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The purpose of this study was to gauge the impact of social embarrassment on caregivers of Alzheimer's patients. Two hypotheses were tested: First, social embarrassment adds a unique component of distress to caregivers of Alzheimer's patients, controlling for other factors known to cause depression; second, the negativity of the embarrassment varies according to the caregiver's race/ethnicity. Using data from the Alzheimer's Disease Demonstration Grants to States program ( N = 1,183), the caregiver's perceived depression was regressed on culturally situated variables and a set of covariates that included characteristics of both caregiver and care receiver. Results indicate that social embarrassment exerts a substantial effect on caregiver depression, but the effect does not vary meaningfully across cultural groups. In addition to social embarrassment, the health of the caregiver, the certainty of the Alzheimer's diagnosis, and the caregiver's perceived duty to care all uniquely contribute to the caregiver's level of depression.

This study examined whether a reciprocal relationship exists between measures of self-assessed global health and depressive symptoms, net of covariates that included chronic illness, functional disability, education, income, gender, race, and age. Analyses of five waves of data from the Rand version of the Health and Retirement Survey (N=7,475), using an autoregressive, cross-lagged panel design, indicated that self-assessed overall health had a modest but statistically significant and consistent effect on depressive symptoms. In contrast, the level of depressive symptoms had a statistically nonsignificant effect on self-assessed health. There has been growing interest in identifying the factors that inform self-assessments of overall health. The present findings indicate that self-assessed global health is not simply a manifestation of depressed affect.

Objectives: To examine the potential facilitators of or deterrents to end-of-life planning for community-dwelling older adults, including personal (health-related and sociodemographic) and social (physician and family) influences. Design: In-person interviews with older adults, telephone interviews with physicians and family members. Setting: Cleveland, Ohio. Participants: Two hundred thirty-one adults aged 65 to 99 who were aging in place, 99 of their primary care physicians, and 127 of their family members. Measurements: Questions assessing older adults' discussions with others about end-of-life plans, implementation of advance directives, and physical (Older American Resources and Services) illness index and mental (Short Portable Mental Status Questionnaire) health status. Results: Just fewer than half of older adults had executed an advance directive and discussed their wishes with others. Only personal characteristics of elderly individuals were related to end-of-life plans, with whites, unmarried individuals, and younger adults more likely to have made preparations. Older adults' health status, as evaluated by the patient, physician, and caregiver, did not relate to the tendency to have made advance care plans. Older adults' family members were much more likely to report knowledge of advance care plans than were physicians. Conclusion: These findings suggest that many physicians are not talking with their patients about their end-of-life wishes. Furthermore, the propensity to have such discussions may relate more to the personal preferences and level of comfort of patients, physicians, and family members than on the health status of the older adult.

Maintenance of functional health and high quality of late life are crucial concerns for gerontologists and health researchers, as rapidly growing numbers of very old adults face the challenges and opportunities of increasing longevity and frailty in the twenty-first century (Atchley, 1995; Institute of Medicine [IOM], 1991). The present formulation outlines how older adults of tomorrow can enhance their own quality of life through a broad array of proactive adaptations. By recognizing and accepting older adults’ right to, and preference for, proactive involvement in shaping their own destiny, we can make important strides toward facilitating elders’ successful ageing. Successful ageing, based on our model, is an attainable goal within reach of even those aged traditionally relegated to ranks of passive and stigmatized recipients of care.

Caregiver burden is one of the most commonly used variables in caregiving research, both as a predictor and as an outcome. It has been suggested that caregiver burden can be measured in terms of discrete dimensions of well-being and that burden and well-being represent opposite sides of the same coin. The goal of this study was to explore this issue further by comparing commonly used dimensions of burden with parallel dimensions of well-being, both as outcome variables and as predictors of other outcomes, in a sample of caregivers. The findings suggest that burden may tap a unique domain of caregiving outcomes that is not represented by more objective indicators of these effects. Dismissing burden as an unnecessary or redundant construct seems premature.

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care. Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.

Background Falls are common in community-dwelling elderly persons and are a frequent source of morbidity. Simple indices to prospectively stratify people into categories at different fall-risk would be useful to health care practitioners. Our goal was to develop a fall-risk index that discriminated between people at high and low risk of falling. Methods We evaluated the risk of falling over a one-year period in 557 elderly persons (mean age 81.6) living in a retirement community. On the baseline interview, we asked subjects if they had fallen in the previous year and evaluated risk factors in six additional conceptual categories. On the follow-up interview one year later, we again asked subjects if they had fallen in the prior year. We evaluated risk factors in the different conceptual categories and used logistic regression to determine the independent predictors of falling over a one-year period. We used these independent predictors to create a fall-risk index. We compared the ability of a prior falls history with other risk factors and with the combination of a falls history and other risk factors to discriminate fallers from nonfallers. Results A fall in the previous year (OR = 2.42, 95% CI = 1.49-3.93), a symptom of either balance difficulty or dizziness (OR = 1.83, 95% CI = 1.16-2.89), or an abnormal mobility exam (OR = 2.64, 95% CI = 1.64-4.26) were independent predictors of falling over the subsequent year. These three risk factors together (c statistic =.71) discriminated fallers from nonfallers better than previous history of falls alone (c statistic =.61) or the symptomatic and exam risk factors alone (c statistic =.68). When combined into a risk index, the three independent risk factors stratify people into groups whose risk for falling over the subsequent year ranges from 10% to 51%. Conclusion A history of falling over the prior year, a risk factor that can be obtained from a clinical history (balance difficulty or dizziness), and a risk factor that can be obtained from a physical exam (mobility difficulty) stratify people into groups at low and high risk of falling over the subsequent year. This risk index may provide a simple method of assessing fall risk in community-dwelling elderly persons. However, it requires validation in other subjects before it can be recommended for widespread use.

This research compared attitudes of 143 nursing home employees toward three hypothetical target groups of older adults: well elderly persons, physically ill elderly persons, and elderly persons with Alzheimer's disease. Staff provided successively less positive evaluations of physically ill elderly persons and elderly persons with Alzheimer's disease compared to well elderly persons. Age, education, and contact with grandparents differentially predicted positive evaluations toward well and physically ill older adults. Self-efficacy was a significant predictor of positive evaluations across all target groups. Findings suggest that interventions designed to increase staff members' feelings of self-efficacy may lead to more positive evaluations of elderly clients and, ultimately, improved quality of care.

Objectives We used McCubbin's Resiliency Model of Family Stress, Adjustment and Adaptation ( McCubbin, Thompson, & McCubbin, 2001) to examine how demographic factors, family stress, grandmother resourcefulness, support, and role reward affect perceptions of family functioning for grandmothers raising grandchildren, grandmothers living in multigenerational households, and grandmothers not caregiving for grandchildren. Methods A sample of 486 grandmothers completed a mailed questionnaire. We used structural equation modeling to (a) test the effects of demographic factors (i.e., grandmother's age, race, marital status, and employment), family stressful life events and strain, grandmother's resourcefulness, subjective and instrumental support, and role reward on perceptions of family functioning for each grandmother group; (b) evaluate differences in the measurement and structural models between the grandmother groups using multisample analysis; and (c) test the model on the full sample, coding for caregiver status. Results The models did not differ significantly by grandmother group; therefore we assessed the composite model using a multisample analysis. We found general support for the resiliency model and equivalence of the models across grandmother groups. Less support, resourcefulness, and reward, and more intrafamily strain and stressful family life events contributed to perceptions of worse family functioning. Discussion Findings demonstrate the importance of the quality of family functioning for grandmothers in all types of families.

There is a need to understand the variables that influence the illegal behavior of older persons, and whether these predictors differ from those of younger age groups. This article attempts to address these issues through a review of the relevant literature. An analysis of elderly-specific theories of crime provides few suggestions where one might anticipate different predictors for older versus younger persons. And a comparison of research on youths with results from surveys of the general population indicates that the causes and correlates of crime generally do not change as individuals grow older.