Elder self neglect: A geriatric syndrome or a life course story?

AimsTo explore the unique aspects of the elder self-neglect phenomenon and to achieve phenomenological understanding of self-neglect through the eyes of self-neglecting elders.MethodA qualitative study based on a sample of 16 self-neglecting elders. Data collection was performed through in-depth semi-structured interviews, followed by content analysis.FindingsFour major themes emerged from the older participants: “I was unlucky:” a life course of suffering; “That's the way it is:” self-neglect as a routine of life; “They tell me that I'm disabled:” old age as exposing situations of self-neglect; “My empire:” how do I perceive my old age.ConclusionsSelf-neglect is not necessarily an issue of old age, but is related to the person's life history. Self-neglect as a way of life accompanied the participants into old age, but it was not originated or created there. The overall message of the self-neglecting elders was to see them as human beings and not as old neglected people; not to label them as an “age syndrome” but to perceive them in a holistic and humanistic manner.     

Returnees' Perspectives on Their Re‐migration Processes

The return of refugees and migrants back to their country of origin is an important topic on the agenda of Western European governments, as return is considered as the most “durable solution” for the “refugee problem”, and as an instrument with which to tackle “illegal” migration. However, these migration policies generally lack a clear evidence base, as little studies have focused on returnees' current living situations and on their perspectives on the re‐migration process. In this paper we therefore try to listen to returnees' voices, through in‐depth interviews with four Nepalese migrants both before (in Belgium) and after (in Nepal) their return, and with 16 returnees after their return to Nepal. The interviews show how most returnees start with a disadvantageous “point of departure” to realize a “successful” return: mostly, they do not really depart “voluntarily”, and they only have limited possibilities for preparing their return and setting realistic expectations. But also, back in the “home country”, most returnees judge their current economic, social and political living situation as bad, meeting little of the expectations that they set before they returned. The participants consider the support they received through the NGOs' return programmes as minimal, because they are mostly limited to a small amount of financial support, and thus of little significance in these returnees' efforts to rebuild their lives in their “home” country. If return programmes want to make a difference in returnees' lives, they should have two extensive components in the “home” and the “host” country, incorporating in both components an integral approach, including economic, political, social and psychological aspects. Viewing these findings, it is not surprising that most interviewees eventually evaluate their return as unsuccessful, and many returnees consider re‐emigration, all of which clearly questions the current basis of worldwide migration policies.     

Prevalence of Elder Mistreatment as Reported by Social Workers in a Probability Sample of Adult Day Health Care Clients

ABSTRACT

There are growing numbers of Adult Day Health Care (ADHC) programs providing needed health services to community-dwelling elderly. Therefore, ADHC staff are in an opportune position to identify and to intervene in suspected elder mistreatment (EM) cases. In this paper, prevalence estimates of EM are reported for a probability sample of ADHC clients in New York State, using data provided during a social worker informant interview. The abuse “signs and symptoms” items in the social worker informant interview schedule were divided into two categories: (1) physical indicators and (2) client's behavioral indicators. Physical indicators included unexplained bruises and welts, unexplained burns, unexplained lacerations or abrasions, human bite marks, and frequent injuries that are “accidental” or “unexplained.” Client's behavioral indicators included apprehension, being frightened, and afraid to go home. EM prevalence for all 8 items was 12.3 percent. When “apprehensive” was excluded, the EM prevalence was 3.6 percent in this sample. These findings suggest that ADHC provides a point of contact for the assessment and intervention of EM that might otherwise be overlooked among elders who are often isolated or homebound.     

Willingness and availability: Explaining new attitudes toward institutional elder care among Chinese elderly parents and their adult children

This paper studies the attitudes of Chinese elderly parents and their family members toward institutional elder care. Based on a sample survey of 265 elderly residents in 67 elder home institutions and 114 family members, this study finds that elders and family members generally had high evaluations of institutions' quality in terms of facility, medical, and direct care conditions. Elders who reported improved health and emotional well-being after entering institutions gave higher ratings to those institutions' quality. Among adult children, those who had more siblings tended to rate institutions higher than those who had fewer siblings. Factors that influenced elders' willingness to stay in an institution included marital status and financial ability. Widowed elders were more willing to stay in institutions compared with married counterparts. Elders who rated service charge very high preferred to stay at home due to the high cost of institutional care. In the family relatives' sample, gender was found to be related to willingness to place elderly parents in an institution; female children were less willing to place elderly parents in the institution.     

Recent developments in institutional elder care in China: changing concepts and attitudes

This study examines recent developments in institutional care for Chinese elders and attitudinal changes toward institutional care in Tianjin, China. Based on studies in 12 elder home sites and survey interviews with 265 older residents, this study compares institutional differences between government and non-government-owned elder homes, and examines elders' evaluations of elder homes' quality and their level of willingness to stay in elder homes. Findings suggest that government-owned elder homes still enjoy institutional and bureaucratic privileges in funding, staffing, and insurance. Elders' overall evaluation of elder home quality was high. Elders' former living arrangement and financial ability were related to their willingness to stay in the elder home. The unfair competition between governmental and non-governmental elder homes is likely to hinder the development of elder home industry in the free-market system and foster a growing gap between the rich and poor elders in their capability and decisions in elder home care. As adult children become increasingly unavailable due to the one-child policy and geographic mobility, institutional care for aging parents is likely to become one of the major options for parent care.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Enhancing Gerontology Education

Abstract

Co-learning opportunities for elders and students may enhance the ability to make course information “real” for traditional students and provide elders with new relationships that can reduce stereotypical thinking about younger people. A Human Development and Aging course taught at Kansas State University in the Spring of 2003 brought eighteen young adult students and eighteen auditors from a retirement community together to explore their understanding of aging issues. Based on evaluations through focus groups and written surveys, older and younger participants alike experienced changes in their attitudes toward persons of age groups other than their own.     

The Mobility of Elderly Residents Living in Suburban Territories

Abstract

Many authors have observed die elders' unanimous aspirations to age in place. Such residential aspirations echo theoretical concepts such as “environmental-fit.” Aging residents adapt to their residential environment according to their autonomy level, their financial and social resources, as well as the meanings they invest in both residential situations and lifestyle (Lord, 2004; Wagnild, 2001). Therefore, the suburbs constitute a challenge for aging residents' intentions to remain in their home for as long as possible. These low-density environments encourage car dependency for almost every daily activity. In that regard, many studies have investigated the daily mobility patterns of elders living in such areas. However, most of them have focused on aspects linked to transportation and driving security (Rosenbloom, 2003). In this context, with a socio-anthropological (in-depth interviews) method, the elders' daily mobility is explored in a complex layering of issues. Two interdisciplinary qualitative researches on the daily and residential mobility of elderly suburbanites have been used: a group living in Quebec City's Post-War suburbs in Canada (n = 56) and another in Marseille's periurban suburbs in France (n = 36). The results show that we must investigate beyond the elders' “emotional attachment”to their “home” in order to explain the everyday tensions underlying accessibility and daily mobility. Aging in a single-family house is more than a deliberate choice. Moving away from one's neighborhood is considered a last resort alternative by the majority. Instead, the elderly from both milieus will adapt their lifestyles to the environment by redesigning their daily activities and their mobility practices in order to age in place. Therefore, adapting daily mobility practices to social interactions and social representations all become a sine qua nonecondition.     

Korean American Elderly's Knowledge and Perceptions of Elder Abuse

ABSTRACT

“This study examines Korean American elders” perceptions of elder abuse and its perpetrators and explores cultural, as well as non-cultural influences on such perceptions. Face-to-face interviews were conducted with 100 elderly Korean Americans, 60 years of age or older, residing in Los Angeles County. Respondents reported 46 abuse cases, categorized into the following six types: financial abuse (36%), psychological abuse (24%), culturally specific abuse (17%), neglect (15%), physical abuse (4%), and other (4%). Most respondents identified elder abuse in terms of abrogation of filial piety, suggesting the centrality of “children” in Korean American elders⁵ lives and well-being. Findings demonstrate that employing a uniform definition of elder abuse across all cultures and ethnic groups without attending to the cultural and subjective aspects of a given situation may result in missing problems and needs identified as important by the elderly themselves. Implications for social work practice and program development are discussed.     

Farm Friends

Abstract

Intergenerational programs have proliferated in community and educational settings, yet research on their effects and impacts lags (Kaplan, 2002; Kuehne, 1998/99), and the benefits and learning that occur for participants are under-theorized (Abrams and Giles, 1999; Smith and Yeager, 1999). Similarly, insufficient research has been reported on the learning that takes place in environmental education programs. In this paper we focus on the relationship that developed between community elders and elementary school-aged children during the first year of an intergenerational environmental education project. Our goal is to better understand these experiences so we can sustain participation and develop programs rich in rewards for elders and children. We are particularly interested in the nature of intergenerational learning that occurs when children are brought together with community elders for environmental education that is integrated into a school program. Granville and Ellis (1999) propose that for a program to be defined as intergenerational, it must show a benefit and value for both generations and “demonstrate an improvement in the quality of life for both, and from that, an improvement in the quality of life for all” (p. 236). We concur with these criteria and designed a program linking community elders with farming backgrounds with one class of 18 grade-seven girls for the purpose of fostering environmental consciousness. In this paper we focus our attention on the learnings of participants in order to understand the mutuallearning that occurs in an intergenerational environmental program.     

Support Network Connectedness in the Lives of Community-Dwelling Rural Elders and Their Families

Rural elders face challenges when accessing assistance from family, neighbors, and paid helpers. This support is essential to allow them to remain community dwelling as they develop physical challenges that limit their ability to care for themselves. This qualitative study followed a group of 16 rural elders with physical limitations for 1 year. In-depth interviews were conducted with them and eight members of their support networks, including five family members, to explore how rural older adults create and maintain support networks that allow them to remain community dwelling despite physical challenges that limit their self-care. The research question is, “How do members of the support network connect with each other to maximize the effectiveness of the network?” Family members coordinated assistance to maximize the abilities and availability of various network members. In addition, family members worked together with other family members, neighbors, and paid helpers to assist the elder. These strategies enhanced the ability of the network to assist the rural elder and also lessened the burden of care by dispersing it among network members.     

Mistreatment of Vietnamese Elderly by Their Families in the United States

ABSTRACT

Generally, research on elder abuse has focused on the elders in mainstream America so that little is known about the nature and scope of elder abuse occurring in the Vietnamese community. This study presents the results of a research project on the relationship of Vietnamese elders residing in Santa Clara County, California and their families. It also explores cultural factors that may be associated with elder mistreatment such as issues of dependency and personal indebtedness. The implications for intervention and prevention are discussed, along with proposed changes in human service programs that could enhance the well-being of Vietnamese elders.     

The Portable Community: Mobility and Modernization in Bluegrass Festival Life

Drawing from six years of ethnographic field research, I examine participants' involvement in bluegrass music and festival culture in the American West. Participants left their community‐starved home neighborhoods to cultivate what I refer to as “portable communities”: temporary forms of mobile gemeinschaft community that participants found in multiple settings. Festivalgoers articulated a consistent vocabulary of intimacy, inclusion, and simplicity when describing their continued involvement in this setting. They described their involvement as driven by a quest for intimate community, open and equal social relations, and simple living, elements they found in short supply in their daily lives. Whereas traditional community forms depend on residential stability, these participants intentionally cultivated and supported alternatives that emerged in response to participants' geographic mobility.     

FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

A comment on Wong and Waite, “Elder mistreatment predicts later physical and psychological health: Results from a national longitudinal study,” JEAN Issue 29(1), pp. 15–42

Wong and Waite present a longitudinal study of elder abuse and its effects. However, they contend that their data do not support the protective effects of social support, a finding in contrast with virtually all existing research on the topic. Closer inspection of their variables indicates that they misclassify elder abuse insofar as their results are actually in terms of only one type of elder abuse, psychological abuse, ignoring physical and sexual abuse. They also define “elder abuse” using only one question: “Is there anyone who insults you or puts you down?” Finally, they measure social support with the single item: “if they generally feel they can open up to, and rely on, these significant others.” It is not, therefore, surprising that they observed that social support was not protective considering health outcomes.     

Elder Abuse: What Coroners Know and Need to Know

This article presents findings from a survey examining knowledge of elder abuse among Georgia's coroners. More than half of the 116 respondents indicated that they know “almost nothing” or “a little” about distinguishing signs of physical abuse from signs of aging (54%) and mandatory reporting laws and related elder abuse statutes (63%). When asked the frequency with which older adult cases were referred to the medical examiner, 49% indicated “rarely if ever.” Study findings reveal specific opportunities for enhancing training efforts aimed at coroners, who play a critical role in the identification of elder abuse.     

Disaffiliation from a New Religious Movement: The Importance of Self and Others in Exit

Challenging the popular belief that people who join new religious movements (NRMs) become “entrapped,” this study describes the way in which 23 former members of 11 different “cults” personally negotiated disaffiliation. The current findings support previous studies that posit exit as a resolution to unresolved doubts and dissonances, and contribute to this literature by suggesting that the nature of these dissonances, and the way in which exit constitutes a “solution” to these dissonances may vary. It is suggested that for approximately half of the participants in this study, the dissonances that precipitated exit, were relatively minor, primarily caused by organizational changes and inconsistencies in the teachings. While generally doubts were resolved privately and commitment sustained, exit occurred when alternate discourses or other identity resources became available through which doubts could become resolved. The remaining participants describe the conflicts that precipitated disaffiliation as pertaining to tensions between the groups' expectation of conformity and their sense of autonomy. These participants describe exit as a solution to the stress and emotional exhaustion of membership. To make sense of these different disaffiliation narratives, symbolic interactionist notions of the self as constructed in both the realm of “Self” and “Others” are applied.     

Elder Abuse in Costa Rica

ABSTRACT

This paper describes how the problem of domestic elder abuse in Costa Rica is being perceived and acted upon by direct service providers and other professionals in the field of aging. Costa Rica is a small Central American democracy in which the family is the central institution and the sense of filial obligation is strong. In this cultural context elder abuse often takes the form of overprotection by family members who deprive elders of their autonomy. Although they suffer from this loss, elders frequently do not define it as abuse, making it difficult for professionals to intervene. A more serious concern was abandonment of elders by families (with or without intent to harm) since there are few facilities or resources to accommodate such elders. Overall we found a mixture, sometimes in the same person, of resignation in the face of a phenomenon that may come inevitably with modernization and committed activism. We illustrate the latter by describing the efforts of two Costa Rican organizations to prevent elder abuse.     

Residential Adjustment of Elders: Learning from Experiences With Parents and Peers

The ways elders learn from the experiences of their parents and peers in coping with declining health can affect residential adjustments they make themselves to minimize their exposure to long-term-care risks. Experiences of parents and peers can affect predisposition toward residential options, and parental and peer experiences sometimes can have major influences in elder residential choices. Drawing on qualitative interviews with community-residing elders, we illustrate how elders critically assess how their own parents and peers responded to declining health. We then show how these assessments influence the residential thinking and adjustments of these elders in anticipation of their own declining self-care capacity.