Barriers to the Use of Mental Health Services by African-American and Hispanic Elderly Persons

Abstract

This study discusses barriers to the utilization of community-based mental health services by African-American and Hispanic elderly persons. The study sample consists of “key Informants,” chosen because they were knowledgeable about the mental health needs and use of mental health services by African-American or Hispanic elderly persons. Principal component analysis using orthogonal rotation was conducted on the 23 item barrier scale and identified three levels of service barriers for the entire sample and for each subsample of African-American and Hispanic informants. Based upon the study findings, a number of strategies are offered to improve Utilization and overcome service delivery barriers.     

Caregiver's Spirituality and Its Influence on Maintaining the Elderly and Disabled in a Home Environment

ABSTRACT

This study examined the role that faith-based organizations play for caregivers in maintaining the elderly and disabled in their homes. The study explored if persons who use religious beliefs and practices cope with caregiver stress better than those who do not use religious beliefs and practices. The study also explored the role of religious coping as a factor affecting decisions to institutionalize, and the role that faith-based practices and organizations play in helping caregivers maintain the elderly and disabled in their homes.     

Depression and Suicide Among Community Elderly

Abstract

The phenomena of hopelessness, depression and, suicidality among the elderly have been long recognized as a social problem. It is commonly agreed that the rates of depression, sense of hopelessness and, suicidality in that age group are higher among older people. Due to its sensitive nature, the gerontological literature has been paid more theoretical and empirical attention to the understanding of such phenomena at the last two decades.

The present study concerned hopelessness, depression and, suicidality among an elderly community population. It aimed at providing a demographic profile of factors contributing to depression and suicidality among old people. At five senior citizen centers at the north of Israel, 316 old people living in the community were randomly selected. Subjects were administered the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (HS), and the Scale for Suicidal Ideation (SSI). The data suggest that four main demographic variables contributed to the explanation of suicidality, depression, and hopelessness among the elderly. Practical implications are discussed.     

Distribution of home help services in an elderly urban population: data from the Kungsholmen Project

Data from the total urban population 75 years and older in Kungsholmen, Stockholm were used to calculate the distribution of home help services. A structured questionnaire was used to collect information about education, occupation, living conditions, Katz Activities of Daily Living Scale, contact with the family, medical treatment and also questions about help needed and functional ability. Home help was considered to be provided when the subjects reported receiving home help service from the municipality. The number of hours of home help and the services received were registered. The results show that 86% of the elderly population in the Municipality of Kungsholmen live in their own homes, even when they are very old. Twenty-seven percent of those over 74 years and 33% of those over 80 years received home help services. The people receiving help were mostly women, single living, older and with disability detected by the Katz Activities of Daily Living Scale. The predicting factors of hours of home help are older age, condition of single living, disability detected by the Katz Activities of Daily Living Scale and less years of education. Our results also show that, among those who receive home help service, those with disability in the activities of daily living get more hours of help. However, a considerable group of elderly people are disabled but do not receive any home help. Our data stress the need for more attention by health care planners of domiciliary and intensive care and residential facilities for the high risk population (very old, living alone and with disability).     

Disability insurance risks: The Argentinian case

This article analyses the risk of disability facing workers who contribute to the Argentinian Integrated Social Security System (Sistema Integrado Previsional Argentino— SIPA). Using administrative records as our source of data for the period 2000‐2006, the results indicate that 1.46 workers per 1,000 became disabled annually during that period. The risk of disability rates were higher for men than for women, but increased with age for both sexes. The risk of disability rates have also been broken down by pathology and social security scheme, taking the effects of age and sex into account. To conclude, international comparisons are presented.     

Race and income disparities in disaster preparedness in old age

ABSTRACT

This study investigated to what extent income status and race/ethnicity in old age interplayed with disaster preparedness. Data came from the 2010 Health and Retirement Study, a nationally representative panel survey of older Americans over 51 years old. Our sample was restricted to respondents who participated in a special survey about disaster preparedness (N=1,711). Disaster preparedness was measured as a score, which includes 13 variables. Race/ethnicity was categorized by White, Black, and Hispanic. Low income was defined as below 300% of the federal poverty line. OLS regression was used to examine the main and interaction effects of race/ethnicity and lower income status on disaster preparedness scores. We found that older adults in lower income status had lower preparedness level than those in higher income (Coef. =-0.318, p<.01). Hispanics tend to be less prepared compared to White and Blacks (Coef. =-0.608, p<.001). Preparedness of Black elders was not significantly different from that of Whites. However, interestingly, Black elders in lower income status were significantly less prepared for disaster than other groups (Coef. =- 0.622, p<.05). This study identified vulnerable subgroups of older adults for disaster preparedness and suggests that preparedness programs should target minority and low income elders.     

Nonmarried Aging Parents' and Their Adult Children's Characteristics Associated with Transitions Into and Out of Intergenerational Coresidence

Abstract

Using data from the 1993-1995 waves of the Asset and Health Dynamics among the Oldest Old (AHEAD), this study focuses on analyzing elderly parents' and their children's characteristics associated with the transitions into and out of intergenerational coresidence. Multinomial logistic regression results show that transition into coresidence was primarily initiated by the parents' old age and deteriorating health and/or health-related crises. Transition out of coresidence into parents' institutionalization was also likely to have been triggered by the parents' health problems. In addition, other things being equal, divorced/separated or never-married parents were more likely but African American and Hispanic parents were less likely to have moved into an institution over a 2-year period. Children in the newly coresiding pairs and those of institutionalized parents were more likely to be married than children in the continuously coresiding pairs. The implications of these within-group differences for social work practice are discussed.     

Depression,Hopelessness, and Suicidal Ideation Among the Elderly

Abstract

This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one's own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and depression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment.     

Poverty Among Korean Immigrant Older Adults: Examining the Effects of Social Exclusion

ABSTRACT

Previous studies have shown that elderly Asian immigrants face greater risks for living in poverty compared with their native contemporaries. Particularly, Korean immigrant older adults are reported to be most likely to experience poverty among many Asian immigrant groups. The purpose of this study is to examine the extent to which demographic, human capital, and social exclusion factors contribute to such economic vulnerability among Korean immigrant older adults. Adding to previous research, this study broadly conceptualizes social exclusion and tests for its additive effects on poverty using nationally representative public data of Korean immigrant older adults. From the 2008–2010 Public Use Microdata Sample of the American Community Survey, this study extracts a sample that consists of individuals aged 65 years and older whose national origin is Korean, who were not born in the United States, and thereafter immigrated to the United States (N = 3,820). The findings indicate that 3 dimensions of social exclusion—exclusion from social and civic life, exclusion from asset building, and exclusion from the labor market—contribute significantly to Korean immigrant older adults’ odds of living in poverty. The study concludes with practice implications for socially inclusive workforce development as a way to ameliorate economic afflictions among Korean immigrant older adults.     

Examining Parental Monitoring as a Pathway From Community Violence Exposure to Drug Use,Risky Sex,and Recidivism Among Detained Youth

ABSTRACT

This study examined whether parental monitoring mediated the relationship between community violence exposure and a spectrum of behaviors such as recidivism, risky sex, and drug use among youth with a history of being detained. It also explored whether risk pathways differed by gender. Adolescents (n = 550) who were detained or previously detained were recruited from eight regional detention facilities in Georgia. Audio computer-assisted self-interviewing technology was used to assess demographic factors (i.e., age, race, and socioeconomic status), risky sex, drug use, and recidivism prior to being detained. Major findings indicated direct relationships between community violence exposures and risky sex and drug use in the 2 months prior to being detained. Findings also indicated that parental monitoring mediated these relationships for both adolescent males and females. These findings document that parental monitoring is an important element even for troubled youth across a broad spectrum of risk factors. Consequently, it is recommended that intervention programs examine the differential effects of monitoring behaviors by a variety of groups such as parental figures, teachers, and peer mentors.     

Using work, health and sick leave to predict work disability

In the Netherlands, a situation has developed in which there is one permanently disabled person for every seven to eight people active in the workforce. This is an economic emergency, for which countermeasures have been taken. The employer is made in large part financially responsible for employees' sickness absence and work disability and, at the same time, is obliged to use the professional support of a Health and Safety Service (HSS). It stands to reason that in this situation, making use of the HSS, the employer is motivated to prevent sickness absence and disablement of employees as effectively as possible. Preventing work disability critically depends on being able to predict disability through early identification of the future disabled. In order to develop a prediction procedure at the individual level, the present prospective study was conducted. Some 3,500 employees were followed for up to five years. Predictors of disability were sought among employees'opinions on their health, work, and working conditions as measured by the Questionnaire on Work and Health (QWH), and sick leave data. The QWH items are concerned with health, work and job circumstances. As expected, most (two thirds) cases of disability occur in male employees aged 50 and over. Disability in this group is strongly predicted by complaints about work strain, health, and illness behaviour, with the odds being in the 4 to 6 range. The odds can be raised to over 10 by including sick leave data. These predictions warrant individual preventive interventions. The results, taken together, speak for the predictive validity of the questionnaire and its usefulness to occupational health services in combating disability.     

Can welfare reform make disability disappear?

I argue here that, while welfare reform policy and the disability rights movement appear to share a common agenda based on the belief that disability is a social creation which can be remedied by way of increased access to employment and social resources, their world views and objectives could not be more at odds. By demonstrating how welfare reform policy makers have opportunistically appropriated the language which frames the disability rights movement and, in the style of Orwell's Newspeak, used it to conceal an agenda which actually aims for the reverse of what it promises, I seek to show that what is being promoted as a means for increased access to a better life for disabled people could be more aptly described as a gateway to poverty.     

Diseased, maimed, mutilated: categorizations of disability and an ugly law in late nineteenth-century Chicago

The article places Chicago's "ugly" law—an 1881 municipal ordinance that fined "any person who is diseased, maimed, mutilated or in any way deformed so as to be an unsightly or disgusting object" for appearing in public—within the context of late nineteenth-century imaginings of disability. Drawing on the framework of disability studies, this paper demonstrates that nineteenth-century understandings of disability had little to do with the impairments of individuals but instead were tied to the status of the person with the disability. Examining the role of disabled people as workers, as bodies and as charity recipients reveals the hierarchies of disability in late nineteenth-century Chicago and demonstrates who the ugly law intended to restrict and, just as importantly, who it did not. While the law appears to be a blanket indictment of all physically disabled people, multiple sources indicate that the public expected disabled veterans, workers, and freak show performers to occupy the public realm; they therefore cannot be the intended objects of the ordinance. Instead, Chicago's ugly law was one of many pieces of legislation enacted in the wake of the panic of 1873 that attempted to eradicate street begging in general by specifically targeting beggars with disabilities.     

Psychiatric Non-institutionalisation: Whose Needs are Served?

This article outlines the social problems experienced by persons with a chronic psychiatric disability, and their families. The disabled person's lifestyle is characterised by poor social and vocational skills, poverty, inadequate accommodation and alienation. Many of these problems increase the dependence of the disabled person, emotionally and financially, on their family of origin. The author suggests that these social problems will only be ameliorated if family members are provided with active support and information, and if hospital and community services are integrated and complementary. The disabled person's quality of life can only be improved by accessible intensive social and vocational rehabilitation programs. As these issues are not being comprehensively addressed at the present time family self-help organisations such as the Association of Relatives and Friends of the Mentally III (ARAFMI) will need to politicise their plight.     

Income mobility among the elderly in Sweden during the 1990s

Using a large panel dataset, this article investigates the degree of, and explanatory factors for, income mobility amongst the elderly in Sweden during the 1990s. It contributes to literature on welfare indicators for the older population as it supplements the welfare picture of the income adequacy with insights into income certainty during old age. Our methodological approach is to work with the administrative register data for Sweden, and this allows us to use a reliable record of incomes for a large sample of the elderly. Results for Sweden-born and foreign-born elderly persons are analysed separately and compared with corresponding groups of people of working age. Not surprisingly, nearly all of our results indicate that the income of the older population is more stable than that of the working age population, and upward income mobility is not as usual among the elderly as among other groups. The multivariate regression analyses identify several explanatory factors affecting those elderly who experienced income mobility. Most importantly, the death of a spouse increases the probability of downward income mobility, particularly amongst women. These and other findings of this research point to triggers of income poverty in old age that should be taken into account in policies concerned with the level and indexation of retirement income of future pensioners.     

Out-of-home care among immigrant children in Sweden: a national cohort study

We used data from several national registers for ten entire birth cohorts ( n  > 1 million) to examine the representation of first generation immigrant children among first time entries into out-of-home care (foster or residential care) at ages 7–12 and 13–17. Logistic regression models were used to adjust results for socioeconomic background factors. Immigrant children were categorised in six groups relating to birth country/continent. Compared with Swedish-born peers, immigrant children from non-European countries had between two- and three-fold sex and birth-year adjusted odds for being placed in care for the first time at ages 7–12. After adjustments for five socioeconomic background variables, none of these overrisks remained. Instead there was a tendency towards immigrant background being associated with reduced risks, statistically significant for immigrant children born in non-Nordic European countries. Immigrant children had between two- and six-fold age and birth-year adjusted odds for entering care for the first time during adolescence. After adjusting the results for socioeconomic background, only immigrant children born in Sub-Saharan Africa or in Asia outside the Middle East had significant overrisks for care entries at ages 13–17 (odds ratio = 1.5).     

Body Mass Index,Demographic and Socioeconomic Risk,and Protective Factors of Type 2 Diabetes Among Six Groups of Foreign-Born Asian Americans

ABSTRACT. This study examined the association of body mass index (BMI), demographic variables, and self-reported type 2 diabetes among Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese adults. A sample of 3,204 Asian American respondents born outside of the United States was selected from the 2007 California Health Interview Survey. Logistic regression was used to estimate the relationships between BMI, age, sex, marital status, education, poverty level, years in the United States and self-reported type 2 diabetes. The findings revealed that Koreans had the lowest prevalence for type 2 diabetes and South Asians had the highest. Type 2 diabetes had a statistically significant association with BMI and demographic variables but varied across ethnic groups. Due to sampling variations, no meaningful results were found in the Filipino and Japanese samples. BMI and older age are common risk factors for type 2 diabetes among Asians, but whether sex, marital status, education, and years in the United States are risk factors varies among ethnic groups. Culturally specific prevention programs for type 2 diabetes are important for Asian Americans. Given the diversity of cultures and demographic and socioeconomic factors across the Asian American populations, future research should not combine all ethnic Asian groups into 1 sample.     

Working‐age people with disability and labour force participation: Geographic variations in Australia

To examine geographic variation in labour force participation rate (LFPR) of working‐age people with disability in Australia and associated factors. This study uses Australian Census 2016 data at Statistical Area Level 2 (SA2) and engages multiple linear regression to explore the relationship between the dependent variable,= LFPR of people with disability, and diverse independent variables that reflect collective characteristics of people with disability and their non‐disabled peers within SA2. While LFPRs for people with disability varied greatly by SA2, people with disability had considerably lower LFPR than their non‐disabled peers in all areas. The LFPRs tended to be higher in SA2s with higher percentages of people with disability who had completed year 12 or gained post‐school education, with higher household income, and where a higher proportion of people with disability mainly spoke English at home. These results indicate that where people live matters. Geographic variation in LFPR for people with disability is associated with geographic variation in their educational attainment and other social and community characteristics of the areas in which they live. This study contributes towards gaining a more sophisticated and nuanced understanding of the factors that influence LFPR of people with disability in relation to their local community environment.     

Pictures and silences: memories of sexual abuse of disabled people

The article de–individualises the debate about sexual abuse of disabled people, especially women, by showing that both the sexual and asexual identity of impaired persons are invariably fashioned within the institutional arrangement of domination and subjugation. It shows that if disabled persons are seen as asexual or if they are sexualised, they cannot escape sexual violence, which is not an aberration, but is intrinsic to the social construction of disability. The article includes personal testimonies of women with different disabilities from Slovenia, who were abused either at home or in public care and shows some responses of the professionals and caregivers who minimise the importance of abuse. It claims that ignoring the memories of sexual abuse is part of a subtle and unintentional discrimination, which reflects a continuity of prejudices and hatred toward disabled children and adults in the private realm as well as in public care. People from ethnic minorities, such as Roma, are still today more often diagnosed as mentally disabled, which shows that the disability diagnosis has to be seen as part of cultural responses towards an economically and socially marginalised group. The author uses different perspectives: historical, social work theories, cultural studies and feminist analysis.     

Social Vulnerability to Environmental Hazards*

Objective. County‐level socioeconomic and demographic data were used to construct an index of social vulnerability to environmental hazards, called the Social Vulnerability Index (SoVI) for the United States based on 1990 data. Methods. Using a factor analytic approach, 42 variables were reduced to 11 independent factors that accounted for about 76 percent of the variance. These factors were placed in an additive model to compute a summary score—the Social Vulnerability Index. Results. There are some distinct spatial patterns in the SoVI, with the most vulnerable counties clustered in metropolitan counties in the east, south Texas, and the Mississippi Delta region. Conclusion. Those factors that contribute to the overall score often are different for each county, underscoring the interactive nature of social vulnerability—some components increase vulnerability; others moderate the effects.