“Do They Think I Am a Pack Rat?”

This case study presents details of the life of one older man who lived in seclusion and squalor, surrounded by hoarded possessions. This man was one participant of a focused ethnography of eight older adults who received home care. All participants in the original ethnography were identified by their community care coordinators as exhibiting hoarding behaviors. The case study presented here provides rich narrative and photographic detail in order to add strength to what has already been presented in previous research articles about compulsive acquisition. The narratives reveal examples of debilitating dysfunction, distress associated with decision making, broad acquisition of free things, compulsive buying, and ritualistic discarding. Quotes included in the case study stem from the original ethnography.     

Decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia

Purpose: To describe factors influencing decisional conflict among Chinese family caregivers regarding nursing home placement of older adults with dementia. Design and Methods: Individual interviews were used to collect data with 30 Chinese family caregivers of older adults with dementia in Taiwan. Data were analyzed using thematic analysis. Results: Factors influencing caregivers' decisional conflict included the Chinese value of filial piety, limited financial resources and information, placement willingness of the older adult, family disagreement, distrust of nursing home care quality, and limited nursing home availability. Factors influencing caregivers' decisional conflict post placement included disappointment with nursing home care quality and self-blame for the placement decision. Implications: Findings resulting from this study indicate that Chinese family caregivers experience decisional conflict during the nursing home decision making process as well as after the placement decision. It is important to provide appropriate decision support beginning before admission and across the trajectory of the older person's nursing home stay in order to decrease decisional conflict and facilitate a more positive decision making process for caregivers, family members, and older adults with dementia.     

“She was a little bit unrealistic”: Choice in healthcare decision making for older people

This paper examines autonomy, choice, options, and power in healthcare decision making for older people. Using discourse analysis and a case study from data gathered as part of an ethnographic field study we critique a common conceptualization of healthcare decision making as patients choosing from an array of options offered by healthcare providers. A discourse of “giving options and being realistic” used by healthcare providers is contrasted with the experience of a single patient's transitional care from hospital to home after hip fracture. This illustrates how a wide variety of actors, institutions, values, and resources take precedence in determining a discharge destination. While the accounts given by healthcare providers cast patient choice in respectful terms, an ethnographic approach illustrates that the “choices” are structured by a discourse which simplifies the complexity of what is offered and who gets to choose. In the case study the patient's choice was subjugated by expertise and institutional concerns; her options were largely illusory; and her autonomy was “at risk” due to her age, poor health, and limited resources. We use Foucault's ideas about discourse and governmentality to question the scope of agency in healthcare decision making. We argue that the conceptualization of informed patients making autonomous choices acts as “misdirection” which deflects problem solving and discussion away from a productive examination of the differences between healthcare system offerings and client needs. We conclude by posing questions to reorient the debate surrounding healthcare decision making for older adults and recommend a more participatory approach to designing social services.     

Where You Lead,I Will Follow: Exploring Sibling Similarity in Brain and Behavior During Risky Decision Making

This exploratory study examined whether social learning increases similarity in adolescent siblings’ behavior and neural patterns during risky decision making. Participants included 86 adolescents (43 sibling dyads; younger siblings: M_age = 12.2 years; 22 females; older siblings: M_age = 14.6 years; 20 females) who completed questionnaires, and a decision‐making task during an fMRI scan. Younger siblings became more similar to their older siblings’ risky decision making after observing their older sibling take risks). Younger siblings who reported greater modeling of their older sibling, and less differentiation from them, showed increased neural similarity to their older siblings in the ventromedial prefrontal cortex, and the right anterior insula and ventral striatum, respectively. These findings highlight siblings as salient social agents in how adolescents process risky decision making.     

Effectiveness of a training program for ECT nurses

Electroconvulsive therapy (ECT) is a highly technical procedure requiring a team that consists of an anesthetist, a psychiatrist, a clinical nurse specialist, and recovery nurses. Traditionally, nursing education and training in the context of providing a safe and high standard of care has not been addressed. Ninety-two nurses from 42 different health agencies participated in a training program focusing on defibrillation, electrocardiogram (ECG) and electroencephalogram (EEG) monitoring, intubation, stimulus dosing, setting up the ECT equipment, and caring for the patient. A non-experimental, one-group, pretest-posttest research design was used in this study to evaluate the effectiveness of the training program for nurses working with ECT. Effective training for nurses was hypothesized to make a difference in the standards of practice and clinical effectiveness for patients undergoing ECT. Findings from this study indicated a major knowledge deficit in key components of ECT among nurses who have responsibilities in this area of nursing care. With effective training, nurses' confidence levels increased related to setting up the equipment, administering a double dose, helping with intubation, and using a defibrillator. If nurses are to effectively function as team members in the ECT procedure, they must receive the training necessary to prepare them for this important role. The results of this study support the recommendation of the Royal Australian and New Zealand College of Psychiatrists that ECT nurses should be appropriately trained in anaesthetic and resuscitation techniques and modern ECT practice.     

Commentary: the forgotten older adult with serious mental illness: the final challenge in achieving the promise of Olmstead?

Older adults with serious mental illness disproportionately reside in nursing homes despite the U.S. Supreme Court Olmstead decision supporting the rights of persons with disabilities to benefit from integrated services in the community. This commentary addresses the neglected policy debate on implementing Olmstead for this rapidly growing, older population with special needs. First, the author describes research findings on older adults with serious mental illness living in nursing homes who might more appropriately reside and receive services in the community. Second, the author summarizes the evidence base for effective psychosocial rehabilitation interventions and services facilitating independent living in community settings for this subgroup. Finally, he concludes with seven policy recommendations aimed at advancing the promise of the Olmstead decision with respect to older adults with serious mental illness.     

Deciding Not to Un–Do the “I Do:” Therapy Experiences of Women Who Consider Divorce But Decide to Remain Married

This study explores women's experience of marital therapy while they navigated decision making around divorce. A qualitative method was used to gain a deeper understanding of the participants' therapy and relationship decision‐making experiences. How are women's decisions whether or not to exit their marriage affected by therapy? The researchers interviewed 15 women who had considered initiating divorce before they turned 40 and had attended at least five marital therapy sessions but ultimately decided not to divorce. In general, participants reported that the therapy was helpful to them, their decision‐making process and their marriages. Five main themes emerged from the interviews: Women Initiated Therapy, Therapist Was Experienced as Unbiased, Therapy was Helpful, Importance of Extra‐therapeutic Factors, and Gradual Process.     

Older Adults’ Receipt of Financial Help: Does Personality Matter?

This study examined the role of personality traits in the receipt of financial help at older ages using the 2006 and 2008 waves of Health and Retirement Study data. An investigation of (1) how the five domains of personality traits (openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism) are associated with the receipt of financial help among older adults and (2) the relationship between personality traits and the source of financial help received was examined. Three sets of probit analyses were conducted. The results indicated that personality can predict financial help and the source of financial help. Specifically, older adults who exhibited relatively higher levels of neuroticism and agreeableness were more likely to receive financial help, whereas those who exhibited relatively higher levels of conscientiousness were less likely to receive financial help regardless of the source. Furthermore, older adults who had relatively higher levels of neuroticism were more likely to help themselves with individual sources such as credit cards whereas agreeable older adults were more likely to receive financial help from family members. These findings have implications for financial counseling, planning and education professionals, public assistance program directors, and policy makers. Understanding the effect of personality on financial decision-making can help with financial planning throughout life and inform outreach efforts for those in need of financial help.     

Assessing Capacity Within a Context of Abuse or Neglect

In 2000, with the implementation of Part III of the Adult Guardianship Act: Support and Assistance for Abused and Neglected Adults, British Columbia formally recognized the need to examine issues of decisional capacity of older adults within a context of abuse or neglect. Interestingly, however, although the test of capacity was clearly laid out under this piece of legislation, the potential influence that living in a situation of abuse or neglect may have on how the person makes decisions is not explicitly addressed. Similarly, this is a missing link throughout the literature discussing decisional capacity in older adults. This gap exists despite the fact that determining the “protection” needs of someone who is being abused and/or neglected often hinges directly on that person's decisional capacity. The purpose of this article is to examine the unique aspects associated with assessing and determining capacity for older adults who are living in a situation of abuse or neglect. The specific objectives are to: (a) examine how living in a situation of abuse or neglect may influence the determination of capacity and (b) explore the implications of conducting an assessment within a potentially abusive context. The legal notion of undue influence and the psychological concept of relational connection are introduced as potentially important for considering decision making within this context.     

Casino Gambling Among Older Adults in North Dakota: A Policy Analysis

This article examined social issues surrounding casino gambling among older adults both nationally and in the state of North Dakota. An exploratory review of gambling trends among older adults and an examination of policies to protect older gamblers revealed that older adults are targeted by the gaming industry as a lucrative market (Singh et al. J Retail Leisure Property 2007, 6(1):61–68). The authors used the national literature to frame their qualitative study, which explored gambling issues among older adults in North Dakota from the perspective of six counselors trained in gambling addiction who provide treatment services in the state. Findings indicated that relatively few policies existed at the state and national levels to protect older, more vulnerable adults who gamble. Further, the six casinos in North Dakota were viewed as very effective in marketing their casino gaming opportunities to older citizens by the gambling treatment providers interviewed. Additionally, barriers to gambling addiction treatment involved lack of available services and distance to receive services in this rural state. Based on the findings of this study, social policy changes which could lead to increased protection for older adult gamblers in the state were included.     

Older Drivers Retiring From the Road: An Application of the Selection,Optimization, and Compensation Model

Purpose: This study uses the selection, optimization, and compensation (SOC) model to compare older adults who have given up driving, those who still drive, and those who drive less to identify differences in the three groups. Design and Methods: This cross-sectional study of 281 older adults is part of the Naturally Occurring Retirement Community Demonstration Project. Study participants completed interviews that included questions on demographics, health and functioning, mental health, social support, and current levels of engagement in activities including current driving status. Results: Data suggest that driving retirement is a process and that a substantial number of people are in the transitional stage, where they are less functional than those who still drive and more similar to those who have retired from the road. Implications: Given the similarity of those who drive less to those who have given up driving, front-line professionals and policy makers must work together to ease the transition to driving retirement for those without adequate ability to effectively compensate for their inability to continue to drive safely.     

Learning Style Characteristics of Adult Dependent Decision Makers: Counseling and Instructional Implications

Dependent decision makers form a significant population of students and adults who seek help from career counselors. This study investigated the learning style characteristics of dependent decision makers in an urban community college setting. The results suggest that the dependent decision makers as a group may have reduced motivation for learning, show limited persistence, and take less responsibility for their learning. Because of these learning style characteristics, we recommend that these characteristics be considered when making counseling interventions and instructional modifications when working with dependent decision makers.     

A Typology of Source of Information About the Continuing Care Retirement Community and Older Adults’ Living Arrangement

Abstract

A continuing care retirement community (CCRC) represents a residential alternative for older adults. It offers a variety of social and health care services to meet older adults’ needs and preferences. Using the theory of innovation as a theoretical basis, the overall goal of the study was to use the source of information about the CCRC as a potential predictor of the decision to move. In total, 76 older adults responded to a question about the source of information on the CCRC. Of these, 40 were CCRC residents and 36 were community dwellers, who expressed an interest in the CCRC but decided to remain in their community. Based on their responses, respondents were classified into one of five clusters (e.g., spouse, friends, children, nonhuman sources, mixed human and nonhuman sources). Those classified into the spouse or adult children as sources of information were more likely to live in a CCRC. Results show that information about the CCRC should be conveyed to additional members in the family, such as adult children, as they often take a major role in the decision to relocated. The findings have implications for administrators as they clearly point to potential sources of greater influence on older adults’ decision to relocate.     

Does yoga engender fitness in older adults? A critical review

Interest in yoga is growing, especially among older adults. This review critically summarizes the current literature to investigate whether physical fitness and function benefits are engendered through the practice of yoga in older adults. A comprehensive search yielded 507 studies; 10 studies with 544 participants (69.6 ± 6.3 yr, 71% female) were included. Large variability in yoga styles and measurement outcomes make it challenging to interpret results across studies. Studies reported moderate improvements for gait (ES = 0.54, 0.80), balance (ES = 0.25-1.61), upper/lower body flexibility (ES = 0.25, 0.70), lower body strength (ES = 0.51), and weight loss (ES = 0.73, 0.99).Yoga may engender improvements in some components of fitness in older adults. However, more evidence is needed to determine its effectiveness as an alternative exercise to promote fitness in older adults. Further investigation into yoga as an exercise activity for older adults is warranted.     

’Til Divorce Do Us Part: Marriage Dissolution in Later Life

Late-life divorce—commonly referred to as gray divorce—is a rising trend that parallels the growth of the older adult population. We sought to gain an in-depth understanding of the experience of marriage dissolution, the divorce process, and life following divorce in a sample of older adults who divorced after more than 20 years of marriage. Qualitative data were collected from 10 divorcees (7 women and 3 men; M age = 63.5) and analyzed to understand the gray divorce experience; that is, factors that determined or delayed the decision to divorce and divorcees’ coping during and after divorce. Participants’ stories demonstrate that marriages endure despite problems because relationships are complex, and good experiences mix with bad ones. Outcomes of late-life divorce have significant health and financial implications for both individuals and society.     

Volunteer Behavior and Factors that Influence Volunteering Among Residents in Continuing Care Retirement Communities

The purpose of this survey was to explore volunteer preferences, perceived benefits and barriers, and the factors that influence volunteering among older adults living in a continuing care retirement community. This was a single group, one-time survey completed via a face-to-face interview. The sample included 127 older adults who were eligible and completed the survey. The majority were women (78%) and White (98%), with an average age of 88.0 (SD = 6.5) years. Engagement in volunteer activities ranged from 0 to 7, with a mean of .94 (SD = 1.30). Just under half (47%) of the participants were engaged in volunteer work, with the majority (87%) volunteering within the facility. Perceived benefits and barriers to volunteering were described. Chronic illness, age, time spent exercising, and resilience accounted for 25% of the variance in volunteer activity. Those who had fewer chronic illnesses, were younger, spent more time exercising, and were more resilient were more likely to volunteer. Findings from this study suggest that there are advantages to offering volunteer activities within senior living facilities. Ongoing study is needed to develop and implement successful facility-specific volunteer programs.     

"You feel like people are looking at you and laughing": Older adults' perceptions of aquatic physical activity

Older adults' participation in Physical Activity (PA) in the United Kingdom remains low. Moreover, although the subjective and narrative elements of aging are increasingly studied, promotion of healthy behaviours such as aquatic PA still frequently reduces older adults to passive recipients who rely on health professionals for their wellbeing. Using a figurational perspective, the relationship between participants' perceptions of the aging body and participation in aquatic activity was investigated. Interviews were completed with 22 adults aged over 50years (7 men, 15 women). Participants highlighted a number of perceptual barriers that were contoured by wider social representations of older adults. Perceptions focussed upon the perceived limitations of the aging body. The need for regular participation in PA was recognised. However the potential for angst when wearing a bathing costume in the presence of 'others' was expressed, particularly amongst those considering themselves overweight. Participants objectified their bodies and compared them with those of other participants. The difficulties of managing physical (e.g. injury and illness) and environmental risk were described. At the same time, participants experienced the development of new webs of interdependence. These webs were both enabling and constraining. Some participants felt empowered. However, the exclusivity of many aquatic activity sessions re-emphasised the status of older adults as outsiders in the wider figuration of physical activity.     

Physical activity in the post-hip-fracture period

The purpose of this study was to characterize physical activity (PA) based on survey and ActiGraphy data from older adults at 2 mo post-hip fracture and consider the factors that influence PA among these individuals. The sample included participants from a current Baltimore hip study, the BHS-7. Measurement of PA was based on the Yale PA Survey (YPAS) and 48 hr of ActiGraphy. The sample included the first 200 individuals enrolled in the study, with analyses including 117 individuals (59%) who completed the YPAS and wore the ActiGraph for 48 hr. Half the participants were male, with an overall mean age of 81.3 yr (SD = 7.9). Findings indicate that at 2 mo post-hip fracture participants were engaged in very limited levels of PA. Age and comorbidities were the only variables to be significantly associated with PA outcomes.