A Systematic Review of Interventions for Elder Abuse

The purpose of this study was to use rigorous systematic review methods to summarize the effectiveness of interventions for elder abuse. Only eight studies met our inclusion criteria. Evidence regarding the recurrence of abuse following intervention was limited, but the interventions for which this outcome was reported failed to reduce, and may have even increased, the likelihood of recurrence. Elder abuse interventions had no significant effect on case resolution and at-risk caregiver outcomes, and had mixed results regarding professional knowledge and behavior related to elder abuse. The included studies had important methodological limitations that limit our ability to draw conclusions about the effectiveness of these interventions.     

Inclusion of Caregiver Supports and Services in Home- and Community-Based Service Programs: Recent Reports from State Units on Aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services–funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

Informal Caregiving for Elders in Sweden: An Analysis of Current Policy Developments

The purpose of this study was to conduct a systematic review of the literature related to state policies concerning older drivers and to draw policy conclusions about which policies appear to work to reduce older driver crashes and to identify areas needed for further research. Specific policies examined in this paper concern medical reporting and medical review, license renewal processes, and driver testing. A study was included in the systematic review if it met the following criteria: published in English between 1991and January 2013; included data on human subjects aged 65 and older residing in the United States; included information on at least one policy related to older drivers; and had a transportation-related outcome variable (e.g., crash, fatality, renewal). A total of 29 studies met inclusion criteria. Twenty-two studies investigated license renewal and seven articles examined medical reporting. In-person license renewal requirements were associated with reduced risk for fatal crashes. Restricted licenses were associated with reduced number of miles driven per week. More intensive renewal requirements and being the subject of a medical report to the licensing authority was associated with delicensure. Given the importance of driving to mobility, quality of life, and public safety, more research is needed.     

Environmental and Policy Change to Support Healthy Aging

Given the growing evidence of the influence of the environment on older adult health, the need to design and implement effective environmental policy around healthy and vital aging is urgent. This article describes issues amenable to improvement through policy change, evidence supporting specific policy approaches and outcomes, and promising strategies for implementing those approaches. Key areas of focus are neighborhood design and safety, housing, transportation, and mobility. Strategies to build capacity for policy change are also addressed. Our goals are to foster greater attention to environmental change in support of healthy aging and to illuminate directions for policy change.     

Health Insurance for All Long-Term Care Workers: Estimated Costs and Coverage Impacts in Minnesota and Recommendations for States

A major barrier to building a strong workforce to meet the growing need for long-care is lack of affordable health benefits. This study projects impacts of funding health coverage for all long-term care workers in Minnesota. Under the most cost effective model plan design, enrollment in employer-sponsored coverage would increase 73% to 100% for individual coverage and 26% to 42% for family coverage. Total monthly costs would be $698/worker in the commercial market or $634/worker through a new dedicated risk pool. Based on our findings and past research, the authors present recommendations for structuring and implementing a long-term care worker health insurance initiative.     

Retirement Patterns in Modern Western Societies

Abstract

INSURING THE ESSENTIALS: BOB BALL ON SOCIAL SECURITY by Robert M. Ball. Century Foundation, New York, 2000, 324 pp. (paper). Reviewed by Robert B. Hudson.     

Transition from Home Care to Nursing Home: Unmet Needs in a Home- and Community-Based Program for Older Adults

A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.     

A Profile of Middle-Aged and Older Adults Admitted to Nursing Homes: 2000–2008

Middle-aged adults are becoming an increasing share of the nursing home population. Minimum Data Set assessment data for 2000 and 2008 are used to explore similarities and differences in sociodemographic, residential, medical, and psychiatric characteristics of newly admitted middle-aged adults (31–64) compared to their older counterparts (65+). Relative to their share of the state population, Black middle-aged adults are overrepresented in nursing homes across 45 states and the District of Columbia. Chronic conditions, including diabetes, renal failure, chronic obstructive pulmonary disease, asthma, and circulatory/heart disorders, appeared to contribute to the increasing presence of middle-aged adults. There were substantial increases in diagnoses of psychiatric disorders at admission; psychiatric diagnoses were significantly higher among middle-aged adults. Middle-aged adults were also more likely to have residential histories of prior stays in psychiatric facilities relative to older adults. States' rebalancing efforts need to attend to the increasing presence of disability associated with chronic medical and psychiatric conditions among middle-aged adults.     

Financial decision-making abilities and financial exploitation in older African Americans: Preliminary validity evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS)

ABSTRACT

This study examines preliminary evidence for the Lichtenberg Financial Decision Rating Scale (LFDRS), a new person-centered approach to assessing capacity to make financial decisions, and its relationship to self-reported cases of financial exploitation in 69 older African Americans. More than one third of individuals reporting financial exploitation also had questionable decisional abilities. Overall, decisional ability score and current decision total were significantly associated with cognitive screening test and financial ability scores, demonstrating good criterion validity. Study findings suggest that impaired decisional abilities may render older adults more vulnerable to financial exploitation, and that the LFDRS is a valid tool.