Perceived Need for Home- and Community-Based Services: Experiences of Urban Chinese Older Adults With Functional Impairments

Guided by Cantor’s social care model, this study identified individual, family, and social support factors that influence urban older adults’ need for home- and community-based services, including medical and rehabilitation, instrumental care and support, and psychosocial services. The data were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2006. Results from multiple logistic regression show that older adults’ need for medical and rehabilitation services is significantly related to instrumental activities of daily living, depression, not having filial children, friend support networks, and having a confidant. Older adults’ need for instrumental care and support is related to their educational attainment, financial strain, instrumental activities of daily living, not living with children, and friend support networks. Finally, older adults’ need for psychosocial services is significantly related to educational attainment, depression, not being married, friend support networks, and having a confidant. Implications for social service development are discussed.     

Assisted Living for Lower-Income and Frail Older Persons from the Housing and Built Environment Perspective

Abstract

This paper examines the linkages between housing and supportive services from the built environmental perspective. When it comes to linking supportive services, it is usually true that the wealthier an individual is the more private resources he or she has available to define a personal support system at every step in the aging process; the poorer the individual is, the fewer choices she or he has and the successful linkages of government subsidized housing, health and supportive services become more important to successful aging of that person. Low-income and aging individuals are the real testing ground for whether current policy allows holistic support linkages to occur and whether programs are available in both the quantity and quality to empower low-income older persons with options and support choices.

The discussion that follows is limited to supportive services and aging in place in conventional housing and affordable purpose built assisted living programs and facilities; it omits institutional living. For low-income older persons, institutional care provides few if any housing choices or individual power to control support delivery, and thus linkages between cooperating support professionals and programs becomes increasingly moot.     

Powerlessness and Abuse and Neglect of Older Adults

ABSTRACT

This article is a qualitative study which addresses the interacting relationship between the environmental context of care giving and abuse and neglect of older adults. These are examined through a thematic content analysis of risk factors identified in sixteen ‘in depth’ interviews of abused and neglected victims including two of their abusers. The interviews provide a portrait of their past and present situations, their roles and relationships and the process through which the interviewees move into their described process of powerlessness.

The interviewees are analysed through a critical, systemic, ecological analysis of the historical, gender and cultural perspectives of the interviewees. Through the relationships of the victims and their abusers in the macro, meso, exo and micro systems, questions are raised about the growing debate regarding changes in family patterns and demographics that affect how societies define the provision of care to their dependent adults. They demonstrate that violence is produced by complex interacting systems and significant events, that impact on the life courses of some older adults and some care givers leading them into powerless positions and resulting in abuse and neglect.     

Geographic distance and intergenerational relationships in Chinese migrant families

ABSTRACT

This study examines the effect of adult Chinese migrants’ geographic distance from home on their intergenerational relationships with parents who remain behind. We compared monetary and family care support as well as emotional relationships among four parent-child groups: older adults and international migrant children, older adults and internal migrant children (who migrated to other cities in China), older adults and coresiding children, and older adults and local children (living in the same city as their parents). Data were derived from 332 older adults in Beijing, China, with at least one child who migrated to another country or city. Results from chi-square tests, anaylsis of variance (ANOVA) tests, and regression analyses indicate that international and internal migrant children maintain similar intergenerational relationships with their parents, and that both of those groups are less likely than coresiding and local children to have family care exchanges and emotionally close relationships with their parents. The results may help professionals develop supportive services and policies for older adults in migrant families.     

Treatment and Prevention of Elder Abuse and Neglect: Where Knowledge and Practice Meet—A Model for Intervention to Prevent and Treat Elder Abuse in Israel

Successful handling of elder abuse and neglect requires various interventions. This article presents findings from an evaluation study of a model for intervention implemented in three municipalities in Israel. Data from 558 older adults, exposed to abuse and treated through the program, and interviews with victims, abusers, and professionals revealed that improvement was achieved in 66% of the cases. In 20% of the cases, the abuse was stopped. The most widespread type of intervention consisted of individual counseling. Legal intervention yielded the highest rate of improvement (82%). Provision of supportive services for victims of neglect was found to be most effective (82% of improvement in the situation).     

Experiences of Informal Caregivers of Older Adults Transitioned From Nursing Homes to the Community Through the Money Follows the Person Demonstration

This study examined experiences of 156 informal caregivers of older adults who transitioned to the community through the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration after prolonged nursing home stays. Caregiver burden, positive aspects of caregiving, depressive symptoms, anxiety, and comparative subjective stress were examined in relation to caregiver demographics and care receiver characteristics with a cross-sectional survey. Caregivers reported low burden, depressive symptoms, and anxiety, and fairly high levels of positive aspects of caregiving and satisfaction with community services. Most caregivers were less stressed compared to the time the care recipient was in, or before they entered, a nursing home. Live-in caregivers experienced more positive aspects of caregiving, but adult children reported higher burden than other caregivers. Unmet service needs also increased caregiver burden. Programs like MFP are a viable option with broadly positive outcomes from a caregiver’s perspective. Enthusiasm for increasing access to community care is growing for older adults who otherwise would reside in nursing homes for extended periods. Identifying unmet service needs and needs for targeted functional support could further enhance caregiver experiences and contribute to the successful transition of older adults to the community.     

Comparing the effectiveness of individual and group therapy for students with symptoms of anxiety and depression: A randomized pilot study

Abstract

Objective: To examine the effectiveness of individual versus group therapy for anxiety and depression among university students. Participants: Forty-one university students experiencing moderate to severe symptoms of anxiety and/or depression participated during one of three academic semesters from 2015 to 2016. Methods: Participants were randomly assigned to either 6-weeks of individual or group therapy and completed outcome measures at pre-and-post-treatment. Results: Significant reductions in both depression and anxiety scores were found across time, with no significant difference between group and individual therapy outcomes. Exploratory analysis of attitudes toward therapy found that while individual therapy was rated more favorably than group therapy overall, attitudes toward therapy became more favorable from pre to post-treatment for all participants. An interaction showed differences in attitudes toward individual and group therapy according to participants’ randomly assigned treatment. Conclusions: These findings support the increased usage of group therapy within university counseling centers, with implications for stepped care discussed.     

"Living well in later life": an overview of the National Service Framework for Older People in England

The National Service Framework (NSF) for Older People is a set of standards produced by the Department of Health in England in 2001 to overhaul the health and social service delivery systems over a 10-year period aimed at optimizing the care received by older adults. The NSF arose from broader social and health care reforms that likewise sought the establishment of performance assessment, augmented consumer sovereignty, and greater coherence across health and social services. The United States shares with England similar problems with care for its older adults, strategies for improvement, and obstacles to successful implementation of change.     

“Living Well in Later Life”: An Overview of the National Service Framework for Older People in England

The National Service Framework (NSF) for Older People is a set of standards produced by the Department of Health in England in 2001 to overhaul the health and social service delivery systems over a 10-year period aimed at optimizing the care received by older adults. The NSF arose from broader social and health care reforms that likewise sought the establishment of performance assessment, augmented consumer sovereignty, and greater coherence across health and social services. The United States shares with England similar problems with care for its older adults, strategies for improvement, and obstacles to successful implementation of change.     

Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far the fastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of later life is essential. In particular, anxiety and depression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

Needs and Perceptions of LGBTQ Caregivers: The Challenges of Services and Support

Increasing attention has been paid to the lack of services and support afforded older lesbian, gay, bisexual, transgender, and queer (LGBTQ) women in same-sex relationships, including caregivers. This study was designed to investigate the needs and perceptions of LGBTQ women from ages 35 to 91, including informal caregivers and older adults regarding services and support from health care providers. Questionnaires were completed by older LGBTQ women (N = 76), and follow-up interviews were conducted with 25% of caregiver respondents. The majority of subjects indicated a fear of future challenges and discrimination. Four main themes emerged when analyzing the open-ended responses: the need for health care workers who were both supportive and knowledgeable about LGBTQ issues; better and consistent recognition of same-sex partners and their rights to make decisions as primary caregivers; increased sensitivity training regarding the needs of LGBTQ patients and caregivers; and more open and accepting environments where LGBTQ patients and caregivers could feel comfortable discussing issues with the staff.     

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.     

Statute Definitions of Elder Abuse

ABSTRACT

Older women victims of violence by a partner or family member are more often categorized as victims of elder abuse, not victims of family violence. Their needs are assessed, if at all, by social and health service agencies, often with little knowledge or understanding of domestic violence, while domestic violence policy initiatives, advocacy, and services focus on younger women and children. A survey of domestic violence services in British Columbia and the Yukon found that women over 60 years of age were a very small fraction, generally less than two percent, of women served, and those 50 to 59 years of age were also substantially under-represented. Only four percent of respondents had special services for older women. Comments from respondents confirm that abused older women face enormous difficulties in trying to establish a safe and secure future. It was also evident that better interaction is needed between those providing support and advocacy for abused women, and those who provide health and social services for older persons. A majority of the shelters provided community education to a wide range of agencies. Most have only partial accessibility to women with mobility handicaps.     

Services Planned in Abusive Elder Care Situations

This study contrasted 96 physically abusive caregivers of elderly persons with 266 non-caregiver abusers and examined service plans for the two groups of victims and abusers. While elderly persons victimized by caregivers were offered home health care, case management, and adult day care at higher rates than victims of non-caregivers, less than 20% of the victims of caregivers were offered any of these services and 5% or less were offered outreach, counseling, and crisis intervention. Persons abused by caregivers were at particular risk of nursing home placement. Although 25% of the caregiving abusers and 34% of the non-caregiver abusers were reportedly alcoholic, only 3% in each group were referred for alcohol or drug treatment.     

Elderly Living in the Community:

Helping an older individual remain in the community requires the creation of living environments that maximize the individual's strengths while providing supportive services in the areas of decreasing competency. Historically, the community care system has not been viewed by reimbursers as terribly important. The aging of the population, plus the high cost of institutional care has resulted in renewed interest in services provided in one's own home. However, there are both challenges and opportunities in providing such service. Adapting supportive housing and neighborhood environments which help unstable persons remain in their homes is crucial to this effort.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Giving up the car: older women's losses and experiences.

Numerous activities, often life-long patterns, are based on driving and access to a car. When driving ceases, the challenge to change and develop new behavior patterns occurs. Women in this study had many losses and challenges to usual ways of doing things. Various coping strategies were described, including types, benefits, and potential challenges of both informal and formal helpers. Implications for health care providers include empathic awareness of the nature and extent of loss initiated by giving up driving and determining how best to support older adults in coping. More work needs to be done to develop strategies that support optimal function and ease this difficult transition for older adults.     

Exploring e-Mental Health Preferences of Generation Y

E-Mental Health services could substantially increase the capacity of the mental health care system. This article explores youth consumer preferences for online interventions targeting depression and anxiety. Twenty-three participants who had experienced suicidal ideation and either depression or anxiety and completed one qualitative interview were included. Interviews were topically guided to cover themes of e-Mental Health service preferences around online help-seeking behavior, appearance, content, privacy, and support. We found that youth positively received the idea of, and appreciated the need for, e-Mental Health services. Noted preferences for services were those that are simple to use, interactive, and include support through an online community.