinstitutionalisation recommendations are given.