The meaning of frailty according to Dutch older frail and non-frail persons

Frailty is a term often used by researchers and clinicians to describe a state in which older persons are at risk for adverse outcomes such as falls, disability, institutionalization and mortality. However, no study so far examined what frailty means to older persons. Therefore the aim of this study was to describe the meaning that older community-dwelling persons attach to frailty. Twenty-five semi-structured interviews were conducted. The interviews were analyzed using the grounded theory method. Frailty was described as being in poor health, having walking difficulties, feeling down, being anxious, having few social contacts and not being able to do the things one likes to do. Men described in more detail the physical dimension whereas women elaborated in more depth on the psychological and social component. Existing definitions of frailty should be adjusted to better reflect the meaning of frailty for older persons.     

From these roots: The role of historically Black colleges and universities in preparing the nation’s gerontologists for an aging society

ABSTRACT

The aging of the United States population is creating an increased need for social workers and other helping professionals with training in gerontology. Recent estimates indicate that less than 3% of MSW students are enrolled in an aging concentration, as compared to 19% enrolled in children/youth concentrations. In addition, the phenomenon of a diverse baby boomer generation joining the ranks of persons age 65 and older has created a plethora of scholarship and curriculum development aimed at readying the aging network for the unprecedented growth of older persons. Social work can make unique professional contributions to the field of gerontology and older persons. This study asserts, however, that social work is not adequately prepared to practice in an increasingly diverse aging society. The social work profession has articulated commitments to acknowledging and affirming how diversity and culture shape the human experience and to developing social workers who can competently engage in research-informed practice and practice-informed research. However, there remains a need in social work education for more widespread use of culturally relevant pedagogies that can help achieve these goals. Informed by both the Afrocentric and Black perspectives, this study presents a content analysis of the curricula infused at two historically Black universities. The nature and extent of the contributions of historically Black universities to social work education is the focus of this article. The scope of this investigation also includes the identification of prominent Black social work educators and discusses the implications of these perspectives for more culturally informed gerontology curricula that promote culturally competent gerontological social workers.     

Recent developments in the employment and retirement of older workers in Germany

Against a background of an aging population, rising social security costs, and foreseeable labor and skill shortages, there have been public policy changes affecting older workers in Germany. Labor-market related initiatives aim at an increase of labor force participation among this group. Enterprise-related, active age-management strategies aim at improving occupational conditions of aging workers. In this context, prolonging the working life must be seen as one option of "active aging." Another view of the current retirement discussion is the question of how the unused potential of Germany's younger, early-retired seniors can be exploited. Active aging has become a social duty nowadays, with the intention that older persons contribute to society to avoid generational conflicts. In the future, active aging will preserve the competitiveness of enterprises and of the entire economy, despite an aging labor force. But gerontological research points out that different options to carry out individual life plans of active aging are also required. This article reviews the changes in public policies towards older workers and includes the findings of a project that illustrates good practice to combat age barriers in the labor world.     

Planning for Aging in Place: Incorporating the Voice of Elders to Promote Quality of Life

Abstract

Aging in place offers emotional and physical benefits; however, challenges associated with advanced age may make aging in place difficult. As communities across the country prepare for forecasted increases in the proportion of older residents, it is important to understand barriers that may prevent aging in place. Perceived barriers voiced by residents of a suburban county who completed an Aging in Place Needs Assessment Survey were categorized into four themes: need to downsize/home modification; need for assistance; family desire to reciprocate care; and isolation. A fifth group with no intent to relocate, but with concerns about having to, was also identified. Included among this group were persons with mental health or developmental disorders, such as anxiety and autism spectrum disorder. Results were examined through a person-centered lens to illustrate that aging in place may be the desired option even among residents who indicate that it is not. It is important that aging-in-place initiatives preserve identity by fostering a sense of autonomy, control, and well-being in older residents.     

The contextual and social locations of older women's experiences of disability and decline

Understandings of disability and decline within health and social care seem to focus mainly on the bodies and function of older persons. However, the way that older people's experiences of disability and decline are fixed into rigid functional classifications such as ‘frailty’ are problematic. Drawing on the narratives of twelve diverse older English-speaking women in Montreal, Canada, I will argue that older women's experiences are more connected with the contexts within which they experience disability and decline, and the social locations they bring to these experiences, than the functional limitations of their bodies. Older women's stories – particularly those related to the home and the bus – reveal the clash between dominant understandings of ‘frailty’ and older women's contextual and social experiences of disability and decline; expose tensions within health and social care practices; and highlight the potential which exists in both context and social location.     

Homes of Choice

Abstract

State policymakers increasingly recognize that housing is not only an important shelter resource for older persons, but also a key element of community-based care. Over the last two decades, significant state and local activity has led to an increase in service-enriched housing for older persons. Service-enriched housing refers to living arrangements that include health and/or social services in an accessible, supportive environment. Emerging forces are leading to increased pressure for the expansion of service-enriched housing. These forces include: a growing and diverse population of older renters; older adults' preferences to age in place; the increasing frailty of subsidized housing residents; the development of assisted living (AL); the enactment of Medicaid waivers; and implementation of the Olmstead decision. Although studies have not included cost-analysis, available research demonstrates that service-enriched housing promotes resident satisfaction, successfully provides services to frail populations, and supports aging in place.

Given both limited resources and research, this article addresses how states can adequately respond to and capitalize on these forces in order to best meet the long-term needs of older adults.     

Infantilization as elder mistreatment:evidence from five adult day centers

To prevent maltreatment, aging services must be age appropriate even as consumers suffer from physical and cognitive disabilities. In this paper, it is argued that exposing older persons to childoriented settings, activities and speech patterns in aging service environments represent a form of psychological mistreatment. Ethnographic evidence from 220 hours of field observations in five "social model" adult day centers revealed infantilization of service users in the form of confinement, baby-talk, nicknames, child-oriented decor, teacher-student learning format, reprimands, use of toys, as well as a loss of privacy regulation, autonomy, choice, and adult status. All centers exhibited some mistreatment, but severe examples were present in two of the five centers studied. Negative influences on behavior, well-being, self-identity, relationship formation, and social interaction were detected, which distinguished mistreatment from poor quality of care. Insider interviews (23) revealed resentment and adaptive strategies employed to distance themselves from infantilization.     

Demographic Comparisons of Aging in Five Selected Countries

The worldwide aging of the population is having a major impact upon society. The United Nations General Assembly has declared 1999 to be the International Year of Older Persons to increase the awareness of aging worldwide. They identified five principles for older persons: independence, participation, care, self-fulfillment, and dignity. The numbers of elderly are growing around the world with many elderly living considerably longer than in past times. Developed countries are struggling with the high cost of maintaining support programs, and developing countries face dissolution of traditional care systems without institutional replacements. Women around the globe typically live longer than men, often without the economic resources to maintain independence. As nations adapt to their aging populations, a partnership among policy makers, family members, and older persons themselves is needed to offer alternatives to meet the needs of elders.     

Infantilization as Elder Mistreatment: Evidence from Five Adult Day Centers

ABSTRACT

To prevent maltreatment, aging services must be age appropriate even as consumers suffer from physical and cognitive disabilities. In this paper, it is argued that exposing older persons to child-oriented settings, activities and speech patterns in aging service environments represent a form of psychological mistreatment. Ethnographic evidence from 220 hours of field observations in five “social model” adult day centers revealed infantilization of service users in the form of confinement, baby-talk, nicknames, child-oriented decor, teacher-student learning format, reprimands, use of toys, as well as a loss of privacy regulation, autonomy, choice, and adult status. All centers exhibited some mistreatment, but severe examples were present in two of the five centers studied. Negative influences on behavior, well-being, self-identity, relationship formation, and social interaction were detected, which distinguished mistreatment from poor quality of care. Insider interviews (23) revealed resentment and adaptive strategies employed to distance themselves from infantilization.     

Residential Differences in Filial Responsibility Expectations Among Older Persons1

Abstract This study examines variation in filial responsibility expectations-the extent to which adult children are expected to assist and care for their aging parents-among a sample of 440 older persons. The analysis focuses on the relationship of filial responsibility expectations to residential location and tests the hypothesis that older rural residents have higher expectations for assistance from their children than do older urbanites. Current residential location is found to have little impact on expectations, but older persons who were raised in rural areas, particularly on farms, have significantly higher expectations for filial assistance than do older persons from urban backgrounds. Possible consequences of these patterns for the transmission of expectations from parents to children are discussed.     

Applying a social model of disability across the life span

With an estimated 21.3% of persons aged 15 and older experiencing disability in the USA, social workers will see clients present with disabilities across all practice settings and stages of human development. Yet, the training and terminology of social workers—which often closely aligns with medical professionals—may seem to occur in isolating silos or disciplinary theories. Social work education often views the needs of older adults and people with disabilities as two distinct populations, despite the fact that many of these individuals share similar needs for access, resources, and support. Furthermore, when discussing human development, the focus may skew to individual affective, behavioral, and cognitive processes and indicators of abnormal development and frailty. Thus, by clarifying terminology and applying a social model of disability across the life span, we identify how educational efforts related to human behavior and the social environment can promote intersectional and inclusive social work related to aging and disability.     

Frailty in self-neglecting older adults: A secondary analysis

ABSTRACT

Self-neglect (SN) and frailty in older adults is associated with increased disability and mortality. Despite these commonalities, there have been no studies objectively assessing frailty in older adults who SN. This secondary analysis classified frailty in N = 37 older adults with Adult Protective Services validated SN using the Fried Frailty Phenotype (FFP) of weight loss, weakness, exhaustion, activity level, and walking speed. Overall, 3% were classified as robust, 62% as prefrail, and 35% as frail. Most (72%) were overweight/obese, with clinically significant decreases in activity level (60%) and walking speed (97%). Compared to the original FFP population, older adults who SN exhibit important differences in frailty phenotypes, and finding that the largest percentage of older adults who SN were prefrail may indicate a critical opportunity for intervening in this population to reduce future functional decline and mortality.     

Teaching pedagogies enhancing social work students’ perceptions and attitudes toward older age in an undergraduate course on working with older people

Approximately threefold increases in older age population groups (+65 years) are projected in the next 15 years. Demographic changes in society will mean greater numbers of older adults in proportion to the younger generation. In the current policy on older age groups, emphasis is placed on healthy aging warranting a multidisciplinary workforce to work with older people. Despite this need and increased demand in the aged care sector, a fewer social work students are willing to undertake aged care placements or to choose it as a career option.

An innovative teaching and learning pedagogy was used in designing the course curriculum titled ‘Social Work with Older People’, including the input of invited specialist guest speakers, an on-campus interactive workshop with older guests, and an assessment designed to evaluate the learning related to the workshop content. The paper reports changes in the attitudes of students studying gerontological social work after the course delivery, evaluated through an online survey with the purpose of improving the learning outcomes in the course and to gauge students’ interest, experiences, attitudes and motivation to work in the aged care sector. The paper contributes to building knowledge in addressing the needs of the changing social demographic.     

Autonomy in long‐term care: a need,a right or a luxury?

Doyal and Gough’s theory of human need highlighted that personal autonomy is a universal need and human right, essential for well‐being. In applying their theory to older disabled people in the UK the author suggests that their ‘minimally autonomous’ threshold would exclude some older people in long‐term care who still have a fundamental need for autonomy or, alternatively, extant autonomy. The disability movement has highlighted that independent living is fundamental to achieving self‐determination for disabled people and debate on equality and caregiving emphasises the autonomy of carers. However, there is a lack of recognition in both academic research and government policy of autonomy as a need and right of older disabled people. The author argues that autonomy is a human right of older people living in long‐term care settings, but that social rights are necessary to facilitate their autonomy.     

Parenting in Later Life: A Cross-Cultural Study

This study explored older parents’ beliefs about their parental role with their adult children, their perceptions of intergenerational conflicts between themselves and their adult children, and the negotiation of autonomy versus dependence with adult children in later life. The influence of cultural norms and mutual dependence on these intergenerational relationships was also evaluated. Focus groups were conducted with two groups of older adults attending a senior center in New York City—one who identified as American and the other as Asian Indian. Implications of the findings and recommendations for social workers are highlighted.     

NASW’s Supervisory Leaders in Aging: An Acceptable and Feasible Model for Training and Supporting Social Work Supervisors

Social services are instrumental in addressing challenges associated with aging. Yet, practitioners report needing expanded gerontological knowledge and better supervision. The Supervisory Leaders in Aging (SLA) program of the National Association of Social Workers (NASW) was designed to improve gerontological services by strengthening supervision of the social service workforce. With support from the John A. Hartford Foundation, the program was adopted between 2015 and 2017 in four regions, where NASW trained 134 MSW supervisors who support 1200 social service staff, potentially enhancing the well-being of 264,000 clients annually. The SLA curriculum and in-person educational approach constitute a model for supervisor professional development. Quality improvement evaluations suggested feasibility of program adoption and acceptability. Participants rated each of 10 workshops and 97% agreed that instructors were effective, that knowledge was expanded, and that content was relevant, appropriate, and likely to be used. Implications of this model for enhancing supervisory practice are discussed.     

Gendered Self-Improvement: Autonomous Personhood and the Marriage Predicament of Young Women in Urban China

How does gender shape the experience and imaginaries of self-realisation? This article explores practices of self-improvement among young women in China, namely workshops for interpersonal skills. These practices direct participants to express themselves as autonomous persons, disembedded from social hierarchies and familial responsibilities. Unmarried women who attend workshops conceive of marriage as an unavoidable impediment to their self-realisation. This is due to a prevailing gender inequality in marriage, as well as the ongoing expansion of an ideal of individual autonomy in China through economic reforms. In this article, I do not centre my analysis on a cultural clash between this ideal and local cultural practices. Instead, it is the possibility of this ideal, which is always shaped and restricted by socio-economic imperatives, that induces women’s frustration with their local culture. The fact that this ideal promises universal attainment highlights for women the gender roles that limit their autonomy.     

Over the Hill,Under Siege: Labor Force Graying,Labor Market Pushes,and Consequences for Life Chances

Interest in older workers has recently expanded due to concerns over labor force “graying.” Research and policy on aging adults' labor market participation have, thus far, framed the decision to labor as one shaped solely by the desires and capacities of older workers themselves. This perspective fails to recognize how multiple employer‐side barriers play a large role in defining – and limiting – available choices. In this review, I synthesize the multi‐disciplinary literature on employer‐side barriers to older workers' labor market participation. In particular, I identify and discuss individual‐, meso‐, and social structural‐level barriers that uniquely affect this group, noting where gaps in understanding remain. I consider older workers primarily as a whole to demonstrate how age operates as a distinct, important identity; however, I also reflect on how age overlaps with both other identities and cohort membership. Next, I briefly consider the relationship between these employer‐side barriers and aging adults' life chances, particularly in an era of austerity. Although I focus on the United States case, I also note key cross‐national similarities and differences. Finally, reflecting upon the foregoing review, I suggest that a redirection of public policy is necessary to effectively respond to this contemporary demographic shift.     

Who is responsible for this? Assigning rights and consequences in elder care

In the context of providing health and human services for older individuals, modern American culture often depends on formally asserting and battling over a clashing array of rights among respective combatants as a first resort at problem-solving. A substantial impediment exists in our cultural environment that discourages families and professionals, and the agencies that employ them, from recognizing and respecting the rights of older persons in a less adversarial and more subtle, sensitive, and flexible manner. This article discusses this barrier, illustrating it in several aging-related settings, and suggests a paradigm for addressing the situation. Then, several current challenges to the rethinking of rights and responsibilities in geriatric and gerontological practice are acknowledged.