Key Determinants to using Telehealth Technology to Serve Medically Ill and Depressed Homebound Older Adults

Despite the increasing evidence for the effectiveness of telehealth technology in screening and treating chronic diseases, and comorbid depression among older adults, they have been slowly adopted by home health care (HHC) agencies. Therefore, this study aimed to identify factors that determine telehealth technology adoption. Twenty directors from the National Association for Homecare & Hospice member agencies completed a 45-min telephone interview. Questions were asked regarding their perceptions of telehealth, the key determinants of telehealth adoption and use, and recommendations they would give on telehealth adoption. The majority of the participants perceived telehealth as effective for managing symptoms and reducing cost. Meanwhile, some participants had a mixed feeling toward telehealth for depression care as they did not recognize their agency as equipped with the necessary resources and trained staff. Moreover, significant determinants of telehealth adoption included the agency-related characteristics, the patient-home environment, reimbursement and cost-related factors, and staff telehealth perception. Findings imply that there is a need for financial support both at the state and the federal levels to encourage telehealth adoption among HHC agencies. Future studies should consider exploring strategies used by successful programs to overcome barriers.     

Volunteerism and Older Adults

Abstract

This study was designed to examine differences in care-giver and care recipient characteristics, caregiving and work demands and resources, and role strain among Black, Hispanic, Asian, and White employed family caregivers. Significant differences were found with respect to caregiver and care recipient characteristics, types of assistance provided, and workplace support. Minority caregivers were economically disadvantaged and provided higher levels of care. Whites reported higher levels of role strain than Black and Hispanic caregivers, after controlling for caregiver and care recipient characteristics, demands, and resources. The findings indicate that care giving policies and programs must be broadened to incorporate the strengths and needs of ethnically diverse caregivers. Family practitioners need to be able to assess the applicability and differential impact of particular interventions, policies, and benefits, and to design relevant programs for ethnically diverse care-givers and their families.     

The DASH Pilot Project: Developing Community-Based Nutrition Education for Older Adults

ABSTRACT

Nutrition-related chronic health conditions among older adults are a growing concern. In this study, nutrition education materials were created for use in senior centers by graduate nutrition students. After the materials were presented, focus groups were conducted with participants (n = 62) to obtain feedback on the content and presentation. Findings related to the participant’s knowledge of nutrition-related information, strategies to improve future class sessions, and participant recruitment will be discussed. These findings will be useful to program administrators as they develop nutrition programs for older adults who are vulnerable to nutrition-related health problems.     

Depression in Older Adults: A Meta-Synthesis

Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge—both quantitative and qualitative—has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.     

Depression in Older Adults: Psychological and Psychosocial Approaches

Correspondence to Margaret A. Fielden, Burton District Hospital Centre, Belvedere Annexe, Lower Outwoods Road, Burton-on-Trent, S.E. Staffs. Summary Depression is a commonly experienced psychiatric disorder inthe adult population. The elderly require special considerationsince they show higher prevalence rates than younger adults,high levels of re-occurrence, and a different presentation ofsymptoms. This suggests a need to understand depression in theelderly within a psychological frame and within a psychosocialsetting, where symptoms and themes express the physical, social,and emotional losses of ageing and age-associated developmentaltasks of role change, accepting dependence, and preparing fordeath. An effective therapeutic approach must encompass physical, social,and psychological care. Psychological and psychosocial responsesto depression in the elderly are reviewed here in terms of theirsensitivity to issues of ageing and their preventative valuein minimizing vulnerability to depression.     

Home-Based Practice with Older Adults

Abstract

Social work with older adults frequently occurs in the client's home. Although practitioners and the professional literature acknowledge the existence of differences between agency-based and home-based practice, little attention has been given to the way the home environment impacts on the intervention process. This exploratory study examined practitioner-identified events that impact on the intervention process in home-based practice. The events elicited two general categories, the context and the process of interventions. Factors subsumed under intervention context are situational and geographic factors, such as practitioner and client comfort, and differences in urban and rural environments. Examples of intervention process categories include setting up home visits, assessment, boundaries, common distractions, and termination in home-based practice.     

Older Adults Navigating Medicare: When Benefits Are Denied

Guided by Bourdieu's theory of practice and symbolic violence, this qualitative study explored experiences and perceptions of elderly beneficiaries who had been denied rehabilitation services by Medicare. In semistructured interviews, 12 beneficiaries or family members told of the physical, psychological, and financial consequences of service denial/termination. The resulting perception of Medicare was as a cumbersome, difficult to negotiate system. Findings have implications for future research on service denial and indicate the need for better communication with, and support of, consumers by health care professionals when this occurs.     

Care of Older Adults in Iceland: Policy Objectives and Reality

ABSTRACT

We examine the implementation of the Icelandic government's policy on formal care of older adults in Iceland. The policy as expressed in legislation and other policy documents is to ensure access of older adults to the appropriate level of health and social care services. How does the actual level of formal care compare with the policy objectives? Does there exist an implementation deficit, and if so, why? We address the question by analyzing Icelandic and international statistical databases. The findings reveal a gap between the aims of the current policy and its delivery. As elsewhere in the Nordic region, the policy allows for the emphasis to be on home-care services in which the individual's needs are assessed comprehensively. Administrative problems and insufficient resources to better understand and explain the problem are identified. Current steps to address the problem include the necessity of a comprehensive evaluation of the level and quality of elder-care services in Iceland, which would help compensate for the shortcomings of the existing public statistical databases. In future research, it is necessary to analyze how services can be coordinated while increasing responsiveness to the voices of older adults and their relatives on the care of older people.     

Attitudes Toward Younger and Older Adults: An Updated Meta-Analytic Review

This meta-analytic review of 232 effect sizes showed that, across five categories, attitudes were more negative toward older than younger adults. Perceived age differences were largest for age stereotypes and smallest for evaluations. As predicted by social role theory ( Eagly, 1987 ), effect sizes were reduced when detailed information was provided about the person being rated. The double standard of aging emerged for evaluations and behavior/behavioral intentions, but was reversed for the competence category. Perceptions depended on respondent age also. Results demonstrated both the multi-dimensionality and the complexity of attitudes toward older adults ( Hummert, 1999 ; Kite & Wagner, 2002 ).     

Self-Neglect and Neglect of Vulnerable Older Adults: Reexamination of Etiology

Using assessment and investigation data from the reported APS cases in Texas, this study examines the types of elder self-neglect and neglect, including medical neglect. It then examines the association between self-neglect and neglect and individual economic resources as well as health care and social service programs for the poor. The findings show that elder self-neglect/neglect is, in large part, attributable to frail older adults' and their families' lack of resources to pay for essential goods and services and the inadequate healthcare and other formal support programs for the older adults and their caregivers. This inadequate public policy coverage, rather than individual and intrafamily risk factors per se, needs to be considered as a significant cause of elder self-neglect/neglect.     

Religion and Spirituality as Defined by Older Adults

ABSTRACT

This exploratory qualitative study examined the intrinsic definitions of spirituality and religion across three different religious or ethnic groups of older adults – Jewish, African American Protestants and Caucasian Protestants. The study explores how older adults from these various backgrounds self-identify with the terms religion and spirituality. Because both African-Americans and Jewish older adults are underrepresented in the research on spirituality and religion, their inclusion lends insights to this topic and helps to anchor the findings in a cross-cultural context. Focus groups were employed to understand how these groups characterize their relationship to spirituality and religion. Social work professionals can utilize these findings to work more effectively with the diverse and complex issues of older adults.     

Network and Health Changes Among Older Dutch Adults

A negative effect of good health on the instrumental support received can be viewed as an effect of the mobilization of helpers. A positive effect of good health on the personal network size and the instrumental support given demonstrates that people in poor health have difficulty actively maintaining their relationships. Furthermore, the support received and given is positively related to the support given and received in the past. In four waves of a seven–year longitudinal study, personal interviews were conducted with 2,302 older Dutch adults (aged 60 to 85) who live on their own. The hypotheses have been confirmed. An implication is that investing in relationships by giving support might pay off in times of need.     

Mindfulness-Based Cognitive Therapy With Older Adults: An Exploratory Study

An 8-week mindfulness-based cognitive therapy (MBCT) group for older adults with depression and/or anxiety is described. This article is based on an exploratory study of this therapeutic approach and changes in participants’ symptoms associated with participation. Pre-post data from 5 MBCT groups showed significant improvements in reported anxiety, ruminative thoughts, and sleep problems and a reduction in depressive symptoms. Case examples are presented to illustrate these symptom changes. Findings showed that this nonpharmacological intervention is acceptable to older adults and is associated with positive changes. Suggestions are provided for both practitioners and researchers interested in using MBCT with older adults.     

Hispanic Familism in Caretaking of Older Adults

The role of familism in elderly adults has been professed to be the central institution in their lives. Though, Hispanic caretakers have provided high levels of informal care, it is the purpose of this paper to give evidence that current under utilization of formal services by the Hispanic family has dysfunctional side-effects. Reliance solely upon informal familial support increases dependency upon children which has been correlatcd with depression. Reliance also perpetuates a cycle of poverty as children's economic opportunities are sacrificed due to caregiving. Ideas for how to effectively intervene in this self-destructive pattern are suggested.     

Social Insurance and Older Adults in China: Effect of Education and Household Income on Coverage Following the 2009 Health Reform

Abstract

Education and income have been considered two primary determinants to affect individuals’ health outcomes. China initiated a comprehensive health reform in 2009, with the goals to provide equal access yet sufficient healthcare to all residents. However, social disparities continue to persist following this large reform. This research hypothesized that older adults’ years of education and income are determinants of participation in each social insurance scheme following the 2009 health reform. Multilevel logistic regression models were used with a nationally representative sample (n?=?5,274) to investigate the education and income disparities in each social insurance scheme for older adults, with random effects among provinces at the national level. The analyses show that years of education was not associated with enrollment in three social insurances, with the exception of the association between 11?years of formal education or above and the rural coverage. Participants with higher levels of household income had greater odds of having urban social insurances, but had lower odds of having the rural scheme. Further research should continue to investigate the disparities of enrollment of each social insurance. Chinese policy makers should consider these social factors carefully to reach a true universal coverage.     

Unmet Needs and Depressive Symptoms Among Low-Income Older Adults

Previous studies have found that declining health, decreased social interaction, and inadequate financial resources were significant risk factors for late-life depression, and social support from families and friends and religiosity were significant protective factors. In this study, we examined if low-income older adults' perceived unmet need for home- and community-based services for many aging-associated problems would be independently associated with their depressive symptoms, controlling for these known risk and protective factors. We interviewed a total of 213 community-residing older adults to assess their depressive symptoms, using the Geriatric Depression Scale (GDS), and unmet needs in the areas of personal assistance, instrumental and environmental support, emotional support, and other facilitative/enabling services. We found that the number of unmet needs was significantly positively associated with these older adults' depressive symptoms, although it explained only a small proportion of the variance of the GDS scores. Future research and practice implications are discussed.     

A Model for Community-Based Mental Health Services for Older Adults:

The mental health needs of older adults have historically been underserved by existing mental health service delivery systems. This paper presents a model for the delivery of comprehensive mental health services to older adults in their own homes, based on sound clinical practice, and incorporating a cross-cultural perspective coupled with a strong social and community support base.