Using Community-Based Participatory Research Strategies in Age-Friendly Communities to Solve Mobility Challenges

ABSTRACT

The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person’s ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults’ abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.     

Awareness of LGBT Aging Issues Among Aging Services Network Providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Awareness of LGBT aging issues among aging services network providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Training,Geography, and Provision of Aging Services to Lesbian,Gay, Bisexual,and Transgender Older Adults

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.     

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.     

Creating aging-enriched social work education:a process of curricular and organizational change

The CSWE Geriatric Enrichment in Social Work Education Project, funded by the John A. Hartford foundation, aimed to change curricula and organizational structure in 67 GeroRich projects so that all students would graduate with foundation knowledge and skills to work effectively with older adults and their families. The emphasis was on change processes to infuse and sustain gerontological competencies and curricular resources in foundation courses. This article presents lessons learned and strategies for engaging faculty, practitioners and students in the curriculum and organizational change process.     

Bringing the community in: partnerships for aging enrichment

Aging enrichment of undergraduate social work curricula ensures that program graduates will be prepared to practice with older adults. This article reports the results of focus group research that was designed to engage social workers from community agencies serving older adults in preparing students to become "aging-savvy" social workers. The workers highlighted the importance of wide-ranging exposure to older adults, the changing needs of older adults, and the importance of increasing students' comfort with self-determination. These findings informed the program's ongoing curricular transformation process through the incorporation of new assignments that enabled increased contact with older adults in a variety of settings.     

Creating Aging-Enriched Social Work Education

Summary

The CSWE Geriatric Enrichment in Social Work Education Project, funded by the John A. Hartford foundation, aimed to change curricula and organizational structure in 67 GeroRich projects so that all students would graduate with foundation knowledge and skills to work effectively with older adults and their families. The emphasis was on change processes to infuse and sustain gerontological competencies and curricular resources in foundation courses. This article presents lessons learned and strategies for engaging faculty, practitioners and students in the curriculum and organizational change process.     

Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation

ABSTRACT

This study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study’s findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.     

Bringing the Community In

Summary

Aging enrichment of undergraduate social work curricula ensures that program graduates will be prepared to practice with older adults. This article reports the results of focus group research that was designed to engage social workers from community agencies serving older adults in preparing students to become ‘aging-savvy’ social workers. The workers highlighted the importance of wide-ranging exposure to older adults, the changing needs of older adults, and the importance of increasing students' comfort with self-determination. These findings informed the program's ongoing curricular transformation process through the incorporation of new assignments that enabled increased contact with older adults in a variety of settings.     

Anticipated Engagement in a Village Organization for Aging in Place

Although older adults prefer maintaining residence independently in the community as they grow older it is not always possible due to impairments, isolation, and changing health needs. Villages, an emerging consumer-directed care model providing social engagement and services, support aging in place. To be viable organizations villages must attract and enroll sufficient numbers of members. This study examined factors associated with older adults anticipated engagement as a village member. Using a cross-sectional survey design community residing older adults (N?=?193) identified predisposing, enabling, and need factors associated with anticipated engagement. Participants rated anticipated engagement between “Slightly Unlikely” and “Likely” (Mean?=?2.71, SD?=?1.31). A model including predisposing and enabling factors produced the best overall fit [?2 Log likelihood?=?246.514, χ2(8)?=?20.414, p.?=?.008] correctly classifying 61.1% of cases and explaining 13.4% of the variance according to the Nagelkerke R² statistic. Older adults who engage in preventative health behaviors may be predisposed to joining a village as well as those who are already engaging in supportive acts of neighboring. Villages might consider these factors in designing outreach and service programing. Future research should identify how factors such as income and personal health practices contribute to interest in village membership.     

Gambling Among Older Adults in Singapore Some Preliminary Empirical Findings

The purpose of this study is to shed light on gambling among older adults (age 60 and above) in Singapore. A sample of 74 older adults who were participants of a community-based elderly outreach program was surveyed. The results indicate that 27% of the respondents had gambled in the past one month and their favorite gambling game was 4D. Those who gambled were found to have more free time than those who did not (64 hours per week vs. 38 hours per week). Almost all the respondents (97%) did not know where to get help for problem gambling.     

Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands

Elissen AMJ, Van Raak AJA, Derckx EWCC, Vrijhoef HJM. Improving homeless persons' utilisation of primary care: lessons to be learned from an outreach programme in The Netherlands Faced with rising homelessness, countries around the world are in need of innovative approaches to caring for those without shelter, who, more often than not, suffer from severe health problems. We conducted a case study of an innovative Dutch Primary Care for the Homeless (PCH) programme to gain insight into clients' demographic characteristics, health problems and service use, and to develop an explanation for its success in increasing the latter. Our analyses are based on a combination of quantitative and qualitative data. The results of the study suggest that the success of the PCH programme can be explained by the providers' pragmatism and will to adapt their mode of care provision to the behavioural patterns and needs of their homeless clients.     

Factors associated with the preventive healthcare service use among older adults in Korea: Focusing on age variation

The importance of preventive health examinations for older adults has been well emphasized due to an increase in chronic diseases associated with age. In this study, we estimated the preventive health examination participation rate and its associated factors among the elderly with specific focuses on the moderating effects between age and socioeconomic status. We used data drawn from the first to sixth waves (4164 people) of the Korean Longitudinal Study of Aging for the elderly aged 65 and over. A generalized linear model was used to address research questions. The results showed that the participation rate decreased as older adults age. The interaction between age and education was also significant, indicating that older adults with higher education were more likely to use a preventive health examination compared to those with lower education. There were no significant interaction effects between income and age. Based on the findings, implications for theory and practice were discussed with specific focuses on age‐specific approaches in preventive healthcare services for older adults.     

Using Groups to Advance Social Work Practice–Based Research

A discussion about the importance of research for social work practitioners and the nature of academic–practitioner partnerships set the scene in this article for a discussion about an innovative academic–practitioner partnership. This partnership, aimed at strengthening research mindedness and research activity in social service settings, has been fuelled by a belief in the power of groups to achieve what individuals cannot. The authors reflect on the range of inputs and synergistic group processes that allowed for a series of outcomes that would not have been possible within an individualized initiative. In conclusion, lessons learned from the use of groups to advance practice-based research are outlined.     

Psychological Distress and Help-Seeking by Residents of a Neighborhood Naturally Occurring Retirement Community (NNORC)

This article presents findings from an annual program survey of residents of a horizontal neighborhood naturally occurring retirement community (NNORC). The study explored the relationship between several factors (age, co-residents, number of chronic illnesses, self-reported health, loneliness, sense of mastery, locus of control, pain, and psychological distress) and their ability to predict general health, level of psychological distress, and the quantity and type of help-seeking behaviors. Although residents generally reported moderate to high levels of chronic disease, pain, loneliness, and concerns about life issues, 25% of them sought no help from any of the listed resources, and 65% sought help from only one of seven resources. The most common source of help for most (70%) was a primary care physician (PCP), and comparatively few respondents sought help from other sources. Older adults, especially those with chronic illness, generally consider their PCP to be the first, and perhaps only, source to consult. However, research indicates that the most effective health promotional programs for older adults are social and educational group activities, rather than individual health-focused interventions. Possible means of redirecting residents toward NNORC services include more vigorous outreach and creating collaborative partnerships between local PCPs serving older populations and the NNORC.     

New Directions for the Study of Incarcerated Older Adults: Using Social Capital Theory

As the population of older adults continues to rise, so, too, does the population of older adults in prison. The body of literature on older adults in corrections is scant, particularly with regard to health and social functioning. Past studies of aging inmates primarily focus on health care and related costs. The purpose of this article is twofold: (a) outline and synthesize the research on older adults living in prison; and (b) propose a framework for future research and intervention development based on social capital theory. Recommendations for social work practice, programs, and research are discussed.     

Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment

Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (N = 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.     

Understanding Quality-of-Life While Living with Late-Stage Lung Cancer: An Exploratory Study

U.S. Veterans have a higher prevalence of advanced lung cancer and poorer survival outcomes compared to the general population; yet, no studies exist which specifically explore the psychosocial and existential quality-of-life (QOL) of late-stage lung cancer among this population. This article presents the perspectives of older veterans (N = 12) living with late-stage lung cancer who were receiving chemotherapy, routine hospice care, or both concurrently. Based on individual interviews, themes associated with loss of functionality, close relationships, and communicative acts contributed to veterans’ perceptions of diminished or enhanced QOL while living with advanced disease. An overarching theme, loss of the person I know myself to be, suggests that personhood is an important concept to consider in QOL assessment. While findings suggest that the experiences of older Veterans with late-stage lung cancer are similar to other populations of lung cancer patients, and persons with incurable cancer in general, further research regarding the influence of veteran identity at end-of-life is warranted. Further research is needed which explores the influence of a whole person approach to QOL during life-limiting illness and end-of-life decision-making, particularly while receiving late-stage cancer-directed therapy.     

Advance care planning throughout the end-of-life: focusing the lens for social work practice

Advance care planning throughout the end-of-life is an increasingly important aspect of professional practice with older adults and their families. As the nation's population continues to live longer, more and more people will experience years of functional and cognitive decline prior to death. This article discusses the growing importance of advance care planning using a long-range, holistic perspective of examining care needs throughout the end of life. End-of-life care is conceptualized by three trajectories of decline leading to death, with about two-thirds of all older adults succumbing to four key conditions: congestive heart failure, emphysema, frailty, and dementia. Research regarding the advance care planning needs of older adults with the key conditions is presented. Further research is needed to enhance social work practice in this area.