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.     

Characteristics of Women Seeking Services at a Transitional Housing Facility for Women Leaving Street-Based Sex Work: Implications for Social Service Providers

ABSTRACT

Women who decide to leave street-based sex work often struggle with addiction, trauma-related mental health consequences, and exclusion from employment and housing. To offer recommendations for social service providers, this article draws upon primary data from interviews and surveys with 87 residents at a transitional housing facility for women leave sex work to elucidate: 1) a demographic profile of the women, 2) life history patterns and circumstances that encourage women to leave street-based sex work and 3) recommendations for service providers. Results indicate the need for service providers to assist women with basic needs, strengthen referral networks, and extend trauma-informed services.     

Self-reported mental health problems and post-traumatic growth among children in Pakistan care homes

ABSTRACT

Children in care experience multiple risk factors, particularly in low-income countries such as Pakistan. The aim was to establish rates of mental health problems and their relationship with posttraumatic growth, as reported by 132 children aged 9–19 years, living in three care homes in Pakistan. Children reported high rates of posttraumatic stress (70.45%) and common mental health symptoms (43.94%) within the clinical range, but also high levels of posttraumatic growth. These findings highlight the high levels of mental health needs among children in residential care, as well as the importance of understanding factors that promote their posttraumatic growth and resilience.     

Comparing Perceived Quality of Life in Nursing Homes and Assisted Living Facilities

Abstract

Residents 65 years old and older living in nursing homes (NH) and assisted living facilities (ALFs) were matched on a scale of functional ability: The Sickness Impact Profile for Nursing Homes (SIP-NH). Of the 97 NH and 100 ALF residents who were evaluated using the SIP-NH, 43 pairs, matched by level of disability, were formed. Each member of the 43 pairs was administered two quality of life instruments: the Ferrans and Powers Quality of Life Index (QLI), as well as a single direct question regarding quality of life. Matched pair t-tests revealed no differences in quality of life scores, contrary to the hypothesis that the matched residents in nursing homes would have perceptions of a lower quality of life than residents of assisted living facilities.     

Gambling Behaviors Among Oxford House Residents: A Preliminary Investigation

ABSTRACT

The present study investigated the prevalence of gambling behaviors among 71 individuals recovering from substance-dependent disorders and living in self-run recovery homes (Oxford Houses). Residents were given the South Oaks Gambling Screen to assess gambling behaviors and pathological gambling, and 19.7% of the sample was identified as having probable pathological gambling. These residents reported proportionately more involvement in a variety of gambling behaviors than other residents. Engagement in various gambling activities was consistent with previous investigations and suggested that self-run recovery homes such as Oxford Houses might be suitable referral sources for recovering persons who have comorbid gambling problems.     

Self-efficacy and psychological well-being of nursing home residents in China: the mediating role of social engagement

Abstract

The purpose of this study was to explore the role of self-efficacy and social engagement in psychological well-being of Chinese nursing home residents. A total of 307 residents completed the measurement of social engagement, self-efficacy and psychological well-being. The results showed that satisfaction with physical environment, social support, social activity engagement and self-efficacy were all positively correlated with psychological well-being. At the same time, social engagement partially mediated the effect of self-efficacy on psychological well-being. The results of this study should indicate additional actions for managers of nursing homes and social workers to improve the psychological well-being of older adults.     

Friendship Across the Life Cycle

Abstract

Using a group work model, this article discusses a short term group for older women developed to explore the importance of friendship in late life. In collaboration with group leaders, group members determined weekly topics that explored the significance of friendship through the life cycle. Social work group practice that focuses on the meaning and development of friendship for and with older women is presented as an effective therapeutic intervention for practitioners in settings such as community mental health clinics, senior centers, elderly housing, home care agencies and nursing homes.     

Death and suicidal ideation among nursing home residents in a Chinese city – a pilot study

This paper examines death and suicidal ideation among nursing home residents in a Chinese City using a questionnaire survey data. Findings from the survey show that 17.4% of the participants have death and suicidal ideation, and the prevalence of passive and active ideation are 15.4% and 6.2% respectively. The presence of death and suicidal ideation among nursing home residents correlates with depressive symptoms, life satisfaction, and satisfaction with nursing home services. As death and suicidal feelings are risk factors for suicide, the findings imply that implementing depression prevention programmes and improving service quality of nursing homes are vital in preventing suicides among nursing home residents.     

Sexuality in the Nursing Home

Abstract

Despite a growing body of literature that contradicts previous stereotypes, negative myths about late life sexuality have persisted. These attitudes had been more entrenched in nursing homes where residents' sexuality have been perceived primarily as behavioral. At one nursing home, a policy and video training program on sexual expression was developed, with staff training, environmental modifications, and work with families, based on sexual expression as a right of consenting adults. This policy can serve nursing homes which face challenges presented by new cohorts of older adults and their families.     

Chapter 7 Sexual Abuse of Older Women Living in Nursing Homes

Abstract

Aggregated data from APS case files of sexually abused older women between the agesof70 and 89living in nursing homes were collected over a five-year period, yielding a total of 50 substantiated cases. The most common types of sexual abuse involved instances of sexualized kissing and fondling and unwelcome sexual interest in the women's body. All alleged perpetrators were male; they typically were 70 years of age and older and residents in the nursing home. In only three cases was the alleged offender prosecuted in court and only one of these cases was the offender convicted. Implications of these data for future practice and research are discussed.     

The Role of the Nursing Home Social Worker in Terminal Care

This study examines the role of the nursing home social worker in terminal care. Questionnaires were distributed to 60 social workers in 14 nursing homes in the greater Milwaukee area. The hypothesis was that the presence of policies/procedures governing terminal care would be related to a decreased amount of stress for social workers. This correlation was not supported by the survey results. Although 71% of respondents indicated no policies were available to them, only 32.6% of social workers reported that terminal care was a source of stress. In fact, 59% reported that the social worker's role in terminal care had not been discussed in the social services department of their facility. Comparative lack of stress for social workers may be related to the lack of perception that social workers play a significant role in the terminal care of residents.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

Incremental Validity of Stressful Life Experiences in Predicting Psychiatric Comorbidity Among Women in Substance Abuse Treatment

ABSTRACT

The dynamic contribution of stressful life experiences in predicting psychiatric comorbidity continues to challenge clinical practice and research. This study tested incremental validity of stressful life experiences related to psychiatric comorbidity among 128 young women in a Midwestern substance abuse treatment facility. Respondents reported low income, homelessness, and health and mental health issues. Using the Addiction Severity Index (ASI), Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision, and Stressful Life Experience (SLE) Screen as correlates, hierarchical linear regression demonstrated support for incremental validity of SLE uniquely accounting for 6.5% of variance in ASI psychiatric scores. Findings support future use of SLE in clinical settings for assessment and intervention purposes.     

Role Orientations,Attributions to Nursing Facility Personnel,and Unresolved Complaints of Volunteers in an Ombudsman Program

Abstract

This research linked volunteers' orientations to their work in an ombudsman program, their attributions of support to facility personnel, and unresolved complaints. A significant feature of the research was relating volunteers' attitudes and an objective indicator of their practices. Data were analyzed from volunteers' replies to a mail questionnaire (n = 481) and unresolved complaints coded from records. Advocates differed from mediators and therapeutic supporters with significantly more unresolved complaints and more negative attributions to facility personnel. Attributions to facility staff influenced the magnitude of unresolved complaints only among advocates. Implications for practice are noted.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Nursing Homes in England and their Capacity to Provide Rehabilitation and Intermediate Care Services

The numbers of older people living in residential and nursing home care in the UK have risen exponentially since the early 1980s when the closure of long–stay geriatric wards and changes in social security funding of care home places led to a rapid expansion of the care home industry. While the implementation of the 1990 National Health Service (NHS) and Community Care Act shifted the responsibility for the commissioning and funding of these services to local authority social services departments, the provision of most health services (such as general practitioner care, physiotherapy and specialist nursing services) to nursing home residents remains the responsibility of community–based NHS practitioners. Recently, the attention of policy–makers in the UK has been focused on the need to improve the throughput of the acute sector. Older people who have received treatment but are not yet able to return to their own homes are to be transferred into intermediate care facilities, often by using nursing home beds, with the aim of supporting short–term rehabilitation outside of the acute sector. This paper presents evidence from a study of health service provision to older people living in nursing homes in England. It examines whether nursing homes have the capacity to fulfil the rehabilitation and intermediate care function envisaged by policy–makers. It concludes that shortfalls in the provision of NHS services to nursing homes and difficulties faced by nursing homes in paying for health services themselves may hinder the rehabilitation potential of intermediate care placements in nursing homes.     

Depression Treatment and Cost Offset for Rural Community Residents with Depression

ABSTRACT

This study examined the relationship between costs of treating physical problems and costs of treating depression, for 322 rural residents with depression. Multiple regressions were used to control for sociodemographics, depression severity, and physical and mental health comorbidities at baseline. The results indicated a $1.42 (n = 322) reduction in the costs of treating physical problems for a $1.00 increase in the costs of treating depression. The reduction was $2.61 (p < 0.05) among those receiving depression treatment (n = 125). These findings suggest a net savings from depression treatment, in addition to other benefits such as improved symptoms and functioning and increased productivity.     

Calling the Question of “Possible Dying” Among Nursing Home Residents

Abstract

Glaser and Strauss reported decades ago that in order for a person to be treated as dying, he/she must be defined as dying. Defining nursing home residents as “dying” can be complicated because most residents are in advanced old age with multiple chronic conditions. Using a social construction theoretical framework, this study looks at the step before the declaration of dying, that is, the consideration of the possibility of dying. This qualitative study is a secondary analysis of prospective data collected during 16 months of fieldwork on behalf of 45 nursing home residents whose health was considered declining. The purpose of this paper is to build understanding about the social construction of “possible dying” by reporting triggers that can call the question of possible dying and stimulate a discussion about the nursing home resident's status, prognosis, care options, and preferences. These triggers include: Health status decline; noncompliance with diet or medications; available medical interventions not being well suited for the residents; and family consideration of an out-of-town trip. The paper also reports barriers (family, staff, and disease process) and facilitators to calling the question of possible dying, including families having a sense of treatments they would like to avoid and having the opportunity to talk through options. Findings are discussed in light of basic assumptions of social construction. Implications for social workers include helping residents, families, and staff anticipate and address the possibility of dying, and to reflect these discussion in care plans, as well as the need to be available to help residents and family members with psychosocial issues related to living and dying in the nursing home setting, including the profound issues that can be provoked or exacerbated by resident health status decline and possible dying.     

Functional Status of the Non-Institutionalized Elderly in Sweden

Abstract

Functional ability was assessed in a randomly recruited population of elderly persons, totalling 553 individuals, living in their homes in four municipalities in central Sweden. These subjects were interviewed at home, using the Sickness Impact Profile. The response rate was 75%. No significant differences in functional ability were found among the municipalities. For those subjects 85 years old or more, average physical and overall functional ability was significantly worse than among the 81-84 year olds. Women had a significantly lower functional ability than men. Less well educated elderly persons had lower psychosocial and overall functional abilities than had the better educated. Physical dysfunctionbut not psychosocial dysfunctionwas significantly associated with formal and informal home help.