The Impact of Religiousness,Spirituality, and Social Support on Psychological Well-Being Among Older Adults in Rural Areas

Summary

This paper presents the results of a study on the impact of spirituality, religiousness, and social support on the psychological well-being among rural elderly. With a rural community sample of 215 older adults, hierarchical regression analyses found significant associations between dimensions of spirituality/religiousness, social support, and psychological well-being, with spirituality/religiousness inversely related to depression and social support, positively related to life satisfaction. Findings of this study suggest that practitioners need to develop programs or services that are congruent with religious/spiritual beliefs and practices in order to better enhance the psychosocial well-being and improve the quality of life among older persons in rural areas.     

Providing Mental Health Services to Older People Living in Rural Communities

Summary

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional well-being and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.     

Life values,family support and psychosocial adaptation among older people in Taiwan: an institutional and community comparison

The purpose of this study was to investigate the psychosocial adaptation among elderly persons in institutional and community settings, and to explore factors influencing their adaptation. A cross-sectional survey was conducted with a convenience sample of 165 residents of four institutions (two assisted-living facilities and two nursing homes) and 209 community-dwelling elders served by a primary care centre, all located in middle Taiwan. A structured interview questionnaire was used to collect data. Results: community-dwelling elderly had significantly higher adaptation scores than those in institutional settings. Factors related to adaptation differed between institutional and community settings, with more variables influencing adaptation in the community than in the institution. Physical functional status was the major influence on adaptation of the elderly in institutions. Dietary support from family was negatively associated with adaptation in this group. Influencing factors for community-dwelling elders were more complicated, including perceived family emotional and economic support, personal life values and physical functional status. Implications: greater support from government, including economic resources and assistance in community care are needed to achieve the policy goal of ‘aging in place’. Further investigation of the influence of family interaction on elders' adaptation is needed.     

Depression,Hopelessness, and Suicidal Ideation Among the Elderly

Abstract

This study attempts to compare levels of depression, hopelessness, and suicidal ideation among elderly males and females, in reference to their living arrangement, i.e., community vs. nursing homes. For many elderly people, old age is characterized by various losses: physiological, functional, social, cognitive, financial, etc. The outcomes of such losses often include, more often than not, environmental isolation, a subjective feeling of loneliness, anxiety, depression, and frequently, loss of motivation to continue living. In light of the rise in life expectancy and the multitude of losses which can be associated with the aging process, it is probable that one out of five elderly persons will spend part of his/her life in a long term care institute. Such living arrangements may have negative effects on the mental health of its residents, because placement is often accompanied by feelings of lack of control over one's own life, and inability to make decisions regarding daily issues. Elderly persons living in the community (227: 78 men, 149 women) and 91 living in nursing homes (33 men, 58 women), in both independent and frail functional status (ADL), participated in the study. Findings show significantly more hopelessness, helplessness, and depression among residents of nursing homes compared to those living in the community, differences between men and women living in both environments, and a correlation between other demographic variables and the three dependent variables of the study. The conclusions of the study indicate a need to pay interdisciplinary attention to the mental health of elderly residents of nursing homes, particularly in the preliminary stages of placement and adjustment.     

Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.     

Home modification among families with older adults with disability in Korea

Abstract

This study explores psychosocial factors related to the use of home modification among older adults with disabilities and their caregivers in Korea. Using in-depth interviews, this study elaborates specific socio-cognitive factors leading to home modification from the multiple perspectives of care recipients, family caregivers and home care helpers. The study findings are theoretically organised into four domains: structural factors, care recipients’ service needs, socio-cognitive factors, and enabling resources. Practice and policy implications are discussed in the context of underdeveloped housing policies for ageing-in-place in Korea.     

Moderation effect of social capital on flourishing among left-behind and other children in rural China

ABSTRACT

This study examines the ways that social capital sustains flourishing among rural Chinese children, including left-behind children (LBC). Social capital combines structural, substantive, and functional components. Data came from a survey of 995 children in rural areas of China. Results show that LBC experienced significantly lower flourishing and social capital than did other children. In addition, background factors including caretakers’ education and parental marital status had great positive effects on flourishing. Furthermore, the interaction effect of social capital and parental marital status was significantly positive on flourishing. The findings imply the need to boost social capital and flourishing in LBC. Meanwhile, maintaining parental marriage is important for boosting flourishing.     

The Effects of Housing Costs on Nursing Home Diversion

Abstract

This article examines the effect of the housing market on nursing home diversion and/or transition. Prior evaluations of federally funded diversion/transition efforts indicate that lack of housing may be a significant impediment to diversion policy efforts. We test this charge by examining the transition rates in all 351 municipalities in Massachusetts, using a data set of over 15,000 individuals seeking to remain or transition home between 2010 and 2014 through Massachusetts' Options Counseling program and their relation to key indicators of housing quality and affordability, including housing burden, crowding, and incomplete kitchen and plumbing facilities. We also control for demographic indicators identified in previous findings, which are age, level of frailty, and whether seniors live alone. We do not find a significant relationship between housing affordability or quality and successful nursing home diversion. This fact suggests that consumers are not as sensitive to housing costs and conditions as previously expected. Future research should continue to investigate the economic and social conditions behind this fact in the context of home value appreciation, incidence of home ownership, and the ability of seniors to offset nursing home costs through accumulated home equity.     

Pathways to Service for Older Persons

Abstract

As services for older persons continue to shift from hospital and nursing home care to greater reliance on support for care at home, the need to understand the ways older persons obtain services becomes more important. This study examines the use of home-delivered meals as a case study to gain insight into the process of service use from the recipients' point of view. It explores the research question: What are the pathways by which older persons acquire home delivered meals? Narrative analyses of structured and unstructured questions asked of thirty frail older persons suggested that the process of acquiring home delivered meals was accompanied by patterns of adjustment in shifting between independence and dependence in managing loss of physical function, and themes of isolation, loss, and abandonment. The results provide insights for social workers in providing the support needed for the role transition that service acceptance symbolizes for older adults.     

Caregiver's Spirituality and Its Influence on Maintaining the Elderly and Disabled in a Home Environment

ABSTRACT

This study examined the role that faith-based organizations play for caregivers in maintaining the elderly and disabled in their homes. The study explored if persons who use religious beliefs and practices cope with caregiver stress better than those who do not use religious beliefs and practices. The study also explored the role of religious coping as a factor affecting decisions to institutionalize, and the role that faith-based practices and organizations play in helping caregivers maintain the elderly and disabled in their homes.     

Inequality in the welfare state? Local variation in care of the elderly – the case of Sweden

This article uses Sweden as an example to describe and analyse municipal variation in services and care for elderly people. Responsibility for these services lies with the municipalities. National statistical data on municipalities are analysed to map out the variations in old-age care; to study compensating factors in the care system; and to explore the connection with municipal structural and political conditions. The overall finding of the bivariate analyses was that most relations with structure and policy were weak or non-existent. The final multivariate model explained only 15% of the variance. The large differences between municipalities makes it more appropriate to talk about a multitude of 'welfare municipalities' rather than one single welfare state. The article concludes that this municipal disparity constitutes a greater threat to the principle of equality in care of the elderly than gender and socio-economic differences.     

Barriers to the Use of Mental Health Services by African-American and Hispanic Elderly Persons

Abstract

This study discusses barriers to the utilization of community-based mental health services by African-American and Hispanic elderly persons. The study sample consists of “key Informants,” chosen because they were knowledgeable about the mental health needs and use of mental health services by African-American or Hispanic elderly persons. Principal component analysis using orthogonal rotation was conducted on the 23 item barrier scale and identified three levels of service barriers for the entire sample and for each subsample of African-American and Hispanic informants. Based upon the study findings, a number of strategies are offered to improve Utilization and overcome service delivery barriers.     

Caregiver Support Groups: Finding Common Ground

SUMMARY

Members of caregiver support groups for the elderly have much in common but also bring to the group different experiences and attitudes. This article explores how group workers knowledgeable about significant caregiver differences and their effects on the group can enrich the group experience for all members. The four caregiver issues examined are: (1) past history between the caregiver and care recipient, (2) ability of caregiver to privately pay for home care, (3) views on long-term care placement in a nursing home, and (4) stage of disease or level of care needed by care recipient. Essential beliefs regarding the value of differences described by Northen and Kurland provide a framework for the group worker.     

Integrated Group Program for Improving Sleep Quality of Elderly People

ABSTRACT

This article reports an exploratory study on the effects of an integrated group program for improving the sleep quality of elderly people in Hong Kong. Elderly people aged over 55 who had obtained a Pittsburgh Sleep Quality Index (PSQI) score >5 were recruited as subjects of the study. While 19 subjects of the treatment group were taking part in an integrated group program involving social group work intervention as well as Chinese medicine therapeutics, 9 subjects of comparison group received no intervention. Using a pretest and posttest design, the study revealed positive effects of the integrated group program. It has added knowledge serving the development of interventions that can help to improve the sleep quality of elderly people.     

Unmet Needs at the End of Life

Abstract

Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient-related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs.     

Social Policy and the Politics of Hispanic Aging

Abstract

This study examines the contributing factors to job satisfaction and commitment among lower-income, older (age 55 and over), part-time employees (N = 164). Job satisfaction index (JSI) scores were relatively high for all subjects and did not differ significantly for age, gender, or Senior Community Service Employment Program (SCSEP) status. While not particularly low, white employees were significantly less satisfied with their employment experiences than Hispanic or African American workers. The scarcity of fringe benefits was the least satisfying aspect of employment. Older Hispanics, whites, and men reported less interference between job, family, and home life than African Americans and women. Multiple regression analysis revealed that race/ethnicity, skill utilization opportunities, perceived views of elders held by younger workers and supervisors, availability of fringe benefits, and suitable work days explained the majority of variance in JSI scores. Opportunities to interact with others and stay active were more important than financial supplementation in these elders' assessment of the benefits of part-time employment. Findings provide further understanding of those elders likely to be placed successfully in part-time employment.     

State Variations in Nursing Home Social Worker Qualifications

ABSTRACT

This is the first published account of state administrative code variations in nursing home social worker qualifications. It is important to review state codes because the majority of nursing homes in the U.S. have fewer than 121 beds and therefore are not required by the federal government to employ at least one full-time qualified social worker. States have the option of extending the federal regulations to homes with 120 or fewer beds, or strengthening the federal requirements in other ways. Findings indicate enormous variation in state requirements for qualifications of nursing home social workers, and even when states define a qualified nursing home social worker (not all do), they often exempt facilities from employing one. Seven states were found to be out of federal compliance. Research describing the qualifications of people employed in nursing home social services is called for, as well as research documenting effective psychosocial interventions, especially as they relate to resident quality of life. Ten recommendations for enhancing nursing home social work services are included.     

Case Management in the Law Office

Abstract

This study examines the assumption that including Black-Americans with larger samples of White-Americans produce an accurate picture of the predictors of nursing home use by Black-Americans. Using the Longitudinal Study of Aging (1984-1990), Cox proportional hazard models are estimated for Black-Americans and White-Americans. This study finds that in fact the models for Black-Americans are not the same as for White-Americans. For Black-Americans, living below the poverty line, problems of functional status, age, and not having the potential for care for a few weeks from relatives (in or out of the home) are predictive of a higher risk of nursing home use while, for White-Americans, age, lower versus higher income, being female versus male, poor evaluation of self health care, poor functional status, lower levels of community activity, and living alone compared to living with a spouse or children were predictive of a higher risk of nursing home admission. The implications for policy and case management practice are discussed regarding these findings.     

Effects of sharing the parental leave on pensioners’ poverty and gender inequality in old age: A simulation in IFSIM

Female old age poverty is affected by family policy reforms which are meant to promote gender equality when young. Using our in house agent based simulation model IFSIM we show that sharing equally the parental leave can increase or reduce poverty among elderly women depending on the macro and behavioural (i.e. labour supply) responses that the reform off-sets. In general, the reform can be good for highly educated women, who will have an incentive to work more full time thanks to their higher earnings, which can compensate any loss in household income due to the man's staying home. For lower educated however, work might not pay as much and a reduction in labour supply might actually ensue (e.g. to reduce childcare costs). This will reduce also their pension rights at retirement. Furthermore, keeping men at home might slow down economic growth, and consequently growth of income pension accounts will be lower. This effect, combined with lower pension contributions (due to reduced labour supply), might result in higher poverty rates for women with lower education, compared to a scenario where the woman takes the whole leave. Other policies, such as more subsidised child care, might be an alternative worth considering to reduce female poverty in old age more evenly across educational levels.