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In July 2015, the Journal of the American Geriatrics Society published a manuscript titled, "Failing to Focus on Healthy Aging: A Frailty of Our Discipline?" In response, the American Geriatrics Society (AGS) Clinical Practice and Models of Care Committee and Public Education Committee developed a white paper calling on the AGS and its members to play a more active role in promoting healthy aging. The executive summary presented here summarizes the recommendations from that white paper. The full version is published online at GeriatricsCareOnline.org. Life expectancy has increased dramatically over the last century. Longer life provides opportunity for personal fulfillment and contributions to community but is often associated with illness, discomfort, disability, and dependency at the end of life. Geriatrics has focused on optimizing function and quality of life as we age and reducing morbidity and frailty, but there is evidence of earlier onset of chronic disease that is likely to affect the health of future generations of older adults. The AGS is committed to promoting the health, independence, and engagement of all older adults as they age. Geriatrics as an interprofessional specialty is well positioned to promote healthy aging. We draw from decades of accumulated knowledge, skills, and experience in areas that are central to geriatric medicine, including expertise in complexity and the biopsychosocial model; attention to function and quality of life; the ability to provide culturally competent, person‐centered care; the ability to assess people's preferences and values; and understanding the importance of systems in optimizing outcomes. J Am Geriatr Soc 67:17–20, 2019. [ABSTRACT FROM AUTHOR]

The future welfare of older adults is a worldwide concern. By 2034, it is estimated that individuals 65 and older in the U.S. will be 77 million. Consequently, this reality will impact healthcare facilities and increase Medicare and Medicaid costs, resulting in higher incidents of homeless older adults, children caring for parents, the need for more caregivers, and an increased number of older individuals experiencing various forms of dementia. To address these concerns, the current trend for treating the onset of dementia and Alzheimer's disease has been moving toward nonpharmaceutical interventions. Even though researchers have tapped into the benefits of several nonpharmaceutical treatments, there appears to be a constant debate on establishing which method is most effective. Deciding on best practices and methods to slow down and/or halt the progression of dementia is the gap this research needs to fill. To provide clarity on the topic, an analysis of alternative interventions to treat the onset of dementia is what this paper strived to achieve. The analysis involved comparing and contrasting the benefits of each intervention as well as illustrating the implications of the findings. In this regard, a systematic review was conducted examining the benefits of five nonpharmaceutical strategies; mental training, music therapy, technology usage, physical activity, and social interaction. Although findings revealed some form of improvement in each of the nonpharmacological interventions examined, the overarching theme appeared to lean toward providing mental stimulation. It was also not conclusive that physical activity prevented cognitive decline. More research is recommended. [ABSTRACT FROM AUTHOR]

Financial exploitation (FE) is one of the most common reports to Adult Protective Services (APS) and the cases are often complex. Consequently, APS caseworkers report FE investigations to be among the most difficult while simultaneously reporting low confidence in productive outcomes for these investigations. This necessitates finding ways to support APS FE investigations. This paper describes the structure, process, and formative findings of a collaboration between forensic accounting examiners and APS workers to investigate complex cases of FE. Among the 77 FE cases completed, forensic examiners reviewed multiple years of financial records which included over 101,000 transactions, totaling over $213,000,000.00 in finances, and identified over $8,000,000 in questionable activity. Scores on the 8-item Client Satisfaction Questionnaire were high indicating high program satisfaction by APS workers, subject matter experts, and forensic examiners. These findings support the feasibility and acceptability of forensic accounting and APS collaborations to investigate complex cases of FE. [ABSTRACT FROM AUTHOR]

Between 1949 and 1966, the Stephen Smith Home, one of the oldest African American "homes for the aged" in the United States, went from partially condemned to new construction. Through his leadership at this historic Philadelphia institution, administrator Hobart C. Jackson learned firsthand the "double jeopardy" of Black aging, culminating in the 1970s with his national advocacy efforts on behalf of minority elders. The intersectionality of age and race was intimately tied to the built environment of homes for the aged, the precursor of today's nursing home. This paper considers how structural racism and ageism were materially manifested in the strug gle of African American eldercare institutions to respond to protean building and safety regulations for se nior care. I introduce a necessary architectural analy sis into histories of aging in the United States by examining how building maintenance, upkeep, and volunteerism offer a way of understanding social history. This research reveals Philadelphia's Stephen Smith Home to be both representative and singular: like other African American facilities, the home strug gled with building obsolescence and funding shortfalls, but unlike many of its counter parts, it nonetheless survived and developed into a hybrid campus of historic and newly built structures within a growing Black neighborhood. Ultimately this article does foundational work in exploring the shifting building and social cultures of the charitable old age home in the mid-twentieth century by examining a mode of community- based care that, when rendered within the built environment, contrasts greatly with con temporary perceptions of institutionalization. [ABSTRACT FROM AUTHOR]

The article reports on the release of the paper "Technologies to Help Older Adults Maintain Independence: Advancing Technology Adoption" from the Center for Technology and Aging in the U.S. The paper describes seven technologies that could improve chronic health care and increase independence among older adults while reducing health care costs. The discussed technologies include the assistive technologies, remote training and supervision, and medication optimization.

Presents a set of papers featured in the December 1999 issue of "Culture, Medicine and Psychiatry," which analyzed narratives of caregivers of elders with dementia in Boston, Massachusetts. Methods shared across the papers; Multidimensional framework for ethnicity; Directions for future research.

This paper deals primarily with social policy considerations relevant to the development of long-term care policy for the frail elderly in the United States. However, it also includes some commentary on meeting the acute care needs of the frail elderly. It defines chronic care treatment as a mix of "short-term" and "long-term" modes of care. Furthermore, it explores the need for treatment of such long-term illnesses to recognize the importance of alternative modes of caring which include strategies, both medical and nonmedical, delivered within and outside of hospitals and nursing homes. The paper includes an analysis of public and private sector priorities based in data published by the U.S. Health Care Financing Administration. It also includes some discussion of the PACE program in the United States and some other efforts to stimulate more in-home and community-based alternatives to nursing home care. Furthermore, it includes a discussion of the policy goal of "appropriateness" in developing long-term care (as well as general health priorities) and provides a critical discussion of problems with utilizing "cost/benefit analysis." The study concludes that too exclusive a focus on nursing home care for the elderly in the United States is unfortunate--both in terms of the desires of the elderly, their families and friends and in terms of focusing on "appropriateness" as a legitimate policy goal in the development of long-term care policy for the elderly in the United States. [ABSTRACT FROM AUTHOR]

Forty-five years ago, the first author of this paper surveyed the US medical schools to determine their offerings on EOL (End-of-Life) issues. The results showed limited exposure for medical school students to learn about dying and death, thus their "learning" was apparently on-the-job training. The EOL offerings were so limited that the American Association of Medical Colleges (AAMC), following the 1975 publication from the survey, contacted the first author to inquire about death and dying in the curricula of their medical schools. Apparently, it was so insignificant that the AAMC did not have such information. Palliative medicine, geriatric medicine, and hospice were then in the "birthing" process, a mere blur on the horizon. Today, as in 1975, it is likely that most medical students have personally had minimal experience with death and that for many entering students, other than on television, the cadaver is their first sight of a dead person. The objective of this research is a longitudinal study at five-year intervals since 1975 reporting on EOL education in US medical schools. The total number of medical schools has increased from 113 in 1975 to 150 in 2020. The current study surveyed medical schools electronically and via postal services with a response rate of 37%. Findings from the survey over time revealed significant inclusion of death and dying and palliative medicine as well as geriatrics and hospice. Gross anatomy has evolved from strictly hands-on to integrating 3D/virtual models, a change not without controversy. A noticeable difference in emphasis is obvious as care now plays a more significant role in medical training than previously, thus making modern medicine not only about cure, but more about care than was previously emphasized. Communication with dying patients and families, analgesics for chronic pain, and advance directives all are covered in over 90% of schools today. The current emphasis on EOL care, not just disease management, is increasing and puts more of a human face on modern medicine. [ABSTRACT FROM AUTHOR]

Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives. [ABSTRACT FROM AUTHOR]

Physical/cognitive limitations associated with the aging process place older adults at disproportionate risk of negative consequences during disasters. Guided by the profession's commitment to supporting vulnerable populations, gerontological social workers have long been on the frontlines supporting older adults during disasters. Yet, disaster social work practice remains an undeveloped and under-researched area. Thus, we asked "what is the current role of gerontological social workers in disaster preparedness with older adults in the United States, and potential areas for improvement?" This paper systematically reviews the literature discussing social work and disaster preparedness/response with older adults in the U.S., to identify needs and inform future directions. PRISMA guidelines were followed to conduct a systematic search across relevant databases for peer-reviewed-publications between January 1, 2009-June 12, 2020. Eleven articles met inclusion criteria. This body of literature is small and covers two broad areas: (1) charging the social work profession to engage in this work, and (2) describing current efforts and unique challenges of older adults during disasters. Only three empirical studies were identified. Future educational efforts should formalize training to prepare social workers for this practice area. Research should detail the roles of social workers in disaster preparedness/response, and factors that predict involvement. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an overview of rural older veterans in the USA and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas.Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans.Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas.Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a case study that illustrates how professional associations can provide the context for development of formal and informal interdisciplinary collaboration and promote advancement and dissemination of useful knowledge among disciplines and across geographic boundaries. This paper reports the work of the Rural Aging Special Interest Group of the Gerontological Society of America to develop and disseminate approaches that leverage existing resources to address the challenges of providing services to rural – dwelling older adults. It describes the challenges and the roles of networks in developing and supporting these partnerships to better meet the challenges.Design/methodology/approach This paper describes how interdisciplinary partnerships can enhance existing resources to better meet the unique needs of rural older adults and describes an example of how a professional association facilitated the process of creation and dissemination of knowledge about this approach. An overview of the process is provided with additional information relating partnerships to improving programs and services for rural older adults.Findings While addressing the unique needs of rural older adults can sometimes prove challenging, a number of entities have developed successful interdisciplinary partnerships that have expanded resources and improved effectiveness in addressing these challenges.Originality/value This paper illustrates how a professional association can play a key role in supporting creative interdisciplinary and international problem solving. [ABSTRACT FROM AUTHOR]

This paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5 percent per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes. (JEL E01, H51, I10) [ABSTRACT FROM AUTHOR]

Based on data from an eight year longitudinal study of Ohio's long-term care use patterns, this paper describes the changes now being experienced by this industry. Although Ohio has been a state with a heavy reliance on institutional services, the data suggest a change in how long-term care is provided in the state. Over the past eight years, despite an increasing disabled older population, nursing home occupancy rates have fallen from 92.5% to 83.5%. At the same time, in-home service and assisted living use has increased. The paper concludes by describing how such changes are likely to impact the system of the future. [ABSTRACT FROM AUTHOR]

mcinnes e., seers k. & tutton l. (2011) Older people's views in relation to risk of falling and need for intervention: a meta-ethnography. Journal of Advanced Nursing 67(12), 2525-2536. Abstract Aim. This paper is a report of a meta-ethnography of qualitative studies of older peoples' views on risk of falling and need for intervention. Background. Falls and falls-related injuries in older people are worldwide problems. A conceptual understanding of older people's views about falls risk and need for intervention is useful for understanding factors likely to impact on acceptance of risk and recommended interventions. Data Sources. Seven electronic databases were searched 1999-2009. Reference lists of included articles were screened for eligible papers. Review Methods. Assessment of quality was carried out. Themes and concepts were extracted using a meta-ethnographic approach to compare similarities and differences across the retrieved studies. A line of argument was developed to produce an explanatory framework of the extracted themes and concepts. Results. Eleven relevant qualitative research articles of reasonable quality were identified. Six key concepts were identified: beyond personal control; rationalizing; salience; life-change and identity; taking control and self-management. A line of argument synthesis describes how older people approach self-appraisal of falls risk and intervention need, and how they cope and adapt to falls risk and intervention need. Conclusion. In response to having an elevated risk status and perceived associations with frailty and impact on an independent life-style, some prefer to adapt to this reality by taking control and implementing self-management strategies. Healthcare professionals should take into account beliefs about risk and negotiate choices for intervention, recognizing that some individuals prefer to drive the decision-making process to preserve identity as a competent and independent person. [ABSTRACT FROM AUTHOR]

Social workers (SW) and community health workers (CHW) have emerged as key workforce personnel in efforts to care for elders in the U.S. However, little is known about the presence and roles of SW and CHW in primary care practices. This paper presents findings from a nationally representative survey of geriatrics and primary care practices. Physician and nurse practitioner clinicians were randomly selected within practices, stratifying by practice staffing and presence/absence of geriatric clinicians; our final sample for this analysis included 341 practices. Key findings include: reported challenges in meeting the social service needs of elders, underutilization of SW, and fuller utilization of social work competencies in practices in which both SW and CHW were present. These findings offer a unique perspective of SW on interprofessional teams and have implications for the future of the profession. [ABSTRACT FROM AUTHOR]

This paper presents an overview of the relationship between population aging in the United States, the growing demand for geriatric social workers, and how that need can be met through graduate-level social work training. We describe the basic components of graduate level social work training and discuss two key elements in the training of geriatric social workers. Focussing on a recent initiative by the John A. Hartford Foundation, we discuss the program in geriatric social work training recently implemented at the University at Albany School of Social Welfare and the consequences of improved training and awareness in geriatric social work for the social work community. [ABSTRACT FROM AUTHOR]

Research on caregiving in the United States has not clearly identified the scope of the gap between care needed and care received and the changes implied by ongoing and anticipated shifts in family structure. This article examines the magnitude of contemporary gaps in care among older adults in the United States and how they are likely to evolve through 2050. We use data from the Health and Retirement Study (1998–2014) to estimate care gaps, operationalized as having difficulties with activities of daily living (ADLs) or instrumental activities of daily living (IADLs) but not receiving care. We also estimate variation in care gaps by family structure. Then, we use data from demographic microsimulation to explore the implications of demographic and family changes for the evolution of care gaps. We establish that care gaps are common, with 13% and 5% of adults aged 50 or older reporting a care gap for ADLs and IADLs, respectively. Next, we find that adults with neither partners nor children have the highest care gap rates. Last, we project that the number of older adults with care gaps will increase by more than 30% between 2015 and 2050—twice the rate of population growth. These results provide a benchmark for understanding the scope of the potential problem and considering how care gaps can be filled. [ABSTRACT FROM AUTHOR]

As a result of the aging of American society and the fact that older persons require a great deal more healthcare and much more expensive treatments, the costs are on the rise and spiraling out of control. As a solution, ethicists Daniel Callahan and others have proposed healthcare rationing on the basis of age. On the basis of utilitarian ethicist, these writers have argued that age-based rationing will lead to the provision of healthcare to the greatest number of people. Of course, utilizing other ethical theories other writers have opposed the rationing of healthcare on the basis of age. The paper presents the arguments made, and the ethical theories employed, by both sides, which suggest an ethical dilemma, thus most probably a debate about age-based rationing in the future. The author found it interesting to seek the views of professors teaching healthcare -related courses about this type of rationing. Utilizing grounded theory/ quantitative research methodology, designing a questionnaire that included some 14 questions, the author interviewed some 18 professors of healthcare courses in Pennsylvania. Utilizing grounded theory in the analysis of the results of the interviews led to some eight interesting themes, which are presented and analyzed in the paper. After presenting the results of that study, and not finding the application of age-based rationing feasible, the paper also discusses other alternative solutions for reducing healthcare costs, including the notion of fair innings suggested by Allan Williams. All these alternatives are discussed in the paper. [ABSTRACT FROM AUTHOR]

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004–2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care. [ABSTRACT FROM AUTHOR]

To achieve optimal, equitable health outcomes for all older adults, the United States desperately needs equity in access to, quality of, and cost of aging care. To illustrate these needs, we discuss the current inequitable state of frailty care. Frailty disproportionately affects marginalized populations, yet these populations struggle to access high-quality geriatrics care and long-term care services and supports (LTSS) that mitigate frailty, leading to accelerated frailty trajectories. Health services research can provide the data needed to document, elucidate, and address health inequities in frailty care, including early identification and referral of frail adults to specialized care and financing LTSS. [ABSTRACT FROM AUTHOR]

Purpose - Millions of older adults in the USA are being abused, neglected, and exploited. Older victims who are abused by a spouse, partner, family member, or caregiver experience unique barriers and challenges. The Department of Justice's Office on Violence Against Women (OVW) funds a small but promising Abuse in Later Life Program. This article seeks to briefly describe the dynamics of abuse in later life and the design and outcomes experienced by local grantees funded by the OVW Abuse in Later Life Program.Design/methodology/approach - This paper is designed to describe the key components of the OVW's Abuse in Later Life program and outcomes experienced by local practitioners.Findings - The paper describes lessons learned by local practitioners who use a multidisciplinary approach to respond to abuse in later life.Practical implications - Collaboration and a coordinated community response are vital to enhance older victim safety and quality of life.Originality/value - This paper describes model programming in the USA that could be replicated in Britain and elsewhere. [ABSTRACT FROM AUTHOR]

Greater attention is being paid to issues surrounding end-of-life care for aging adults with developmental disabilities. The purpose of this qualitative study was to explore the end-of-life experiences of two aging adults with developmental disabilities and life-limiting serious illnesses who received care in settings in the United States. Using a comparative case study design, data from three sources (records, staff, surrogates) were collected sequentially and triangulated via within and cross-case analyses. Although the setting and design limit the generalizability of these findings, the feasibility of delivering high quality care to adults with developmental disabilities as they age and experience terminal illnesses is supported. Insights are presented regarding how nurses can address barriers by adapting policies and practices to accommodate the distinct needs that arise as people with developmental disabilities age, become seriously ill, and reach life's end. [ABSTRACT FROM AUTHOR]

This paper valued the quantity of child, sick, and elderly care provided by households using anew, direct measure. Such measures add to the literature that estimates the size of the contribution of non-market work by household members, particularly women, and to literature about valuation of childcare. This production remains unvalued in standard national income accounts. Traditional attempts to quantify this care multiplied care-giver hours by a wage rate, a method that suffers from several drawbacks, including omitting the contributions of anything but labor, the inability to handle joint production, and the use of an arbitrary wage rate. This study avoided these problems by valuing the amount of care with its market price based on data from a small urban area. The mean value was $3,547 annually (97 percent of it childcare) for all sample households and $9,610 for those providing care. The results afforded evidence of scale economics in parental childcare and quantified care furnished by different kinds of providers. [ABSTRACT FROM AUTHOR]

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An introduction is presented in which the editor discusses various topics within the issue, including the cognitive health and psychological well-being of Latinx older adults, health care services, and pension systems.

This paper details a study on ethnic identity in midlife, illuminating identity formation as a complex life course phenomenon. The study addresses the importance of ethnic identity in understanding the experiences of racial and ethnic Baby Boomers as both recipients of care and as caregivers to their aging parents (first generation immigrants). Using a case study of second-generation Korean American Baby Boomers, the primary aims of this study are: (a) to explore how the relationship between age and race/ethnicity influences identity formation, and (b) how contexts influence ethnic identity formation. Findings reveal that cumulative experiences over earlier developmental years resulted in resolutions to appreciate their ethnic identity at midlife. Increasing racial and ethnic diversity in the U.S., combined with the large number of aging Baby Boomers, necessitate recognition of the cultural and racial differences within the Baby Boomer generation. [ABSTRACT FROM AUTHOR]

Despite the documented and well-publicized health and well-being benefits of regular physical activity (PA), low rates of participation have persisted among American older adults. Peer-based intervention strategies may be an important component of PA interventions, yet there is inconsistent and overlapping terminology and a lack of clear frameworks to provide a general understanding of what peer-based programs are exactly and what they aim to accomplish in the current gerontological, health promotion literature. Therefore, a group of researchers from the Boston Roybal Center for Active Lifestyle Interventions (RALI) collaborated on this paper with the goals to: (a) propose a typology of peer-based intervention strategies for use in the PA promotion literature and a variety of modifiable design characteristics, (b) situate peer-based strategies within a broader conceptual framework, and (c) provide practice guidelines for designing, implementing, and reporting peer-based PA programs with older adults. We advance clarity and a common terminology and highlight key decision points that offer guidance for researchers and practitioners in using peers in their health promotions efforts, and anticipate that it will facilitate appropriate selection, application, and reporting of relevant approaches in future research and implementation work. [ABSTRACT FROM AUTHOR]

This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain. [ABSTRACT FROM PUBLISHER]

As the baby boomer generation ages, the need for laws to enhance quality of life for the elderly and meet the increasing demand for family caregivers will continue to grow. This paper reviews the national family leave laws of nine major OECD countries (Canada, Denmark, France, Germany, Italy, Japan, Netherlands, Spain, and the United Kingdom) and provides a state-by-state analysis within the U.S. We find that the U.S. has the least generous family leave laws among the nine OECD countries. With the exception of two states (California and New Jersey), the U.S. federal Family Medical Leave Act of 1993 provides no right to paid family leave for eldercare. We survey the current evidence from the literature on how paid leave can impact family caregivers' employment and health outcomes, gender equality, and economic arguments for and against such laws. We argue that a generous and flexible family leave law, financed through social insurance, would not only be equitable, but also financially sustainable. [ABSTRACT FROM AUTHOR]

The rapid aging of OECD country populations and the now five-year-long financial crisis in Europe are causing many OECD countries to reconfigure their assistance programs for the elderly, particularly their long-term care (LTC) policies. Debates about intergenerational responsibilities are evident in recendy published research papers that examine how countries are revising programs for the elderly. Building financial sustainability into program reforms has suddenly become a priority. Until just recendy, reform efforts focused on creating efficiencies and better quality of services. What emerges from the recent literature is a strong sense that the OECD countries are responding to the financial crisis and the rapid aging of populations in very similar ways. Given the countries' different histories of how they provide assistance to their elderly citizens, the convergence of policy responses is not something we might have foreseen. The United States could learn much from the OECD countries' choices. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to identify the characteristics of 260 adults, 65 and over, who applied for services through an Area Agency on Aging in a western state in the United States, and to determine the conditions that resulted in referral to the state-funded Home and Community Based Alternatives Program (Alternatives) or the Medicaid Aging Waiver (Waiver) program. Design/methodology/approach - The study was an exploratory one utilizing quantitative data from an existing database of older adults who sought home and community based services from Mountainlands Area Agency on Aging (AAA) between January 1, 2006 and December 31, 2007. Findings - Although most of the sample rived at or near poverty levels, results suggest that higher monthly income and riving alone predict referral to the Alternatives program, whereas greater need for assistance with bathing and performing heavy housework are the primary determinants of referral to the Medicaid Waiver program. Originality/value - This study adds to the body of knowledge concerning the characteristics of people who access home and community based services. Most people in this study, who were seeking assistance from public programs, were riving at or below the US Federal Poverty Line. One home and community based program was more likely to serve people who rived with others and had cognitive impairments, and referral to a Medicaid home and community based program was more likely for people who needed assistance with bathing and heavy housework. [ABSTRACT FROM AUTHOR]

Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to care, and are often a barrier to support and equality for minority communities. The 'conundrum of health disparities' refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans. [ABSTRACT FROM AUTHOR]

Informal care provided to the elderly by their children is proposed as a less expensive alternative to institutional long-term care. This paper explores how the elderly's consumption of medical care changes in response to changes in the informal care they receive from their children. Many earlier studies have ignored both the endogeneity of informal care and the complicated nature of health care utilization data. This paper develops a two-part model with informal care treated as an endogenous regressor and imposes exclusion restrictions on the selection process. The model is fitted using the Bayesian Markov Chain Monte Carlo (MCMC) methods, in particular the Gibbs sampler and the Metropolis-Hasting algorithm. The average treatment effects and the distributions of the treatment effects are obtained via posterior simulation. The results indicate that informal care provides a substitute for nursing home care and hospital inpatient care, but it does not affect paid home health care on average. The treatment effects are heterogeneous. The largest substitution effects occur for nursing home and hospital inpatient care at the intensive margin. The policy analysis suggests that informal care policies targeting the group that incurs the largest substitution effect may help to reduce government spending on Medicaid and Medicare. [ABSTRACT FROM AUTHOR]

The article discusses papers in the special issue of "Clinical Gerontologist," devoted to care concerns for elders in Korean and Korean American communities, including one about attitudinal differences between subgroups of Korean Americans dementia caregivers with regard to use of community services and an assessment of published research on strategies for recruitment of Korean and Korean Americans.

This paper reviews out-of-pocket (OOP) medical expenditure measures collected in the Health and Retirement Study (HRS). Medical expenditures are an important cost of poor health. Medical expenditure measures are important for understanding retirement decisions, financial preparation for retirement, and predicting the consequences of health care reform, particularly Medicare reform. Despite the comprehensiveness of the HRS, there are always limitations to what can be learned from population interviews. To assess the quality of current HRS measures of OOP spending, we compare various measures of OOP spending across survey waves to the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS), two surveys that expend considerable resources on measuring both OOP spending and total medical expenditures. Such comparisons make it possible to identify potential bias in the HRS data and to improve HRS measures of OOP. We find that the HRS produces good quality and useful data on OOP spending. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To improve the health, independence and quality of life of all older people, every older American should receive high quality, patient-centered care (AGS, 2010). With a changing demographic that is older and more diverse, especially of the older-old, along with greater use of clinical services by this fast-growing subset of older adults, a special focus and commitment to assure a well prepared workforce is urgently needed. However there currently exists a disconnect between the expanding health care needs of older adults, the educational institutions responsible for training health care providers and the entities paying for health care provider training.In this paper, we review several health professions' current readiness to address the care of a rapidly expanding older population. Emerging themes include: 1)insufficient numbers of prepared faculty; 2)lack of value placed on geriatrics where curriculum decisions are made; 3) the lower income of those working with older adults, despite added education and training; 4)a need for competencies to guide care so all health care providers are skilled in caring for older adults, and probably most importantly; 5)the need for a "business case" in care delivery showing how and why these competencies produce safer, quality and value-based care that also demonstrate economic effectiveness. The ultimate health and well-being of older Americans is a broad issue that needs system wide support by all committed to this aging and growing demographic. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to examine the relationship between health-related admission factors and post-hospital physical function at 3, 6, 9 and 12 months in older adult nursing facility residents. BACKGROUND: Physical functional decline is a significant health problem for older adults and has far-reaching effects. In particular, the immediate post-hospital period is a high-risk time, because shortened hospital stays make it likely that older patients are discharged in a state of incomplete recovery. METHOD: Data spanning from July 2002 to June 2005 were extracted from a comprehensive assessment tool, the Minimum Data Set, for 38,591 beneficiaries of a federal health insurance programme covering older adults in the Midwestern region of the United States of America. We investigated relationships between admission factors and post-hospital physical function at 3, 6, 9 and 12 months. The admission factors were health-related variables assessed at the time of skilled nursing facility admission from an acute care hospital. FINDINGS: The most important admission factors related to post-hospital physical function at 3, 6, 9 and 12 months were baseline physical function, urinary incontinence and pressure ulcer. Cognitive impairment at admission demonstrated a stronger relationship with poor physical function as resident length of stay increased. CONCLUSION: Nurses in skilled nursing facilities should screen post-hospital older adults for risk of physical functional decline at admission using identified admission factors. For continuous nursing care, older adults need to be assessed at least once a month during the first 3 months after hospital discharge. [ABSTRACT FROM AUTHOR]

Some workers today are caring for family members at both ends of the life span - children and elders. This first national study specifically of dual-earner couples in the sandwiched generation examined their prevalence and their work and family characteristics and outcomes. Couples who were married or living together for at least 1 year who met additional study qualifications were identified using computer-assisted telephone interviewing; both members of 309 couples from across the United States independently completed mail surveys. Screening results indicated that between 9% and 13% of U.S. households contain adults aged 30 or over who work and who provide care to both aging parents and children. This paper (a) presents an overview of existing literature concerning the sandwiched generation; (b) describes key characteristics and outcomes for dual-earner couples caring for children and aging parents; (c) compares the findings for husbands and wives; and (d) discusses the implications of these findings both for future research and for current practice by managers. [ABSTRACT FROM AUTHOR]

This paper examines how family friendly policies affect mothers' wages. Standard economic theory predicts that workers who desire family friendly policies would accept lower wages, all else equal. However, in the US labor market, the workers who have access to these policies tend to be in the higher-prestige and higher-earning occupations. This study examines the effects on wages of having had access to maternity leave and the ability to control one's schedule, using the Survey of Income and Program Participation. The present-day wages of mothers who were working prior to the birth of their first child and received pay during their maternity leave are 9 percent higher compared to other mothers, controlling for other personal and job-related characteristics. Mothers who report working their current schedule because it helps them address their caring responsibilities - child care, elder care, or care for a sick family member - do not suffer a wage penalty as a result. [ABSTRACT FROM AUTHOR]

This paper reports the results of a study that examined attitudes towards and strategies for providing family care for African American elders. The study utilized qualitative methodology to gather the data and a Kinscripts perspective as a framework through which to analyze the data. Specifically, this was a case study of one large, extended African American family which has its roots in a rural area of North Carolina. The study found a continued commitment to provide in family care for elders with an emphasis on spreading tasks across a broad range of family members rather than relying on a primary caregiver. [ABSTRACT FROM AUTHOR]

Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being. [ABSTRACT FROM AUTHOR]

The ‘sandwich generation’ has been conceptualised as those mid-life adults who simultaneously raise dependent children and care for frail elderly parents. Such a combination of dependants is in fact very unusual, and the more common situation is when adults in late mid-life or early old age have one or more surviving parents and adult but still partly dependent children. It can be hypothesised that for parents in this pivotal position, the demands from adult children and from elderly parents compete, with the result that those who provide help to one are less likely to provide help to the other. An alternative hypothesis, however, is that family solidarity has an important influence but is not universal, so that some pivotal-generation parents engage in intergenerational exchange in both directions, and there is a positive association between helping parents and helping children. To investigate this question, the paper presents an analysis of data from two broadly comparable national surveys, in Great Britain and the United States, on the care provided by women aged 55–69 years to their descendent and ascendent relatives. The results show that around one-third of the women reported providing help to members of both generations, and that around one-fifth provided support to neither. They broadly support the solidarity hypothesis, but provide some evidence that having three or more children is associated with a reduced likelihood of providing help to a parent. [ABSTRACT FROM AUTHOR]

This paper investigates the effect of health insurance on health and the use of health services by exploiting a change in insurance status that occurs for most Americans at age 65; that is, eligibility for the U.S. Medicare program. A regression discontinuity design is employed to identify discontinuities at age 65 in the relationship between age and access to care and health status, especially for groups more likely to be uninsured prior to age 65, such as those with less than a high school education or blacks and Hispanics. The paper focuses on the use of health services and health outcome related to breast cancer, a common cause of death among women, and one for which good access to early detection services is thought to significantly improve survival. Results show that the use of health services including mammography increases discontinuously at age 65, especially for women without a high school degree and for black and Hispanic women. A modest decrease in the probability of late-stage breast cancer diagnosis at age 65 is also found for white and Hispanic women. [ABSTRACT FROM AUTHOR]

Eldercare, like other forms of care work, is often taken for granted and undervalued. The burdens as well as the failures of providing care for the elderly are often borne disproportionately by women. This paper documents inequality of access and low quality of care for the elderly in the United States. It argues that public funds used to subsidize nursing homes are poorly spent and that profit-maximizing competition in the nursing home industry adversely affects the quality of care provided. In seeking to address these problems, policy-makers can learn important lessons from several different sources. The experiences of several European countries, current regulatory efforts in the state of Massachusetts, and more decentralized volunteer efforts to promote humane visions of eldercare all offer some hope for the future. [ABSTRACT FROM AUTHOR]