Functional Independence of Community-Dwelling Older Adults in China and South Korea

ABSTRACT

Population aging is occurring at an unprecedented pace in China and South Korea. This study intended to identify and compare factors associated with older adults’ functional status in China and South Korea using data from 2 national surveys. The study sample consisted of adults aged 65 to 79 years old drawn from the Chinese Longitudinal Healthy Longevity Survey (2005; n = 4,898) and the Korean Longitudinal Study on Aging (2006; n = 4,152). The outcome variable, functional status, was defined as dependence in self-care tasks. Stepwise multiple regression analysis was used to assess the explanatory contributions of sociodemographics, health conditions, and health behaviors and activities to functional status. These Asian older adults shared certain commonalities in maintaining functional independence in their communities, and absence of diseases and higher cognition were associated with functional independence in both countries. Rural residence and outdoor activity were significant for Chinese older adults; for their South Korean peers, gender, employment status, drinking, and exercise were important. This study adds to a slowly growing body of knowledge of ways to improve the functional independence of community-dwelling older persons in these 2 Asian countries and beyond. More research is needed to identify cross-cultural and/or cross-country differences.     

High Life Satisfaction: Exploring the Role of Health,Social Integration and Perceived Safety among Mexican Midlife and Older Adults

We sought to investigate the relationship of high life satisfaction with important physical health, mental health, social integration and perceived safety factors among midlife and older Mexican adults. We examined 2,200 midlife and older adults (aged 50–101 years) from the Mexican arm of the Study on global AGEing and adult health (SAGE) and used binary logistic regression models to identify key factors associated with high LSA. Our final logistic regression model revealed self-rated health, affect, interpersonal activities and perceived safety on street to be significantly associated with high life satisfaction. Results from this study add to the nascent literature on subjective well-being of midlife and older Mexicans. Although social work with older adults is not well established in Mexico, researchers and practitioners should collaborate on the development and implementation of social worker-led strategies for prevention and intervention to enhance well-being among midlife and older Mexicans.     

Depression in Older Adults: A Meta-Synthesis

Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge—both quantitative and qualitative—has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.     

Out with the Old,In with the Old: A Closer Look at Younger Versus Older Elderly Migration*

Objective. This research examines the migration behavior of the elderly, recognizing that the older and younger elderly may make different decisions and have different consequences for the states in which they live. Methods. Using U.S. Census migration flow data, we describe the movements of the younger and older elderly. Our econometric analysis brings together the wisdom of elderly migration research that focuses on motives (amenity vs. return/assistance) and the Tiebout‐related research that considers the effects of policy. Results. We find that all elderly age groups avoid moving to states with high estate/inheritance/gift taxes, although the effect weakens with age. Likewise, the younger elderly appear to be “shopping around” for destinations with a temperate climate and favorable government policies regarding income taxes and welfare spending, whereas the older elderly are more likely to be “driven out” of their origin state by a high cost of living and income and property taxes. Conclusions. Our findings suggest that both the patterns of migration and the factors that affect migration decisions differ between the younger and older elderly.     

Home and Community-based Services and Life Satisfaction among Homebound and Poor Older Adults

ABSTRACT

Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (P-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (n= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction (β = ?0.15, p< .05), but better life satisfaction when they used HCBS (β = 0.33, p <.10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services.     

Combating Conflicting Messages of Values: A Closer Look at Parental Strategies

This study examined how parents respond when their children encounter values outside the home that conflict with family values. Forty‐eight middle‐class European American parents completed questionnaires consisting of 11 vignettes asking how they would respond to hypothetical situations where outside sources posed potential conflicts with parental values to their adolescent child (M age of child=13.33 years). We identified five strategies that parents might use: controlled cocooning, reasoned cocooning, compromise, pre‐arming, and deference. Parents in the study enlisted all five strategies, with reasoned cocooning and pre‐arming occurring most frequently. The self‐reported importance of values to parents was the most important predictor of which strategy parents used, with parents using more controlling strategies to defend values that were most important to them. Importance of values also mediated the relation between religion and the parent's self‐reported desire for the child's compliance on personal issues, and parental strategy choice. This study is among the first to examine alternative parental strategies for regulating children's values acquisition outside the home, and shows that the extent of parental control is related to the importance of specific values to the parent.     

Factors Protecting against Suicidal Ideation in South Korean Community-Dwelling Older Adults: A Systematic Literature Review

This systematic literature review investigates protective factors against suicidal ideation among community-dwelling older adults in South Korea. Existing research focuses on risk factors for suicidal thoughts among older adults living in the community, but research on protective factors for this population is rare. Furthermore, studies have been more likely to examine individual and social factors rather than macro factors, yet suicidal thoughts among older adults may come from various long-term challenges. This study applied Bronfenbrenner’s ecological frame to synthesize 60 studies. The results reveal that protective factors against suicidal thoughts among community-dwelling older adults in South Korea are found at four levels: individual, family, community, and macro-level factors.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

A New Look at Home Care and the Hospital Social Worker

Clinical, administrative and social action reasons for expanding social work services in hospital based home care programs are persuasive. Hospital departments of social work should consider carefully how they may expand services in home care and coordinate and integrate such activities with social work and discharge planning processes occurring throughout the hospital. It is necessary for social work leadership to be present on professional advisory, quality assurance and similar committees and to use these committees as arenas for expanding the social work role in home care.     

Health Self-management Among Older Prisoners: Current Understandings and Directions for Policy,Practice, and Research

The population of aging prisoners has increased significantly over the past several decades, resulting in concerns about the criminal justice system’s ability to address the needs of prisoners and parolees with chronic health conditions. This is troubling, given the health disparities among incarcerated populations. Health self-management has become a strategy within the community-based health care industry to improve health services and outcomes while reducing health care costs for nonincarcerated individuals with chronic conditions. However, to date little research has focused on the practice or promotion of health self-management among current and former incarcerated populations. This article highlights current understandings about chronic health self-management among older prisoners and parolees, with an emphasis on the potential benefits and current challenges in promoting their health self-management practices. Finally, specific recommendations are made for promoting health self-management for these populations through social work practice, policy advocacy, and research to achieve goals in improving health outcomes and reducing healthcare costs.     

Race and Place: Exploring the Intersection of Inequity and Volunteerism Among Older Black and White Adults

Although the historical impact of racial segregation and ongoing health and economic inequities between older Black and White adults is well documented, little is known about the relationships among race, individual- and neighborhood-resources, and formal volunteering in later life. This study explores this intersection. Individual-level data from 268 respondents aged 55+ were collected in the St. Louis metropolitan area through paper-based mail surveys. Objective neighborhood data were obtained at the zip code level from secondary sources and matched with respondents. Using exploratory factor analysis, we constructed a 14-item environmental scale with 3 neighborhood dimensions (economic, social, and built environment). Older Black adults had lower levels of education; had fewer financial assets; lived in neighborhoods with less economic resources and lower built environment scores; and fewer formally volunteered when compared to older White adults. Individual resources (financial assets, health) and neighborhood resources (social and built environment) were positively associated with formal volunteering among older Black adults. Only individual resources (age, marital status, financial assets, health) were associated with formal volunteering among older White adults. A coherent set of policies that bolsters individual and environmental capacities may increase the rate of volunteerism among older black adults.     

Unmet Home Care Service Needs of Rural Older Adults With Alzheimer's Disease: A Perspective of Informal Caregivers

This study assessed unmet service needs of rural older adults with Alzheimer's disease (AD) and identified factors that were related to these needs. Data were collected from 109 informal caregivers of AD patients. Over half of the patients experienced unmet service needs in 1 or more areas of activities of daily functioning. Informal caregiver burden and patient's gender and functional status were significantly related to patients' unmet service needs. Patients' use of formal services was marginally related to their unmet service needs. To better address patients' service needs, a comprehensive needs assessment should be conducted with both patients and their caregivers.     

Variations in the Life Histories of Incarcerated Parents by Race and Ethnicity: Implications for Service Provision

ABSTRACT

Incarcerated parents have complex life histories that often remain unresolved during incarceration, can continue to create barriers to prosocial success on release, and present similar intergenerational challenges for their children. This study examines the life histories of incarcerated fathers and mothers from the Pacific Northwest and how their experiences vary based on race and ethnicity. Five areas examined were exposure to trauma, child welfare involvement, mental health and substance abuse problems, juvenile justice and adult criminal justice involvement, and intergenerational criminal justice involvement. The sample comprised 359 incarcerated parents, and their racial/ethnic composition was 59% White, 14% African American, 11% multiracial, 8% Native American, and 7% Latino. Few differences were found across racial and ethnic groups. Mothers appeared more similar to each other across groups than fathers. Results illustrated similarities yet some surprising differences with national trends on key study variables. Implications for future research and intervention and prevention are discussed.     

Self-Neglect and Neglect of Vulnerable Older Adults: Reexamination of Etiology

Using assessment and investigation data from the reported APS cases in Texas, this study examines the types of elder self-neglect and neglect, including medical neglect. It then examines the association between self-neglect and neglect and individual economic resources as well as health care and social service programs for the poor. The findings show that elder self-neglect/neglect is, in large part, attributable to frail older adults' and their families' lack of resources to pay for essential goods and services and the inadequate healthcare and other formal support programs for the older adults and their caregivers. This inadequate public policy coverage, rather than individual and intrafamily risk factors per se, needs to be considered as a significant cause of elder self-neglect/neglect.     

Beyond Income: A Social Justice Approach to Assessing Poverty among Older Adults with Chronic Kidney Disease

ABSTRACT

How social workers define and assess poverty is a matter of economic and social justice. Recent conceptual and measurement advances point to a multidimensional definition of poverty which captures material, social, and political deprivations. Using data from a survey, this article describes how nephrology social workers assess poverty among older adults living with a chronic kidney disease (N = 52). Results suggest respondents already conceive of poverty as a multidimensional experience, support awareness-raising about poverty, and primarily assess poverty by employment status, income, access to transportation, and education. Opportunities to expand poverty assessment in future work are promising.     

Disaster Preparedness among Older Adults: Social Support,Community Participation,and Demographic Characteristics

This study examined factors associated with disaster preparedness among older adults, with special attention paid to demographic characteristics, social support, and community participation. From a larger study about disaster preparedness of persons with disabilities, a total of 719 adults aged 55 years and older were used for this study. The results of the logistic regressions indicate that individuals who have higher levels of social support and more connections to community organizations are more likely to be prepared for disaster-related emergency situations. In another model, using resource preparedness as the dependent variable, an interaction effect between social support and income was found. Overall, higher income and higher informal support are related to a higher level of resources for disaster preparedness. However, the relationship between income and disaster preparedness is much stronger for those sub-groups receiving more informal support. The findings of this study expand knowledge regarding issues of disaster preparedness among older adults and demonstrates the importance of social resources and networks. This study suggests an intervention model for decision-makers and community leaders in terms of providing information and advice to members of their communities about how to adequately prepare for natural disasters.     

Show Me the Way to go Home: A Narrative Review of the Literature on Delayed Hospital Discharges and Older People

Correspondence to Jon Glasby, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Edgbaston, Birmingham B15 2RT, UK. E-mail J.Glasby{at}bham.ac.uk Summary This Research Note reports findings from a narrative reviewof the literature on the rate and cause of delayed hospitaldischarge in the UK. In addition to summarizing our knowledgeto date in this important area, the Research Note raises a seriesof questions about aspects of current hospital discharge policyand practice (and in particular, the recent reimbursement policyto charge social services departments for delayed discharges).     

Relationship Between Pain and Chronic Illness Among Seriously Ill Older Adults: Expanding Role for Palliative Social Work

Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 Institute of Medicine . ( 2011 ). Relieving pain in America: A blueprint for transforming prevention, care, education and research . Washington, DC : National Academies Press . [Google Scholar]). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.     

A Tale of Two Cultures: Cross-Disciplinary Perspectives in the Care of Older Adults with Combined Visual and Medical Disabilities

A comparison of the vision rehabilitation and medical rehabilitation systems suggests that, despite the distinct professional cultures that have evolved around them over the past 50 years, their commonalities are more notable than their differences. The older adult, who frequently develops simultaneous visual and medical disabilities, demands a greater degree of cooperation between these systems, than that required for the younger client who was the primary focus of the rehabilitation paradigm in the years following World War II. This article includes guidelines for practitioners that should help them achieve a more comprehensive approach to their elderly visually impaired clients.