Are Methadone Counselors Properly Equipped to Meet the Palliative Care Needs of Older Adults in Methadone Maintenance Treatment? Implications for Training

Today's methadone patients differ greatly from those of the past. Because of the rise of polydrug use and the HIV and hepatitis epidemics, treatment has become much more complex, which multiply the concerns and complexities of treatment. Patients entering methadone programs are also more commonly presenting at ages well into their 50s, 60s, and 70s; and this phenomenon of high rates continues to grow. The majority of these individuals in treatment have presented with a number of significant comorbid medical conditions that will progress and eventually lead to death. This aging cohort must be approached with a modified treatment plan that focuses on management and promoting healthy aging, while attending to their maximum delay of illness, disease, and disability. This article argues that it is necessary for counselors working with this group to adopt a palliative care philosophy. This article also makes recommendations in areas that counselors need to be knowledgeable and skilled in to provide appropriate palliative services specific to this aging population with multiple needs as they near end of life.     

“The Wisdom of Age”: Perspectives on Aging and Growth among Lesbian Older Adults

Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians’ experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians’ experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65–80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline.     

Solutions to the Challenge of Meeting Rural Transportation Needs: Middle-Aged and Older Adults’ Perspectives

This study aimed to explore how the aging population in Appalachia manages its transportation and plans for the transition to non-driving and to seek possible solutions to the challenge of meeting rural transportation needs. Four focus groups (N = 38) were conducted, supplemented by a questionnaire, in Appalachian Kentucky. The results showed that few alternative transportation existed except a local paratransit service and informal transportation support. Compared to older adults, middle-aged adults reported a greater willingness to use mobile phones and the Internet to arrange transportation if they were available. Participants also recommended expanding the use of existing transportation in the community – such as church vans – to better meet the aging population’s needs. The findings suggest that partnership between government, non-profit, and private sectors is needed, not solely focusing on a tax-dependent solution. Additionally, information and communication technology-based transportation management system would help maximize the use of scare but existing resources in rural areas.     

Community Service Use by Older Adults: The Roles of Sociocultural Factors in Rural–Urban Differences

ABSTRACT

This study examined the influence of sociocultural factors in explaining the rural–urban differences in home and community-based service (HCBS) use among older adults. Survey data of 228 older adults living in Alabama were analyzed. Sociocultural factors included participants’ perceptions of service availability, attitudes toward seeking formal help, informal support, and religious behaviors. Rural older adults were less likely to use HCBS than their urban counterparts (p < .05). An interaction effect between perceived service availability and church attendance was found. These findings suggest a need for collaborations between community aging services with religious organizations to ensure existing programs are accessible to older adults living in rural areas. Future research based upon large probability samples is needed to shed more light on the relation between church attendance and service use.     

Exploration of Choice for Older People with Daily Care Needs: Scottish Professionals’ Perspectives on Self-Directed Support

ABSTRACT

This article explores The Social Care (Self-Directed Support [SDS]) (Scotland) Act 2013 developments, influence’s on individuals informed choices for care decisions and implications for direct practice situations. The article discusses perspectives from 18 professionals and front-line care workers interviewed in Scotland on SDS policy changes. Barriers included attitudes on dependence, power and control, shortage of direct client contact time, clients becoming “employers,” and reductions in the number of qualified social workers. Some recommendations included allowing social workers freedom of creativity, sharing and application of practice experience. Findings revealed an outcome-focused, person-centered approach was utilized to support an independent living environment.     

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.     

Involvement in Voluntary Organizations: How Older Adults Access Volunteer Roles?

ABSTRACT

This study examines how older adults access organizational volunteer roles and what socio-structural factors are associated with the access. Using the data from the Current Population Survey (U.S. Department of Commerce, Bureau of the Census, 2002 U.S. Department of Commerce, Bureau of the Census. 2002. Current population survey, September 2002: Volunteer supplement, Washington, DC: Author. [Computer file] [Google Scholar]), bivariate analyses show that there are variations in access to volunteer roles across types of organizations. Results from multinomial logistic regressions indicate that education, income, age, and race are associated with the ways that older adults access volunteer roles. Voluntary organizations are advised to approach older adults directly, use current volunteers to recruit potential ones, publicize their organizational goals, and disseminate relevant information in efforts to improve access of older adults to volunteer roles.     

A Brave New World of Personalized Care? Historical Perspectives on Social Care and Older People in England

Social care policy for older people in England continues to generate extensive discussion around the need to break with the past and to deliver a personalized response to need. This article explores the extent to which this represents a complete break with the past by looking at four key reports from the past, namely the Rucker Report (1946 ) on the break up of the Poor Law, the Seebohm Report (1968 ) on the personal social services, the Griffiths Report (1988 ) on community care and The Royal Commission on Long Term Care ( Sutherland Report, 1999 ). Each is interrogated in terms of how social care is defined, how services are to be delivered, how quality is understood and the assumptions made about who will be able to access services. This analysis is used to draw out key continuities in policy assumptions such as the primacy of family and the ongoing debate about ‘What is social care?’ and how it can be distinguished from health care. The article also argues that the voluntary sector has always been seen as a ‘key player’ in social care. Finally, the analysis of the four reports is used to trace the ever changing role of local authorities in the planning, purchase and provision of social care services for older people.     

From “Dependent Aged Care” to “Independent Aged Care”:An Important Transition in Aged Care in the One-child Family

Since China began to adopt the fertilitypolicy of "one couple, one child" in the1970s, many demographers have warned thatwe need to be concerned about the aging ofpopulation brought about by this policy andthe accompanying issue of social securityfor the aged. Now more than quarter of a     

A Pilot Randomized Trial of an Intervention to Enhance the Health-Promoting Effects of Older Adults’ Activity Portfolios: The Engaged4Life Program

The purpose of this study was to evaluate the feasibility and outcomes of the Engaged4Life program, an intervention to encourage inactive community-dwelling older adults to embed physical activity, cognitive activity, and social interaction into their everyday lives in contexts that are personally meaningful and natural for them. Fifteen participants were randomized to the intervention group (technology-assisted self-monitoring of daily activity via pedometers and daily tablet-based surveys; psychoeducation + goal-setting via a 3-hour workshop; and peer mentoring via phone 2×/week for 2.5 weeks) and 15 to the control (technology-assisted self-monitoring only). Recruitment was shown to be feasible and efficient, but not able to reach the target for men. Retention rate was 83% and participants manifested high adherence and engagement with the intervention. Though this pilot trial was not powered to demonstrate significant differences between groups, daily steps increased by 431 (11% increase) from baseline to Week 4 for the intervention (p < .05), but decreased by 458 for the control, for a net difference of 889 steps (p < .05). Findings were sustained at Week 8 (p < .01). In a future trial, difficulties in recruiting men, barriers due to the technology-intensive design, and the optimization of secondary outcome measures should be addressed.     

An Exploration of Congruence in the Community Service Use Attitudes of Older Spousal Caregiver–Care Recipient Dyads

ABSTRACT

This study explored within-dyadic congruence in community service use attitudes of older spousal caregiver–care recipient couples. Primary data collection consisted of in-person, standardized survey interviews with 30 caregiver–care recipient pairs. The study employed the intraclass correlation coefficient (ICC) to examine within-dyadic similarities on caregivers' and care recipients' responses to 29 items from the Community Service Attitude Inventory (CSAI). To measure the degree of match between caregiver and care recipient pairs, ICCs were calculated for each dyad (n = 30) and ranged from ?.26 to .84, indicating variation in the degree to which caregivers and care recipients displayed congruence on community service use attitude scores. The distribution of the Index of Dyadic Similarity was highly negatively skewed (skewness = ?2.159), indicating overall patterns of similarity at the dyadic level of analysis. Service use preferences and values across the seven attitudinal domains (confidence in service system, wait-and-see attitude, concern for opinion of others, pride in family independence, rejection of government assistance, worry and fear about outside help, and preference for informal care) were similar between dyadically related individuals. Although the overall trend of dyadic similarity was notable in this sample, variation in the Index of Dyadic Similarity suggests the need for future dyadic-level research to better understand within-dyadic congruence on specific attitude constructs and in relationship to service use outcomes. Specific methodological challenges relevant to conducting dyadic-level primary research with older spousal couples are discussed.     

“Talking in a New Way”: Older Individuals' Experiences of Group Work in an Acute Psychiatric Ward

Group work is frequently used in mental health, however qualitative studies on service-users' views are rare. Semistructured interviews explored 12 participants' experiences of a café-style social group and a mutual-aid group offered on an older persons psychiatric ward in Christchurch, New Zealand. The values of the strengths-based approach underpinning the groups were reflected back in the experience of an affirming environment, an exchange of strengths, and the capacity to change. The appeal of the café-style may be culturally specific to European women however, reinforcing the importance of an awareness of culture and diversity.     

Using Private Social Care Services in Finland: Free or Forced Choices for Older People?

ABSTRACT

Use of private social care services among older people is increasing in Finland. This study aims to understand why older people choose private care in a comprehensive tax-subsidized social care system and examines whether people choose private service as a free choice or a forced choice as well as what factors contribute toward making these choices. Data for this study (N = 1,436) were gathered in 2010 from people aged 75 and above living independently at home in two Finnish cities: Tampere and Jyväskylä. Data were analyzed with several quantitative tests: chi-squared tests, multinomial regression analysis, and qualitative content analysis (for the open-ended responses from the survey questionnaire). Findings reveal that people chose private services mostly because of the effortlessness involved in its use and of the need for additional services that are unavailable through municipality; for example, cleaning. Majority of the respondents performed a free choice to use private services. People who lived in a city center with a higher level of income and who needed more services were more likely to be constrained toward using private support. Major concern, due to diminishing public service provision, is about service accessibility of economically disadvantaged groups; therefore, more research is required to understand the effects of the growing care market in Finland.     

A Triumph of Hope over Experience? Modernizing Accountability: The Case of Complaints Procedures in Community Care

Complaints procedures are one component of maintaining and improving the quality of community care services. However, how effective are they in providing a means of redress for service users? This article presents the findings from four research projects, which included complaints procedures in their survey of service users’ experiences of community care provision. These findings are compared with the outcomes of similar research projects. The article concludes by evaluating the Department of Health’s consultation proposals on complaints procedures, and other policy documents, in the light of the research findings.     

‘We’re Civil Servants’: The Status of Trauma-Informed Care in the Community

ABSTRACT

Trauma-informed care (TIC) in social service organizations means that the organizations operate with the understanding that everyone involved has possibly experienced trauma in their lifetime. This qualitative study examined local service organizations’ usage of the 5 main principles of TIC: safety, trustworthiness, collaboration, empowerment, and choice (as developed by Fallot & Harris, 2006). Ten focus groups (n = 69) and 6 individual interviews (n = 6) with employees from administration through management were interviewed such that almost all facets of each agency were represented. The participants were asked about their agencies’ policies and practices for utilizing the 5 principles of TIC. The results suggest that the vast majority of organizations in this study implemented many of the principles of TIC with clients, though they had not labeled their practices as “trauma-informed.” However, although clients were receiving TIC, some of the principles were neglected as they pertain to staff, such as choice and empowerment. The findings of this study suggest that agencies are unaware of the relevance of TIC as it relates to staff. It is recommended that future research examine whether the use of TIC in agencies prevents “burnout,” high turnover rates, and vicarious traumatization of staff.     

The Development of a “Neighborhood in Solidarity” in Switzerland

ABSTRACT

This article presents a case study based on the “Neighborhood in Solidarity” (NS) methodology to illustrate its application in a locality of 8,000 inhabitants in Switzerland. This specific project is proposed to exemplify the global aim of the NS methodology. That aim is to increase the integration of elderly persons in societies in order to improve their quality of life. The case study demonstrates the enhancement of the capacity of the older people to remain actively engaged in their neighborhood. The article focuses on the creation of an autonomous community of empowered older people who can resolve their own problems after a 5-year project. The construction of the local community is presented throughout the six steps of the methodology: (1) preliminary analysis, (2) diagnostic, (3) construction, (4) project design, (5) project implementation, and (6) empowerment and with three degrees of involvement (community, participative, and integrative involvement). Performance and output indicators, quality indicators, and social determinants of health assess the development of the local project. The impacts of the projects which are illustrated in this specific example motivated this publication to inspire practitioners from other countries.     

On “Imposed Interpretation” in Literary Criticism: The Issue of “French Theory”

This paper is a response to what Professor Zhang Jiang of the Chinese Academy of Social Sciences (CASS) terms as “imposed interpretation.” In his article “On Imposed Interpretation,” Professor Zhang sees imposed interpretation as a fundamental feature and basic defect of contemporary Western literary criticism. The author analyzes some of the interpretations, as criticized by Professor Zhang, imposed on some literary classics by feminist, eco-critical, psychoanalytical, structuralist and deconstructivist methods. She reviews the sources and the limitations of the so-called “French theory” in cultural studies courses in American universities before raising the critical practice she endorses: a synthesizing critical methodology that is based on the specificity of the text, uses multiple applicable theories in relation to the socio-temporal context in which the work was produced, while bearing in mind the author’s intentions and the reader’s active participation. Through rigorous textual analysis, literary criticism can identify some new perspectives offered by the text which enable construction of the meaning of the text and of life. This can highlight the functions of literary reading in enriching people’s lives and enhancing the role of reality and man’s spiritual realm.