Changes in Self-Rated Health During the Transition to Retiring Living Among Medicare Managed-Care Recipients

ABSTRACT

Moving into a retirement community may be precipitated by or bring about changes in health status. We hypothesized that moving into a retirement community would be associated with a decline in self-rated health (SRH), but that health-related factors would mitigate this association. We analyzed data from 58,272 participants in Cohort 3 of the Medicare Health Outcome Survey. Individuals answered questions regarding living status in 2000 and 2002. Those who moved into a retirement community were compared with those who did not. The primary outcome was change in SRH. We created adjusted and unadjusted models. A total of 2,520 participants (4.4%) moved into retirement communities between 2000 and 2002. There were no substantial differences in the mean change in SRH between those who moved and those who did not. In adjusted and unadjusted models, moving was not significantly associated with changes in SRH. In an analysis stratified by SRH, only those with the best SRH had a significant decline in SRH during the move. SRH mainly remained stable for most people regardless of moving into a retirement community. These findings argue against environmental context being a main determinant of self-perceived health status among older adults.     

Aging with HIV: Historical and Intra-Community Differences in Experience of Aging with HIV

Gay men living with HIV/AIDS face a complex of health issues, including those associated with the aging process, long-term HIV infection (25 years or more), and side effects from Highly Active Anti-Retroviral Therapy (HAART). If aging can increase marginalization, this is more likely for the aging HIV positive gay man, who is already marginalized for being queer and living with a stigmatizing disease. This article presents findings from a study of a long-running HIV support group. It locates the members, all gay men living with HIV, in a specific historical and political context to explore how feelings of loss and the struggle to sustain community affect long-term survivors and other older HIV+ gay men. We identify specific challenges presented by aging for men who contracted HIV early in the epidemic, contrasting them with those faced by men infected with the virus later in life. While both groups appear to struggle with a vision of what life could have been, had AIDS not forced loss and change, they also celebrate the community their shared plight has enabled.     

Walking on the Edge: Towards a Sociography of Discrimination against the Buraku: Lectures on Discrimination in Letter Format

This article demonstrates a new methodological approach to recognize, analyze and write about discrimination against the buraku, which is one form of social discrimination in contemporary Japan. The structural discrimination proposed in this study is based on the concept of relational discrimination, which is derived from fundamental criticisms of the conventional concepts of material and psychological discrimination. Relational discrimination occurs when we are placed in a certain type of relationship and may become accomplices to discrimination or cause it, regardless of whether or not there is any individual prejudice or discriminatory consciousness at work. From this perspective, this article tries to fundamentally re-examine the binary thinking assumed in conventional sociology that there are minorities (those who are discriminated against) and majorities (those who discriminate against the minority). I focus on the complex ways of being human, and in particular on the transformations that accompany changes in particular relations such as from a person who does not discriminate to one who discriminates against others; from a person who is discriminated against to one who discriminates against others and from a person who is not discriminated against to one who is discriminated against. By focusing on the meaning of the deep suffering of a man who made discriminatory remarks to people living in a buraku community, and of a woman who married into a family living in a buraku community, I try to understand life ethics for people who discriminate and who at the same time are discriminated against.     

Two cultures: one life

Recognition of the communal nature of the culture and traditionsof many refugees who have resettled in Australia in recent years,particularly those from African countries, has urged a strongerconsideration of community-based approaches to their recoveryand resettlement. In 2004, a framework of recovery, developedto enhance the mental health and well-being of refugees duringresettlement in Australia, was applied to a community capacity-buildingprogramme among South Sudanese refugees living in an outer westernsuburb of Melbourne. This paper explores the integration ofrecovery goals into the structures and processes initiated throughoutthe programme. It assesses the contribution of this model tostrengthening the community's ability to adjust to resettlementand enable greater control in determining their lives in Australia.     

The Quality of Life of People 12 Years after Resettlement from Long Stay Hospitals: users' views on their living environment, daily activities and future aspirations

We report service users' views on three important domains of their quality of life in the community 12 years after resettlement for long-stay hospitals. These concerned their living environments, daily activities and future aspirations. We asked a series of open questions as part of a structured interview with service users with learning disabilities (n = 196) and mental health problems (n = 102). The study is the longest reported follow-up of deinstitutionalisation in the UK and one of the longest anywhere in the world. The most frequently self-reported positive aspects of users' quality of life were the living environment, the social milieu and independence. The most frequently mentioned problems occurred within the social milieu and included bullying, the social regime, the physical aspects of the accommodation, and the personal feelings of loneliness and boredom. The most preferred activities were outings, education and work, relaxation and leisure. The most disliked activities were household chores and having nothing to do. About half those interviewed did not or could not answer a question about their future; those who did mentioned a wish for greater independence, more outings and personal and sexual relationships. We remark on some implications for services and for staff training.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

Problems in community living identified by people with schizophrenia

1. Problems in community living were identified by a group of people with schizophrenia who received a telephone nursing intervention after discharge from a state psychiatric facility. 2. The most frequently reported problems were medication side effects, financial concerns, and anxiety. 3. A telephone nursing intervention has the potential to reduce the negative effects of stressors on people with schizophrenia living in the community.     

Between skepticism and empowerment: the experiences of peer research assistants in HIV/AIDS,housing and homelessness community‐based research

People living with HIV/AIDS (PHAs) in Canada are a highly researched population, yet their inclusion in the research process is minimal. Community‐based research (CBR) has become a recognized tool for addressing issues of power and exclusion within researcher/community relationships by inviting the community's equitable involvement as research partners. Within the context of HIV/AIDS research, this includes a commitment to the Greater Involvement of People Living with HIV/AIDS (GIPA) at all stages of the research process. One way of adopting GIPA principles within CBR is through providing employment, research training, and capacity building opportunities for PHAs as peer research assistants (PRAs). Drawing on data from two in‐depth focus groups with seven PRAs from the Positive Spaces, Healthy Places: Community‐based Research Study, this paper will highlight important methodological practices for academic and community‐based researchers who are working with and supporting PRAs.     

Ready or not: assessing youths' preparedness for independent living

This article discusses the utility of the Ansell-Casey Life Skills Assessment (ACLSA) in assessing life skills necessary for living successfully in the community upon emancipation from out-of-home care. ACLSA, completed by youths and their caregivers, identifies skills that have been mastered and those yet to be learned. Assessment information can be used for goal setting, strength identification, and relationship building, as well as to direct program planning and training in self-sufficiency services.     

Using an action research approach to involving service users in the assessment of professional competence

This paper reports on a piece of action research that has involved people who use mental health services in systematically providing feedback from a user perspective on participants’ assessed work completed for one module of a masters’ training programme in mental health. In an attempt to improve professional practice and include people who were accessing mental health services in so doing, it outlines how users were trained to provide feedback and the training methods employed. The findings summarise the kind of issues users raised in their feedback to participants about the evidence professionals provided to demonstrate their learning from the training programme. A focus group interview with professionals provides a contrasting insight into the participants’ experience of having their work commented upon from a user perspective. The paper draws on the experience of a five-year external evaluation of an interdisciplinary programme in community mental health at Birmingham University in the UK which has highlighted the involvement of people who use mental health services as a particular innovation in the design, delivery and evaluation of the curriculum.     

Life skills training and the politics of personal effectiveness

In recent years social and life skills curriculum has emerged to occupy an important place in new training initiatives, particularly those associated with YTS and pre-vocational courses such as TVEI, CPVE and City and Guids 365.* one level the attraction of‘life skills’training is that it is relevant and address, in ways that traditional Liberal and General Studies could not, the practical problems likely to affect young people as adults, as parents and as employees. another, ambiguity surrounds the criteria upon which such skills for living are constructed and appraised, not least because of their close behavioural connection with altering young peoples’attitudes toward authority, industry and society. Despite recent concern about the dangers of bias and indoctrination elsewhere in mainstream education, this controversial aspect of government intervention in vocational training (DEP 1981; MSC 1981; DEP 1984) has escaped the critical attention of those who currently express concern about standards in education (Scrution et al 1985). For this reason the paper seeks to examine the kind of‘official’thinking which lies behind life skills training, and the skills which are thought necessary to enhance the‘personal effectiveness’of young people. This would seem all the more important in view of the government's contention that technical and vocational education (14-18) now constitutes a viable alternative for those who fail to succeed in mainstream education. (DEP 1981, 1984; MSC 1981, 1982a).     

Patterns of Competence and Adjustment Among Adolescents from Authoritative,Authoritarian, Indulgent,and Neglectful Homes: A Replication in a Sample of Serious Juvenile Offenders

The correlates of authoritative, authoritarian, indulgent, and neglectful parenting were examined within a sample of 1,355 14‐ to 18‐year‐olds adjudicated of serious criminal offenses. The sample is composed primarily of poor, ethnic‐minority youth living in impoverished urban neighborhoods. As has been found in community samples, juvenile offenders who describe their parents as authoritative are more psychosocially mature, more academically competent, less prone to internalized distress, and less prone to externalizing problems than their peers, whereas those who describe their parents as neglectful are less mature, less competent, and more troubled. Juvenile offenders who characterize their parents as either authoritarian or indulgent typically score somewhere between the two extremes, although those from authoritarian homes are consistently better functioning than those from indulgent homes. These patterns did not vary as a function of adolescents' ethnicity or gender.     

Black adolescents' participation in a prenatal care program

This study explores the relationship between socio-demographic variables and the participation in a prenatal care program among Black adolescents living in a southern community. The analysis of data found that the number of months pregnant and type of living arrangement significantly influenced participation. Greater participation was found among adolescents in the first trimester of pregnancy and those who lived with their mothers only or in other living arragements than with both parents. These findings suggest outreach to sustain participation and the need for additional research with Black adolescents in two-parent families.This study was made possible by funding from the University of Alabama Research Grants Committee, 1988.     

Does 3rd age plus 3rd world equal 3rd class?

The patterns of care of the aged population are being influenced by demographic changes, migration, and industrialization in developing countries. There is no longer a secure place for the elders in the community as chiefs, sages, or useful members of the household. In very large mega-cities the aged living in an extended family are more prone to psychological problems than in a lone living situation. There are many variations in the degree of abandonment or loss of dignity, which are described in examples from Vilcabamba, Potosi, Lima, and Belize. For example in Belize, there are no cities to migrate to so people leave to seek their fortunes in the US or the UK. Solutions are possible within the community. The experiences of HelpAge International are reported for Pro Vida, Colombia; India; and Sri Lanka. In Colombia efforts were made to acquire a bakery so that the elderly could be employed in bread baking, donating loaves to institutions, and selling half the loaves on the street. Other projects involved improving living conditions for lone old people in shanty towns and training social workers. The institutional aim was to concentrate on a locale. Attention was given to providing instruction in classrooms to enlighten youth about the needs of the elderly. HelpAge in India concentrated on eye problems of the elderly in remote areas through awareness and fundraising campaigns. HelpAge Sri Lanka has set up seminars and training programs which have been models for similar programs in Thailand. Shared experience with the problems of aged beggars suggests that funding must come from nongovernmental agencies. The cultivation and sale of herbs by the elderly was promoted in Vilcabamba; in Jamaica a memory bank was established for preserving cultural traditions. Abandoned industries have been revived. The needs of the organizers, who are primarily volunteers, are organization skills. Governments can supplement meager funds by enhancing traditional life, by removing obstacles to foreign aid, and by avoiding spending on prestige projects and questionable projects imported from Western countries. Reinforcement of families and of local community groups is needed.     

The Unity Council at 40: a pioneering community development and service organization (1967-2007)

The Spanish Speaking Unity Council (Unity Council) is a community development nonprofit organization that was established in 1964, during the civil rights movement, by a group of community members who wanted to ensure the political representation of the Latino community. Over its 45-year history, the Unity Council has grown into a $12 million community development organization that delivers a range of programming, including social services and employment training as well as facilitating the development and support of local businesses, low-income housing, and neighborhood improvement activities. The history of the agency presents the multiple challenges and rewards associated with development in an underserved community and an example of the important role that leadership plays in the growth of a nonprofit.     

"Who believes most in me and in my recovery": the importance of families for persons with serious mental illness living in structured community housing

In this article, the authors report on qualitative findings on the role of family in supporting recovery for mental health consumers living in structured, community housing in a large Canadian city. Despite living separately from families and relying heavily on formal services, residents identified their families more often than mental health professionals, friends, and residential caregivers as those who most believe in them and their recovery. Families supported recovery by providing affection and belonging, offering emotional and instrumental support, and by staying actively involved with residents. Families are a vital, untapped resource for social workers in promoting independent living.     

The Community Child Placement Budget:

This article presents a mechanism for empowering communities to take responsibility and control for their vulnerable children. The community placement budget is based on the daily living costs associated with children in state custody. Based on data from a real community, the budget includes where these children are living, the cost associated with these placements, and who is paying. Strategies are suggested that will help community groups compare ideas about what they want for children in their community and identify possible areas for change.     

The Influence of Self-Selection on Older Adults' Active Living in a Naturally Occurring Retirement Community

A cross-sectional, single-case study of older adults (N = 197) in a Midwestern rural naturally occurring retirement community compared the active living behavior and salience of socio-physical characteristics for three subsets of older residents: (1) in-migrants who moved based on recreational opportunities; (2) in-migrants who moved for other reasons; and (3) long-time residents. Some older adults with preferences for outdoor recreation self-selected into the naturally occurring retirement community due to opportunities for water-based activities. Self-selectors engaged in light recreation activities more frequently and for longer durations, received more frequent spousal encouragement to be active, and identified more types of activity companions than in-migrants who had moved for other reasons.     

Community reintegration for people with psychiatric disabilities: challenging systemic barriers to service provision and public policy through participatory action research

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.     

Fifteen years afterAsylums: Description of a program for victims of the total institution

Since the publication of Goffman'sAsylums in 1961, major changes in the philosophy of treatment have been made within psychiatric facilities. While legislative and judicial action have done much to encourage community service provision and to protect the rights of prospective inpatients, long-term psychiatric patients have been neglected. Socialized into the lifestyle described by Goffman as the “total institution,” the chronic patient lacks the skills and motivation to successfully adjust to community living. The needs of the long-term inpatient can be met through a nontraditional training model, but only if intervention is made on community, political, and staff levels as well.