Understanding Very Old Age: Looking Back and Thinking Forward

ABSTRACT

Understanding human development among the oldest old is a sequential building process taking into account building-block data, theories, and models from childhood, adulthood, and old age toward a new territory of oldest-old survivors who have lived way beyond the average life-span. A central question is whether the oldest-old survivors have developed specific survival techniques and/or protective environments that nurture survival. Or are the oldest old statistical outliers who by happenstance continue to survive further into old age? This commentary provides a historical framework on the papers in this series that describe challenges confronted by the oldest-old survivors in order to advance our understanding of survival of the oldest old. A clear understanding of the contributors to longevity could guide public policies toward well-being and life satisfaction among our oldest-old citizens.     

Chapter 2. Housing and Household Movement in Later Life

ABSTRACT

In most developed countries housing policies are focusing on enabling elderly and very elderly people to remain in their own homes. Attention is also turning to people in the Third Age to see how their housing needs to be different from earlier stages of their lives but also as a preparation for old age. This paper presents evidence from the United Kingdom (UK) about choices and policies at different stages of middle and old age and on the developing range of housing options to meet these needs.     

Protecting Older People From Burglary: Prevalence of Security Devices in the Homes of Older Adults in Perth,Western Australia

ABSTRACT

Fear restricts the activity of older adults, potentially leading to social isolation and unhealthy life styles. Consequently, this population remains a priority for home security research and intervention. One option is to increase home security by installing security devices. However, little is known about how older adults protect their homes. In this study, 5,582 community-dwelling older people completed a cross-sectional survey. The survey was able to document the prevalence of security measures taken by older adults. More than 70% of the respondents had security screens and key-operated deadlocks and 148 (2.7%) respondents reported no security features. Respondents living alone had the lowest prevalence of home security devices. Female living alone protected their home differently from male living alone by installing different security devices. Logistic regression analysis indicated that older adults living in detached houses feel particularly vulnerable to burglary (p < .001). These survey findings have practical implication for burglary prevention.     

The Presence of Memory-Enriched Environments for Cognitively Impaired Nursing Home Residents

Abstract

Enriched living environments that contain a wide array of personal memorabilia and memory-stimulating cues have the potential to support cognitive functioning. The purpose of this ethnographic research was to describe the care environments of older adults with cognitive impairment living in nursing homes (n?=?42), to evaluate the degree to which these environments contained memory-stimulating cues, and to understand the extent to which these environments were cognitively stimulating for older adults with dementia. Results indicated varying levels of enrichment both within and between homes, with nearly a quarter of the residents living in environments that contained no memory-enhancing stimuli.     

Chapter 5 Impacts of Profit Status of Assisted Living Facilities

Abstract

Florida is a bellwether state in terms of the need for assisted living among elderly persons and has more than 2,000 of the nation's estimated 11,459 assisted living facilities (ALFs). The authors of this article surveyed 140 ALFs in Florida in order to examine the relationship of profit status to ownership of other facilities, willingness to serve low income groups, formal policies, and persons involved in decisions about resident retention. Significant differences were found between for-profit and non-profit facilities in terms of ownership of nursing homes and resident involvement in retention decisions. A discussion of how the profit motive and formal policies can impact residents concludes the article.     

Housing for Older People in Iceland: Apartments and Nursing Homes

The first residential and nursing homes in Iceland were built in the early 1920s, and the first apartments for older people in the early 1970s. Most of the existing housing for older persons was built in the last 30 years. Legislative provisions on housing and particularly on assisted living have not changed significantly since laws relating to the affairs of the elderly were first passed in 1983. While approximately 90% of older people in Iceland own their own home and the primary stated goal of the government is to support independent living, official policy relies on placement in nursing homes. Services and care at home, provided by social and home healthcare services, has not been developed to the same extent as in the other Nordic countries. Clearer guidelines on integrated service housing are needed to reach the government's primary stated goal. Placing more emphasis on delivering services, care, and rehabilitation to people living in the community could shorten individuals’ length of stay in hospitals, delay admission to nursing homes, and better meet the expectations of older people for independent living.     

Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

Housing in Old Age: Dynamical Interactions Between Neighborhood Attachment,Neighbor Annoyance,and Residential Satisfaction

Objective: Residential satisfaction and neighborhood quality play major roles in aging well. However, longitudinal research about the interplay between such factors is still sparse. Our 1-year study examined whether change in residential satisfaction was associated with change in two indicators of neighborhood quality: neighborhood attachment and neighbor annoyance.

Methods: Findings come from a longitudinal study with 85 community-dwelling German older adults (age range: 60 to 92 years). Participants filled out questionnaires at two measurements that were 1 year apart. The interplay between residential satisfaction and neighborhood was explored using a cross-path model.

Results: Higher levels of residential satisfaction predicted enhanced attachment and reduced annoyance over time. Moreover, attachment predicted positive change in residential satisfaction over the course of 1 year.

Conclusion: Results suggest that older adults may apply adaptive behaviors and strategies to optimize their neighborly experiences. Such findings have implications for improving residential satisfaction in community-dwelling older adults.     

Health and Aging-in-Place: Implications for Community Practice

ABSTRACT

There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n?=?114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.     

Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge

ABSTRACT

Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the very old; the balance between formal and informal care; and the development of suitable places for living. Besides more specific measures, we propose that policies promoting the social integration of very old adults in their communities would be particularly helpful, as these may benefit not only the very old and their families but also individuals of all ages. We conclude that the development of suitable policies addressing the needs of the very old will benefit from future investigation of cross-cultural similarities and differences in centenarians’ characteristics, available services, as well as life conditions they encounter in communities and institutional contexts.     

Environmental Evaluations and Modifications to Support Aging at Home With a Developmental Disability

ABSTRACT

Increasing numbers of people with developmental disabilities are living into old age and are now residing in community-based housing, largely due to the deinstitutionalization movement. The overlay of age-related impairments onto pre-existing, lifelong disabilities puts this population at a magnified risk for premature behavioral limitations and loss of independence. This article describes a demonstration project designed to enable people with developmental disabilities to age in place. Interviews and observational assessments with 45 older adults with developmental disabilities were conducted in their community-based homes to identify potential barriers to aging in place. An Individualized Environmental Intervention Plan was developed for each study participant, recommending ways to solve problems and eliminate potential barriers. Individualized Environmental Intervention Plans were implemented to the extent possible through home modifications and assistive technology. Pre- and post-modification task performance and self-report revealed the positive impact that home modifications and assistive technology can have. The study demonstrates the need for ongoing evaluation and assessment sensitive to the needs of people with developmental disabilities and the unique characteristics of supported living settings.     

The Coming Home Program

Abstract

This paper describes barriers and opportunities to creating affordable assisted living facilities for older persons eligible for Medicaid services. This information is based on the practical experiences of the Coming Home Program, a project of NCB Development Corporation (NCBDC) with funding from the Robert Wood Johnson Foundation (RWJF). Begun in 1992, this national program has contributed to the creation and adoption of state policies including regulations, implementation of state programs, creation of development and operational feasibility analysis tools, and the identification and structuring of financing sources. It has also fostered and supported public-private partnerships that have resulted in 31 operational affordable assisted living demonstration projects with another 73 in development.

The paper explains the need for affordable assisted living, Coming Home's definition of affordable assisted living, and the structure of the Coming Home Program. Four case studies are presented that summarize the goals and outcomes of the Coming Home Programs in Arkansas, Florida, Washington, and Vermont. The paper's conclusions provide lessons learned during the program's first twelve years and their implication for state policies and programs.     

Voices of 65 Young People Leaving Care in Sweden: “There Is So Much I Need to Know!”

Abstract

The purpose of this study is to examine young care leavers’ experiences of supportive and nonsupportive factors after leaving care. Telephone interviews were conducted with 65 young people, between 18 and 26 years old, who had left care in Sweden within the previous 3 months to 3 years. The care-leaving process was in many cases described by the young people as badly planned and compressed. Some interviewees received support from the formal network (social services, foster carers, residential homes, contact persons) for housing (37) and financial matters (36), but few received support from the formal network concerning employment (14) and education (11). Emotional support was mainly provided by partners and friends. Altogether, the results suggest that access to support is a helpful factor for young people leaving care, but also that many of our interviewees had no such access, from neither formal nor informal networks.     

What do Potential Residents Need to Know about Assisted Living Facility Type? The Trade-off between Autonomy and Help with More Complex Needs

The current study surveyed 74 assisted living facilities to examine the effect of facility type on resident autonomy and the willingness of providers to admit residents requiring complex services. Facility types included adult family homes, residential care facilities, and traditional assisted living facilities. Adult family homes were more willing to admit residents with higher care needs. By contrast, assisted living facilities’ policies did not support the provision of intensive services, but their policies promoted higher resident autonomy, suggesting that consumers may have to choose between autonomy and help with complex needs when exploring assisted living for long-term care.     

HIV/AIDS Orphans' Education in Uganda

Abstract

The HIV/AIDS epidemic in most sub-Saharan African countries has created a crisis in the African family structure. In Uganda, older people's roles have been reversed from being provided for to providers. Older people, who are already poor, face the loss of economic support from their adult children and unexpected social, psychological and economic burden due to the care-giving role they assume. In this study, we used cross-sectional data from Kayunga district in Central Uganda to examine the impact of HIV/AIDS on the role of older persons. We found that there were HIV/AIDS related deaths in 82.3% of the surveyed households. In almost 34% of the households, the care-givers of HIV/AIDS orphans were older people over 50 years old. Almost all households headed by older people (97.8%) had on average three school-going orphaned children living in the household.     

Foster care,geographic neighborhood change,and the risk of delinquency

Background and purposePrevious studies report that foster care placement is associated with an increased risk of delinquency. Yet it remains unclear which aspects of the placement experience increase the risk of delinquency. The current study addresses this knowledge gap. This study investigates the relationship between geographic neighborhood change and the risk of delinquency for adolescents in foster care settings. Based on findings from the neighborhood effects literatures, we hypothesize that moving to a neighborhood characterized by concentrated disadvantage and residential instability is associated with increased risk of delinquency.MethodsThe design for the current study is longitudinal. The sample is comprised of 145 foster youth from two birth cohorts, one born in 1983 and one in 1984, in Chicago, Illinois. The sample was 92% African American and 52% male. Overall, 11% had an official juvenile arrest. We used data from multiple sources, including the 1990 census data and administrative data from the Illinois Department of Children and Family Services and the Cook County Juvenile Court. To measure neighborhood change, we calculated a difference between children's home and placement neighborhoods on ten census variables: percentages of households in a given neighborhood that were below the poverty line, neighborhood households on public assistance, female-headed households, unemployed population, and persons < 18 years old, African American, Latino, foreign-born, residents living in the same house as five years earlier, and owner-occupied homes, all of which are commonly used in neighborhood studies. We identified two factors within the neighborhood variables—concentrated disadvantage and residential instability,—and used the two-factor scores in the following analysis. We conducted a Cox regression to model time to first arrest.ResultsThe results indicate that moving to a neighborhood with high residential instability significantly increases an individual's risk of juvenile delinquency. In addition, two subgroups—male foster youth; and all foster youth with an experience of neglect—are significantly more likely to be associated with a formal delinquency petition.Conclusions and implicationsThe current study is unique and builds the knowledge base with regard to the placement of children and adolescents in substitute care settings. The findings indicate that the neighborhoods in which children are placed do matter in terms of their outcomes, and thus they should be considered in the placement decision process. This finding is consistent with the “person-in-environment” concept advanced by social work professionals.     

The Role of the Environment in Sedentary Behavior in Community-Dwelling Older Adults

To compare amounts of sedentary behavior and physical activity in adults residing in planned group residential settings to those residing in private homes, this study recruited 31 older adults who resided in planned group residential settings (n = 13) and in private homes (n = 18). Daily activities were measured using the SenseWear Armband for 7 days. Estimates of the duration of daily activities performed across sedentary, light, and moderate-to-vigorous intensities were captured. It was found that participants in planned group residential settings were older (age 85.9 ± 3.5 vs. 78.3 ± 7.2; p = 0.001) and spent more time in sedentary behaviors (12.7 ± 1.5 vs. 11.3 ± 1.6; p = 0.02) than participants in private homes. The difference was attenuated slightly after controlling for age and wear time (adjusted difference 1.2 ± 0.6 hours, p = 0.06). Thus, adults residing in planned group residential settings, which provide supportive services, were more sedentary than adults residing in private homes. The environment in which older adults live may contribute to sedentary behavior.     

Everyday Meaning of Neighboring in Old Age in an Urban District

ABSTRACT

Contact and assistance between neighbors are prominent forms of social exchange in a spatial context. For older adults, the neighborhood gains in importance when mobility disabilities increase. This explorative study, therefore, aimed to investigate given and received neighborhood help and the everyday meaning of neighboring among older adults in an urban district. Study participants were aged 60 years and older (N = 100) living in an urban district of Zurich, Switzerland. Results highlight that older adults reported vivid interactions with their neighbors and that reciprocity exists between given and received neighborhood help. Besides that, daily contact and neighborhood help affect the perceived feeling of neighboring. Data indicate that neighboring is a meaningful resource for coping with everyday life situations in old age in an urban context.     

A qualitative analysis of factors related to late life independence as related by the old-old and viewed through the concept of locus of control

The purpose of this research was to better understand what factors a sample of independent living oldest-old people believed contributed to their late-life independence. Participants selected from a list of Medicare recipients were interviewed in their homes and asked to identify factors that they felt were responsible for their ability to remain independent in late-life. Content analysis was used to analyze the data. Locus of control emerged as a useful conceptual framework for describing the data. Five styles of locus of control were identified. The fifth style, Integrative Locus of Control, suggested that the oldest-old may integrate multiple styles of internal and external locus of control. Family members and service providers can encourage independence by respecting the oldest-olds' abilities to make decisions, solve problems, and resolve conflicts, while concurrently acknowledging and providing for their identified needs.     

‘The Older I Get,the Colder I Get’—Older People’s Perspectives on Coping in Cold Homes

Abstract

An average of 26,560 UK excess winter deaths occur in people 65+ years old each winter, of which 30% are attributed to cold homes. Cold homes are known to exacerbate health problems prevalent in the 65+ demographic. Through conducting interviews in homes occupied by 65+-year-olds known to be achieving less than the World Health Organization (WHO) minimum recommended temperature (18ºC), this article highlights their struggles in maintaining health and managing their homes, with instances of extreme and potentially dangerous methods to achieve thermal comfort identified. Fairer energy provision, better targeted financial aid, and improved support networks are necessary to alleviate current problems.