Aging in America: Limits to life span and elderly care options

Expanding longevity among the elderly and fertility decline are contributing to an aging US population. The number of persons 65 years or older is projected to double from about 32 million in 1990 to 66 million by 2030; the elderly proportion is expected to increase from 13 to 22 percent over the same period. Chronic illness and functional disability afflicts a significant proportion of older persons. An estimated 80–85 percent of people over age 65 have at least one chronic illness, and nearly one-half of older people report that chronic illness limits their activity to some degree. Altogether, about one-third of the population over 65 may need some kind of medical or social assistance. This paper discusses the three primary modes of care available to older persons: (1) the informal network of the family, (2) the more formal arrangements of home and community care, and (3) the institutionalized care of nursing homes. Of particular policy interest are the questions: Who provides the care? What type of care is available? Who receives the care? How much does each type of care cost? and Who pays? The current patterns and costs especially of long-term care provide a framework for planning future options. A discussion of research and policy recommendations concludes the paper.     

Intergenerational relations in urban China: Proximity, contact, and help to parents

Although most older Chinese parents live with an adult son or daughter, most adult offspring do not live with parents. We examine the relations of these noncoresident offspring with parents in terms of proximity, frequency of contact, and exchange of help. Based on a 1993 random sample survey conducted in two major Chinese cities, we find that although rates of coresidence are high, noncoresident sons and daughters live close to parents, have frequent contact with their parents, and provide regular help to parents. Relationships with noncoresident sons and daughters are unaffected by whether parents coreside with another child. There is some evidence of closer relationships with sons than with daughters, but parents without a son receive as much help from all children as do parents with sons. The effects of these and other predictors are estimated in multivariate analyses, and results are interpreted in terms of the persistence or change of traditional family norms.     

Creating coherent perinatal care journeys: An ethnographic study of the role of continuity of care for Danish parents in a vulnerable position

BackgroundWhile continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period.AimTo explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period.MethodsAn ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences.FindingsThree key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services.ConclusionAll forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.     

Parental marital disruption and intergenerational transfers: An analysis of lone elderly parents and their children

Although one of the most marked demographic trends observed over the twentieth century is the increased rate of divorce, relatively little research has explored the effects of these changing marital patterns in the context of an aging society. Using a sample of lone elderly parents and their adult children, we analyze the direct and indirect effects of marital disruption on four important dimensions of intergenerational transfers: coresidence, financial assistance, adult children's provision of informal care, and parental purchase of paid care. Our findings suggest that divorce has deleterious effects on intergenerational transfers, particularly for elderly fathers. Remarriage further reduces exchange. Our results reveal that parents engage in lower levels of transfers with stepchildren relative to biological children. Moreover, intergenerational transfers are sensitive to characteristics of biological children but not to those of stepchildren. Taken together, these results suggest that exchange at the end of the life course continues to be adversely affected by marital disruption.     

A methodology for identifying married couples in medicare data: Mortality, morbidity, and health care use among the married elderly

Wedescribe a method for the development of cohorts of up to three quarters of the 14 million married couples aged 65 and over in the United States. The health care experiences, illness histories, and mortality of these identified couples can be assessed longitudinally using Medicare data. We summarize strengths and limitations of using data from Medicare administrative records for the study of marriage, health, and aging. We illustrate the method by demonstrating substantial differences in survival in a cohort of hospice patients as a function of not only the patient's own diagnosis and illness burden but also the patient's spouse's illness burden.     

Assortative mating among unmarried parents: Implications for ability to pay child support

Assortative mating is of interest to both theoretical and applied social scientists. Previous research is based almost entirely on married couples and parents. In this paper we use data from the NSFG to examine assortative mating among unmarried parents in the US and to examine the robustness of estimates of nonresident fathers' income based on assortative mating assumptions. We find that never married parents are similar, though not identical, to married parents in their choice of partners. White unmarried women are much more likely to have a child with a non-white male than white married women. On the other hand, unmarried women are more likely than married women to have a child with a more educated male. Received: 31 May 2000/Accepted: 2 January 2001     

"If I'm not allowed to put my family first": challenges experienced by women who are caregiving for family members with dementia

In this study of 26 employed, West Texas women caregivers, we found that women worried that they would not be able to give their family members the care they deserved because of the multiple demands placed on them. Women actively negotiated working conditions to achieve flexibility. Women who did not have access to flexibility often changed jobs until they had working conditions that provided it. Work provided a respite and a chance to feel some measure of control. In spite of the importance of work to them, these women paid costs for balancing both roles.     

The paradoxes of communication and collaboration in maternity care: A video-reflexivity study with professionals and parents

BackgroundResearch on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”.MethodsWe used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units.FindingsWe conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”.DiscussionAcknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents.ConclusionGood communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training.     

Population changes and the cost of health care for the elderly in Poland

"The author...has attempted to measure the effects of population changes upon the costs of health care [in Poland] by applying a simulation model. In this model the total cost of health care is a function of the per capita cost of health care by age, sex, and place of residence (urban, rural) and population structure.... The paper includes...the results concerning population 60 years of age and over." Data are from several official health-related surveys carried out in 1989.     

Coming out to parents: perceptions of family relations, perceived resources, and identity expression as predictors of identity disclosure for gay and lesbian adolescents

This paper examines perceptions of family relations, identity expression, and pro-lesbian/gay resources as factors influencing coming out to parents. One hundred seventy-two adolescents responded to a survey originating from a clinical support group for lesbian and gay youth. Findings indicate that weak family relations significantly detract from coming out to parents indirectly through identity expression and perceived resources. Excluding the effects of family relations, adolescents perceiving supportive resources and expressing their lesbian/gay identity were more likely to come out to parents.     

Caring together for elderly mothers: a qualitative study of relations between adult daughters and supportive home care workers

This qualitative study examines relationships between adult daughters caring for elderly disabled mothers and the mothers' personal care workers (PCWs) paid directly by the Wisconsin Community Options Program (COP). A subset of a larger study, in these five cases PCWs provide substantial hands on care without substituting for the heavy care also provided by the daughters. Direct payment offers the daughters and workers freedom to schedule around their family obligations and other limits and tailor care to the abilities of all three participants. It also allows the daughter to be the paid provider when she chooses. Expansion of such supportive services could benefit many more low and middle income families.     

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital

BackgroundThere is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.AimThe aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.MethodsA retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.ResultsData for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p = 0.002) and spontaneous vaginal birth (38% vs. 22.4% p = <0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p = 0.050) and caesarean sections (18.8% vs. 22.5% p = 0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.ConclusionStrategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.     

Gay male couples: the importance of coming out and being out to parents

This exploratory study applied grounded theory methodology to examine what coupled gay men thought were the relationship impacts of being out to parents and in-laws. Data were collected from an accidental sample of 40 men in 20 homosexual couples using a standardized, open-ended interview. Virtually all of the respondents who had come out to their parents experienced initial and ongoing parental and in-law disapproval for their lifestyles and relationships. However, most men believed that it benefitted their unions to be out to their parents and partner's parents. Not having to hide the relationship was seen as a primary relationship advantage. Inclusion of one's partner in family events also emerged as a significant benefit. In contrast to the existing literature, a large proportion of respondents believed that parental/in-law antagonism had no adverse impacts on their dyads. They shielded their relationships by maintaining a strong sense of independence and in turn solid intergenerational boundaries. This study provides evidence to suggest that disclosure of sexual orientation to parents may be a distinctive, important developmental task for gay men which is critical to their relationships with their partners. Based on the findings of this research, mental health practitioners would be advised to assist gay men in the establishment and maintenance of strong intergenerational boundaries to protect their unions from parental/in-law disapproval.     

Searching for therapies,seeking for hope: transnational cancer care in Asia

ABSTRACT

This paper is about transnational cancer care in Asia. People with terminal diseases such as cancer increasingly escape devastating prognosis of their local regimes of clinical diagnostic truth by traveling to destinations where medicine is more advanced, yet affordable for them, and hence offers a broader scope for hope. The paper suggests that transnational cancer care provides an instructive case of the enormous geographical disparities in the availability of therapies and how this, combined with economies of hope and the marketization of health care, affects patients and their family caregivers. The primary contribution of the paper is the introduction of the concept of relational subjectivities to the health mobilities literature. The findings presented proof that the concept provides a fruitful analytical lens, yielding not only fresh empirical insights but prompting re-conceptualizations of medical travel itself as hopeful, yet risky transnational acts of family care.     

Heterosexuals' use of "fag" and "queer" to deride one another: a contributor to heterosexism and stigma

This paper is on heterosexuals' use of words such as "fag" and "queer" to refer to one another in an insulting manner. This behavior perpetuates heterosexism and the stigmatization of gays. Two hundred and fifty-seven university students (73% Euro-American) served as participants. Males exhibited more anti-gay prejudice and anti-gay behavior than females. Heterosexual males frequently used words such as "fag" and "queer" to put one another down. Anti-homosexual prejudice was predictive of anti-gay behavior. However, approximately half of those who engaged in the behavior were not strongly anti-homosexual. For these individuals, the behavior may win approval from their social group. Awareness campaigns and peer reminders that the derisive use of "fag" and "queer" harms homosexuals may be effective in changing this group. It is more difficult to reduce this behavior in individuals with strong anti-homosexual attitudes. The role of individuals and educational and work organizations in bringing about change is discussed.