Journal of Applied Gerontology

This survey of grantmakers and experts in the field of aging gives a picture of where grantmakers say their funds will be targeted in the first half of the 1990s and where experts believe these funds should go. A review of the similarities between grantmakers and experts indicates that community-based support services geared toward traditional populations are a priority among both groups. The most dramatic difference is in how best to package these services. We discuss implications of the findings.

This study focuses on the decision to either stop or continue driving among a cohort of Danish seniors whose driving licenses expire, for the first time, at the age of 70. Based on 1,537 standardized telephone interviews with licensed drivers, we compared persons who intended to renew or not to renew their licenses. The results partly recapture the findings of earlier studies. However, in contrast to former cohorts, a much higher percentage of older drivers intended to keep their licenses. The strongest factors predicting the intention to renew were active car use, feeling safe as a driver, and not having illnesses that impaired driving ability. Three of these factors were strongly correlated with gender, indicating that efforts to prevent premature driving cessation should especially focus on increasing women's confidence and experience in driving.

Research available to inform the development of effective community-based elder abuse protective response interventions is severely limited. Elder abuse intervention research is constrained by a lack of research capacity, including sensitive and responsive outcome measures that can assess change in case status over the course of intervention. Given the heterogeneous nature of elder abuse, standard scales can lack the flexibility necessary to capture the diverse range of individually relevant issues across cases. In this paper, we seek to address this gap by proposing the adaptation and use of an innovative measurement strategy-goal attainment scaling-in the context of elder protection. Goal attainment scaling is an individualized, client-centered outcome measurement approach that has the potential to address existing measurement challenges constraining progress in elder abuse intervention research. © The Author(s) 2015.

The effectiveness of three case-finding strategies for locating elderly alcohol abusers and linking them with an alcohol treatment program was explored. The three approaches emphasized the formal caregiver (CARN), the general public (PAC), and community health clinics (CBO). The CARN and PAC approaches appeared to be most cost-effective. I discuss implications of the findings.

We report on findings of an empirical study of attitudes and access to health care by elderly Cuban immigrants and native-born Americans in Southeast Florida. Major findings based on a random sample of 1,216 respondents indicate a need for bilingual educational materials to inform consumers of health support services available and ethnic-sensitive public health services for the indigent Cuban population.

There is increasing evidence that electronic and other aids can support older people's memory. In an effectiveness study, we explored whether assistive technologies could benefit 200 potential beneficiaries in a naturalistic setting. We first interviewed 50 participants to assess needs and preferences for memory aids, then researched, developed and trialled specific aids, and finally administered a follow-up questionnaire assessing future use of aids. Matching aids to needs was not easy. Relatively few people were interested in trailing aids. Simpler aids were most successful. Participants were curious about electronic aids, but found them too complicated and not adapted enough to their needs. Assistance from other people was necessary to prompt use of all types of aids. Future effectiveness studies should focus on longer trials with greater training and support for participants, a wider range of technologies, and more promotion of possible benefits.

Purpose: The purpose of this study was to determine whether case characteristics are differentially associated with four forms of elder maltreatment. Method: Triangulated interviews were conducted with 71 APS caseworkers, 55 victims of substantiated abuse whose cases they managed, and 35 third party persons. Results: Pure financial exploitation (PFE) was characterized by victim unawareness of financial exploitation and living alone. Physical abuse (PA) was characterized by victim's desire to protect the abusive individual. Neglect was characterized by isolation and victim's residing with the abusive individual. Hybrid financial exploitation (HFE) was characterized by mutual dependency. Implications: These differences indicate the need for tailoring interventions to increase victim safety. PFE requires victims to maintain financial security and independence. PA requires services to meet the needs of abusive individuals. Neglect requires greater monitoring when elderly persons reside with another person. HFE requires the provision of services to both members of the dyad.

Recent research findings indicate that with older adulthood, there are functional decrements in spatial cognition and more specially, in the ability to mentally represent and effectively plan motor actions. A typical finding is a significant over- or underestimation of one's actual physical abilities with movement planning-planning that has implications for movement efficiency and physical safety. A practical, daily life example is estimation of reachability-a situation that for the elderly may be linked with fall incidence. A strategy used to mentally represent action is the use of motor imagery-an ability that also declines with advancing older age. This brief review highlights research findings on mental representation and motor imagery in the elderly and addresses the implications for improving movement efficiency and lowering the risk of movement-related injury.

Accurate retrospective reporting of activities and symptoms has been shown to be problematic for older adults, yet standard clinical care relies on self-reports to aid in assessment and management. Our aim was to examine the relationship between self-report and sensor-based measures of activity. We administered an online activity survey to participants in our ongoing longitudinal study of in-home ubiquitous monitoring. We found a wide range of accuracies when comparing self-report with time-stamped sensor-based data. Of the 95 participants who completed the 2-hr activity log, nearly one quarter did not complete the task in a way that could potentially be compared with sensor data. Where comparisons were possible, agreement between self-reported and sensor-based activity was achieved by a minority of participants. The findings suggest that capture of real-time events with unobtrusive activity monitoring may be a more reliable approach to describing behavioral patterns and meaningful changes in older adults. © The Author(s) 2015.

Few studies have examined the health-related consequences of gardening among older adults. This scoping review summarizes and characterizes current research that examines the relationship between physical health and participation in planned gardening activities, including establishing, maintaining, or caring for plants. Six databases were searched. Eligible studies were published between 2000 and 2013, were published in English, and assessed different aspects of physical health (e.g., functional ability, energy expenditure, injury) for older adults who had participated in a planned gardening activity. Of the eight eligible studies identified with these criteria, four assessed energy expenditures and four assessed physical functioning. Studies assessing energy expenditures documented that the majority of gardening tasks were classified into low-to-moderate intensity physical activity. The current literature does not provide sufficient evidence of the physical functioning consequences of gardening. Future studies should consider how specific gardening interventions help older adults meet physical activity guidelines. © The Author(s) 2014.

The purpose of this study was to test the feasibility and effectiveness of an adapted 8-week Mindfulness-Based Stress Reduction (MBSR) program for elders in a continuing care community. This mixed-methods study used both quantitative and qualitative measures. A randomized waitlist control design was used for the quantitative aspect of the study. Thirty-nine elderly were randomized to MBSR (n = 20) or a waitlist control group (n = 19), mean age was 82 years. Both groups completed pre-post measures of health-related quality of life, acceptance and psychological flexibility, facets of mindfulness, self-compassion, and psychological distress. A subset of MBSR participants completed qualitative interviews. MBSR participants showed significantly greater improvement in acceptance and psychological flexibility and in role limitations due to physical health. In the qualitative interviews, MBSR participants reported increased awareness, less judgment, and greater self-compassion. Study results demonstrate the feasibility and potential effectiveness of an adapted MBSR program in promoting mind-body health for elders. © The Author(s) 2014.

There has been a dramatic increase in the number of new HIV diagnoses among people aged 50 to 64 in the United States, and according to the Centers for Disease Control and Prevention (CDC), in just 7 years (by 2015) 50% of those living with AIDS will be aged 50 or older. To address this public health concern, viable HIV/AIDS prevention and treatment options for individuals over the age of 50 are necessary. This article discusses the No One Is Immune initiative that planned, implemented, and coordinated evidence- based HIV/AIDS prevention and education programs specifically tailored for middle-aged and older adults. Guided by the health belief model, an educational conference entitled "Sexuality, Medication, and HIV/AIDS in Middle and Later Adulthood" was conducted along with research activities that assessed HIV/AIDS knowledge gained using both qualitative and quantitative measures. This project can be replicated by other providers within the aging network.

There is increasing interest in the development of economical and accurate approaches to identifying persons in the community who have mild, undetected cognitive impairments. Computerized assessment systems have been suggested as a viable approach to identifying these persons. The validity of a computerized assessment system for identification of memory and executive deficits in older individuals was evaluated in the current study. Volunteers (N = 235) completed a 3-hr battery of neuropsychological tests and a computerized cognitive assessment system. Participants were classified as impaired (n = 78) or unimpaired (n = 157) on the basis of the Mini Mental State Exam, Wechsler Memory Scale-III and the Trail Making Test (TMT), Part B. All six variables (three memory variables and three executive variables) derived from the computerized assessment differed significantly between groups in the expected direction. There was also evidence of temporal stability and concurrent validity. Application of computerized assessment systems for clinical practice and for identification of research participants is discussed in this article.

The phenomenon of aging in place poses fundamental questions for administrators and planners of housing for the elderly. Based on a planning study for one retirement facility in the upper Midwest, we reviewed current knowledge pertinent to aging in place and present the findings of interviews with 13 housing administrators and present some limited market analysis of the host community of the subject retirement facility.

Care challenges have been described for hospitalized morbidly obese (MO) patients. These challenges likely persist post discharge. As a result, nursing homes (NHs) may be reluctant to admit these patients, potentially leaving them "stranded in hospitals". This study identified issues NHs consider in admission decisions for MO patients transitioning from hospitals. Approved surveys were mailed to nursing directors at federally-certified NHs in Arkansas (n = 234) and Pennsylvania (n = 710) to collect NH experience in the admission of patients weighing ≥325 pounds. Analyses included descriptive and inferential statistics to summarize and identify predictors of MO patient admission decisions. In total, 360 surveys were returned (38.1% response rate). Although two-thirds of respondents reported patient size as an admission barrier, only 6% reported that MO patients were always refused admission. Adjusted analysis showed that NHs with adequate staff were significantly (p = .04) less likely to report obesity as an admission barrier whereas NHs reporting concerns about availability of bariatric equipment were significantly (p < .0001) more likely to report obesity as a barrier. Lack of staff and bariatric equipment in NHs appears to negatively affect the transition of MO patients out of the hospital to NHs. Additional research, including examination of current regulations and reimbursement policies, should be undertaken to understand NH staffing and equipment acquisition decisions in light of the current obesity epidemic. Such research has implications for the optimal care of obese individuals during times of transition. © The Author(s) 2014.

This study investigates differences in social support and nursing home admission by rurality of residence. We use discrete-time event history models with longitudinal data from seven waves (1998-2010) of the Health and Retirement Study to prospectively examine the risk of spending 30 or more days in a nursing home (n = 5,913). Results show that elders with a health problem who live in rural areas of the South or Midwest have approximately 2 times higher odds of nursing home entry than elders living in urban areas in the Northeast. Rural elders report somewhat higher social support than non-rural elders, and controlling for these forms of social support does not explain the higher risk of a nursing home stay for Southerners and Midwesterners living in rural areas. Results suggest that social support has a similar association with nursing home entry for rural, suburban, and urban elders. © The Author(s) 2015.

Parents and children are linked across the life course, and they share common experiences. This article focuses on the bereavement experience of adult children's loss of a first parent during adulthood and examines the downward influence of emotional closeness with a surviving parent on adult children's depressive symptoms following loss. Analyses are based on adult children who experienced the death of a first parent (N = 227), drawn from the Longitudinal Study of Generations, a study of three-and four-generation families from Southern California. Multilevel lagged dependent variable models indicate that an emotionally close relationship with a surviving parent is related with fewer post-bereavement depressive symptoms when a mother survives a father, but not vice versa. This analysis extends the theory of linked lives and highlights the mutual influence parents and children exert, as well as the complex role of gender in shaping family relationships. © The Author(s) 2014.

Data derived from a mailed questionnaire of adult day-care providers in Illinois and from the records of the Illinois Department on Aging for fiscal years 1984 and 1985 were analyzed to determine which factors affect growth or decline in the programs, measured in terms of number of clients served and units of service provided. Initial analysis revealed that all providers under contract with the state for less than 3 years were growing, and approximately one half of the older providers had similar changes. A separate regression analysis of the older adult day care providers indicated that growth tended to be positively associated with reports of good relationships with referral agents and resource support from umbrella organizations and the larger community, and negatively associated with longevity of the provider. These findings highlight the importance of supportive interorganizational relationships for program growth.

Purpose of the study: Adult children are often directly affected by aging parents' decision to limit or stop driving. This qualitative study examined the process of driving reduction and cessation (DRC) from the perspective of adult children, with a focus on family communication. Design and methods: Four focus group interviews were conducted with 37 adult children (29/37 female; mean age = 45.5) of older parents using a structured protocol. Transcripts were analyzed by two independent coders to identify major themes. Results: Themes represented three aspects of the DRC process: family communication and dynamics (i.e., discussion, negotiation, and planning; avoidance and side stepping; resignation and refusal), taking action to end a parent's driving career (i.e., engaging a third party; taking away the car), and post-cessation reflection (i.e., relief; social benefits; resentment and guilt). Implications: Despite the potential benefits of planning for DRC, families are unsure about how best to approach this topic. Adult children worry about assuming responsibility for their parents' transportation needs and their parents' reactions to restricted mobility. Despite a reluctance to communicate openly about DRC, adult children and their parents share similar and significant concerns that merit increased attention.

Heterogeneity in older adults' mobility and its correlates have rarely been investigated based on objective mobility data and in samples including cognitively impaired individuals. We analyzed mobility profiles within a cognitively heterogeneous sample of N = 257 older adults from Israel and Germany based on GPS tracking technology. Participants were aged between 59 and 91 years (M = 72.9; SD = 6.4) and were either cognitively healthy (CH, n = 146), mildly cognitively impaired (MCI, n = 76), or diagnosed with an early-stage dementia of the Alzheimer's type (DAT, n = 35). Based on cluster analysis, we identified three mobility types ("Mobility restricted," "Outdoor oriented," "Walkers"), which could be predicted based on socio-demographic indicators, activity, health, and cognitive impairment status using discriminant analysis. Particularly demented individuals and persons with worse health exhibited restrictions in mobility. Our findings contribute to a better understanding of heterogeneity in mobility in old age.

To explore primary care providers' HIV prevention practices for older adults. Primary care providers' perceptions and awareness were explored to understand factors that affect their provision of HIV prevention materials and HIV screening for older adults. Data were collected through 24 semistructured interviews with primary care providers (i.e., physicians, physician assistants, and nurse practitioners) who see patients older than 50 years. Results reveal facilitators and barriers of HIV prevention for older adults among primary care providers and understanding of providers' HIV prevention practices and behaviors. Individual, patient, institutional, and societal factors influenced HIV prevention practices among participants, for example, provider training and work experience, lack of time, discomfort in discussing HIV/AIDS with older adults, stigma, and ageism were contributing factors. Furthermore, factors specific to primary and secondary HIV prevention were identified, for instance, the presence of sexually transmitted infections influenced providers' secondary prevention practices. HIV disease, while preventable, is increasing among older adults. These findings inform future research and interventions aimed at increasing HIV prevention practices in primary care settings for patients older than 50. © The Author(s) 2015.

The purpose of this study is to examine the physical and cognitive impacts of digital games on older adults. We conducted five independent meta-analyses by reporting 58 effect sizes generated from 36 studies. Results suggested that playing digital games is effective in improving older adults' physical balance (g = 0.67), balance confidence (g = 0.46), functional mobility (g = 0.53), executive function (g = 0.76), and processing speed (g = 0.54). Based on the results of heterogeneity analysis, we conducted moderator analyses for physical balance and processing speed. Key findings included the following: Playing digital games can not only improve the physical balance of older adults living in community but also those living in nursing homes; the relationship between age of participants or amount of time of gameplay and effect size is weak and the direction of the relationship is not definitive. © The Author(s) 2015.

Some studies indicate that older adults lead active lives and travel to many destinations including those not in their immediate residential neighborhoods. We used global positioning system (GPS) devices to track the travel patterns of 40 older adults (mean age: 69) in San Francisco and Los Angeles. Study participants wore the GPS devices for 7 days in fall 2010 and winter 2011. We collected survey responses concurrently about travel patterns. GPS data showed a mean of four trips/day, and a mean trip distance of 7.6 km. Survey data indicated that older adults commonly made trips for four activities (e.g., volunteering, work, visiting friends) at least once each week. Older adults regularly travel outside their residential neighborhoods. GPS can document the mode of travel, the path of travel, and the destinations. Surveys can document the purpose of the travel and the impressions or experiences in the specific locations.

Equine assisted activities (hippotherapy and therapeutic riding) improve balance in patients with disabilities such as cerebral palsy, but have not been systematically studied in older adults, at risk of falls due to balance deficits. We conducted a 10-week, single blind, controlled trial of the effect of a therapeutic horseback riding course on measures of balance in community-dwelling adults 65 years and older. Nine riders and six controls completed the trial. Controls were age matched to riders and all participants were recruited from the local community. Both groups showed improvements in balance during the trial, but did not reach statistical significance. Sample size was small, participants had relatively high initial balance scores, and controls tended to increase their physical activities, likely influencing outcomes. No adverse events occurred and the supervised therapeutic riding program appeared to be a safe and effective form of exercise to improve balance in older adults. A power analysis was performed to estimate numbers of participants needed for a larger study. © The Author(s) 2012.

To estimate the odds of death associated with documented unintentional falls and acute care hospitalization among older adults in the United States. Data were abstracted from the 2005 Nationwide Inpatient Sample (NIS) and odds of death were modeled using logistic regression. The age 65 and older fall rate per 1,000 discharges was 53.0 while the mortality rate for those who fell was 33.2. Older-old (odds ration [OR] = 2.93; confidence interval [CI] = [2.50, 3.43]), men (OR = 1.64, CI = [1.54, 1.75]), and non-White (OR = 1.09; CI = [1.01, 1.19]) had higher odds of death compared to younger-old, women, and Whites. Additional comorbidity (OR = 3.41, CI = [3.05, 3.82]), dehydration (OR = 1.14; CI = [1.05, 1.25]) and intracranial fractures (OR = 4.46; CI = [4.02, 4.95]) resulted in greater odds of death. Among older adults who experienced a fall and hospitalization, odds of mortality appear influenced by factors beyond injury severity related to falling. Additional research is necessary to delineate the mechanisms behind these phenomena to inform the public about falls-prevention programs.

Optimizing duration of participation in health promotion programs has important implications for program reach and costs. We examined data from 355 participants in EnhanceWellness (EW) to determine whether improvements in disability risk factors (depression, physical inactivity) occurred early or late in the enrollment period. Participants had a mean age of 74 years; 76% were women, and 16% were non-white. The percent depressed declined from enrollment to six months (35% to 28%, p = .001) and from six to 12 months (28% to 22%, p = .03). The percent physically inactive declined over the first six months, without substantial change thereafter (47%, 29%, and 29%). Those remaining inactive at six months had worse self-rated health and more depressive symptoms initially; a subset of those increased their physical activity by 12 months. These data suggest that enrollment could be reduced from 12 to six months without compromising favorable effects of EW participation, although additional benefits may accrue beyond six months.

This study of Ohio CMHC directors' perceptions examines three systems dimensions: how mental health services are provided to elders, levels of service needs and whether they are met, and barriers to service delivery. Two distinct types of centers are compared--those that do and do not have specialized geriatric components. Specialized programming efforts appear to be making a difference in bridging the gap between levels of service delivery and need.

This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, white) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do white older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, while the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian and white elders. More research on the ways oral health affects the lives of older adults is warranted.

The Revised Observed Tasks of Daily Living (OTDL-R), a performance-based test of everyday problem solving, was administered to a sample of community-dwelling older adults. The OTDL-R included nine tasks, representing medication use, telephone use, and financial management. The OTDL-R had a desirable range of difficulty and satisfactory internal consistency and showed a relatively invariant pattern of relations between measured tasks and the underlying latent dimensions they represent across White and non-White subsamples. The OTDL-R also correlated significantly with age, education, self-rated health, a paper-and-pencil measure of everyday problem solving, and measures of basic cognitive functioning. Thus, the OTDL-R is a reliable and valid objective measure of everyday problem solving that has great practical utility for assessing performance in diverse populations.

Community resources can influence health outcomes, yet little research has examined how older individuals use community resources for osteoarthritis (OA) management. Six focus groups were conducted with 37 community-dwelling older adult African Americans and Caucasians who self-reported OA and resided in Johnston County, North Carolina. Descriptive analyses and qualitative constant comparison methodology revealed individuals use local recreational facilities, senior centers, shopping centers, religious organizations, medical providers, pharmacies and their social network for OA management. Participants also identified environmental characteristics (e.g., sidewalk conditions, curb-cuts, handicapped parking, automatic doors) that both facilitated and hindered use of community resources for OA management. Identified resources and environmental characteristics were organized around Corbin & Strauss framework tasks: medical/behavioral, role, and emotional management. As older Americans live with multiple chronic diseases, better understanding of what community resources are used for disease management may help improve the health of community-dwelling adults, both with and without OA.

The purpose of this study was to understand self-reported transportation difficulty among rural older adults. We used data from the UAB Study of Aging (255 Black and 259 White), community-dwelling participants residing in rural areas. We examined the relationship of predisposing characteristics, enabling resources, and measures of need for care with self-reports of transportation difficulty. Blacks reported having more transportation difficulty than Whites (24.7% vs. 11.6%; p ≤ .05). When we introduced other variables, race differences disappeared, but there was a race by income interaction with transportation difficulty. Whites with lower incomes were more likely to have transportation difficulty than Whites with higher incomes. When data from Blacks and Whites were analyzed separately, income was the only variable associated with transportation difficulty among Whites. Among Blacks, income was not related to transportation difficulty but several variables other than income (age, gender, marital status, MMSE scores and depression) were.

Dignity and independence are widely considered as core concepts to aging well, yet little research has explored how older adults perceive these issues in the context of community life. Moreover, little is known regarding the ways in which the broader public views and enhances aging with dignity and independence with their older residents. Using participatory action research, multiple methods of qualitative inquiry, and tenets of appreciative inquiry, this article reports on a community-based initiative aimed to better understand the positive aspects of aging with dignity and independence. Synthesized findings yielded 6 "actionable themes": (1) meaningful involvement, (2) aging in place, (3) respect and inclusion, (4) communication and information, (5) transportation and mobility, and (6) health and well-being. The findings invoke a new paradigm for community aging that highlights the unique contributions of older adults as a core social resource. Implications for mobilizing community action to promote aging with dignity and independence are discussed. © The Author(s) 2012.

Although prior literature has shown the plausibility of combining the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) items to form an expanded scale for measuring the degree of functional decline, this has not been shown in older adults with diabetes who are disproportionately affected by functional disability. Using the 2009 Medicare Current Beneficiary Survey data, we evaluated the factor structure of the pooled ADL and IADL items. Based on our study comprising 2,158 community-dwelling older adults (≥65 years) with diabetes, the unidimensional model exhibited good fit. Despite well-fitting indices, high correlations were observed between the latent constructs (>.70) of the multi-factor models, suggesting a lack of discriminant validity. These findings provide empirical support for a combined scale that can comprehensively and efficiently characterize the extent of functional disability in older adults with diabetes for research, risk adjustment, and evaluation in patient-centered medical homes. © The Author(s) 2014.

This article sought to determine the extent to which the number of self-reported mentally unhealthy days (MUDs) in the past 30 days estimates depressive symptoms in older adults. The sample of 4,321 community-dwelling residents aged 65 and above originated from an ongoing population-based study of older Blacks and Whites. Participants' data from 1993 through 2005 included the single MUD question and questions from the Center for Epidemiologic Studies Short Depression Scale (CES-D). Fourteen percent of participants had four or more depressive symptoms at baseline; of these, only 52% reported one or more MUD. Thirty-eight percent of those with one or more MUDs had four or more depressive symptoms. The results illustrate an interesting association regarding the measurements of two distinct, but related, mental health constructs. Although the number of MUDs was associated with having more depressive symptoms over time, the single-question MUD measure does not fully capture depressive symptomatology.

While the potential benefits of unobtrusive in-home sensing technologies for maintaining health and independence of older adults have been highlighted in recent research, little is known about their views toward such technology. The aims of this project were to identify monitoring needs and expectations of community-residing elderly and their family members. Focus groups were presented with examples of in-home monitoring devices and data output; participants were asked to consider whether the data showed information that was meaningful to them, and how and to whom they would like to have such data disseminated. Content analysis of transcripts revealed four dominant themes: maintaining independence, detecting cognitive decline, sharing of information, and the tradeoff between privacy and usefulness of monitoring. The acceptance by elderly of unobtrusive in-home monitoring was closely tied to perceived utility of data generated by such systems. Privacy concerns appeared to be less of an issue than anticipated in this sample.

Social support has been shown to influence health outcomes in later life. In this study, we focus on social engagement as an umbrella construct that covers select social behaviors in a lifespan sample that included oldest-old adults, a segment of the adult population for whom very little data currently exist. We examined relationships among social engagement, positive health behaviors, and physical health to provide new evidence that addresses gaps in the extant literature concerning social engagement and healthy aging in very old adults. Participants were younger (21-59 years), older (60-89 years), and oldest-old (90-97 years) adults (N = 364) in the Louisiana Healthy Aging Study (LHAS). Linear regression analyses indicated that age, gender, and hours spent outside of the house were significantly associated with self-reported health. The number of clubs and hours outside of home were more important factors in the analyses of objective health status than positive health behaviors, after considering age group and education level. These data strongly suggest that social engagement remains an important determinant of physical health into very late adulthood. The discussion focuses on practical applications of these results including social support interventions to maintain or improve late life health.

This article presents a framework for evaluating long-term care policies and programs to determine how well community-based programs benefit the older adult population. Equity, accessibility, quality, and efficiency are identified as core criteria for implementing and evaluating long-term care policy. Special problems with conducting process and/or outcome evaluation of community-based programs are noted, and findings of evaluation research on community-based health care programs are reviewed. Most previous research indicates that community-based health programs for older adults are not a substitute for institutional care and do not reduce either informal caregiving or ambulatory medical services. The article concludes with policy implications.

This article examines the social impact of Medicaid policy on the elderly in long-term care and identifies a previously unrecognized problem produced by Medicaid in New York State. Recent fieldwork in proprietary nursing homes in New York City shows that this state's Medicaid system results in a selection hierarchy on admissions and within nursing homes not only in terms of sponsor of payment but also in value, based on residents' functional level. Specifically, New York State Medicaid's Resource Utilization Groups (RUGs II) system is responsible for a new and startling phenomenon in long-term health care of the elderly: the creation of "minihospitals" in lieu of traditional skilled nursing facilities. This problem indicates the complex ways in which reimbursement policy drives priorities in nursing homes and creates unintended negative outcomes. In light of this consideration, various policy alternatives to Medicaid that would improve the plight of the elderly in long-term care are suggested and evaluated.

The use of electronic information systems (EISs) including electronic health records continues to increase in all sectors of the health care industry. Research shows that EISs may be useful for improving care delivery and decreasing medical errors. The purpose of this project is twofold: First, we describe the prevalence of EIS use among residential care facilities (RCFs), and second, we explore utilization differences by ownership status and chain affiliation. We anticipate that RCFs that are non-profit and non-chain will use more EIS than other categories of RCFs. Data for this project come from the 2010 National Survey of Residential Care Facilities. The sample consists of 2,300 facilities. Overall use of EIS was greatest among RCFs that are non-profit and chain-affiliated. Conversely, the use was lowest among for-profit RCFs that were also non-chain affiliated. This may suggest that these facilities lack the necessary resources or motivation to invest in information systems. © The Author(s) 2014.

We examine rural-urban differences in reliance on secondary caregivers for African American female primary caregivers (250 rural, 242 urban) and their care recipients. Logistic regression was used to identify caregiver and care recipient characteristics significantly associated with the likelihood of having a secondary caregiver within rural and urban samples. Post hoc Wald chi-square tests were used to identify significant between-sample differences in regression coefficients. Secondary caregivers were more common in urban than rural contexts. Having a secondary caregiver was more strongly related to primary caregivers' poorer physical health and nonresidence with care recipients in rural than urban contexts. Findings suggest that policy initiatives, such as the National Family Caregivers Support Act and the cash and counseling model, may benefit rural and urban residents, particularly rural residents as the majority of them lacked secondary caregiver assistance.

Older people experience sensory, cognitive, and social deficits that adversely affect their interaction with the environment. Design of institutions for the elderly resident should be prosthetic to ensure that environments optimally accommodate the functioning of the residents. The sensory and cognitive state of the residents should be considered in every facility. This review discusses how sensory and cognitive changes in aging affect orientation and wayfinding as well as how the physical aspects of the environment can accommodate these changes to reduce confusion and disorientation. Environmental features that promote social interaction are reviewed. Because the environmental needs and unique characteristics of the cognitively impaired resident differs from that of the nonimpaired resident, special issues in the design of facilities for demented residents are reviewed. Conclusions are offered with regard to research needs and applied problems.

The aim of the study was to examine staff and family members' perceptions of each other's roles and responsibilities in the Australian residential aged care setting. Data was collected by interview and focus group from 27 staff and 14 family members at five residential aged care facilities in the state of Victoria, Australia. Findings highlight "communication" as the core category supporting the formation of constructive staff-family relationships, as described by three main themes; "building trust," "involvement," and "keeping the family happy." Staff attitudes, mutual cooperation, meaningful engagement, and shared expectations lay the foundation for relationships. Findings suggest that further efforts to establish and sustain good relationships with families are required by facilities. Characteristics, roles, and expectations of staff and family that can both promote and hinder the formation of constructive staff-family relationships are discussed.

Respect for a person's right to make choices and participate in decision making is generally seen as central to quality of life and well-being. When a person moves into a residential aged care facility (RACF), however, decision making becomes more complicated, particularly if the person has a diagnosis of dementia. Little is known about how staff in RACFs perceive that they support decision making for people with dementia within their everyday practice, and this article seeks to address this knowledge gap. The article reports on the findings of a qualitative study conducted in the states of Victoria and Queensland, Australia with 80 direct care staff members. Findings revealed that the participants utilized a number of strategies in their intention to support decision making for people with dementia, and had an overall perception that "a little effort goes a long way."

Critical review of the health and social service use literature reveals a need to elaborate on the dynamics of factors identified in the behavioral models applied to this field. In particular, research has tended to omit direct measures of attitudes and awareness of social services, including their interrelationships. This study examines determinants of knowledge, use, and future use of local home support agencies among a sample of community-dwelling elderly over the age of 74 living in Kitchener-Waterloo, Ontario. Measures of domestic self-reliance, independent living and perceptions of futurity are incorporated into the analysis. Logistic regression is used to test the models. The results show that attitudes regarding domestic self-reliance and independent living influence use of home support agencies largely through their impact on service awareness. Interestingly, these relationships are opposite to those hypothesized. Education is also found to be a predictor of knowledge of home support, and living arrangement, health status measures, and knowledge arise as important predictors of use and future use. The findings are discussed in terms of their implications for the underlying behavioral models, and for service providers and policymakers.

This study examined the effects of exposure to the aggressive and disruptive behavior of institutionalized elderly patients on health care staff's job satisfaction. Aggressive behavior was defined as physical, verbal, or general disruptive behavior. Health care staff from a geriatric long-term care hospital were interviewed about their exposure to these types of aggressive behavior and the effect of this exposure on job satisfaction. Job satisfaction was significantly correlated with overall exposure to aggressive behavior. Although physical aggression was reported more frequently, exposure to verbal aggression correlated higher with job satisfaction. Exposure to aggressive behavior was the best predictor of job satisfaction, followed by level of education. These findings indicate that job satisfaction is negatively affected by exposure to aggressive behavior but positively affected by educational level. The role of educational programs in moderating the impact of exposure to aggressive behavior on job satisfaction is discussed.

State units on aging (SUAs) from 29 states with continuing care retirement community (CCRC) legislation were surveyed to (a) assess staff familiarity with CCRC legislation, (b) examine interdepartmental working relationships surrounding such legislation and ask what role(s) ombudspersons are playing in CCRC oversight, (c) determine what role(s) aging units have had in developing legislation, and (d) gain insights regarding legislative impact. Results indicate that SUAs have been active in legislative development but vary greatly in the intensity of their involvement with the implementation and enforcement of CCRC regulation and in their perception of legislative impact.

In 1987 the Indiana Task FOrce on Aging and Aged Persons with Developmental Disabilities was formed to address interagency planning and public policy issues related to this newly emerging population. Data were collected from major state agencies now serving either the aged or individuals with developmental disabilities to assess the portion of the population currently receiving services. These data were compared to population projections for 1990. Service needs in health care, residential services, day programming, and other support areas were identified. We discuss direct planning outcomes and indirect process outcomes related to increased interaction among state-agency employees.