The purpose of this study was to determine the impact on resource use of providing case managers with information on the potential for patients to benefit from home care services.
Twenty-four case managers working in the Arizona Long Term Care System (ALTCS) were randomized into treatment and control groups. Members of the treatment group were given patient assessments for 25 ALTCS clients, estimates of the patients' risks for various adverse outcomes, and estimates of the aggregate potential benefit for each patient. Members of the control group were given only patient assessments (as is usual practice) for the same sample of 25 clients. Both groups were asked to independently write nonbinding care plans for each patient. The cost of each case manager's care plans was computed by multiplying standard costs per service times the mix and volume of services prescribed for each patient.
Treatment group care plan costs were, on average, lower than control group costs and closely tracked variation in estimated patient risks. Comparison group care plan costs were unrelated to risks.
Information about risk and potential benefit can improve targeting of services to long-term-care clients. A prospective study using such an approach is warranted to see if provision of risk and potential benefit information would produce better clinical and economic outcomes.
Continued employment after retirement and engagement in unpaid work are both important ways of diminishing the negative economic effects of the retirement of baby boomer cohorts on society. Little research, however, examines the relationship between paid and unpaid work at the transition from full-time work. Using a resource perspective framework this study examines how engagement in unpaid work prior to and at the transition from full-time work influences whether individuals partially or fully retire.
Design and methods:
This study used a sample of 2,236 Americans between the ages 50 and 68, who were interviewed between 1998 and 2008. Logistic regression was used to estimate transitioning into partial retirement (relative to full retirement) after leaving full-time work.
We found that the odds of transitioning into part-time work were increased by continuous volunteering (78%) and reduced by starting parental (84%), grandchild (41%), and spousal (90%) caregiving and unaffected by all other patterns of engagement in unpaid work.
Our findings suggest that volunteering is complementary with a transition to part-time work, and starting a new caregiving role at this transitioncreates a barrier to continued employment. In order to provide workers the opportunity to engage in the work force longer at the brink of retirement, it may be necessary to increase the support mechanisms for those who experience new caregiving responsibilities.
Homebound Learning Opportunities (HLO) represents an innovative health promotion and educational outreach service for homebound
older adults and their caregivers. It provides over 125 topics for individualized learning programs delivered to participants
in their own places of residence, an audiovisual lending library, educational television programming, and a peer counseling
service. Shut-ins are recruited as instructors and as participants in service projects that benefit the greater community.
Preliminary assessments reveal high levels of participation and satisfaction with the program.
Much has been written about theories of aging in premodern times, but much less is known about theories of residential care.
This article describes a handbook prescribing the building, staffing, and running of residences for seniors: The Gerontocomos, published in Italy in 1489 by Gabrielle Zerbi. The handbook describes in detail the physical environment and architecture,
the qualifications of the administrator, and the hiring and training of assistants for what is essentially an Assisted Living
Facility. Although ancient-to-Renaissance theories of aging differ widely from contemporary theories, some of the practical
suggestions are not so different.
In the months following the introduction of the National AMBER (America's Missing: Broadcast Emergency Response) Alert plan used to locate missing and abducted children, Silver Alert programs began to emerge. These programs use the same infrastructure and approach to find a different missing population, cognitively impaired older adults. By late 2008, 17 states had enacted Silver Alert policies, and several more planned to take advantage of National Silver Alert grant funding to initiate policies in 2009. To date, however, no research has examined the efficacy of such programs, which have widely varying parameters and criteria to initiate the alerts. In this study, we empirically examine the 17 existing state Silver Alert and related policies. The analysis includes an examination of the varieties of programs: dementia related and AMBER extension, the dates of enactment, the criteria for activation, and the process of activation. We conclude with two salient questions that emerged from the analysis. We examine these questions and make recommendations for future research, including examining whether Silver Alerts are an appropriate response to address the problem of missing adults with dementia or cognitive impairments and examining the costs and benefits of the programs including determining how best to balance efforts to keep cognitively impaired elders safe while keeping their basic human rights of autonomy and empowerment intact.
Nonprofit organizations in Massachusetts serving the elderly are a major beneficiary of capital grant awards for vehicles under the 16(b)(2) program. As a result these agencies are able to provide low-cost transportation for their own programs. The continued economic viability of for-profit firms in para-transit and the 16(b)(2) recipients' limited service to individual requests are of concern. Modifications in 16(b)(2) to allow participation by for-profit firms should be considered.
The ages of life portrayed in literature and the arts from the late Middle Ages up to the 16th century provide valuable information on how aging and old age were perceived in earlier times. Themes related to old age include ambivalence, decay, and age-appropriate behavior.
As America ages, greater numbers of older adults will be living with Alzheimer’s disease or a related dementia, leading to
increased incidence of wandering. Currently there are several initiatives to assist older adults who go missing. We describe
and critically examine three prominent and widespread programs: Safe Return, Project Lifesaver, and Silver Alert. Despite
their emergence, there has been little research on their effectiveness. More fundamentally, the nature and scope of the missing
elder problem is understudied. We call for further research into this issue, as well as assessments of how well such programs
balance individual liberties with safety concerns.
The overall purpose of the study was to examine the relationship between widowed persons' baseline assessments of self-efficacy beliefs and their ratings of perceived health-related quality of life, life satisfactions, and self-esteem obtained in an 18-month follow-up.
At Time 1, a survey of sociodemographics, a multidimensional measure of global self-efficacy, and a domain-specific measure of self-efficacy, having eight subscales of self-efficacy (interpersonal, instrumental, emotional, social support, nutritional, physical, financial, and spiritual) were administered to a group of 231 widows and widowers to obtain baseline assessments of their self-efficacy beliefs. At Time 2, a follow-up of 211 widows and widowers was conducted to obtain their perceptions of health-related quality of life, life satisfactions, and levels of self-esteem 24 months following spousal loss and to assess whether self-efficacy beliefs play a predictive role in widowed individuals' perceptions of their health-related quality of life, life satisfactions, and self-esteem.
A series of gender-specific multiple regression analyses models revealed that widows and widowers differ significantly with respect to the relationship between specific domains of self-efficacy and their perceived quality of life in the longer term following spousal loss.
Implications of the findings are discussed for clinicians and health professionals working with bereaved spouses in terms of intervention programs for retraining of self-efficacy.
This paper examines diaries written by an Iowa farm woman and her daughter in the 1880s that focus on care of the former's father. It highlights the problems intergenerational living arrangements could produce in the 19th century. In addition, it examines three general themes: the impact on adult children of financial responsibility for elderly parents, the responses of elderly people to structures of subordination, and the significance of hierarchies of gender as well as generation.
Analysis of U.S. census data provides evidence that decreased labor force participation of older people, 1890 to 1970, was chiefly due to the combined effects of: (1) the disproportionate growth in numbers of persons aged 65 or older, and (2) the growing economic dominance of industries that provide relatively few opportunities for older people's participation.
In this article, data on life expectancy are used to illustrate the array of differences among human beings of various advancing ages. Not only are there differences between cohorts (groups of persons born at approximately the same period) but there are sex and color differences within the cohort which, in turn, increase with the passage of time. Then there are differences among the residents of the various States as well as differences among the residents of the same State. The technical concepts of lfe expectancy and life span are not the same: Life expectancy (average remaining years of life) for white males born in 1974, for instance, is 68.9 years; however, half of the white males born in 1974 can be expected to reach age 72.4 (life span).
The stereotype of the old of the past nestled in the bosom of their family obscures the real living situation of old people. A sample of the aged derived from the 1900 federal manuscript census reveals that when aged parents and children co-resided the old were more often the heads of the house than their children. In many respects, the old in 1900 were indistinguishable from other adults. Unlike the aged today, they continued to work and to have children at home as they did in middle age.
The Social Security Act of 1967 requires that all States must license nursing home administrators and establish an educational
program of at least 100 hours' duration to help prepare present administrators to pass the licensure examination; the educational
areas have been identified, and Federal guidelines have been established. Connecticut has just completed a year of effort
and preparation for implementing the law, which became effective July I, 1970. Training can be accomplished on either a credit
or noncredit basis, and this State's experience indicates that it can be accomplished even with a heterogeneous population
States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care. A substantially greater share of long-term-care dollars supports community-based care for individuals with intellectual and developmental disabilities, relative to older and working-age persons with primarily physical disabilities.
We used state-level data for the period from 1992 to 2001 to estimate fixed-effects panel models. We compared state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals (O/WAIs) relative to waivers serving individuals with intellectual and developmental disabilities (IDDs).
We found community-based-care capacity to predict use and expenditures for both target groups. Although regulation of institutional supply was positively related to expenditure measures for IDDs, it was not related to use or expenditures for O/WAIs. Demand variables (e.g., the size of a state's African American population) predicted use and expenditures for IDD waivers, but they were less consistent for O/WAI waivers. State resources were a robust predictor of use and expenditures for both groups.
Increased community-based-care capacity appears to be an important factor in efforts to expand the availability of Medicaid community-based care. Federal policies that address state resource issues may also spur growth in community-based long-term care.
The career and accomplishments of Dr. Robert N. Butler highlight the history of postwar gerontology and geriatrics here and
abroad. Butler was an idea broker: He introduced “life review” as a therapeutic intervention and coined “ageism.” Butler was
the only researcher on aging to win a Pulitzer Prize or long after normal retirement lay the foundations for a new gerontology.
Butler was an institution builder: he served as first director of the National Institute on Aging, created the first department
of geriatric medicine in the United States, and mobilized support here and abroad for global aging. His legacy provides much
for successive generations to emulate and enhance.
With a little chauvinistic impress, the first national congress on aging was held in Kiev, USSR, in 1938, where precedent
empirical and scientific thought was joined to newer developments. In other nations, gerontological logistics were being developed
along similar lines at the same time and these data moved readily across rigid disciplines and geographical boundaries. Representatives
of 41 nations attended the 9th Congress of the International Association of Gerontology in 1972, again in Kiev, where a comprehensive
program on aging was offered. Accomplishments in one generation, the most important period in the long history of gerontologic
thought, readily disclosed ties to the earlier session in confirmation of continuous lines of investigation.
A detailed content analysis study was undertaken to determine how the aging have been portrayed in children's realistic fiction
books published in the United States during the period 1945-1975. Findings indicated that overall characterizations of the
elderly depicted in the 125 books analyzed were neither negative nor stereotypic but were varied in presentation.
In this article we determine whether rectangularization of the survival curve occurred in the Netherlands in the period 1950-1992. Rectangularization is defined as a trend toward a more rectangular shape of the survival curve due to increased survival and concentration of deaths around the mean age at death. We distinguish between absolute and relative rectangularization, depending on whether an increase in life expectancy is accompanied by concentration of deaths into a smaller age interval or into a smaller proportion of total life expectancy. We used measures of variability based on Keyfitz' H and the standard deviation, both life table-based. Our results show that absolute and relative rectangularization of the entire survival curve occurred in both sexes and over the complete period (except for the years 1955-1959 and 1965-1969 in men). At older ages, results differ between sexes, periods, and an absolute versus a relative definition of rectangularization. Above age 60 1/2, relative rectangularization occurred in women over the complete period and in men since 1975-1979 only, whereas absolute rectangularization occurred in both sexes since the period of 1980-1984. The implications of the recent rectangularization at older ages for achieving compression of morbidity are discussed.
The goal of this project was to examine the factors related to the high level of voter turnout among older adults and how these factors have changed across the past 50 years. The study builds on previous research efforts by combining individual level analyses from three nationally representative surveys.
We examined voter turnout among older citizens using the American National Election Studies (ANES) 1952-1996, the Current Population Studies (CPS) 1972-1996, and the General Social Surveys (GSS) 1972-1996. Logit regression identified significant factors that contribute to or detract from voting in presidential elections.
Included in the extensive results, we found that being married, attending church, and contact by political operatives (since the 1980 election) contributed positively to older voters' turnout, whereas living in the South was a negative predictor.
Triangulating data sources, we are able to utilize the strengths of each study-providing an overview of the determinants of voter turnout and understanding of the changes related to older Americans' turnout in presidential elections.
Data describing elderly interstate migration patterns were compared for the 1960, 1970, and 1980 censuses. Florida dominates as a destination, and its attractiveness is increasing. Arizona and Texas are also increasing in attractiveness, but California and New Jersey have a decreasing share of elderly migrants. Elderly migrants are becoming even more concentrated in only a few destinations, which makes the impact of the migration patterns on service delivery especially significant in those states.
Using income data from the 1960,1970, and 1980 U.S. Censuses of Population, the relative change in income of older women was
examined from several perspectives. As expected, the income distribution of cohorts entering old age more recently is well
above that of the preceding cohorts, and there is some decline in inequality among older women over the past 20 years. The
position of older women relative to middle-aged women, however, has not improved, and cohorts continue to experience large
drops in income as they enter old age.
Data from the 1960-1961 Consumer Expenditures Survey permit comparison of the income, expenditures, and savings of older white and Negro units. They document the lower income of the Negro aged and their greater inability to draw on savings to supplement money income. Consequently, they must restrict total expenditures to the amounts available from money income and distribute such expenditures differently than do the white aged units. The data point to the need for developing policies designed to raise the income of the aged, and particularly of Negro aged units, to levels permitting adequate allocation of funds among the varied consumption categories.
Life expectancy in the USSR reached 71 years (64.5 for males and 75 for females) in 1964 and then declined to 70 in 1970.
Although no official figures of life expectancy have been published in the Soviet Union since 1970, it is possible to estimate
that life expectancy declined further to about 68 years in 1983 (62.5 for males and 73.5 for females). The decline was due
partly to an increase in infant mortality and partly to an increase of mortality among the middle aged and elderly groups
and reflects problems in public health.
This paper analyzes U.S. Census, Current Population Survey data from 1970 to 1988. It establishes that the young-old (age
65–74) and old-old (75 plus) populations are now more likely to live in metropolitan areas, especially within suburban areas,
and are occupying residential locations that are less segregated from other age groups. As early as 1977 the majority of metropolitan
elderly people lived in suburban areas, and by 1988 only just over one-quarter of the U.S. elderly population lived in nonmetropolitan
Examined are the economic consequences of widowhood for both men and women over time and their financial well-being is compared
to that of a matched group of continuously married couples. Past research on this topic has been limited almost exclusively
to cross-sectional studies that focus solely on widows. The findings of this longitudinal study indicate that the loss of
a spouse has negative economic consequences for both widows and widowers relative to continuously married couples.