Perceptions of Preparedness to Assist Elders with End-of-Life Care Preferences

Abstract

Using a systematic sample of Florida licensed clinical social workers (N = 272), this study found that respondents perceived themselves capable of assisting elders with end-of-life care decisions and considered themselves moderately knowledgeable of resources available to elder clients. Respondents indicated slightly positive attitudes for work with elders and elders with Alzheimer's disease, and most respondents believed that elders should have the right of physician-assisted suicide. Using multivariate analysis, four predictor variables were identified that account for 61.3% of the adjusted variance of the dependent variable of preparedness to assist elders with end-of-life care preferences. These predictor variables were (a) knowledge of resources available to elders, (b) desirability of working with elders, (c) desirability of working with elders with Alzheimer's disease, and (d) attitude toward assisted suicide.     

Social work students' perceptions about incompetence in elders

Graduate and undergraduate social work students (N = 172) were surveyed to investigate their perceptions concerning memory impairment in elders. Approximately 70% of those surveyed did not strongly disagree with the perception that all elders are memory impaired. In further analysis, significant correlations were found to exist between this variable and several other variables, including perceptions of elders' behaviors (r = .602, p = .000) and perceptions of communicating with elders (r = .630, p = .000). In a standard multiple regression, three significant predictor variables accounted for 53.4% of the model's adjusted variance. These predictor variables included: (a) perceptions of elders' behaviors, (b) perceptions of communicating with elders, and (c) having taken courses in gerontology.     

The Elder Latino Population in Holyoke,MA

Abstract

Holyoke's elderly Latino population's needs, as well as their patterns of service utilization, were explored through detailed interviews of 13 individual elders and a focus group of an additional 10 participants. The research uncovered a gap in the web of resources available, with some services, such as medical care, functioning well. However, there continue to be unmet needs, particularly in the areas of transportation, social and recreational activities, and sense of safety. Negative perceptions of aging and complaints of anxiety, depression, and boredom are also an area of concern.

The barriers to use of services were also explored. Recommendations for the enhanced provision and utilization of services, many suggested by the elders themselves, are offered. Implications for social work research and policy on, and practice with, Latino elders are discussed.     

"They don't want to hear us": Hispanic elders and adult children speak about end-of-life planning

This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/ parents do not want to have these discussions.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

“They Don't Want to Hear Us”

Abstract

This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/parents do not want to have these discussions.     

Getting affairs in order: influences of social support and religious coping on end-of-life planning among open-heart surgery patients

Despite growing interest in end-of-life issues, little research has been done concerning end-of-life plans made by patients with cardiovascular disease (CVD), a disease that constitutes the highest mortality in the United States. Even less information is available on patients who undergo major cardiac surgery, a life-altering procedure with some risk of death, in terms of their engagement in end-of-life planning (EOLP). This prospective study enabled the contributors to explore EOLP among 309 middle-aged and older open-heart surgery patients, using survey data from three sequential interviews. A hierarchical logistic regression model shows that older age, higher education, greater social support, and negative religious coping were positively related to the likelihood of engaging in EOLP. Minority race was inversely related to EOLP. Findings suggest the potential role for social workers in helping cardiac patients to access social spiritual resources, and to consider engagement in EOLP.     

Managing the Family: Productivity, Scheduling and the Male Veto

This paper argues that research, analysis and policy innovations focused on how households combine paid work with care responsibilities are driven to too great a degree by preconceptions of “the problem” that do not take sufficient account of how families themselves understand their work and care roles and the choices they are making. The evidence of 246 SOCCARE interviews across five European countries (Finland, France, Italy, Portugal and the UK) is that the variables that are conventionally accepted as having fundamental significance (family‐friendly policies and generous care services, flexible working hours, women's work–life preferences, family type, national labour markets, cultural differences) are less important than is often suggested. More important are time pressures and the idiosyncratic factors that constrain the work and care timetables that families are able to construct. We characterize these as “scheduling problems”. They occupied a large part of the accounts of their lives provided by our respondents and are a primary dimension within which their combinations of paid work and care responsibilities need to be understood. The difficulties our respondents faced in coordinating the work and care activities of their families bear a striking similarity to the problems described in the operations research literature on small businesses. Within the context of these scheduling problems a second important factor emerged: the preferences and behaviour of men who played a critical, though often passive, part in the construction of work and care timetables of the families. We characterize this effect as the “the male veto”.     

Education and Social Desirability Bias: The Case of a Black Presidential Candidate*

Objective. Survey research consistently reports a positive association between educational attainment and socially tolerant attitudes, but critics hold that respondents with high levels of education may simply purport to hold attitudes seen as socially desirable. In this article, we seek to adjudicate between the claim that the association between education and social tolerance is simply an artifact of sophisticated social desirability reporting on the part of well‐educated respondents and the competing theory that education has a real impact on increasing forms of social tolerance. Methods. Using support for a black presidential candidate as our measure of social tolerance, we utilize an innovative online list experiment to test whether high levels of support are inflated because of social desirability reporting among the educational elite. Results. We find no evidence of systematic overreporting of support for a black presidential candidate among respondents with high levels of education, and note that social desirability bias declines as educational attainment increases. Conclusions. This research bolsters arguments about the liberalizing effect of education on socially tolerant attitudes, and challenges evidence that attributes this relationship to high levels of social desirability bias.     

The Importance of Feeling Understood in Marital Conversations about End-of-Life Health Care

This study investigates processes within marital discussions about end-of-life medical treatment preferences. The associations among marital quality, the perception of having been understood following discussion, and intentions for whom to appoint as a health care surrogate are addressed. Data from 2,969 white married couples in their mid-60s are analyzed. Four-fifths of primary respondents reported that their partners understood their preferences extremely well. Primary respondents' perceptions of high marital quality were associated with feeling extremely well understood. In turn, feeling understood partially mediated the relationship between perceptions of marital quality and the intention to appoint the partner as durable power of attorney for health care (DPAHC). Implications for research on marital communication and quality end-of-life health care are discussed.     

Impression management pressures on racial attitude surveys

For decades, researchers have expressed concern that self-report racial attitude measures are vulnerable to distortion from pressures respondents feel to present themselves as unprejudiced. A common response to this problem is to measure social desirability separately from racial attitudes and control for its variance in statistical analyses. The present study is designed to test whether such controls are sufficient. Participants rated items from both racial attitude and social desirability scales in terms of the amount of pressure they would feel to respond in a particular way regardless of their true attitudes. Participants report significantly greater response pressure on racial attitude items than on social desirability items, and ratings on the two types of items have only moderately shared variance. Implications for controlling social desirability in racial attitude research are discussed.     

The Negotiation of Child Care and Employment Demands Among Low-Income Parents

Low-income working mothers face significant child care challenges. These challenges are particularly salient in an era of welfare reform, when welfare recipients are under increased pressure to find a job. The current study examines how child care demands are negotiated for an urban sample of low-income mothers. The sample includes a racially and ethnically diverse group of 57 respondents with and without welfare experience who are mothering children under 13 years of age and working in entry-level jobs. Findings suggest that respondents seek arrangements that are affordable, convenient, and safe, and informal arrangements may be most compatible with convenience and cost considerations. Informal care is not universally available, however, andmay be less reliable. Implications for child care policy are discussed.     

Primary Caregivers and Chinese Elders’ Demand on Community Services

Abstract

The most influential model explaining the elderly’s service use is Andersen and Newman's model. But the applicability of the model on elders’ demand on community services has not been tested, especially in developing countries such as China. This research tested the applicability of the model by studying how primary caregiver relations to the elderly influence Chinese community-dwelling elders’ demand on community services. With a total of 2,124 respondents aged 65 and older who reported primary caregivers, six primary caregiver relations were examined: son, spouse, daughter, daughter-in-law, unmarried son and daughter, and other. Data came from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Results indicated that: (1) Elders cared for by daughters-in-law showed a significantly stronger tendency of expecting community services than elders cared for by other caregivers among both rural and urban areas. (2) Elders were least likely to expect community services in two cases: urban elders taken care of by daughters and rural elders whose primary caregivers were unmarried sons and daughters. Since Chinese elders cared for by different caregivers tended to seek community care in different manners, future research may study how suitable community service programs can be developed to well meet the needs of various elderly groups.     

Professional social work education in end-of-life care: contributions of the Project on Death in America's Social Work Leadership Development program

Social work education in both BSW and MSW level courses is missing vital content about end-of-life care, palliative care, and bereavement. End-of-life care training opportunities through continuing education programs have also been limited. This deficit is significant because a vast number of social workers are already confronted with end-of-life issues on a daily basis in a variety of practice settings. Through the Project on Death in America, Social Work Leadership Development Awards initiative, many programs and models for professional social work education and training in end-of-life care have been developed and are presented in this article. These include: end-of-life care courses, symposia, training manuals, certificate programs and fellowships. Although the curricula continue to be refined, many of these programs are available to practitioners to advance their knowledge and skills and their curricular models are available to social work educators for possible replication.     

Developing practice tools for social workers in end-of-life care

This article describes the National Association of Social Workers' (NASW) strategies for providing social workers with important practice and policy information about palliative and end-of-life care. With funding from a Soros Foundation's Project on Death in America grant, NASW developed practice standards, a Web-based continuing education course, and drafted a new policy statement to guide social workers in end-of-life care practice. The article provides an in-depth view of the development and scope of these resources for professional social workers.     

社会资本:破解“空心化”农村养老困境的现实选择——以H村为例

农村"空心化"已成为中国社会经济发展过程中中西部地区的一种普遍现象,年轻人的流失突显了农村的养老问题。在年轻人回乡事亲孝亲和农村社会化养老服务在短时间内都难以做到的情况下,加强农村社区社会资本建设,以协助老年人解决日常生活中的困难,成为破解"空心化"农村养老困境的现实选择和可行之路。     

Professional Social Work Education in End-of-Life Care

Abstract

Social work education in both BSW and MSW level courses is missing vital content about end-of-life care, palliative care, and bereavement. End-of-life care training opportunities through continuing education programs have also been limited. This deficit is significant because a vast number of social workers are already confronted with end-of-life issues on a daily basis in a variety of practice settings. Through the Project on Death in America, Social Work Leadership Development Awards initiative, many programs and models for professional social work education and training in end-of-life care have been developed and are presented in this article. These include: end-of-life care courses, symposia, training manuals, certificate programs and fellowships. Although the curricula continue to be refined, many of these programs are available to practitioners to advance their knowledge and skills and their curricular models are available to social work educators for possible replication.     

Mental Health Service Utilization Among Frail,Low-Income Elders

Abstract

This study was conducted to determine the extent to which service providers in a community-based care program accurately identified and referred elders with symptoms of depression. Interviews were conducted with 79 frail, low-income elders, with the CES-D used to gauge depressive symptomatology. Reviews of their case files were then conducted to determine first, the extent to which case managers recognized depressive symptoms and second, the extent to which respondents who screened with significant symptoms were referred for mental health services. Results suggest an imperfect association between CES-D scores and case managers' perceptions and referrals. Less than 1/3 (31%) of those who screened for depression received counseling.     

Developing Practice Tools for Social Workers in End-of-Life Care

Abstract

This article describes the National Association of Social Workers' (NASW) strategies for providing social workers with important practice and policy information about palliative and end-of-life care. With funding from a Soros Foundation's Project on Death in America grant, NASW developed practice standards, a Web-based continuing education course, and drafted a new policy statement to guide social workers in end-of-life care practice. The article provides an in-depth view of the development and scope of these resources for professional social workers.     

How close is too close?: The negative relationship between knowledge of HIV transmission routes and social distancing tendencies

Data measuring respondents’ knowledge of HIV's transmission routes was obtained via a statewide RDD sample of 603 Nevadans to determine if disease knowledge influences respondent efforts to socially and physically distance themselves from a hypothetical HIV-positive person. Four separate dependent variables (scenarios) are created in which the geographic distance between the respondent and a hypothetical HIV-positive person decreases; while, at the same time, physical personal contact, or potential for contact, increases. Findings show 84.2% of the respondents had sufficient knowledge of HIV transmission routes, and the majority felt comfortable across all four social scenarios. However, multiple logistic regression analyses indicate that respondents with sufficient knowledge of how HIV is transmitted are significantly more comfortable with casual social interactions than those respondents with insufficient knowledge. The results from this study confirm the importance of HIV-knowledge as a tool to combat AIDS-related stigma.