Multidisciplinary Team Perspectives on Older Adult Hoarding and Mental Illness

This qualitative study examined multidisciplinary team members' perspectives of their involvement in older adult hoarding cases. Fifteen informants, as representatives of four hoarding teams, described cases in which teams did or did not work well together. Specifically, informants described their (a) team characteristics, (b) awareness of hoarding as a mental health illness, (c) barriers to providing mental health services for older adults who hoard, and (d) components of successful teamwork within the team and with the older adult as hoarder. Implications include research to better guide interventions, team training to develop common perspectives, and policy development that supports mental health representation on teams and in-home mental health treatment.     

Homelessness Among Older Adults with Severe Mental Illness

ABSTRACT

This article tackles a problem that is often overlooked in the literature-the plight of homeless elders with severe mental disabilities. Drawing on his personal experience working with sheltered homeless persons who were mentally ill, the author argues for a focus not on self-sufficiency but on closely supervised care for this vulnerable population.     

Ambivalence in Older Parent–Adult Child Relationships: Mixed Feelings,Mixed Measures

This research compared direct and indirect measures of ambivalence, 2 commonly used strategies for measuring intergenerational ambivalence between older parents and their adult children. Directly and indirectly measured ambivalence, corresponding to felt and potential manifestations of the construct, were contrasted with each other and across generations. Data were derived from 253 older parent–adult child dyads participating in the Longitudinal Study of Generations in 2005. Direct and indirect measures of ambivalence were moderately correlated with each other within each generation. Children expressed greater indirect ambivalence than their parents but were no different than their mothers or fathers in their levels of direct ambivalence. Multivariate regression analyses examining the relationship between each type of ambivalence with individual and relationship characteristics found differences in associations across equations. The results suggest that direct and indirect measures are related but represent 2 distinct conceptions of ambivalence. This research highlights the challenges in understanding the full complexity of intergenerational relations and suggests that both generational perspectives be considered in future research.     

The Impact of a Substance Abuse Disorder on the Well-Being of Family Caregivers of Adults With Mental Illness

ABSTRACT

The impact that substance use has on an individual with mental illness has been documented; however, little is known about the impact that this may have for a family caregiver. Data was collected in a cross sectional study using mailed questionnaires to a convenience sample of family members of persons with mental illness (n = 110). Hierarchical linear regression analysis was used to determine the impact of substance use status upon four measures of well-being within a stress-coping model. The variables within the model were able to account for a significant proportion of the variance in each of the measures: perceptions of burden, depression, anxiety and physical health status (R² = .419 to .202). However, substance use status was not a significant predictor in any of these equations. Symptomatology and a measure of specific social support were the most significant predictors of burden (β = .345, p < .001 and β = .330, p < .001). Perceptions of caregiver burden were found to be the most significant predictor in each of the other three analyses (β = .515, p < .000; β = .511, p < .000; β = ? .571, p < .000). Results of this study suggest that substance use may not be as important as the other predictors included in the model in determining the well-being of family caregivers.     

Kinship Care for Children of a Parent With a Mental Illness

Little is known about “hidden” kinship caregivers of children of a parent with a mental illness (COPMI). An exploratory study surveyed 56 COPMI caregiver members of a kinship center administered by a school of social work in a large public university. The COPMI sample was a subset of a larger kinship caregiver study. Nearly one in four caregivers was providing COPMI kinship care. The COPMI caregivers reported numerous child behavioral crises and decreased caregiver physical and emotional health since they began providing care. Practice, policy, and research require development to increase support for COPMI caregivers and their families.     

Solidarity and Conflict Between Adult Children and Parents: A Latent Class Analysis

Using multiple dimensions of solidarity and conflict in a latent class analysis, we develop a typology of adult child–parent relationships. The data (N= 4,990) are from the first wave of the Netherlands Kinship Panel Study. In descending order of relationship quality, the 5 types are harmonious (akin to relationships with friends), ambivalent (intensive exchange of material support accompanied by strain), obligatory (just keeping in touch), affective (emotionally supportive with few other meaningful exchanges), and discordant (predominantly negative engagement). The types are differentiated by gender, age, family size, geographic distance, and parental marital history, indicating that they are not fixed but are shaped by social‐structural conditions.     

Ambivalence in the Relationship of Adult Children to Aging Parents and In‐Laws

The concept of ambivalence emphasizes the complexity of family relations and the potential for individuals to evaluate relationships as both positive and negative. Using multilevel models, we investigate ambivalence in adult children's relationships with their aging parents and in‐laws (N= 1,599). We focus on factors predicting adult children's ambivalence toward parents and in‐laws within a gendered kinship structure that shapes these relations. We conclude that ambivalence is a useful concept for representing the complexity of parent‐child relationships and is produced within the context of social relations structured by gender and kinship. Results show greater ambivalence among dyads of women, toward in‐laws, among those in poor health, for daughters providing assistance, and for adult children with poor parental relations in early life.     

Financial Exploitation of Older Persons

Abstract

Financial exploitation is a recognized social problem of unknown, though likely increasing, magnitude. It can occur through numerous methods, including the misuse of powers of attorney and guardianship, illegal transfers of property, and outright fraud and theft. Financial crimes against older persons are difficult to address because they often go unreported. This paper provides a summary of findings from a study of financial exploitation of older persons. We review what is known about the nature and scope of financial exploitation of older persons and describe barriers to addressing the problem. We also identify gaps in knowledge, discuss current methods for addressing financial exploitation, and provide recommendations and suggested policy approaches for prevention and remediation.     

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.     

Pathways of Adult Children Providing Care to Older Parents

Guided by life course and stress process theory, this study investigated pathways of adult child caregivers' family (caregiving, marital, parenting) and nonfamily (employment) roles. Eight waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers. Latent class analysis provided strong evidence for a 4‐class model of caregivers' role pathways. The four pathways were (a) Not‐Married, Early‐Transition to Not‐Working Caregivers (34%), (b) Married, Not‐Working Caregivers (26%), (c) Married, Late‐Transition to Not‐Working Caregivers (23%), and (d) Married, Not‐Working Caregivers with Coresiding Child (17%). Caregivers' background characteristics and contexts predicted pathway membership. Adult child caregivers have structurally diverse life pathways that have implications for theory, research, and practice.     

Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

The Ties That Bind: Midlife Parents' Daily Experiences With Grown Children

Daily pleasant or stressful experiences with grown children may contribute to parental well‐being. This diary study focused on midlife parents' (N = 247) reports regarding grown children for 7 days. Nearly all parents (96%) had contact with a child that week via phone, text, or in person. Nearly all parents shared laughter or enjoyable interactions with grown children during the study week. More than half of parents experienced stressful encounters (e.g., child got on nerves) or stressful thoughts about grown children (e.g., worrying, fretting about a problem). Pleasant and stressful experiences with grown children were associated with parents' positive and negative daily moods. A pleasant experience with a grown child the same day as a stressful experience mitigated effects of those stressful experiences on negative mood, however. The findings have implications for understanding intergenerational ambivalence and stress buffering in this tie.     

Experiences of Biological Parents and Their Older Children in Out-of-Home Care for the First Time

This article will examine the parenting characteristics and challenges that faced a cohort of families participating in an exploratory qualitative research study. This study sought to describe the experiences and characteristics of parents whose children were placed in the child welfare system in early-to-late adolescence (ages 12–18), thus gaining an understanding of the parenting challenges faced as they were able to maintain their children in their homes for a significant portion of their lives. The families of older youths entering care for the first time described how alcohol and drug abuse impacted their relationships with children, significant others, jobs, and their mental health status. A significant issue that emerged in several of the cases were older children who initiated a report to child welfare themselves.     

Repartnering Following Divorce: Implications for Older Fathers' Relations With Their Adult Children

This study examined the implications of postdivorce fathers' new unions and additional (step)children for two aspects of older fathers' relations with adult children born from a prior relationship: frequency of social contact and fathers' financial transfers. Data from multiple waves of the Health and Retirement Study (N = 13,017 observations on 4,997 adult children belonging to 1,917 ever‐divorced fathers) were used to estimate multilevel models. The results indicated that divorced fathers who go on to form a new union have weaker relations with adult children from a prior union than their postdivorce counterparts who remain single. This finding partly reflects the detrimental effects of repartnered older fathers' new biological children and stepchildren. There is no difference between older remarried and cohabiting fathers' intergenerational ties. Moreover, fathers' additional biological children and stepchildren have similarly negative effects on fathers' relations with adult children from a previous union.     

The Critical-Ecological Framework: Advancing Knowledge,Practice, and Policy on Older Adult Abuse

The abuse of older adults in our society is a recognized yet understudied issue compared to other forms of family violence. Within this article, research, theory, and practice in family violence and older adult abuse are compared; elements that can be transferred to the field are analyzed; and gaps are identified. An extensive literature review, two focus groups with local stakeholders, and interviews with six key informants recognized as national subject experts formed the basis of this analysis. The results informed the development of a critical-ecological model designed to address the gaps and advance the field.     

Positive Parenting Among African American Mothers With a Serious Mental Illness

Positive parenting is hampered by social‐contextual risks—lack of income, education, and support, as well as maternal mental illness—but current models do not examine the effect of each factor in concert with the others. Using structural equation modeling and a community sample (N= 202) of African American mothers diagnosed with depression, bipolar disorder, or schizophrenia, we examined the direct and indirect effects of poverty, maternal education, social support, material and social stress, current mental health, and psychiatric history on positive parenting attitudes, involvement in children's education, and authoritative parenting style. The strongest predictors of parenting attitudes were stress and current mental health. Parenting attitudes were the strongest predictors of parent involvement and style but stress and current mental health were also predictive. Involvement was also predicted by maternal education and social support.     

The Mental Health System and Sense of Self Among Adults with Serious Mental Illness

Abstract

Development of a sense of self is a lifelong process. One's sense of continuity in the context of the demands of multiple role identities contributes to both psychological well-being and opportunities for acceptance into valued social roles. The onset of a mental illness can rupture an emerging sense of self and require intense and painful restructuring of one's beliefs and expectations. This study was a secondary analysis of qualitative data from interviews with twenty people who self-identified as having serious mental illness to explore how well the mental health system addresses the ingredients that promote, create, or restore a valued and adaptive sense of self.     

Financial Exploitation of Older Adults in Rural Settings: A Family Perspective

Federal agencies responsible for funding protective services to older adults are increasingly concerned with the growing incidence of financial exploitation in rural areas. The Wall Street Journal recently has reported an increasing trend of unemployed adult children migrating from urban centers to smaller rural towns and countrysides to live with their parents since 2008. This current study explores the attitudes of family caregivers regarding management of financial matters for their elderly care recipients. The major findings of the study include that adult children often (1) overestimate their parents' ability to manage their finances; (2) prefer to manage their parents' finances informally, as opposed to using legal options like power of attorney; and (3) tend to think of their parents' assets as “almost theirs.” The study concludes with recommendations on the critical need for information to help families make important decisions about helping elderly parents with their finances. This information would not only promote the use of safeguards against abuse, but could potentially provide caregivers with greater confidence and protection.