Global Patterns of Healthy Life Expectancy for Older Women

SUMMARY

This paper focuses on patterns of healthy life expectancy for older women around the globe in the year 2000, and on the determinants of differences in disease and injury for older ages. Our study uses data from the World Health Organization for women and men in 191 countries. These data include a summary measure of population health, healthy life expectancy (HALE), which measures the number of years of life expected to be lived in good health, and a complementary measure of the loss of health (disability-adjusted life years or DALYs) due to a comprehensive set of disease and injury causes. We examine two topics in detail: (1) cross-national patterns of female-male differences in healthy life expectancy at age 60; and (2) identification of the major injury and disability causes of disability in women at older ages. Globally, the male-female gap is lower for HALE than for total life expectancy. The sex gap is highest for Russia (10.0 years) and lowest in North Africa and the Middle East, where males and females have similar levels of healthy life expectancy, and in some cases, females have lower levels of healthy life expectancy. We discuss the implications of the findings for international health policy.     

Gender,Widowhood, and Long-Term Care in the Older Mexican American Population

SUMMARY

The objective of this study is to examine the influences of gender on long-term care service use among older Mexican American widows and widowers. Our analysis is based on a sample of 773 widows and 183 widowers from the Longitudinal Study of Elderly Mexican American Health (H-EPESE). In this sample widows resemble widowers in terms of demographic and health characteristics. However, widows report more financial strain than widowers and a greater welfare dependency (SSI) and Medicaid use. Among those who suffered diminished health, widows were more likely than widowers to use community-based long-term care services whereas widowers were more likely to enter a nursing home. Widows also had more instrumental and socioemotional support than widowers. Serious cognitive and functional impairment, though, places widows and widowers at the same risk of institutionalization. We end with a discussion of the policy implications of these findings.     

The Right to Take Risks: Alcohol and Older People

This paper examines policy and practice regarding the purchase of alcohol for older clients of home carers in three local authorities in the Greater London area. Data were gathered from interviews with home carers and their managers, focus group discussions, and a postal survey. None of the local authorities had a written policy or written guidance on alcohol purchase or on appropriate responses to the identification of problematic drinking in older clients. The findings illustrate the problem of balancing "rights" and "risks" within a philosophy of community care which emphasizes client choice and autonomy, and show how policy and practice are "tailored" by local contexts. It is suggested that both home carers and other domiciliary workers, as well as their older clients, could benefit from a clear code of practice regarding responses to alcohol consumption and problematic drinking by older people.     

美国老年人长期照护法律体系及其对我国的启示

以1965年美国老年人法案(the Old Americans Act)及之后的一系列修正案和相关法律法规为主要素材,着重从政府角度介绍美国老年人长期照护法律体系的建立过程以及在此过程中政府职能的相应转变。本文介绍了老年人长期照护的含义,归纳了美国老年人长期照护法律体系建立的意义,指明了老年人长期照护法律关系中政府的特殊地位,并结合中国目前老年人长期照护的现状对我国老年人法律体系的完善提出了一些启示。     

Old and Cold: Older People and Policies Failing to Address Fuel Poverty

Research, funded by the British Gas Help the Aged Partnership and carried out by the Institute of Gerontology, King's College London, explored the multidimensional issues of fuel poverty. A sample of older homeowners and private renters living in England, Scotland and Wales were interviewed in the Spring of 2003 to explore their experiences of keeping their homes warm in the preceding winter. It was found that almost half of the sample for whom full information was available were in fuel poverty. Government schemes failed to address some important issues. Grants were only available to those with “passport benefits”, excluding those who had minimal occupational pensions. Although most respondents had central heating, it was often old and ineffective, yet grants were not available to modernize them. Government schemes did not extend to paying for external and internal insulation for solid wall properties yet many older people live in such property. Several older people lived in rural areas not connected to mains gas. As mains gas currently provides the cheapest fuel, they faced high bills, yet government policies do not address the differential fuel costs in these areas. The culture of many older people in the study contributed to their living in cold homes. They lived frugally and usually turned heating off in daylight hours during winter. It was also a common practice to sleep in an unheated bedroom during winter and to keep the window open at night. Such practices are acknowledged to be unhealthy.     

Personal Reflections on Closeted Helping Professionals

Abstract

The author discusses the situation of closeted professionals whose “private” lives inadvertently cross paths with homosexual students or clients. Personal vignettes highlight the dangers of encounters with “closeted” professionals for homosexual clients and students. Particular attention is given to the long-term impact upon clients and students, who are viewed as more vulnerable than professionals. Reflections upon sociopolitical implications of the “closet” are noted, especially recent retrenchment of media concern for homosexual issues as professionals have retreated to the “closet.”     

Social work in the development of institutional care for older people in Slovenia

Social work in homes for older people in Slovenia has a special role since we have extremely institutionally-oriented care for older people. Characteristic of the development of Slovenian homes for older people is a shift in the dynamics of the orientation of the homes from a medical to a social one. Different factors influenced the shift towards a social orientation, i.e. the policy of establishing homes, the influence of sociogerontological principles, the development of social work and, recently, by their engagement with residents with dementia. In socially-oriented homes a different model of social work is used than in medically-oriented ones. The difference lies in social work methods as well as in the roles of the social worker in different areas of work with the residents, relatives and staff. By defining a model of social work in a socially-oriented home, a special field of social work with older people in the field of institutional care in Slovenia has been developed.     

Transitional Youth Services: Practice Implications from a Systematic Review

Independent living programs have emerged as the primary intervention to address the needs of foster youth transitioning out of care. Prior reviews of independent living programs have focused on implications for research and policy, but not on direct practice. In order to create effective independent living programs, direct service workers must be provided with concrete practice guidelines for providing effective independent living services. This article summarizes 19 studies on independent living and provides evidence-based implications for each in an effort to begin to fill the gap between research, policy and practice.     

The Effect of Veteran Status on Mortality among Older Americans and its Pathways

This research examines excess mortality among American veterans age 70 years or older during a two-to-three year interval from 1993/94 to the end of 1995. Using a structural hazard rate model, we analyzed data on a sample of respondents age 70 or over from the Survey of Asset and Health Dynamics among the Oldest Old (AHEAD). We found that at age 70, older veterans have a slightly higher death rate than their nonveteran counterparts, implying a mortality crossover right before this age. Such excess mortality among veterans increases considerably with age, when other factors are held equal. The direct and indirect effects of veteran status on mortality by means of physical and mental health mostly perform in opposite directions, and such effects vary greatly in magnitude and direction as a function of age. The intervening effects of physical and mental health status decrease substantially with increasing age. Many of the mechanisms inherent in the excess mortality among older veterans are not captured by variations in their health status, especially among the oldest-old. A more extensive study on this topic is urgently needed.     

Characteristics of Older Adult Problem Gamblers Calling a Gambling Helpline

Background Few investigations have characterized groups of older adults with gambling problems, and published reports are currently limited by small samples of older adult problem gamblers. Gambling helplines represent a widespread mechanism for assisting problem gamblers to move into treatment settings. Given data from older adult problem gamblers in treatment, we hypothesized that older as compared with younger adult problem gamblers calling a gambling helpline would be less likely to report gambling-related problems.Design and methods Logistic regression analyses were performed on data obtained from January 1, 2000 to December 31, 2001, inclusive, from callers with gambling problems (N = 1,084) contacting the Connecticut Council on Problem Gambling Helpline.Results Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5%) were from older adults and 850 (83.5%) from younger adults. Age-related differences were observed in demographic features, types and patterns of gambling reported as problematic, gambling-related problems and psychiatric symptoms, substance use problems, patterns of indebtedness, and family histories of addictive disorders. Older as compared with younger adult problem gamblers were more likely to report having lower incomes, longer durations of gambling, fewer types of problematic gambling, and problems with casino slot machine gambling and less likely to report gambling-related anxiety, family problems, illegal behaviors and arrests, drug problems, indebtedness to bookies or acquaintances, family histories of drug abuse, and problems with casino table gambling.Conclusions Older as compared with younger adult problem gamblers calling a gambling helpline differ on many clinically relevant features. The findings suggest the need for improved and unique prevention and treatment strategies for older adults with gambling problems.