Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

FAMILY THERAPISTS' RESPONSE TO AIDS: AN EXAMINATION OF ATTITUDES,KNOWLEDGE, AND CONTACT*

As the number of individuals and families impacted by AIDS continue to multiply, family therapists will increasingly be asked to become engaged in the challenge of caring for those affected. To date, little has been written in family therpy journals regarding the response of family therapists to this crisis. This paper represents an initial attempt to examine the atitudes of clinical members of the American Association for Marriage and Family Therapy toward AIDS and persons with AIDS. Included in the study are data regarding the therapists' contact with persons with AIDS, gays, and lesbians, and the impact of such contact on attitudes. Implications for future research, training, and treatment of those affected by AIDS are also provided.     

Group therapists' countertransference reactions to multiple deaths from aids

Group therapists for those with HIV Related Diseases are becoming the “professional” survivors of this world-wide epidemic. From their experiences we may learn a great deal more about the effects of multiple deaths on mental health care professionals. As therapists they are constantly eliciting and listening to the fears, hopes, agonies and terrors of those with this disease. They become the bereaved. Witnesses to the deaths of many of their group members, they struggle with a wide range of emotional responses while at the same time assisting surviving group members in their struggle to live with these deaths. Mourning reactions and countertransference phenomena are in abundance as these therapists grapple with these group processes. This article identifies and examines these therapists' responses by focusing on clinical illustrations drawn from their bi-weekly supervision sessions.     

A research note on Keyfitz's ‘The demographics of unfunded pensions’

Keyfitz (1985), The demographics of unfunded pensions, discusses the performance of pay-as-you-go old age insurance plans under different financial structures. One arrangement is to pay a fixed pension to retirees and collect the necessary contributions from the working population. Another is to fix the contribution per worker and distribute whatever monies are collected to the retirees. Unfortunately, equity problems arise in a pay-as-you-go plan when the population is not stable. Generally, large cohorts will receive greater rates of return than small cohorts when the pension is fixed, while small cohorts will receive greater rates of return when the contribution is fixed. Social security analysts in the U.S. have been concerned with minimizing inequities in cohort rates of return. In considering the US population in 1980, Keyfitz shows that disparities in cohort rates of return are less under a fixed contribution scheme than under a fixed pension scheme. This research note points out that Keyfitz's finding is limited to the specific situation in 1980. When analyzing in a broader framework the mechanics of unfunded pensions and their interaction with nonstable populations, the reverse is true: fixing the pension yields less disparity in cohort rates of return than fixing the contribution.Keyfitz (1985) a déjà discuté dans cette revue des résultats d'un système de répartition pour le financement des pensions de retraite sous diverses conditions financières. Une solution consiste à payer une pension fixée aux retraités et à collecter les fonds nécessaires auprès de la population active. Une autre solution est de fixer la contribution par actif et de distribuer ce qui a été ainsi collecté aux retraités. Malheureusement des problèmes d'équité surviennent dans ces systèmes de répartition lorsque la population n'est pas stable. Généralement, les cohortes nombreuses bénéficieront de plus forts taux de rendement que des cohortes moins nombreuses lorsque la pension est fixée, tandis que l'inverse se produit lorsque la contribution par actif est fixée. Aux Etats-Unis les analystes des systèmes de sécurité sociale ont cherché à minimiser les inégalités dans les taux de rendement. Lorsque Keyfitz considérait la population des Etats-Unis en 1980, il avait montré que les disparités dans les taux de rendement des cohortes étaient moindres sous la condition d'une contribution par actif fixée que sous celle d'une pension par retraité fixée. Cette note the recherche indique que le résultat obtenu par Keyfitz est propre à la situation spécifique de l'année 1980. Lorsque l'on analyse d'un point de vue général le fonctionnement des pensions de retraite et leurs interactions avec des populations non-stables, l'inverse est vérifié : le fait de fixer la pension conduit à moins de disparités dans les taux de rendement des cohortes que le fait de fixer la contribution des actifs.

---

This research was undertaken when the author was completing her dissertation at the Graduate Group in Demography at the University of California, Berkeley. The author now operates Lapkoff Demographic Research, a private research consulting firm.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Developing Age-Friendly Cities: Case Studies From Brussels and Manchester and Implications for Policy and Practice

Developing environments responsive to the aspirations of older people has become a major concern for social and public policy. Policies and programs directed at achieving “age-friendly” communities are considered to require a wide range of interventions, including actions at the level of the social and physical environment. This article compares the age-friendly approaches of two European cities, Brussels and Manchester, with a particular focus on policies and initiatives that promote active aging in an urban context. The article examines, first, the demographic, social, and multicultural contexts of Brussels and Manchester; second, the way in which both cities became members of the World Health Organization Global Network of Age-Friendly Cities and Communities; third, similarities and differences in the age-friendly approaches and actions adopted by both cities; and fourth, opportunities and barriers to the implementation of age-friendly policies. The article concludes by discussing the key elements and resources needed to develop age-friendly cities.