Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Beyond talk: Contributions of quantity and quality of communication to language success across socioeconomic strata

Infants from low-socioeconomic status (SES) households hear a projected 30 million fewer words than their higher-SES peers. In a recent study, Hirsh-Pasek et al. (Psychological Science, 2015; 26: 1071) found that in a low-income sample, fluency and connectedness in exchanges between caregivers and toddlers predicted child language a year later over and above quantity of talk (Hirsh-Pasek et al., Psychological Science, 2015; 26: 1071). Here, we expand upon this study by examining fluency and connectedness in two higher-SES samples. Using data from the NICHD Study of Early Child Care and Youth Development, we sampled 20 toddlers who had low, average, and high language outcomes at 36 months from each of 2 groups based on income-to-needs ratio (INR; middle and high) and applied new coding to the mother–toddler interaction at 24 months. In the high-INR group, the quality of mother–toddler interaction at 24 months accounted for more variability in language outcomes a year later than did quantity of talk, quality of talk, or sensitive parenting. These results could not be accounted for by child language ability at 24 months. These effects were not found in the middle-INR sample. Our findings suggest that when the quality of interaction, fluency and connectedness, predicts language outcomes, it is a robust relation, but it may not be universal.     

Neural Correlates of Conflicting Social Influence on Adolescent Risk Taking

Adolescence is often characterized by heightened risk‐taking behaviors, which are shaped by social influence from parents and peers. However, little is understood about how adolescents make risky decisions under conflicting influence. The valuation system in the brain may elucidate how adolescents differentially integrate conflicting social information. Twenty‐eight adolescents (M_age = 12.7 years) completed a social influence task during a functional magnetic resonance imaging scan. Behaviorally, adolescents took more risks only when their parent endorsed risky decisions but not when their peers endorsed risky decisions. At the neural level, adolescents showed enhanced vmPFC–striatum functional connectivity when they made risky decisions that followed their parents’ risky decisions. Results suggest that parents’ decisions may guide youths’ risk‐taking behavior under conflicting influence.     

Adolescents’ perceptions of social risk and prosocial tendencies: Developmental change and individual differences

Many prosocial behaviors involve social risks such as speaking out against a popular opinion, bias, group norm, or authority. However, little is known about whether adolescents’ prosocial tendencies develop over time with their perceptions of social risks. This accelerated longitudinal study used within-subject growth-curve analyses to test the link between adolescents' prosocial tendencies and social risk perceptions. Adolescents completed self-reports annually for 3 years (N = 893; M_age = 12.30 years, 10–14 years at Wave 1, and 10–17 years across the full study period; 50% girls, 33% White non-Latinx, 27% Latinx, 20% African American, 20% mixed/other race). The association between social risk tolerance and prosocial tendencies changed significantly across adolescence. Specifically, for younger adolescents, more prosocial tendencies were associated significantly with less social risk tolerance, whereas for relatively older adolescents, more prosocial tendencies were associated marginally with more social risk tolerance. Additional individual differences by empathy (but not sensation seeking) emerged. These findings suggest that prosocial tendencies across adolescence may be associated with an underlying ability to tolerate social risks.     

Listening to Hidden Voices: Power, Domination, Resistance and Pleasure within Huronia Regional Centre

A great deal of material has been written regarding the effects of institutional living on people with learning difficulties. Much of this literature focuses on the negative aspects of institutionalization and views the individual as 'products' of these experiences. This paper argues that adults with learning difficulties are active participants in creating their own sense of cultural identity and community. Stories of four adults with learning difficulties, who have grown up in an institution in Ontario are used to explore how they envision a sense of their community through their shared experiences.     

WHITE, BLACK, AND HISPANIC FEMALE YOUTHS IN CENTRAL CITY LABOR MARKETS

Data from the 1% 1980 Census Public Use Sample are used to estimate the determinants of employment and wage rates for out-of-school female youths residing in central cities. Separate analyses are performed for white/Anglo, black, and Hispanic youths. Independent variables include individual, family background, and local labor market characteristics. The authors find that central city female youths have employment and wage rates substantially below their male counterparts. Their employment rates, however, are responsive to many of the same forces as for other sociodemographic groups in general, and central city male youths in particular. For Anglo females, wage rates are also responsive to many of the effects found for other groups, although they do not follow Anglo male youths in gaining from the "minority threat" effect. On the other hand, the wages for minority females are unresponsive to the usual variables. That is, these workers receive the minimum wage in an essentially undifferentiated manner. Thus, the triple disadvantage of being female, minority, and from a poor household is very much in evidence within 1980 census data.     

THE BODY, IDENTITY, AND SELF:

Serious chronic illness undermines the unity between body and self and forces identity changes. To explicate how the body, identity, and self intersect in illness, one mode of living with impairment, adapting, is explicated in this article. Adapting means altering life and self to accommodate to bodily losses and limits and resolving the lost unity between body and self. It means struggling with rather than against illness. The process of adapting consists of three major stages: (1) experiencing and defining impairment, (2) making bodily assessments and, subsequently, identity trade-offs, as ill people weigh their losses and gains and revise their identity goals, and (3) surrendering to the sick self by relinquishing control over illness and by flowing with the experience of it. Adapting seldom occurs only once. Rather chronically ill people are forced to adapt repeatedly as they experience new losses. The data consist of 115 interviews about experiencing chronic illness and 25 more focused interviews about the body in chronic illness. The strategies of grounded theory provided the methods for completing the analysis.     

Truncation Bias and the Measurement of Income Inequality

An experiment designed to test whether experimenter observation influences play of the ultimatum game led to a comparison of proportions of perfect equilibria obtained under different conditions. Our analysis features a Bayesian approach to this comparison. Our method extends recent work in the nonparametric Bayesian analysis of bioassay problems when the prior constrains the form of the potency curve. Sampling-based approaches to calculating posterior features of interest are used and discussed. We conclude that experimenter observation has a small influence but not enough to account for most of the deviation from perfect-equilibrium play.