Hoarding Cases Involving Older Adults: The Transition From a Private Matter to the Public Sector

Hoarding interventions with older adults require significant resources from multiple public agencies, yet recidivism occurs frequently. To improve services through better coordination, some communities have formed multiagency hoarding teams (MAHT), which include aging services. MAHTs requested this mixed methods study to understand the progression of cases through the public sector. Quantitative data collected on 52 cases involving adults ages 60+ identified steps in this process. Qualitative data collected from MAHT members were the basis for case studies illustrating the progression of cases through the public sector. Findings have implications for social workers involved in local service coordination, training, and policy.     

Predictors of Depression Among Caregivers of Older Adults With Severe Mental Illness

Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with SMI. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient’s symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.     

Relationship Between Pain and Chronic Illness Among Seriously Ill Older Adults: Expanding Role for Palliative Social Work

Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 Institute of Medicine . ( 2011 ). Relieving pain in America: A blueprint for transforming prevention, care, education and research . Washington, DC : National Academies Press . [Google Scholar]). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.     

Prioritizing Choice: Perceptions of Neighborhood Social Cohesion for Residents in Subsidized Housing

ABSTRACT

Many families living in poverty rely on housing subsidies. Housing subsidies restrict the housing stock and neighborhood choices for families living in poverty. Fortunately neighborhood social cohesion can protect families from many of the deleterious consequences associated with living in a low-income neighborhood. This study uses panel data from the Annie E. Casey Foundation's Making Connections initiative to test the role of public housing types on perceptions of neighborhood social cohesion. The probability sample used in the study consists of 2,470 households living in low-income neighborhoods in ten cities in the United States. Results show that public housing residents, both housing choice voucher users and non-housing choice voucher users, on average, report lower neighborhood social cohesion than their non-public housing neighbors. Results also show that moving to a new neighborhood consistently predicts improved neighborhood social cohesion while moving to public housing predicts declines in perceived neighborhood social cohesion. Choice in where one lives seems to play an important and positive role in perceptions of neighborhood social cohesion. Based on these data, it is suggested that policy makers and housing providers prioritize choice in the development and delivery of public housing.     

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.     

Type of Volunteer Experience and Health Among Older Adult Volunteers

Abstract

The purpose of this investigation was to ascertain if the type of volunteer experience was related to the physical health or psychological well-being of older adult volunteers. A central pattern emerged from the data: the type of, as well as the number of, hours donated to a volunteer activity were associated with psychological well-being. Implications for social workers involved with volunteer programs and services are discussed in terms of volunteer recruitment and retention, and the need to develop more significant volunteer roles, especially for low-income older adults.     

The Medicare Part D Coverage Gap: Implications for Non-Dually Eligible Older Adults With a Mental Illness

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.     

Reported Coping Strategies and Depressive Symptoms Among African American and White Residents of Congregate Housing

Chronic health conditions and living in congregate housing, both stressors and losses, are risk factors for late life depressive symptoms. We examined self-reported coping strategies and their associations with depressive symptoms among residents of congregate living facilities. Despite demographic differences between the African American and the White participants, reported coping for the 2 groups was similar, though more African Americans reported spiritual coping. Participants who reported coping through either positive attitude and adaptations or activity participation had fewer depressive symptoms, after controlling for demographics, health, functioning, and other types of coping.     

Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative (HASI)

Without appropriate support, people with mental illness can be excluded from stable housing and social and community participation. Transitional models of support for people with acute mental illness have addressed clinical symptoms and hospitalisation, but they have not facilitated stable housing and community integration. In contrast, individualised housing models aim to improve mental health, housing and community outcomes. These programs are costly and require collaboration between agencies. This article discusses the evaluation findings of one such program – the NSW Mental Health Housing and Accommodation Support Initiative (HASI). The longitudinal mixed‐method evaluation assessed whether HASI supported people with high levels of psychiatric disability to improve housing, mental health and community participation. We discuss the challenges clients within the program faced prior to joining HASI and the changes experienced while in HASI. We conclude by drawing policy implications for programs supporting people with mental illness to live in the community.     

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.     

Supportive Housing for Addicted,Incarcerated Homeless Adults

ABSTRACT

Homeless populations often suffer from mental illness, substance abuse, and criminality. Interventions, such as supportive housing, can have positive impacts, although benefits can be limited. This study examined outcomes for clients (N = 102) of a new supportive housing intervention. Use of formal treatment, jail contact, and community stability were compared pre- and post-housing. Jail bookings and residential substance abuse treatment significantly declined post-housing, while clients improved in income level, access to food, and housing stability. Results from official justice and treatment system data suggest that supportive housing can lead to significant changes. Future research is necessary to understand the relationship between client characteristics and outcomes.     

日、韩公共住宅制度的改革与发展

为低收入阶层供给公共住宅是政府的职责。公共住宅制度包括供给租赁住宅、供给出售住宅以及提供政策性金融支持。本文通过分析日本和韩国的公共住宅制度,指出,日、韩两国以政府为主导,设立了专门的住宅管理机构和租赁住宅供应制度等特点,在实施过程中也取得了较好的社会效果。中国正处于房价快速上涨阶段,建立完善的公共住宅制度具有很强的现实意义。     

Health Self-management Among Older Prisoners: Current Understandings and Directions for Policy,Practice, and Research

The population of aging prisoners has increased significantly over the past several decades, resulting in concerns about the criminal justice system’s ability to address the needs of prisoners and parolees with chronic health conditions. This is troubling, given the health disparities among incarcerated populations. Health self-management has become a strategy within the community-based health care industry to improve health services and outcomes while reducing health care costs for nonincarcerated individuals with chronic conditions. However, to date little research has focused on the practice or promotion of health self-management among current and former incarcerated populations. This article highlights current understandings about chronic health self-management among older prisoners and parolees, with an emphasis on the potential benefits and current challenges in promoting their health self-management practices. Finally, specific recommendations are made for promoting health self-management for these populations through social work practice, policy advocacy, and research to achieve goals in improving health outcomes and reducing healthcare costs.     

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill

This article discusses, from the grandmother’s perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52–90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.     

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.     

Adult adjustment problems of separated children: a longitudinal study from birth to the age of 23 years

The study investigated the risk of adult criminality, alcohol abuse and mental health problems (between 18 and 23 years of age) that were associated with a) the number of separations to which a child had been subjected, b) age at separation and c) the sex of the child. Data were used from a Swedish longitudinal study of a large representative sample. It was found that: 1) experiencing a separation during childhood was associated with a significantly increased risk of later maladjustment for all 3 adjustment problems; 2) the risk increased approximately additively with the number of separation events experienced during childhood; and 3) for all 3 adjustment problems, the risks were largest in the case of early (before age 7) and late (age 12-16) separations and there was not any significant risk increase arising from separations in the intervening age period. These risk increase patterns were similar for males and females, but the levels differed, since male sex in itself almost quadrupled the odds for later criminality and alcohol abuse.     

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.     

Use of an Online Community to Provide Support to Caregivers of People With Dementia

One challenge faced by many family members caring for persons with dementia is lack of information about how to take care of others and themselves. This is especially important for persons from ethnic minority groups, because linguistically and culturally appropriate information is often not available. In response to these needs, we developed a web site for Spanish-speaking caregivers. Cuidatecuidador.com provides bilingual information on dementia and caregiver issues. Content was developed and then evaluated by caregivers residing in 3 countries. Findings suggest trends that exposure to information may be related to a higher sense of mastery and a reduction of depressive symptomatology.     

Changes in Life Satisfaction Among Participants of Adult Day Care and Their Informal Caregivers

This paper examines changes in life satisfaction among participants of Adult Day Care (ADC) in Manitoba, Canada, and their informal caregivers (where applicable). ADC participants (N = 112) and their informal caregivers (N = 34) were interviewed at two points in time. Data analyses reveal that, during attendance at the program, the life satisfaction of both the participant and the informal caregiver tend to improve. Attempts to predict which participants are most likely to improve, remain stable, or deteriorate in life satisfaction were largely unsuccessful. A smaller group of participants in Winnipeg programs were matched on age, sex, functional disability and illness with two control groups. Analyses reveal improvements in life satisfaction among ADC participants appear to be program effects.     

‘Not a good person’: family stigma of mental illness from the perspectives of young siblings

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in‐depth, semi‐structured interviews conducted with seven (n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental‐health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as ‘flawed’ against the mental illness as ‘bad’ and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed.