Anxiety and Depression: Implications for Older Adults

By the year 2030, it is projected that one in every three Americans will be 55-years-old or older. This age group is by far thefastest growing segment of the population. With the growing number of older adults, the importance of understanding aging and common disorders of laterlife is essential. In particular, anxiety anddepression are among the most common problems in older adults. However, differentiating anxiety and depression at the mood, symptom, and syndromal levels has been a long-standing problem in psychopathology research. In addition to a growing need for research, clinicians will also need to take an active role in the development and implementation of treatment as the population of older adults increases. In particular, mental health service providers must become informed about the economic implications for older adults as the structure of health insurance continues to change.     

Health-Related Stereotype Threat Predicts Health Services Delays Among Blacks

To our knowledge, no published research has developed an individual difference measure of health-related stereotype threat (HRST). We adapted existing measures of academic stereotype threat to the health domain on a sample of black college students (N = 280). The resulting health-related stereotype threat scale-24 (HRST-24) was assessed for internal consistency, construct and incremental validity, and whether it explains variance in self-reported delays among four preventive health behaviors—blood pressure and cholesterol assays, physical exams, and routine checkups. After adjusting for several control variables, the HRST-24’s (full scale α = 0.96) perceived black health inferiority (18 items; α = 0.96) and perceived physician racial bias (6 items; α = 0.85) subscales explained unique variance in delays among two of the four behaviors including a blood cholesterol check (p < .01) and routine checkup—albeit at marginal levels (p = .063) in the case of the latter. Overall, these data provide preliminary evidence of construct and incremental validity for the HRST-24 among blacks. Recommendations for administering the scale are provided and future directions for HRST research are discussed.     

Lessons from the evolution of 401(k) retirement plans for increased consumerism in health care: an application of behavioral research

Employment-based health and retirement benefit programs have followed a similar path of evolution. The relative decision-making roles of the employer and the worker have shifted from the employer to the worker, and workers are more responsible than perhaps they ever have been for their well being--both in terms of their health in general and their financial security during retirement. This shift has been supported, in part, by legislation--namely ERISA, the HMO Act of 1973, the Revenue Act of 1978, and most recently, the Pension Protection Act. This Issue Brief does not pass judgment on this development or address who should bear the responsibilities of preparing workers for retirement or of rationing health care services. The current trend in health care design is toward increased "consumerism." Consumer-driven health is based on the assumption that the combination of greater cost sharing (by workers) and better information about the cost and quality of health care will engage workers to become better health care decision makers. It is hoped that workers will seek important, necessary, high-quality, cost-effective care and services, and become less likely to engage providers and services that are unnecessary and ineffective from either a quality or cost perspective. As employers look ahead toward continually improved plan design, there may be benefits in considering the lessons learned from studying worker behaviors. Specifically, there is evidence about the effects of choice, financial incentives, and information on worker decision making. As a result of research in this area, many retirement plan sponsors have moved toward plan designs and programs that recognize the benefits of well-designed defaults, simplified choices, required active decision making, framing, and commitment to future improvements. With respect to choice, it is now known that more is not always better and may even be worse in some cases. Just as fewer shoppers actually bought a jar of jelly when it was one of 24 as opposed to one of six, evidence has shown that people tend to be less likely to join a company-sponsored retirement plan when more investment options are offered. More choice can also lead to lower satisfaction. It is also known that workers may not be able to appropriately sort through many complex alternatives and that education is not always as effective as employers would hope. Decision complexity often forces people to find a way to simplify, and one of the easiest rules of thumb is to pick the option with the lowest short-term cost, even when that alternative is more costly in the longer run. It is also known that, for good or for bad, choices are constructed on the fly; preferences are dynamic, and logic does not always apply. Financial incentives are helpful in motivating behavior, but they do not affect everyone's decisions. Despite significant financial incentives to participate in 401(k) plans, many workers choose not to. Similarly, despite many of the financial incentives embedded in health care plan design, it can be expected that these incentives will not effectively motivate and engage all workers. One seemingly rational approach to improve workers' decision making is to provide education and guidance to help them sort through complex alternatives and to demonstrate the value of financial incentives. Certainly, providing education and guidance in the form of decision support tools may be an employer's responsibility. However, some studies have shown that, even when "educated" workers have the intent to make improved decisions, they often lack follow-through and fail to take action. In short, education and guidance may not be enough to foster improved health care consumerism. Some employers have begun to design benefit programs with a view toward overcoming behavioral tendencies that negatively affect workers' well-being. Newer retirement plan designs involve careful consideration of default choices. These defaults apply unless workers actively choose a different alternative. Typically, the default attempts to "nudge" workers toward optimal behavior. In the case of 401(k) retirement plan design, more employers are moving toward a default of automatic enrollment in the plan, with automatic investment in a diversified portfolio. Still, additional empirical research and experimentation may be needed to further understand the effects of new retirement plan design features. Future work may also precisely illuminate how the lessons discussed in this Issue Brief may apply to health care plan design that results in improved health-related behaviors. Given the impressive preliminary results in improving retirement planning behaviors, such research and experimentation are likely to be worthwhile.     

Afraid to care; unable to care: A critical ethnography within a long-term care home

This paper describes the findings of a critical ethnographic research study conducted in an urban long-term care home. While our intention was to learn more about the culture of care, specifically as it relates to mental health care provision, the participants in the study consistently spoke with us about (what we have labeled as) a culture of compliance. In a context where new long-term care legislation is being implemented along with new, standardized resident assessment instruments, gaining a deeper understanding of the (un)intended consequences of government's efforts to ensure a high quality of care is of paramount importance. This research demonstrates how policy-driven structural mechanisms can (re)produce conditions that result in frontline staff being afraid and unable to care, and thus contributes to a better understanding of the lived experience of frontline long-term care staff who find that their caregiving responsibilities are displaced by caregiving accountabilities.     

Ethical implications of the promotion of elder volunteerism: A critical perspective

This critical inquiry explores the question: What are the ethical implications of promoting normative ideals for healthy aging, such as volunteerism and civic engagement, that specifically emphasize productivity and contribution? In this paper, we identify the values and ethical standpoints embedded in the discourse promoting volunteerism and productive aging and then describe what this suggests about how older adults are viewed, valued and judged. More specifically, we argue that older adult volunteering has at times been framed in a manner that dually suggests: a) lifelong productivity is a necessary condition to be a good old person; and b) lifelong productivity is a necessary condition to be a good old citizen. We then demonstrate that the current promotion of older adult volunteerism and productive aging is ethically troubling because: 1) it fails to capture the full potential of the self — and in particular, the aging self; and 2) it grounds justice in a narrowly defined and unfair distributive scheme. An alternative model of aging is then presented based on equal regard for all persons insofar as this approach is inclusive of the diversity of older adults and aging processes, and policy implications are discussed.     

Children's Cognitive Perceptions of 6/49 Lottery Tickets

Recent studies have shown the high prevalence of youth gambling behavior. In particular, lottery ticket purchases among children and adolescents appear to be a highly preferred activity. Despite this fact, most research has focused on the underlying erroneous cognitions used by adults when selecting lottery tickets. This study examines the cognitive perceptions of children while engaged in selecting 6/49 lottery tickets. One hundred sixty-seven children (61 females; 106 males) from grades 3, 5, and 7 were asked to rank pre-selected 6/49 lottery tickets which were classified into a) long series, b) specific patterns, c) non equilibrated numbers, or d) perceived random selections. Children verbalized their rationale for selecting each ticket and were permitted to change the numbers on the lottery tickets they liked least in order to make them to more likely to be the winning ticket. Findings, in general, revealed small developmental differences in the types of underlying cognitive heuristics used by the children. The use of cognitive heuristics underlying the concept of randomness and the use of significant and meaningful numbers was observed to increase as children got older. Children between 9 and 11 were found to have employed the cluster heuristic more frequently than older children, ages 12–13. The results are interpreted in terms of the cognitive developmental changes in children's perceptions and the potential implication for gambling prevention programs are provided.     

Seeing Agnes: Notes on a Transgender Biocultural Ethnomethodology

In this article, I revisit Harold Garfinkel's classic ethnomethodological account of Agnes, a transgender woman he met in the 1950s. I situate this case in its larger historical context, within the arc of a contemporary transgender studies, and incorporate recent material from bio‐neuro‐cultural studies of gender and sexuality. Within this framework I ask: what can ethnomethodology learn from transgender studies and what can it contribute.     

Assessing attitudes of college students toward cross-cultural relationships: Implications for social work practice,research, and education

Higher education in America is a major social institution and an incubator of intellectual thought, holding an important and transformative place in the public domain, but it has also been implicated in the perpetuation of inequality, and the feeding of racial animus. The research question guiding this quantitative study explored predictors of college students’ perceptions of interracial relationships, which led to the querying of factors likely to impact social distance regarding interracial relationships at a mid-sized, diverse, rural university in the south. Two instruments were utilized to test the variables; the Bogardus Social Distance scale and the Social Dominance Orientation scale. The findings indicate statistical significance among two of the three variables examined, when controlling for socioeconomic and demographic variables; positive interracial experiences (p = < .002) and, greater amounts of interracial social contact (p = < .046) predict lower social distances regarding interracial relationships. Implications for higher education involve greater efforts toward social inclusion, increased cultural sensitivity, and an acknowledgment of the current and past structural and systemic inequities that have hindered positive race relations, and a vow to rectify those.     

Sexual Offending in Adolescence: A Comparison of Sibling Offenders and Nonsibling Offenders across Domains of Risk and Treatment Need

Sibling sexual offending has received limited empirical attention, despite estimates that approximately half of all adolescent-perpetrated sexual offenses involve a sibling victim. The present study addresses this gap by examining male adolescent sibling (n = 100) and nonsibling offenders (n = 66) with regard to maltreatment histories and scores on two adolescent risk/need assessment instruments, the ERASOR and YLS/CMI. Adolescents who sexually abused a sibling, versus a nonsibling, were more likely to have histories of sexual abuse and been exposed to domestic violence and pornography. There were no group differences on ERASOR and YLS/CMI scales. This study adds to the limited discourse on sibling sexual offending and the larger literature on the heterogeneity of adolescents who have sexually offended.