Activity Engagement in Residential Care Settings: Findings from the National Survey of Residential Care Facilities

Assisted living and similar residential care is an important source of care for elders, including those with dementia. Meaningful activities may help residents maintain function, improve self-esteem, and enhance quality of life. Using data from the 2010 National Survey of Residential Care Facilities, this study identifies the extent of resident engagement in different types of activities; examines the extent to which cognitive status, other resident characteristics, and residential care community characteristics relate to activity engagement; and, among cognitively impaired residents, assesses whether being in dementia-specific settings is associated with activity engagement. Compared with persons without cognitive impairment, those with severe cognitive impairment are less likely to go on outings (79% versus 36%) and talk with family and friends (85% versus 72%). Residents with mild to severe cognitive impairment have higher participation in leisure activities than other residents if they live in dementia-specific settings (73% higher) than those who do not.     

Financial Exploitation of Elders: Analysis of Risk Factors Based on County Adult Protective Services Data

ABSTRACT

While all types of elder abuse and neglect are serious problems affecting thousands of vulnerable elders, financial exploitation has especially serious implications for the victims’ economic well-being and quality of life, because it may deprive the victims of their life savings and assets and thus their economic foundation for independence. In this study, data from the case files of a county adult protective services program were analyzed to identify risk factors associated with financial exploitation of and mismanagement by elders. The elders who were financially exploited were, on average, in their late seventies and tended to be cognitively impaired. We also found that owner-occupant elders were especially vulnerable to exploitation and that financial mismanagement and exploitation often occurred together. Approximately 60% of the perpetrators were relatives of the elderly victims, mostly their adult children, and the rest of the perpetrators were not related to the victims. Implications for interventions include case management for frail, cognitively impaired elders; preventive educational programs; and ongoing collaboration among adult protective services, financial institutions, and law enforcement agencies.     

Foster youth transitions to adulthood: a longitudinal view of youth leaving care

The well-being of youths who age out of the out-of-home care system in the U.S. has long been of great interest to child welfare practitioners and policymakers. In spite of this interest, however, very little is known about how these youths fare when they must make the transition to independence. The Foster Youth Transitions to Adulthood Study is tracking the experiences of 141 young adults who left care in Wisconsin in 1995 and 1996. This article describes these youths and their experiences in the first 12 to 18 months after leaving care. The findings suggest that the transition to independence is a difficult time for youth leaving the out-of-home care system.     

Multimedia Biographies: A Reminiscence and Social Stimulus Tool for Persons with Cognitive Impairment

The multimedia biography tells the story of the life of an elderly person with a cognitive impairment in motion picture format. The multimedia biography combines family photographs, film clips, audio narration, and music. It is intended to be screened on an ongoing basis to provide spaces for reminiscence and communication between cognitively impaired persons and their families. Using a production process in which we collaborated with family caregivers, we created 12 multimedia biographies for persons having Alzheimer's disease or mild cognitive impairment. This article describes our production and screening processes. We also share lessons learned from the multimedia biography research to assist practitioners, families, or researchers who wish to use similar technologies and processes for eliciting and sharing life stories.     

Network recall among older adults with cognitive impairments

Although it is widely accepted that personal networks influence health and illness, network recall remains a major concern. This concern is heightened when studying a population that is vulnerable to cognitive decline. Given these issues, we use data from the Social Network in Alzheimer Disease project to explore similarities and discrepancies between the network perceptions of focal participants and study partners. By leveraging data on a sample of older adults with normal cognition, mild cognitive impairment, and early stage dementia, we explore how cognitive impairment influences older adults’ perceptions of their personal networks. We find that the average individual is more likely to omit weaker, peripheral ties from their self-reported networks than stronger, central ties. Despite observing only moderate levels of focal-partner corroboration across our sample, we find minimal evidence of perceptual differences across diagnostic groups. We offer two broad conclusions. First, self-reported network data, though imperfect, offer a reasonable account of the core people in one’s life. Second, our findings assuage concerns that cognitively impaired older adults have skewed perceptions of their personal networks.     

Improving the Archiving of Records in the Out-of-home Care Sector

Abstract

Senate Inquiries into the lives of people who grew up in care, highly critical Ombudsman reports, and advocacy groups for recent and past “care leavers” draw attention to the significance of the records for children growing up in out-of-home care. This article reports on a project in which an interdisciplinary team of social workers, archivists, and historians worked together with 12 community-sector (nongovernment) organisations to look at the question of how to improve the management of the records for people with experience of out-of-home care. A Self Assessment Tool was developed and deployed at two points in time to provide feedback to organisations about the quality of their record-keeping practices. Clear improvements could be documented over a 2-year period in all 12 of the organisations involved.     

Contextualizing mistreatment in cognitive impairment in Latin America

Mistreatment is an important social outcome of the growing cognitive impairment epidemic, particularly in developing countries. This study aimed to bring to light what is known about mistreatment in cognitively impaired individuals in Latin American Countries. We identified a gap in the literature on this topic that opens the door for future research.     

Recent changes in the child welfare system: One state's experience

Nationwide over the past 5 years there has been a substantial reduction in the number of children involved with the child welfare system entering out-of-home care as well as a reduction in the lengths of stay among those who do enter the system. This article compares national data on children entering out-of-home care and the length of stay with data from Florida over a 7-year period (2005–2011). Findings are shared on the strategies and services that stakeholders in one state reported as contributing to preventing out-of-home placements and reducing lengths of stay in residential settings. Federal policies such as IV-E Waivers that support this reduction also are discussed. The article concludes with policy and research recommendations regarding how to sustain this reduction while ensuring that child safety and well-being are preserved.     

Vitamin D Deficiency Associated with Self-Neglect in the Elderly

ABSTRACT

Background. Vitamin D deficiency is common in elders. However, little is known about the implications of vitamin D deficiency in elder self-neglect.

Specific Aims. To characterize a group of self-neglecting elders with vitamin D deficiency based on clinical, cognitive, and functional status.

Participants. Forty-four self-neglecting elders referred by the Adult Protective Services.

Methods. Vitamin D status of the self-neglecting elders was based upon serum levels of 25-hydroxyvitamin D (25-OHD). Demographics, cognitive, and functional characteristics of vitamin D deficient self-neglecting elders were described and compared to those without vitamin D deficiency.

Results. Vitamin D deficiency (25-OHD < 25 nmol/L) was detected in 16 out of 44 self-neglecting elders (36%). Self-neglecting elders with vitamin D deficiency had lower scores in the Physical Performance Test and higher scores in the Kohlman Evaluation of Living Skills, compared with those who were not vitamin D deficient (p = 0.014 and p = 0.018 respectively).

Conclusions. Vitamin D deficiency is common in elder self-neglect. Self-neglecting elders with vitamin D deficiency have impaired physical performance and inadequate living skills, which can be potentially improved by treating vitamin D deficiency.     

Good health and the bridging of structural holes

Bridges that span structural holes are often explained in terms of the entrepreneurial personalities or rational motivations of brokers, or structural processes that lead to the intersection of social foci. I argue that the existence and use of bridges in interpersonal networks also depends on individuals’ health. Poor health may make it more difficult to withstand the pressures and to execute some of the common tasks associated with bridging (e.g., brokerage). I examine this possibility using egocentric network data on over 2500 older adults drawn from the recent National Social Life, Health, and Aging Project (NSHAP). Multivariate regression analyses show that both cognitive and functional health are significantly positively associated with bridging, net of sociodemographic and life-course controls. The relationship between functional (kinesthetic) health and bridging appears to be partially mediated by network composition, as older adults who have poorer functional health also tend to have networks that are richer in strong ties. Several potential mediation mechanisms are discussed. Cognitive function remains significantly associated with bridging net of network composition, suggesting that the inherent challenges of maintaining bridging positions may be more difficult to cope with for those who have cognitive impairments than for those who have functional impairments such as limited mobility. An alternative explanation is that cognitively impaired individuals have more difficulty recognizing (and thus strategically using) bridges in their networks. Theoretical implications and possibilities for future research are discussed.     

Mistreatment of Vietnamese Elderly by Their Families in the United States

ABSTRACT

Generally, research on elder abuse has focused on the elders in mainstream America so that little is known about the nature and scope of elder abuse occurring in the Vietnamese community. This study presents the results of a research project on the relationship of Vietnamese elders residing in Santa Clara County, California and their families. It also explores cultural factors that may be associated with elder mistreatment such as issues of dependency and personal indebtedness. The implications for intervention and prevention are discussed, along with proposed changes in human service programs that could enhance the well-being of Vietnamese elders.     

Caregiving and long-term health care in the People's Republic of China

The growing proportion of frail elderly in the People's Republic of China has necessitated policy of the state toward their long-term care. In this decade, there has been an increase in the amount of data available on the care and needs of Chinese frail elders. This article synthesizes these data and traces the patterns of care of frail elders. It distinguishes between urban and rural patterns, and identifies the increasing role of the family and community in the caregiving of elders. State policy, evident from the data, suggests that the state's role in direct care of elders is minor but that it continues to influence and support eldercare as part of its policy of promoting the one-child per couple policy. This process can be seen in support programs for the childless elder, who symbolizes the expected condition of a large number of future elders under the one-child policy. The article identifies four factors that are influencing the changing patterns of long-term care of elders in China: (1) economic reform programs; (2) the political agenda of the Chinese Communist Party; (3) differences in urban and rural economic conditions; and (4) policy directed at long-term investment in health care technology.     

A Case Series of Abused or Neglected Elders Treated by an Interdisciplinary Geriatric Team

ABSTRACT

Presently the available intervention in the state of Texas for abused or neglected elders is that delivered by the Texas Department of Protective and Regulatory Services. The Harris County Hospital District has a comprehensive Geriatric Program staffed by an interdisciplinary team. The purpose of this report is to describe the team's experience with nine neglected or abused elders who underwent interdisciplinary geriatric assessment and intervention with three and six-month follow-up. Two illustrative cases are described in detail. This series of nine patients who were neglected or abused illustrates the potential impact of a medical intervention program.     

The early home environment and developmental outcomes for young children in the child welfare system

The quality of the early home environment is predictive of young children's subsequent cognitive, academic, and behavioral functioning. Limited research has focused on the effects of the early caregiving environment on the functioning of young children involved with the child welfare system. This study investigated the influence of children's home environments (i.e., number of children in the home, number of moves the child experienced, level of cognitive stimulation, and level of emotional support) during the first 2 years of life on their preschool developmental outcomes (i.e., cognition, language, social skills, and behavior problems).As anticipated, a high-quality early home environment promoted the well-being of preschool children who had entered the child welfare system as infants. Children who lived with greater numbers of children incurred more compromised cognitive, language, behavioral, and social outcomes. No significant associations emerged between the total number of placements and developmental outcomes; children who remained in the same home during infancy (typically the birth family home) had more compromised developmental outcomes in every domain except behavioral problems.Both cognitive stimulation and emotional support in the home predicted higher cognitive and language scores, decreased behavioral problems, and increased social skills. Early out-of-home placement and lack of emotional support interacted to predict children's behavioral problems. These findings are considered in the context of extant research and policy relevant to young children in the child welfare system.     

Remaining home: Well-being outcomes and co-occurring parental substance use following a maltreatment investigation in middle childhood

PurposeThe purpose of the study is to understand differences in child well-being related to parental substance use among children ages 6–12 who were investigated for maltreatment but not removed from their homes. Children with a substance-using parent in the home are compared to those without a substance-using parent in the home.MethodsLongitudinal data from waves 1 and 3 of the second National Study of Child and Adolescent Well-Being (NSCAW II) are used. NSCAW II is a national sample of families with children and youth aged birth to 17.5 investigated by child protective services (CPS). A subset of the data (analyzed with domain analysis methods) is used for this study (n = 575). Eight well-being outcomes from four domains (cognitive development, physical health, psychological/behavioral development and social/emotional competence) are analyzed.FindingsWe hypothesized that (among children investigated for maltreatment and not removed from home) children whose parents used substances would exhibit lower mean levels of well-being at thirty-six months follow-up compared to those whose parents did not use. Unexpectedly, we found no significant differences in well-being levels between children with parents in the home using substances and those without.ConclusionsChildren with substance-using parents may be able to remain at home over an extended period after investigation, while maintaining well-being levels similar to children at home with parents not using substances. If an effective safety plan can be put in place, this option may provide a path to maintaining safety, permanency and well-being for such children without placement in out-of-home care.     

Serving elders in greatest social and economic need: the challenge to the Elderly Nutrition Program

The federally funded Elderly Nutrition Program is mandated to serve elders in greatest social and economic need. Yet researchers have concluded that the program underserves certain groups of elders, including those who are socially impaired and homeless and members of ethnic and other minority groups. This paper reviews the issues involved in serving elders in greatest social and economic need and suggests that reaching all of these elders with program services is not only a laudable goal but also, based on innovative models briefly described, is clearly achievable.     

Behaviorally impaired children in out-of-home care.

This study was undertaken to determine the nature of the out-of-home care placement experience for 131 behaviorally impaired children entering care over the course of a year in Nebraska. Variables analyzed included behavioral impairment, age at entry, age at termination, gender, race/ethnicity, family violence, geographical area before and at termination, closeness to home of most recent placement, and length of time in care. Multiple regression analysis showed that behavioral impairment was the strongest predictor of length of time in care, accounting for 2.4% of the variability.     

Familiäre Netzwerke und Lebenszufriedenheit alter Menschen in ländlichen und urbanen Regionen

Using data from the German Socio-economic Panel (GSOEP) from 1996, we examined whether the size of elders’ family networks differs between rural and urban regions of Germany, and whether the size of the family network gives rural elders an advantage in terms of well-being. We analyzed the association between certain aspects of the family network (size, closeness of relationships, proximity of relatives), feelings of loneliness, sorrow and life-satisfaction in a structural equation model. Results revealed that rural elders do live in larger family networks compared to urban elders. The elders in rural areas had more family relations and felt closer to them; it was especially the latter aspect which had a positive effect on the subjective well-being of older persons. This effect was larger in the western part compared to the eastern part of Germany.     

Deaf people and economic well-being: findings from the Life Opportunities Survey

The present study used propensity score analysis to compare the economic well-being of people with and without hearing impairment in the UK. Using nationally representative 2009/10 Life Opportunities Survey, our study found that economic well-being was significantly worse for people with hearing impairment than people without hearing impairment. Hearing impaired people (1) had lower household income, (2) experienced greater difficulties making ends meets, (3) were unable to pay for unexpected but necessary expenses of ?500, and (4) were less likely to work in paid jobs even after accounting for other demographic characteristics. The findings underscore the barriers and discrimination against people with hearing impairment in the UK. Policy measures to increase access and engagement of hearing impaired people should be considered, including increasing investment in better employment opportunities, sign interpretation, and disability benefits.     

Kinship Care: Analysis of the Health and Well-Being of Grandfathers Raising Grandchildren Using the Grandparent Assessment Tool and the Medical Outcomes Trust SF-36 TM Health Survey

ABSTRACT

As more and more children are being separated from their biological parents because of AIDS, substance abuse, mental and physical illness, incarceration, and child abuse and neglect, child welfare agencies are relying more often on kinship care as a viable option for out-of-home placements. In many cases, kinship care falls on the grandparents. While keeping children within their families is generally viewed as preferable by child welfare agencies, it can be a burden on grandparent caregivers, who often exist on severely limited incomes and without much assistance or support from social service agencies. A research project was conducted which used both quantitative and qualitative data from research conducted by Jones and Gibbons (2000) on grandparent care, but this study focuses on the experiences of grandfathers who participated in the project and examines their outcomes in several different areas.