Health Status and Health Care Services Among Older Persons in India

Summary

India is characterized by significant rural-based living, population heterogeneity, financial constraints, and reverse sex ratio. Traditions of joint families, life-long physical activity, vegetarianism, and social and spiritual enrichment, all known to promote healthy aging, are widely prevalent. With the increasing pace of population aging, the health of older persons in India has been the focus of recent attention. Existing data indicate a significant morbidity among the aged, much of which may remain subclinical. Considerable variations in morbidity exist with respect to gender, place of residence (rural vs. urban), and socioeconomic status. Rapid demographic transition without a concomitant epidemiological transition is responsible for the dual load of infections and degenerative diseases in older persons, these being common causes of death. Most age-related morbidity is preventable. Health promotion and cost-effective interventions based on the primary health care approach over a lifelong course, especially at the village level, will greatly help towards achieving the goal of healthy aging. The rapidly changing socioeconomic scenario in India also calls for appropriate policy actions to achieve this goal.     

Lesbian and Gay Parents: Their Experiences of Children's Health Care in Australia

This study investigates the experiences of lesbian and gay parents seeking health care for their children within the Australian medical system. Previously unavailable demographic data was collected on lesbian and gay families, and qualitative information was sought from parents about positive or problematic health care experiences related to sexual orientation and family constellation. Ninety-two lesbian or gay parents responded to a national postal and Web-based survey. Eighty-nine percent of respondents reported a high level of satisfaction with the health care received by their children. Despite overall satisfaction, however, 49 percent of parents identified fear of disclosure of sexual orientation, and 27 percent reported negative or problematic experiences with their children's health care related to sexual orientation or family constellation. This study indicates that fear of discrimination and homophobic attitudes towards lesbian and gay families remain a factor within the Australian health care system.     

Everyday Racial Discrimination,Everyday Non-Racial Discrimination,and Physical Health Among African-Americans

ABSTRACT

Past research has identified a link between discrimination and health outcomes among people of color. Perceptions of the cause of discrimination (racial versus other) seem to be important for mental health; however, this relationship has not been fully examined for physical health. Using data from the National Survey of American Life, we find that, among African-Americans, racial discrimination and overall discrimination regardless of attribution are associated with negative health outcomes while non-racial discrimination is not. The results suggest that racial discrimination has a unique adverse effect on physical health for African-Americans that practitioners need to better understand.     

Costs and Outcomes of an Extra Care Housing Scheme in England

Extra care housing, which provides support and care for people in specially designed accommodations, has now been part of the range of housing and care services available to older people in England for several years. Currently, the United Kingdom evidence base tells us little about the financing, estimation of the costs, or burden to the public purse of housing with care. The United Kingdom has significant state welfare provision in the areas of health and social care. The objective of this in-depth case study was to investigate the cost and outcome consequences for a sample of people who moved into an extra care housing scheme in Bradford, England, and to reflect on the methodological implications for future research in this developing area. The main finding of the study was that the overall cost per person increased after a move to extra care housing, but that this increase was associated with improved social care outcomes and improvements in quality of life.     

The Limits of Self-Management: Community and Health Care System Barriers Among Latinos With Diabetes

Although numerous studies examine diabetes self-care, few regard ecological framework correlates such as community and institutional level factors as fundamental for understanding diabetes management for Latinos. This article addresses the dearth of research that exists regarding social contextual forces and diabetes management for Latinos. Given the scarcity of research on this topic, studies of non-Latino groups were reviewed to illustrate the importance of community and institutional influences on diabetes care. Consideration of fundamental correlates within the ecological framework may better discern the underlying rationale for inadequate diabetes self-management for individuals who live in impoverished communities.     

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.     

Lesbian,Gay, Bisexual,Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences

The goal of this study was to explore attitudes, health knowledge, and experiences with health care setting and providers among lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals and to identify areas for improvement. Members of Equality Florida? residing in the five counties of the Tampa Bay region were recruited through e-mail invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with health care providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. A total of 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants were White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the health care setting (<10%). Health care settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. Results show high rates of sexual orientation disclosure, greater acceptance from providers of LGBTQ status, and the need for examination of hospital policies and improved cultural competency.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Migrants in the closet: LGBT migrants,homonationalism, and the right to refuge in Serbia

This case study examines the accommodation of lesbian, gay, bisexual, and transsexual (LGBT) migrants both de jure, in law, and de facto, in practice, in Serbia. The Balkan passage was a critical gateway for migrants throughout the 2015 European migrant crisis. Wedged between Eastern and Western politics, Serbia in particular faces pressure to promote LGBT rights arising from its candidacy for EU accession. The plight of LGBT communities seeking asylum is animated by interviews conducted with service providers working with these migrants in Serbia. The findings reflect the challenges of accommodating LGBT migrants in view of Serbia’s geopolitical dynamics, while situating this community’s rights in the broader human rights and legal discourse of continental Europe. Recommendations to service providers working with queer migrant communities are provided.     

Exploring the Relationship Among Mental Health Concerns,Social Support,and Relationship Satisfaction in Female Same-Sex Couples

The purpose of this quantitative study was to examine the relationship among internal factors (mental health concerns) that affect relationship satisfaction and contextual factors (social support) that affect relationship satisfaction in female same-sex couples (N = 99). Correlation and regression analyses indicated significant relationships among the variables. Specifically, mental health concerns were negatively correlated with relationship satisfaction whereas social support was positively correlated with relationship satisfaction. Mental health concerns and social support were found to be significant predictors of relationship satisfaction. Implications for practitioners are provided.     

Local Day Care Quality and Maternal Employment: Evidence From East and West Germany

By investigating how locally available early childhood education and care quality relates to maternal employment choices, this study extends the literature, which mostly has focused on the importance of day care availability or costs. The authors provide differentiated analyses by the youngest child's age and for West and East Germany to examine moderating influences, such as work‐care cultures, in a market with strongly state‐subsidized provision and near‐universal participation of preschool children. The empirical analysis linked the Socio‐Economic Panel and the Families in Germany Study for 2010 and 2011 (N = 3,301 mothers) with regional structural quality data and applied multivariate regression models. In East Germany, mothers with a child under age 3 years who lived in districts with smaller day care groups were more likely to be employed and to extend their work hours. For mothers in West Germany and those with older children, day care quality was not significantly related to employment.     

Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers

Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV; previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons.     

Integrating Sexual Health Services Into Primary Care: An Overview of Health Systems Issues and Challenges in Developing Countries

ABSTRACT

Current attempts to address the high burden of sexual health morbidity and mortality in developing countries remain limited in scale due to a range of health system constraints. We conducted a literature review of the policy and programmatic issues that influence the integration of sexual health into primary care services in developing countries. Forty-seven reports were identified from a search of both peer-reviewed and gray literature. Key issues identified were intersectoral and intergovernmental coordination; management and organizational issues including decentralization, health sector reform, logistics, and referral systems; human resources, including training and support required to increase service scope; relationships between the public and private sectors; and scaling-up and financing issues.     

Meeting Family Housing Needs: Experiences of Rural Women in the Midst of Welfare Reform

Though sometimes overlooked, the availability, affordability, and quality of housing in rural communities are a potential barrier to transitioning from welfare to work. In this investigation we examine housing issues confronting 17 rural women and their families who were recipients of welfare benefits in 1997. Respondents' housing accounts illustrate the significance of reliance on both government housing subsidies and informal subsidies supplied by friends, family, and more distant relatives. The study focuses on concerns women have in meeting their families shelter needs and the complexities involved in doing so. The findings of the research suggest that additional housing policy initiatives, as well as a targeted research agenda are needed, especially for families whose welfare benefits are nearing termination.     

Health Care of American Indian Elderly: Determinants of the Perceived Difficulty Obtaining Access to Health Care

This study examines the perceived areas of difficulty in obtaining access to health care and the factors influencing that difficulty among elderly American Indians in a rural environment. One hundred thirty-seven elderly Indians in the Ponca and Pawnee tribes of Oklahoma were interviewed. Four major difficulties are reported: a long waiting period at Indian health centers, difficulty in making appointments to see physicians, language and cultural barriers to communication with the health care providers, and lack of available transportation. The long waiting period is the most serious problem, and lack of transportation is the least serious. The results of probit analysis show that physical health, automobile ownership, education, employment, and the presence of an informal caregiver are related to difficulty obtaining access to health care. Ways to minimize this difficulty are discussed.     

Youth voice in service acceptability: Experiences of lesbian,gay, bisexual,and transgender adolescents

This study engaged lesbian, gay, bisexual, and transgender (LGBT) youths to tell their stories of satisfying and dissatisfying HIV-related service features and tapped into their common language when expressing satisfaction. Findings included youth agreement with six of the nine features proposed by adult experts and identification of “atmosphere,” the service feature encompassing the youths’ need to be themselves, to find comfort, and to socialize. Inclusion of youth voice in the design of a satisfaction survey highlighted those features most meaningful to these LGBT youths and added to the growing literature regarding power sharing with youths in health services evaluation.     

Housing Implications of Individual Budget Home Care Models for Older Renters: An Australian Case Study

Policies and programs relating to successful aging in place are premised on the fact that older people's housing is stable and suitable. Home-based aged care delivery models such as individual budgets aim to deliver increased service flexibility, choice, and control for consumers. Little attention has been paid to the consequences of such models for older renters, who often have less stable housing and restricted rights to modify their accommodation. This article reports on a project in Australia that explored the delivery and receipt of individual budget style models of home-based aged care services to older renters.     

The Business of Caring: Women's Self‐Employment and the Marketization of Care

Our goal in this article is to contribute to a differentiated analysis of paid caring work by considering whether and how women's experiences of such work is shaped by their employment status (for example, self‐employed versus employee) and the nature of care provided (direct or indirect). Self‐employed care workers have not been widely studied compared with other types of care workers, such as employees providing domestic or childcare in private firms or private homes. Yet their experiences may be quite distinct. Existing research suggests that self‐employed workers earn less than employees and are often excluded from employment protection. Nonetheless, they often report greater autonomy and job satisfaction in their day‐to‐day work. Understanding more about the experiences of self‐employed caregivers is thus important for enriching existing theory, research and policy on the marketization of care. Addressing this gap, our article explores the working conditions, pay and levels of satisfaction of care workers who are self‐employed. We draw on interviews from a small‐scale study of Canadian women engaged in providing direct care (for example, childcare) and indirect care (for example, cleaning).     

The Role of Housing in Community Health Promotion Among the Aged

Abstract

A total of 89 aged residents living independently in single and double occupancy housing in an historic, traditionally planned neighborhood in New Orleans were surveyed with respect to their engagement in the outdoor realm in their immediate neighborhood. An index was developed, comprised of variables spanning the scale of the private dwelling to neighborhood scale. Certain dwelling attributes, health status factors, lifestyle factors, and neighborhood factors were found to be associated with a disinclination to walk outdoors in the community. Among the findings, improperly designed porches and insufficient semi-private exterior space adjacent to the dwelling function as strong deterrents to health-promoting walking activity outdoors, closely followed by fear associated with being victimized by crime in one's immediate neighborhood. Such conditions were found to pose a barrier to full engagement with the community in what on the surface would otherwise appear to be an imminently pedestrian-scaled residential setting. Study limitations, and directions for future research within the environmental design disciplines are discussed for both historic neighborhood settings and in new development.