Depression and elder abuse and neglect among a community-dwelling Chinese elderly population

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51-5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53-5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35-5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10-4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49-7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

Paid personal assistance services:an exploratory study of working-age consumers' perspectives

This study examined the experiences of individuals who use paid personal assistance services (PAS). Structured interview data were collected from a convenience sample of 24 working-age individuals from diverse backgrounds recruited from Centers for Independent Living in nine states. Respondents described their general satisfaction with current paid PAS, but many reported previous experiences with poor care related to the low wages, lack of training of PAS providers, and an inadequate supply of providers. Respondents reported many unmet needs because of a shortage of hours provided by state programs and the lack of help with daily living activities, transportation, childcare, and social activities. The respondents strongly preferred consumer-directed care.     

Using evaluation to improve program quality based on the BELL model

Building Educated Leaders for Life (BELL) is a national not-for-profit organization whose mission is to increase the educational achievements, self-esteem, and life opportunities of elementary school children living in low-income urban communities. BELL has been engaged in formal evaluation, internally and externally, for more than five years and has built internal evaluation capacity by investing in a specialized full-time evaluation team. As part of a continuous program improvement model of evaluation, BELL uses the data to refine program implementation and replicate successful elements of the services and operations. In this chapter, the authors highlight best practices from the field by outlining BELL's approach to using evaluation data for continuous program improvement. Key strategies include (1) carefully identifying intended users of the evaluation throughout the organization and among its external stakeholders, then working closely with intended users throughout the evaluation process, ensuring full engagement at every step of the process; (2) reporting findings in a readable, user-friendly format and timing the reporting so that it is aligned with programmatic decision making and planning cycles; and (3) making and supporting explicit recommendations for the next program cycle, where intended users have agreed to recommendations and ownership is assigned. BELL's successful use of data for improvement is evidenced by the consistently strong outcomes for the students it serves as well as increased efficiency and satisfaction related to service delivery that has supported the replication of BELL's programs nationally.     

Migration and retirement in the life course: an event history approach

Migration at older ages is commonly explained by reference to the search for greater amenity, and subsequently by the onset of greater dependency, but the links between mobility and specific life course transitions have rarely been articulated. We aim to establish the timing of migration in relation to retirement from the labour force, and to determine how its intensity varies around the retirement event. We also seek to identify how household and individual characteristics shape the propensity and timing of migration, differentiating moves according to distance and with particular attention to the characteristics of the spouse. Data are drawn from the first six waves of the Household, Income and Labour Dynamics in Australia survey, a nationally representative panel study covering the period 2001–2006. Migration events are identified relative to retirement and event history methods are employed to establish the characteristics predisposing households to relocate around retirement. Results demonstrate that retirement acts as a trigger to migration but the propensity to move falls as retirement age rises and the hazard is increasingly concentrated in the year retirement occurs. Within this framework the presence, health, education and retirement status of a spouse exert a significant influence on the likelihood of migration, though with different effects for long and short distance moves. Results highlight the importance of variations in underlying life-course trajectories in shaping retirement migration and demonstrate that only a minority of moves at ages 55–69 are directly associated with retirement, underlining the need for caution when identifying retirement migration using age as a proxy measure.     

Climate-related migration in rural Bangladesh: a behavioural model

Research into the climate change and migration nexus has often focussed solely on how people move in response to the impacts of variability and change in climate. This notion often ignores the nature of migration as a tried and tested livelihood choice amid a variety of socio-economic and environmental opportunities and limitations. This paper closely looks at the behavioural aspects of migration decision-making in Bangladesh in the context of changes in its economy, and, increasingly, exposure to the impacts of climate variability and change. We find that villagers in areas particularly affected by increasing climatic stresses and shocks are diversifying their traditional livelihood strategies by migrating. Environmental factors, including climatic stresses and shocks, often make such shifts even more necessary. Although the migrants’ primary motivation is better income, in effect, migration becomes an effective form of adaptation. Based on a qualitative study in three geographically distinct places of Bangladesh, we propose that migration is a socially acceptable behaviour that occurs in the context of perceived environmental change and climate variability. Migration decisions are mediated by a set of ‘behavioural factors’ that assesses the efficacy of different responses to opportunities and challenges, their socio-cultural acceptance and the ability to respond successfully. This understanding has policy relevance for climate change adaptation, in terms of both how migrants are perceived and how their movements are planned for.     

Trends in Functional and Activity Limitations among Chinese Oldest‐Old, 1998 to 2008

China has the world's largest oldest‐old population, but information on trends in late‐life disability is lacking. We use data from the Chinese Longitudinal Healthy Longevity Survey for 1998 to 2008 to determine whether prevalence of limitations with physical functions and daily activities has changed recently among the Chinese population aged 80 to 105 and, if so, to investigate the factors associated with the change. We find that prevalence of need for assistance with activities of daily living and inability to independently conduct instrumental activities of daily living declined substantially. Males did not experience improvement in ability to carry out underlying physical functions over the same period, but females did. Variables associated with trends in one or more of these outcomes were adequacy of medical care as a child, childhood hunger, father's occupation in agriculture, main occupation before age 60 in agriculture, adequacy of current medical care, and body weight.