Does Self-Neglect Occur Among Older Adults With Dementia When Unsupervised in Assisted Living? An Exploratory,Observational Study

The phenomenon of older adults with dementia who develop behavioral expressions when they are unsupervised in assisted living residences is understudied. This qualitative study aimed to bridge this gap in the literature by focusing on 12 residents in various stages of dementia. Grounded Theory was followed to guide data collection and analysis. Data were collected in two special care units of an assisted living residence for 10 months. Participant observation was the primary data collection strategy. Semistructured interviews with staff and managers and review of clinical records augmented the observation data. While unsupervised, residents exhibited a wide spectrum of negative emotional states, behavioral expressions, functional difficulties, wayfinding difficulties, serious hygiene problems, and safety risks. More than half of the identified incidents represented self-neglectful behaviors. The study highlights the need for enhanced supervision and targeted interventions for residents with dementia who are susceptible to self-neglect.     

“Do They Think I Am a Pack Rat?”

This case study presents details of the life of one older man who lived in seclusion and squalor, surrounded by hoarded possessions. This man was one participant of a focused ethnography of eight older adults who received home care. All participants in the original ethnography were identified by their community care coordinators as exhibiting hoarding behaviors. The case study presented here provides rich narrative and photographic detail in order to add strength to what has already been presented in previous research articles about compulsive acquisition. The narratives reveal examples of debilitating dysfunction, distress associated with decision making, broad acquisition of free things, compulsive buying, and ritualistic discarding. Quotes included in the case study stem from the original ethnography.     

Engagement of the Elderly in Time Banking: The Potential for Social Capital Generation in an Aging Society

Community currency systems attempt to empower the economically marginalized and build social capital. This research explores the role of the elderly in a local voluntary organization. The elderly are potentially very important contributors, yet we know little about their participation in these local exchange networks. Eighty-seven months' worth of transaction data from a “time bank,” which has had a total of 950 members, was examined in social network analyses. Measures of quantitative engagement in the system were constructed. The elderly were found to be as active as other members. Qualitative characteristics of the network were also explored. The organization is rather homogeneous, yet exchanges within it tend to connect diverse actors. Male and female seniors undertransact with themselves and with one another, generating bridging social capital. The evidence presented suggests that the participation of the elderly in local currencies is mutually beneficial.     

“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.     

The International Migration of Nurses in Long-Term Care

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings:

• Demographic drivers–The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services.

• Gender and race–A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries.

• Credentialing–The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to “decredentialing” where registered nurses work as licensed practical nurses or aides.

• Colonial history and geography–The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers.

• Worker recruitment–Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.

     

A Qualitative Exploration of Self-Regulation Behaviors Among Older Drivers

While much of the research on aging and driving has focused on sensory and motor changes, little is known about older drivers and the actual self-regulation adjustments they employ to continue driving safely. This research looks at how older drivers have made changes to driving patterns and behaviors that have allowed them to continue to drive without compromising their perceived safety, independence, and quality of life. Nine focus groups were held with older men and women aged 58 to 89 years. Some of the major themes that emerged were the following: older adults are very aware of age-related changes to driving; they perceive that self-regulation behaviors change with age; and they view transportation alternatives as limited or nonexistent. Policy implications include developing functional transit programs for older adults and car manufacturer training workshops to educate older adults on the safety features of newly purchased automobiles.     

Walking the Tightrope: Developing a Systems Approach to Balance Safety and Mobility for an Aging Society

In an aging population, safety and mobility are often viewed as being in conflict, when in fact they are two values that must be reflected equally in transportation policy. The challenge for policy makers and for society is to emphasize and optimize both. To achieve this, a comprehensive systems approach to driver health, personal decision-making and planning, community and transportation systems construction, vehicle design, and licensing regulations is needed. Such an approach requires crafting policies based on conceptualizing the issue as a continuum of resources facilitating safety and mobility regardless of driving status. The discussion that follows reviews components of the issue and suggestions for developing a comprehensive approach.     

Tracing Stigma in Long-Term Care Insurance in Israel: Stakeholders’ Views of Policy Implementation

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.     

Negative Stereotyping of Older Nurses Despite Contact and Mere Exposure: The Case of Nursing Recruiters in Western Australia

Ageist attitudes have been identified across different industries. The nursing profession has a high proportion of older workers. As this facilitates regular contact with, as well as exposure to, older nurses, it may be expected to show less ageism. This study investigated 163 Western Australian nursing recruiters' attitudes toward older nurses. Results showed clear evidence of both negative and positive stereotyping of older nurses. Nursing recruiters indicated that they would be more than likely to hire older nurses and that age was less relevant in making hiring decisions. These findings suggest that enhancing the employability of older workers does not necessarily change ageist attitudes. This is relevant to policy formulation, attitude change interventions, and the well-being of older workers.