The gatekeeper model: implications for social policy

One of the most important needs of an aging population is to insure that older adults are able to live as independently and safely as possible. The question for social policymakers is how to meet this goal in an era of shrinking resources and growing numbers of older adults. The Gatekeeper Model is highlighted as a method to insure that older adults at risk of problems that impact their ability to live independently can be helped by existing systems of care. The model trains employees of community businesses and corporations who work with the public to serve as community gatekeepers by identifying and referring community-dwelling older adults who may be in need of help. A research project was conducted at Spokane Mental Health, Elder Services Division, where the model was developed. The results indicate that community-based gatekeepers found 40% of clients. Gatekeepers find a distinct population of community-dwelling older adults who are not found by more traditional referral sources. The social policy implications of the Gatekeeper Model are discussed.     

Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.     

The Influence of Self-Selection on Older Adults' Active Living in a Naturally Occurring Retirement Community

A cross-sectional, single-case study of older adults (N = 197) in a Midwestern rural naturally occurring retirement community compared the active living behavior and salience of socio-physical characteristics for three subsets of older residents: (1) in-migrants who moved based on recreational opportunities; (2) in-migrants who moved for other reasons; and (3) long-time residents. Some older adults with preferences for outdoor recreation self-selected into the naturally occurring retirement community due to opportunities for water-based activities. Self-selectors engaged in light recreation activities more frequently and for longer durations, received more frequent spousal encouragement to be active, and identified more types of activity companions than in-migrants who had moved for other reasons.     

Sustainability Processes among Naturally Occurring Retirement Community Supportive Service Programs

ABSTRACT

Sustainability remains a concern for community models to better support older adults’ aging in place in their own homes and communities. Based on qualitative data from leaders of 53 Naturally Occurring Retirement Community (NORC) Supportive Service Programs, which is among the most prominent community practice models in aging, we aimed to develop an empirically-grounded framework on sustainability processes. Results indicated that programs use funding, staff members, interorganizational partnerships, and volunteers to offer services to attract older adults, and that older adults’ participation, in turn, is perceived as influencing the accrual of additional resources. Across themes, respondents discussed the importance of being responsive to the community and facilitating consumer participation.     

Service Learning with Rural Older Adults

Abstract

The purpose of this qualitative study was to examine the effects of a service-learning project with rural older adults on social work students' choice of working professionally with older adults upon graduation. Service learning is a course-based community service experience designed to enhance students' understanding of course content while meeting an identified community need at the same time. The service-learning intergenerational project consisted of ten hours of face-to-face interaction between a BSW student and an older adult living in rural South West Virginia and the city of Charleston. Twenty-one undergraduate social work students attending the Micro Practice course participated in the study. Data collection consisted of face-to-face interviews guided by a set of open-ended questions. Data analysis revealed that participation in the intergenerational project did not change a students' choice of major but it increased their desire to explore the field of aging.     

Organizational Responsibility for Age-Friendly Social Participation: Views of Australian Rural Community Stakeholders

This qualitative study critically explores the barriers experienced by diverse rural community stakeholders in facilitating environments that enable age-friendly social participation. Twenty-six semi-structured interviews were conducted across two rural Australian communities with stakeholders from local government, health, social care, and community organizations. Findings identify that rural community stakeholders face significant difficulties in securing resources for groups and activities catering to older adults, which subsequently impacts their capacity to undertake outreach to older adults. However, in discussing these issues, questions were raised in relation to whose responsibility it is to provide resources for community groups and organizations providing social initiatives and whose responsibility it is to engage isolated seniors. These findings provide a much-needed critical perspective on current age-friendly research by acknowledging the responsibilities of various macro-level social structures—different community-level organizations, local government, and policy in fostering environments to enable participation of diverse rural older adults.     

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.     

Giving Back and Staying Put: Volunteering as a Stabilizing Force in Relocation

Relocation in older adulthood has been shown to have health-related and environmental triggering factors. This study explores the relationship between volunteering in a community and relocation. Using data from the 2008 and 2010 Health and Retirement Study, which included 9,220 community-dwelling older individuals who were aged 65 years and older, our findings show that volunteering significantly reduces the likelihood of relocating out of the area, and such a relationship is partially mediated by having friends nearby. This study is innovative because it identifies a stabilizing mechanism important for understanding protective factors, such as volunteering, as a way communities can retain older adults.     

Activating adult allies from a rural community on lesbian,gay, bisexual,transgender, and queer student issues in school using photovoice

Purpose: Many students who are lesbian, gay, bisexual, transgender, or queer (LGBTQ) face hostile school environments that can negatively impact their mental health and education. This study involved a photovoice project where high school students from a gay-straight alliance in the rural southeastern United States took photographs that depicted the issues LGBTQ students were facing and then exhibited their photographs and stories to individuals from the school system and local community to promote awareness, dialogue, and action. Methods: Twenty adults who attended the photovoice exhibit responded to an online survey about their experiences with the intervention. Results: Eighty-five percent of adults reported that the intervention made them think about issues they had not previously considered, including the struggles LGBTQ youths face, gender issues, and living in a rural community. Common emotions experienced at the intervention included feeling excited, concern for the youths, and proud of the youths. Furthermore, 81% of the adults indicated that they would take action or behave differently as a result of the intervention, including supporting and affirming LGBTQ students, using gender-neutral and -inclusive language, and confronting bias in themselves and others. Conclusions: Photovoice is a promising strategy for LGBTQ students to activate adult allies in their community.     

Outcomes of a multicomponent physical activity program for sedentary, community-dwelling older adults

This single-group repeated-measures pilot study evaluated the effects of a 10-wk, multicomponent, best-practice exercise program on physical activity, performance of activities of daily living (ADLs), physical performance, and depression in community-dwelling older adults from low-income households (N = 15). Comparison of pretest and posttest scores using a one-tailed paired-samples t test showed improvement (p < .05) for 2 of 3 ADL domains on the Activity Measure-Post Acute Care and for 6 physical-performance measures of the Senior Fitness Test. Repeated-measures ANOVA revealed significant main effects for 3 of 8 physical activity measures using the Yale Physical Activity Scale. Retention rate was 78.9%, and the adherence rate for group sessions was 89.7%. Results suggest that participation in a multicomponent, best-practice physical activity program may positively affect sedentary, community-dwelling older adults' physical activity, ADL performance, and physical performance.     

An Approach to Community Outreach Practice in the 21st Century

ABSTRACT

This article presents the findings of a study about knowledge, attitudes and beliefs about AIDS held by older Hispanic adults. Members of the convenience sample provided responses that identify concerns about effective practice in outeach and information provision to older adults with regard to risky sexual practices. Intervention to prevent the spread of HIV/AIDS among older adults needs to be culturally competent and to be attuned to social practices, traditions, community concerns, and generational perspectives with regard to serious health problems related to sexual behavior. The sample composition was primarily Hispanic (97.4%); Catholic, (92.1%) and female (84.2%) with a mean age of 73.7 years. Approximately 28.2% of those surveyed stated that they felt that AIDS was an important problem for older adults. The majority, (76.3%) were aware of locations where health information and services were available if AIDS were a problem. Even though the majority indicated knowledge that AIDS is spread through sexual intercourse, more than one third, (36.8%) thought that sexually active adults 55 and over never use condoms. A discussion of the implications for disease prevention programs and community practice is presented emphasizing the importance of empowerment strategies in health promotion programs and the strengthening of multidisciplinary collaborative efforts to effect positive community health changes.     

A Study of Reputational Community Leaders Using The Concepts of Exchange and Coordinative Positions*

The general purposes of this study were to investigate the group and organizational affiliates of reputed community leaders in a rural community. The specific hypotheses were that the higher one is ranked as a reputational leader, (1) the more exchange influence he will likely have accumulated through occupying economic, kinship, occupational, ownership, and political-governmental positions which are reputedly influential in the community, (2) the more likely he is to be an active participant in formal and/or informal coordinative interstitial groups in the community, and (3) the more likely he is to be an active participant in those formal coordinative groups which are reputed to be influential over community affairs. The hypotheses were tested by comparing the sets of rankings of twenty-eight reputational leaders with (1) their rankings in terms of exchange positions scores, (2) their rankings in terms of social participation scores, and (3) their rankings in terms of weighted social participation scores. The results of the study tended to support the hypotheses, as stated, for the community involved.     

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.     

Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults

Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.     

Correlates of Susceptibility to Scams in Older Adults Without Dementia

This study examined correlates of susceptibility to scams in 639 community-dwelling older adults without dementia from a cohort study of aging. Regression models adjusted for age, sex, education, and income were used to examine associations between susceptibility to scams, measured by a five-item self-report measure, and a number of potential correlates. Susceptibility was positively associated with age and negatively associated with income, cognition, psychological well-being, social support, and literacy. Fully adjusted models indicated that older age and lower levels of cognitive function, decreased psychological well-being, and lower literacy in particular may be markers of susceptibility to financial victimization in old age.     

Protecting Older People From Burglary: Prevalence of Security Devices in the Homes of Older Adults in Perth,Western Australia

ABSTRACT

Fear restricts the activity of older adults, potentially leading to social isolation and unhealthy life styles. Consequently, this population remains a priority for home security research and intervention. One option is to increase home security by installing security devices. However, little is known about how older adults protect their homes. In this study, 5,582 community-dwelling older people completed a cross-sectional survey. The survey was able to document the prevalence of security measures taken by older adults. More than 70% of the respondents had security screens and key-operated deadlocks and 148 (2.7%) respondents reported no security features. Respondents living alone had the lowest prevalence of home security devices. Female living alone protected their home differently from male living alone by installing different security devices. Logistic regression analysis indicated that older adults living in detached houses feel particularly vulnerable to burglary (p < .001). These survey findings have practical implication for burglary prevention.     

Factors Predicting Relocation Among Older Adults

Having a greater understanding of what influences the older adults decisions to move and the characteristics of older adults who are more likely to move is valuable to help plan for the housing needs of the expanding older adult population. The authors examined how contextual, push and pull factors influence preferences of older adults to relocate. A total of 1,015 community-dwelling older adults completed a survey. Results of logistic regression analysis indicated the following variables as significantly related to relocation: gender, age, household income, province resided in, driving status, whether the current home met the older adult's needs, and unmet heavy cleaning needs. Policies and services need to focus on identification of those at most risk of relocation and support them either in their preference to age in place or through the relocation process.     

Leisure-time physical activity and health-care utilization in older adults

This study examined whether leisure-time physical activity (LTPA) was associated with health-care utilization in a racially diverse sample of rural and urban older adults. Community-dwelling adults (N = 1,000, 75.32 +/- 6.72 years old) self-reported participating in LTPA and their use of the health-care system (physician visits, number and length of hospitalizations, and emergency-room visits). After controlling for variables associated with health and health-care utilization, older adults who reported lower levels of LTPA also reported a greater number of nights in the hospital in the preceding year. There was no support, however, for a relationship between LTPA and the other indicators of health-care utilization. Our findings suggest that being physically active might translate to a quicker recovery for older adults who are hospitalized. Being physically active might not only have health benefits for older persons but also lead to lower health-care costs.     

TimeOut@UCLA: An Intergenerational Respite Care and Workforce Development Program

TimeOut@UCLA is an intergenerational program that recruits undergraduate college students to provide companionship to older adults with early Alzheimer’s or other forms of dementia in a community setting, providing respite for their caregivers. In the program, 86 students and 89 seniors participated from September 2015 to December 2016. This program appears to reinforce positive attitudes about working with older adults among undergraduate students and gives caregivers an innovative option for respite time.