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A Village is a membership-driven organization based on neighbors helping neighbors age in place. Many Villages express difficulty maintaining membership and have concerns about sustainability. Drawing on socioemotional selectivity theory, we used qualitative and quantitative data from a representative survey of members of ShareCare (N = 91), the first known Village founded in 1994, to 1) identify members' motivations for joining ShareCare, and 2) examine the relationship between motivations for joining ShareCare and being a long-term member. Qualitative data revealed three motivations for joining ShareCare: instrumental, social, and altruistic. Long-term membership was operationalized as 8 years or more. Logistic regression models indicated that people with altruistic motivation were more likely to be long-term members compared to members without altruistic motivation. Instrumental and social motivations were not associated with long-term membership. Our findings inform recruitment and retention of members in Villages, and member-driven organizations for older adults more broadly.

Little research focuses on the mental health of caregivers (CGs) who stop providing care to their community-dwelling spouse. We examine depressive symptoms of former primary CG spouses who stopped caregiving over a two-year follow-up period when the care recipient (CR): (1) no longer has functional problems; (2) continues having functional problems; or (3) dies. Using data from the Health and Retirement Study (2000-2014), we located 2,370 couples who were both 50+ at baseline and where one partner provided help with ADL and/or IADL limitations but did not do so two years later. OLS regressions stratified by gender indicated that both male and female former spousal CGs whose CR died had significantly more depressive symptoms than those who ceased caregiving when their spouse did or did not still have functional problems. Former wife CGs who were older and whose husbands had more baseline ADLs had fewer follow-up depressive symptoms; wife CGs whose husbands had a nursing home stay had more depressive symptoms. Former husband CGs who had provided longer monthly hours of care had fewer follow-up symptoms. Findings underscore the importance of targeting mental and physical health services to both former caregiving husbands and wives, especially after spousal death.

Living in a neighborhood with dense HCBS organizations can promote older adults’ health and well-being and may mitigate health disparities generated by living in materially deprived urban neighborhoods. Using 2016 US County Business Patterns and the American Community Survey (2013–2017), focused on 516 ZIP Codes in Michigan Metropolitan Statistical Areas, this study examines the association between neighborhood characteristics and the relative density of businesses offering services for older adults and persons with disabilities (e.g., senior centers, adult day service centers, personal care) and businesses offering home health care. Results from a series of spatial econometric models show that social care organization density tends to be high in neighborhoods with a greater number of residents who have a bachelor’s degree, who are older, and who are in poverty. Home health care density was not explained by neighborhood factors. Multiple neighborhood socio-demographic indicators explain the spatial distribution of social care organizations.

Objectives: To identify the interrelations between the trajectories of social isolation and dementia in older adults. Methods: Data came from the National Health and Aging Trends Study 2011–2018 surveys. Group-based dual trajectory modeling was used to examine trajectories and their interrelations. Results: Four trajectories of social isolation—rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%) and dementia risk—persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%) emerged. Two-thirds of the low-risk dementia group were in the rarely isolated group. The high-risk dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). Conclusions: Social isolation and dementia mostly evolved in the same direction. However, the pattern of associations between these trajectories is intricate and may be reversed among long-term dementia survivors.

The nature of dementia care provided by social workers across various hospital settings is unexplored. This study utilized the “rigorous and accelerated data reduction” (RADaR) qualitative analysis technique to explore the process of care among social workers for persons with dementia (PWDs) across a Midwestern tertiary care system with two aims: 1) to identify environmental barriers and supports to quality dementia care in two hospital settings (medical and psychiatric emergency departments (ED), and the main inpatient hospital (IP)), and 2) to identify existing strengths and challenges to high quality social work dementia care within these settings. Twelve qualitative interviews were conducted with a purposive, snowball sample of social workers in dementia care in a large, academic health care system in 2016. Results identify environmental barriers in both settings (physical space design, patient-environment interactions, safety, and discharge disposition). Environmental aspects that promote quality care include supportive staff and family in the patient environment in the IP and ED hospital sections while the discharge disposition is more relevant in the IP. While there are some areas of social work involvement (discharge, psycho-social needs, treatment/management issues) that promote quality of care across locales, the pattern of performing roles varied, e.g. there is more focus on discharge planning and less management of competing demands in the IP than in the ED. Also, social workers were more involved in the diagnosis of dementia in the ED than other settings. We offer policy and practice recommendations to improve care for PWDs in academic hospital settings.

Membership is a critical feature of the survival of customer-driven organizations. As a membership-driven organization based on neighbors helping neighbors, many Villages express difficulty in having enough members and lack confidence in sustainability. This is the first study examining the association between length of membership and motivation for becoming a Village member. ShareCare, the first Village, was founded in 1994. We used an open-ended questionnaire to gather information from a representative sample of current Sharecare members (N=100). Three researchers were involved in coding responses with discrepancies resolved via collaborative discussion. Length of membership was categorized as: less than 10-years, and more than a 10-year membership. Motivations to join membership in ShareCare were categorized as: instrumental, social, and altruistic. We conducted three separate logistic regressions with covariates controlled to examine associations between length of membership and various motivations to become a ShareCare member. While the most frequent reason for joining was instrumental where the member would receive service (e.g., care coordination, and home visit), the least motivation for joining was altruism, where the member could help other members (e.g., running errand, and lawn care). More than a 10-year membership was not associated with social or instrumental motivation to join ([OR] 0.50, p = 0.27, [OR] 0.94, p = 0.95) whereas more than a 10-year membership was associated with altruistic motivation to join ([OR] 5.31, p = 0.02). Our findings provide guidance regarding motivating members to join and maintain membership in a consumer-driven organization.

This qualitative study explores the perspectives of aging mothers to understand the ways in which respect is experienced in relationships involving aging mothers and adult daughters with mental illness. Data came from audiotaped personal interviews with a purposive sample of 21 mothers (ages 52–90) of adult daughters with a serious mental illness. An interpretative phenomenological approach was used to analyze transcripts and identify the forms of respect described by aging mothers. Aging mothers and their daughters with mental illness experience multiple forms of respect; however, the meanings of respect vary by generation. These findings have practice, educational, and research implications for social workers serving aging families dealing with mental illness.

Objectives This study explored the process of care for persons living with dementia (PLWDs) in various care settings across a tertiary care system and considers challenges and opportunities for change. Design Aimed at quality improvement, qualitative interviews were conducted with key stakeholders in dementia care across geriatric outpatient clinics, medical and psychiatric emergency departments, and the main hospital in 2016. Setting and participants Forty-nine interactive interviews were conducted with a purposive and snowball sampling of health care professionals (physicians, nurses, social workers, administrators) and families in a large, academic health care system. Measures Qualitative interview guides were developed by the study team to assess the process of care for PLWDs and strengths and challenges to delivering that care. Results Key themes emerging from the interviews in each care setting are presented. The outpatient setting offers expertise, a multidisciplinary clinic, and research opportunities, but needs to respond to long waitlists, space limitations, and lack of consensus about who owns dementia care. The emergency department offers a low nurse/patient ratio and expertise in acute medical problems, but experiences competing demands and staff turnover; additionally, dementia does not appear on medical records, which can impede care. The hospital offers consultative services and resources, yet the physical space is confined and chaotic; sitters and antipsychotics can be overused, and placement outside of the hospital for PLWDs can be a challenge. Conclusions and implications Five key recommendations are provided to help health systems proactively prepare for the coming boom of PLWD and their caregivers, including outpatient education, a dementia care management program to link services, Internet-based training for providers, and repurposing sitters as Elder Life specialists.

Background and ObjectivesThere exists an imperative need to comprehensively evaluate the effectiveness of psychosocial interventions for Chinese geriatric populations’ mental wellbeing. This study conducted a systematic review and meta-analysis of psychosocial services for Chinese older adults’ depression and anxiety.Research Design and MethodsA search of nine electronic databases, five geriatric mental health journals, and reference lists was conducted for studies published between 1980 and April. 2018. Thirty-three studies (including totally 3,478 participants, 107 effect sizes) of true and quasiexperimental controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were geriatric depression and anxiety.ResultsAn overall significant treatment effect was identified for geriatric depression and anxiety (d = 0.577, 95% confidence interval [CI]: 0.288, 0.867, p < .001). Outcomes, geographic area, participants’ marriage, service setting, and types of control group were moderators for treatment effects. Subgroup analysis observed statistically significant effect size among studies in Taiwan, used innovative service methods and small group interventions. Both in-person, home-based interventions and interventions provided by nurse practitioners and specially trained providers were statistically significant.Discussion and ImplicationsPsychosocial services can benefit Chinese geriatric populations. Innovative and culturally relevant programs received strongest research supports. Future research should incorporate social interaction as an important component for serving Chinese older adults’ mental wellbeing.

The purpose of this study was to identify patterns of changes in social isolation and dementia and the interrelations between these developmental trajectories. The study sample included 7,609 Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study 2011 through 2018 surveys. A group-based dual trajectory modeling approach was used to identify distinct groups of developmental trajectories for social isolation and dementia status over the 8-year period. The dual model provided estimates of conditional and joint probabilities linking the two sets of trajectory groups. Changes in social isolation over an 8-year period followed four trajectories: rarely isolated (62.2%), steady increase (13.5%), steady decrease (7.4%), and persistently isolated (16.9%). Changes in dementia risk also followed four trajectories: persistently low risk (80.4%), increasing with early onset (3.9%), increasing with late onset (4.5%), and persistently high risk (11.2%). Over two-third (68%) of the persistently low dementia group were also in the rarely isolated group. Both increasing dementia groups were composed mainly of individuals from the increasing social isolation group (40-43%) and persistently isolated group (24-29%). The persistently high dementia group had the most overlap with the decreasing social isolation group (47%), followed by the persistently isolated group (28%). For the most part, social isolation and dementia evolve in the same direction for older adults over an 8-year period. However, the pattern of associations between these developmental trajectories is complex and may be reversed among long-term dementia survivors.

Older adults aging in place may experience social isolation. Participatory art programs can enhance social connectedness and confidence, thereby improving the health of older adults, but these programs are rarely created for low-income or marginalized older adults. A university social work department and community aging agency collaborated in establishing a professionally run theater group of older adults living in low-income housing in an urban area. The older adults attended a 12-week acting and improvisation skills class and performed a play. The original goal was for 30 residents to join the class but only 13 were recruited through the use of gift cards, presentations by community agency staff at the residences, and active engagement by the service coordinators. While the service coordinators attempted to recruit socially isolated residents, only 1 registered. The remaining members joined from general announcements. Attendance fluctuated over the duration of the class even with weekly reminder calls and letters, intercom announcements, and in-person conversations. Attendance ranged from 4–12 sessions. Pre and post data were gathered on measures of social connectedness including social isolation, community belonging, and social exclusion. Sense of community belonging increased for the participants, while the level of social exclusion remained the same. Results show that this type of activity is beneficial to residents who participate in the group but recruiting and sustaining participants in the class offers challenges. Ideas to address enrollment barriers as well as the role of the professionally trained teaching artist instructor in the maintenance of the program will be discussed.

Many older people want to age in place with one popular model of care being the Village Model. Understanding why people join and why they continue as members are important considerations for a Village to survive. Utilizing open-ended data from a representative sample of current members of a Village (N=100), we examined the reasons for people becoming members as well as continuing their membership. Twenty six percent of the sample were men, age ranged from 50-95, 30% lived alone and 58% believed that their health was very good. Data were coded by three researchers with discrepancies resolved by discussion to refine the codes. Three categories were identified: instrumental, social, and altruistic. The most frequent reason for joining was instrumental (35%) where the member wanted the services provided by the Village. It was also the most frequent reason for continuing membership (57%). An analysis was also conducted to examine predictors of reasons for joining and continuing membership in the Village. These included, age, gender, health, and living alone. Results indicate that men were less likely to join or continue their membership for instrumental reason compared to women, and members who live alone were more likely to become a member for social reasons. When age at entrance into the Village was examined, each increasing year of age was associated a .01 increase in the probability of continuing as a member for instrumental reasons. Findings provide guidance in issues related to sustaining membership in a Village.

Guided by a conceptual framework highlighting multiple facets of social relationships and social support, this study examined the extent to which aging mothers of adult daughters with a serious mental illness were socially integrated with members of their network. It further examined the relational content of these mothers’ social ties as tangible or intangible support and the nature of their supportive exchanges with network members, particularly their adult daughters with mental illness. A structured face-to-face interview was conducted with 22 aging mothers of these adult daughters. Two methods of analysis were used to analyze data: counting and content analysis. Findings showed aging mothers of daughters with mental illness were socially integrated with relatives and nonrelatives, evidenced relational content of tangible and intangible support in their social ties and engaged in bidirectional and asymmetrical support exchanges with network members, including their daughters with mental illness. These ...

Many older people want to age in place with one popular model of care being the Village Model. One main concern for this model has been sustainability. We examined factors that contributed to longevity in a current village that began in 1993. Utilizing administrative data over its 25-year history, data from a representative sample of current members (N=100), and board minutes and qualitative interviews with all board presidents, we explored the organizational dynamics involved in the formation and sustaining of the village, and the perceived impact on its members. Results identify organizational strengths of structure and management, fund raising and fee management as key factors in sustaining the village. Challenges include member recruitment, incorporating member feedback into service delivery strategies and fee structure. Perceived impact of the model on current members in the areas of service access, health quality, self-efficacy and social connectedness show age and gender variation. The youngest and oldest members reported improved quality of life following village membership. Women felt that they were better informed about service access issues and the oldest members felt the greatest increase in social connectedness. While the backbone of service delivery rests on members volunteering, women and the newest members were more likely to volunteer. Findings provide guidance to identify sustainability issues in the village model of care as well as factors that contribute to the impact of this model on its members.

Creative arts can promote social contact and possibly reduce isolation. A professionally run theater group comprised of low-income older adults met for 12 weeks to learn basic skills and perform a play. Using a pre-post questionnaire, data were gathered from the treatment group (n=14) who participated in the class and a non-participating comparison group (n=5) to identify potential program effects on measures of social isolation, community belonging, and social exclusion. Participants were African American living in low-income housing in an urban area. The average age of the sample was 65 years, 21% were men, 83% had at least high school degree, 71% reported good to excellent health, and 58% reported at least one ADL. Regression analyses showed that a sense of community belonging was significantly greater for the treatment group than the comparison group at time 2.This was not the case when considering social isolation or social exclusion. When controls were added (age, health, and previous theater experience), the significant difference remained with higher age predicting a sense of community belonging. The greater number of class sessions attended was also associated with a greater sense of community belonging for the treatment group. Through the shared experience of theater, participants can gain a sense of community, but this activity does not seem to be related to social isolation or social exclusion. It could be that theater participation fosters a sense of belonging due to group dynamics but is not a significant enough activity to reduce a sense of isolation or exclusion.

This paper focuses on 30 couples who received a pension and other services from two private trusts in Detroit, Michigan beginning in 1929 or 1930. Results of the qualitative analysis of case files, which contain notes recorded chronologically for 17 of the couples and then surviving spouses, provide a portrait of older couples' lives prior to a partner's death, circumstances surrounding the death, and changes in the social support systems of widows and widowers until their deaths. Close examination of the experiences of these couples is a reminder of how old age and widowhood were experienced prior to the enactment of public pensions and health insurance in the United States.

Objectives We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts. Method Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms. Results Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment. Discussion Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.

Few studies focus on the mental health of caregivers who stop providing care to their spouse. We know little about these caregivers. Building on Pearlin’s Stress Process Model, this study addresses depressive symptoms of primary spousal caregivers who stopped providing care at follow-up under three circumstances: (1) the care recipient (CR) continues to have functional problems; (2) the CR no longer has functional problems; and (3) the CR died. Using data from the Health and Retirement Study (2000–2014), we included 2,383 couples who were 50+ to identify the first instance of stopping spousal caregiving for ADL and/or IADL limitations over consecutive two-year periods. Results from OLS regressions (stratified by gender) indicate that both male and female former spousal caregivers whose CR died had significantly more depressive symptoms than those who stopped care when their spouse still had functional problems or no longer had such problems. While caregiver’s own baseline mental health and follow-up physical and mental health are associated with higher depressive symptoms for both genders, working for pay at follow-up is associated with lower depressive symptoms for both genders. For wife caregivers, those who were older and whose husband had more baseline number of ADLs had lower depressive symptoms, and those whose husband had a nursing home stay had higher depressive symptoms. For husband caregivers, those who provided longer weekly hours of care had lower depressive symptoms. Findings underscore the importance of targeting mental and physical health services to both husbands and wives after their spouse dies.

Social and built environments have been shown to influence cognitive functioning in older adults. Yet, few studies have addressed to what extent residence in neighborhoods with a greater density of social and institutional resources explains race/ethnic variations in cognitive decline. We use data from a three-year span of longitudinal assessments in older adults receiving state-funded home and community based services (enrolled in 2008 and 2012) in Michigan Metropolitan areas, merged with ZIP Code-level business patterns data (N=19,400). Cognitive performance was assessed by case workers using four items on the cognitive skills for daily decision-making scale. Results show that while baseline cognition was not different across race/ethnic groups, Blacks had more rapid decline in cognition than Whites (p

Few Korean studies have explored factors that influence depressive symptoms, a condition that is likely to increase with age. This study examines how worries, psychosocial resources, specifically family support, are related to depressive symptoms among a sample of the oldest old in South Korea. The buffering effects of psychosocial resources previously identified as reducing the impact of worries on depression in the younger old age group were also examined.Interviews were conducted with 213 community-dwelling oldest old in Seoul, Korea in 2007. 193 of these had children and were included in the analysis. Multiple regression analysis was used to test the hypotheses.Greater worries were significantly related to greater severity of depressive symptoms among South Korean oldest old. Psychosocial resources including mastery, emotional support from adult children, and instrumental support from adult children had main effects on depressive symptoms. Emotional support from adult children had a powerful buffering effect on the relationship between worries and depressive symptoms.Worries and certain aspects of social support are important in understanding the depressive symptoms of South Korean oldest old. Incorporating filial support into the development of services for this age group could be helpful to treating their symptoms of depression.

Although respect is a crucial aspect of social work practice, few studies have examined how social workers convey their respect for elderly clients. This study explored the various forms of respect demonstrated by social workers when they were with older clients. Fifty social workers serving elderly clients were surveyed by a questionnaire with closed- and open-ended questions. Based on data on the way the social workers respected their elderly clients, the study identified seven forms most frequently practiced and considered most important. They are linguistic respect, care respect, acquiescent respect, salutatory respect, presentational respect, spatial respect, and consultative respect. The key expressions of these forms are introduced in quantitative data and a narrative form. This finding provides insights as to how social workers exhibit respect for elderly clients in their practice. The results of this exploration may be useful in developing a more comprehensive typology of the forms signifying respect for elderly clients.

Peoples of East Asia—Chinese, Japanese, Koreans, and others-have long-established cultural approaches to showing respect to elders. Demographic and social changes, however, have affected the ability of the young to meet traditional expectations. Family sizes are much smaller than they once were, many young people live a distance from their parents, and a large number of women—traditional caregivers-work outside the family. Moreover, expectations of the young have been affected by their exposure to other cultures. In general, young people tend to prefer reciprocal patterns of mutual respect between generations. However, the values deeply rooted in their family systems and social structures are preserved even while the manifestation of these values is being modified. Thus, cultural influence persists; only the way of expressing respect is being modified.

Based on the premise that the experience of aging in place is different for vulnerable subgroups of older adults compared with less vulnerable subgroups, we focus on low-income older adults as a vulnerable subgroup and senior housing as an alternative to a conventional, private home environment. Using the 2008 and 2010 waves of the Health Retirement Study, regression models determined the impact of person–environment (P-E) fit between poverty status and residence in senior housing on self-rated health. Consistent with the environmental docility hypothesis, findings show that, among low-income individuals, the supportive environment of senior housing plays a pronounced compensating role and may be a key to successful adaptation in aging. As the first research effort to empirically demonstrate the positive health effects of senior housing among socioeconomically vulnerable elders, our findings provide a much-needed theoretical and practical underpinning for policy-making efforts regarding vulnerable elders.

This article discusses, from the grandmother's perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52-90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.

This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents’ depressive symptoms at follow-up, controlling for other factors identified in Pearlin’s stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings.

While a number of organizations and government entities have encouraged the development of more “age-friendly” environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health. Moreover, individual-level income and education no longer predicted self-rated health once age-friendly environment factors were taken into account. These findings highlight the need for more research documenting the effects of age-friendly environments, particularly across diverse contexts and populations.

With the emerging population of the oldest-old (those ages 85 and older), it is crucial to understand and prepare for their psychosocial needs. Worry is linked to psychological well-being and physical health, but little is known about the oldest-old's everyday worries. The authors explored four research questions: (1)What are the worries of the oldest-old? (2)What are their specific dimensions of worry? (3) How alike or different are the worry patterns over time? (4) What factors are related to variations in the pattern of change in worry? A convenience sample of 193 community-dwelling people ages 85 and older was recruited to examine various aspects of health and well-being between 1986 and 1995. This article reports on the survivors (N = 23) across three time points, waves 1,4, and 5. The findings suggest that the very old mainly worry about health and memory and that, although worry increased over the study period, there were variations in the pattern of worry over time. Results of t tests show that at wave 4 elderly respondents with a higher level of worry reported more frequent social contact than those with a lower level of worry. Implications for social work practice and future research are discussed. KEY WORDS: oldest-old; social support; very old; worry ********** Little is known about the lives of those who are very old, in particular, their everyday worries. Worry is among the more prevalent psychological conditions that people experience at all ages (Carmin, Pollard, & Gillock, 1999), conveying negative thinking about future events (Babcock, Laguna, Laguna, & Urusky, 2000), and it is associated with mental and physical well-being (Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki, Handen, & Morse, 1986). With many very old people facing diminishing physical and social resources, as well as uncertain futures because of advanced age, it would seem that they could have many things to worry about, but it is unclear what their worries are, what specifically contributes to them, and if these worries increase with advancing age. Most of the work exploring everyday worry has focused on young adults, but in recent years the topic of worry has emerged as a research area of interest among elderly people (Cappeliez, 1989; Powers, Wisocki, & Whitbourne, 1992; Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki et al., 1986). Research findings show there is age variation in degree of worry as well as content of worry. In general, older adults are relatively less worried than younger adults (Babcock et al., 2000; Powers et al., 1992). Babcock and associates suggested that there are a variety of reasons for this age variation. Younger adults are developmentally in a transition stage that may cause greater reason to worry. Older adults may be less willing to acknowledge problems dealing with stressful events and less likely to be in a state of ambiguity about their future. Also, older adults tend to experience various stressful situations as they age. Over time, elderly people might have learned better coping strategies to deal with worry more effectively, resulting in less worry than their younger counterparts. Research findings have also suggested that there are age differences in what people worry about. Powers and colleagues (1992) found that older adults expressed less worry about finances and social events than younger adults, whereas both age groups worried about health issues, although the specific dimensions of health were not identified. Similarly, Babcock and associates (2000) found that younger adults were more worried than older adults about work, relationships, and finances. Less is known about degree of worry and content of worry among the oldest-old. A study examining worry among the oldest-old reported that the greatest worries among oldest-old subjects were related to their health and functioning, such as concerns about falls, not having enough energy, or forgetting things (Dunkle, Roberts, & Haug, 2001). …

Using the Andersen-Newman model, we investigated the prevalence of activities of daily living (ADLs) limitations in married couples, and couple characteristics associated with ADL help-receipt. In this sample of 3,235 couples age 65+ in the 2004 Health and Retirement Study, 74.3%, 22.1%, and 3.6% were couples in which neither partner, one partner, or both partners had limitations, respectively. Logistic regression results indicate that help-receipt was associated with certain health needs in the couple, but not with their predisposing characteristics or enabling resources. Social workers could target couples most in need of assistance by assessing both partners’ health problems.

Composition of caregiver networks (spouse only vs. others) for assistance with personal care limitations (ADLs) was examined in the AHEAD nationally representative sample of 215 elderly couples, using logistic regression. Findings showed network expansion beyond the spouse was influenced by a poor fit between solo spousal caregivers and caregiving tasks: Expanded networks were more likely when help recipients had numerous health problems (p< .01) and ADL limitations (p= .063), and when spouses had any ADL limitations (p< .01). Expanded networks were also likely when couples included the wife as help recipient (p< .05), were Black (p= .075), and were in lengthy marriages (p< .05). Implications for theory, research, and family policy and practice are discussed.

Sources of social support for 24 widowed, “worthy” elderly men who were clients of a privately funded foundation in Detroit, Michigan, beginning in 1929 or 1930 until their deaths are described. Beginning with the application for admission, each man's file documents delivery of services in notes recorded each time he had contact with anyone in the foundation. Letters written by and about a man were also kept in his file as well as reports from physicians and other health professionals who treated him. Sources of support for the widowers were fourfold: kin, friends, proprietors of the various residences in which they lived, and the social workers employed by the foundation. The use of each type of support is described. In the final section of the paper, general themes of support are placed in an historical context.

Racial/ethnic variations in instrumental activities of daily living (IADL) caregiver network composition were examined in a nationally representative sample of elders, using task specificity and hierarchical compensatory theoretical perspectives. Logistic regressions tested network differences among White, Black, and Mexican American elders ( n = 531 married, n = 800 unmarried). Findings concerning racial/ethnic differences were partially dependent on marital status, differentiation of spouses from other informal helpers among married elders, and which racial/ethnic groups were compared. Networks including formal caregivers did not differentiate married or unmarried Black from White elders but were more common among unmarried Mexican American elders than for comparable White and Black elders. Married Black elders with solely informal networks were more likely than comparable White elders to have informal helpers other than the spouse. Racial/ethnic similarities and differences in caregiver networks are discussed relative to their sociocultural context, including marital status, elder’s and spouse’s health, and financial resources

Little is known about the cross-sectional or longitudinal relationships between body weight and health at older ages. Using multilevel modeling analyses, this study examined the trajectories of body mass index (BMI), chronic health conditions (CHC), and functional disability (FD); factors associated with the trajectories; and the relationships between the trajectories. The sample of elders aged 65 and older participated in the Americans Changing Lives longitudinal study. Participants showed decreasing BMI and increasing CHCand FD with time. Current smokers presented lowerBMI at Wave 1 and showed a slower decrease inBMIover time than those who never smoked. Obesity was associated with more CHC and greater FDatWave 1 but did not influence their changes. Elders who experienced a slower decrease in BMI showed a slower increase in CHC and FD; the change in health was not related to the change in BMI.

This study explores variables that influence worry and parent contact among senior military officers who face frequent moves, restricted housing, and overseas assignments, and who have been geographically separated from their parents most of their adult lives. Data on predictors of officer worry and parent contacts were collected from 277 senior ranking male officers (40 to 49 years old). A structural equation model of worry and parent contact among male officers showed that previous parental illness, parent’s age, and the tendency among officers to have an angry temperament increased their worry. Conversely, number of siblings and satisfaction with a “parent care plan” decreased worry about parents. Number of siblings also decreased contact with parents. Quality of interpersonal relationships and branch of service (Army and Marine Corps) increased contacts with parents. This research underscores the importance of examining the invisible “anguish” of adult sons who are precluded from visiting their parent...

Framed by Pearlin’s Stress Process Model, this study prospectively examined the effects of three primary stress factors reflecting the duration, amount, and type of care (ADL, IADL, both) on the depressive symptoms of spousal caregivers over a two-year period. This study also measured whether the effects of these stressors differ between husbands and wives. We analyzed data from the 2004 and 2006 waves of the Health and Retirement Study, a nationally-representative sample of adults ages 50 and over in the U.S. The analytic sample included 774 community-dwelling respondents who were married/partnered and providing help to their spouses for Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs). We used multivariate regression models to examine the direct effects of primary stressors on depressive symptoms among the total sample and for husbands and wives. We found that none of the primary stressors were associated with depressive symptoms within the total sample. However, when examining these issues for husbands and wives, wives providing only personal care (ADLs) had significantly more depressive symptoms than wives providing only instrumental care, while husbands providing different types of care showed no significant differences in depressive symptoms. We conclude that wife caregivers’ increased vulnerability to depressive symptoms when providing personal care may reflect different gender roles in caregiving. Future studies that directly address couples’ relational dynamics and gendered experiences in personal care, including emotion work, may further illuminate strategies for reducing depressive symptoms experienced by wife caregivers engaged in personal care assistance.

Currently there is limited evidence linking age-friendly characteristics to outcomes in elders. Using a representative sample of 1,376 adults aged 60 and older living in Detroit (MI, USA), this study examined the association between age-friendly social and physical environmental characteristics and the expectation to age in place, and the potential differences between low- and higher-income elders. Based on U.S. Environmental Protection Agency's (EPA) age-friendly guide, we identified six factors reflecting age-friendly characteristics. Logistic regression models indicated that regardless of income level only neighborhood problems were significantly associated with expecting to age in place. Low-income elders were more likely to expect to age in place than their higher-income counterparts, and it is unclear whether this resulted from a desire to remain in the home or that there is no place else to go. Future research should address the ways in which financial resources affect the choices, expectations, and outcomes of aging in place. Language: en

The purpose of the current study was to compare the association between caregiver background characteristics and care recipients’ behavioral and psychological symptoms of dementia (BPSD) in Black and White community-dwelling family caregivers. Using logistic regression models, caregiver/care recipient dyad data from the Aging Demographics and Memory Study were used to describe associations between caregiver background characteristics (i.e., demographic and socioenvironmental variables) and care recipients’ BPSD (i.e., hallucinations, delusions, agitation, depression) ( N = 755). Results showed that Black caregivers were more likely to be female, younger, an adult child, have less education, and live in the South ( p ≤ 0.05); they were less likely to be married. Several caregiver background characteristics were associated with care recipients’ depression and agitation, but not with other BPSD. Caregiver background characteristics may play a role in the recognition and reporting of BPSD and should be considered when working with families of individuals with dementia. [Res Gerontol Nurs. 2015; 8(4):179–187.]

This study examines how the Medicare Part D coverage gap impacts non-dually eligible older adults with a mental illness. Qualitative, semistructured interviews were conducted with 11 case managers from community-based agencies serving persons, age 55 and over, with a mental disorder. Five themes illustrating the central difficulties associated with the Part D gap emerged: medication affordability, beneficiary understanding, administrative barriers, Low-Income Subsidy income and asset guidelines, and medication compliance. Although the Patient Protection and Affordable Care Act gradually reduces cost sharing within the gap, findings suggest that medication access and adherence may continue to be impacted by the benefit's structure.

Issues related to psychological recovery following coronary bypass surgeries (CABG) have emerged in recent years. Other research has shown the effects of spiritual or religious activities on health and aging. However, little is known about the relationship of spiritual coping, including religious coping, to post-CABG adjustment. This study addressed multifactorial determinants of postoperative psychological recovery and the effects of private prayer, a form of spiritual coping, on the recovery of 151 older patients. Results show that most patients pray about their postoperative problems and that private prayer appears to significantly decrease depression and general distress one year post-CABG.

This research examined the role of self-care behavior of 151 patients (aged 40 to 80) on general psychological distress at one year after coronary artery bypass graft (CABG) surgery. A tested hypothesis was that self-care practices would be associated with a lower level of distress one year after surgery. The results supported the beneficial effect of self-care on psychological adjustment, after controlling for the effects of the number of other chronic illnesses and post-CABG depression. The findings suggest that social work in health care and in-home care may help promote the psychosocial recovery process following surgery.

This research investigated gender differences in psychological adjustment among patients (112 males, 39 females) one year after coronary artery bypass graft surgery (CABG). Information regarding post-CABG depression, non-cardiac chronic conditions, and socioeconomic variables were obtained from a survey. Additional cardiac, surgical, and demographic data were retrieved from a hospital computer database. Women were more likely than men to experience postoperative depression, attributable to their poor health. Depression one year post-CABG was predicted by non-cardiac chronic illnesses, postoperative fatigue and shortness of breath and socioeconomic status.

The social networks of older individuals reflect personal life history and cultural factors. Despite these two sources of variation, four similar network types have been identified in Europe, North America, Japan, and China: namely 'restricted', 'family', 'friend', and 'diverse'. This study identified the social network types of Korean older adults and examined differential associations of the network types with well-being.The analysis used data from the 2008 wave of the Korean Longitudinal Study of Aging (KLoSA: N = 4251, age range 65-108). We used a two-step cluster analytical approach to identify network types from seven indicators of network structure and function. Regression models determined associations between network types and well-being outcomes, including life satisfaction and depressive symptomatology.Cluster analysis of indicators of network structure and function revealed four types, including the restricted, friend, and diverse types. Instead of a family type, we found a couple-focused type. The young-old (age 65-74) were more likely to be in the couple-focused type and more of the oldest old (age 85+) belonged to the restricted type. Compared with the restricted network, older adults in all other networks were more likely to report higher life satisfaction and lower depressive symptomatology.Life course and cohort-related factors contribute to similarities across societies in network types and their associations with well-being. Korean-specific life course and socio-historical factors, however, may contribute to our unique findings about network types.

Objectives: To examine the factors associated with urban African American elders’ utilization of home and community-based services and explore whether these factors differ by category of service. Methods: Data came from a representative sample of 1,099 African American older adults living in Detroit. Logistic regression models were used to explore the predisposing, enabling, and need factors associated with any service use and five categories of service use: in-home care, household services, functional care, out-of-home services, and financial/legal services. Results and Discussion: Findings suggest that previous studies using the Andersen model may not be generalizable to an urban African American population. Service use was related primarily to enabling resources, particularly in terms of financial resources, not driving a car, and social resources and support. Future research should further examine the facilitators and barriers to service use by urban African Americans to improve their access to care.

Accurate conceptualization and measurement of age-friendly community characteristics would help to reduce barriers to documenting the effects on elders of interventions to create such communities. This article contributes to the measurement of age-friendly communities through an exploratory factor analysis of items reflecting an existing U.S. Environmental Protection Agency policy framework. From a sample of urban elders (n =1,376), we identified six factors associated with demographic and health characteristics: Access to Business and Leisure, Social Interaction, Access to Health Care, Neighborhood Problems, Social Support, and Community Engagement. Future research should explore the effects of these factors across contexts and populations.

Managed care increases the demand for efficient and accountable medical care and emphasizes the role of the primary care system. In a managed care network, health care providers are challenged to identify accurately and rapidly a variety of health problems. At the same time there is growing recognition of the need to go beyond individual symptoms to identify potential comorbid problems, levels of client functioning, and quality-of-life issues (Schulberg, 1995). These problems occur within the context of growing evidence that mental health problems tend not to be identified in the primary care system (Schulberg, 1991), although people with mental health problems are more likely to be treated in the general health care system than by specialized mental health services (Barker et al., 1992). Mental health problems like depression can also contribute to serious impairment in functioning (Wells et al., 1989; Williams et al., 1995). In the demand for greater accountability, social workers have not historically played a prominent role in the outcomes research movement. Increased concerns about patient outcomes and costs now act as major incentives for all health care professionals to move in this direction. To meet these challenges tools for assessment and outcome evaluation are being designed or upgraded for use in general medical care. These tools are designed to enable health professionals to gain a more accurate picture of the mental health, functional ability, and quality of life of individuals. This article describes three tools that can be used by social workers and other health professionals for that purpose: the Primary Care Evaluation of Mental Health Disorders (PRIME-MD), the Older Americans Resources and Services Questionnaire (OARS), and the Short Form 36 (SF-36) Health-Related Quality-of-Life Measure. PRIMARY CARE EVALUATION OF MENTAL HEALTH DISORDERS (PRIME-MD) PRIME-MD was designed to diagnose mental health problems in the primary care sector. It targets five basic areas common in the general population and primary care: mood, anxiety, somatoform, and eating disorders and alcohol abuse. The instrument consists of two basic components: a one-page questionnaire (PQ) completed by the patient before seeing the health providers and a 12-page clinician evaluation guide (CEG). The PQ consists of 26 questions regarding physical symptoms and mental health problems. The CEG is a structured interview form that the clinician uses to follow up on positive responses on the PQ. The instrument can be used flexibly. It can be incorporated into routine protocol or as a diagnostic tool with people in whom mental health problems are suspected or who pose management problems. The clinician can decide to follow up with only the elements of the CEG triggered by the PQ or to pursue other areas as well. Using the five basic categories, the clinician can determine the presence or absence of 18 diagnostic categories that correspond to nine specific DSM-IV (American Psychiatric Association, 1994) categories: major depression, partial remission or reoccurrence of major depressive disorder, dysthymia, panic disorder, generalized anxiety disorder, bulimia nervosa, multisomatoform disorder, somatoform pain disorder, and hypochondriasis. Another six are viewed as "subthreshold" because they meet fewer criteria than are required for DSM-IV diagnosis: anxiety disorders not other specified (NOS), somatoform disorder NOS, eating disorder NOS, minor depressive disorder, and binge eating disorder; alcohol dependence is also included in this group because further information is typically required. PRIME-MD has proved an appropriate screening tool for adults ranging from 18 to 91, for both men and women, and for those with different educational levels and belonging to different racial and ethnic groups. The instrument compares favorably with diagnostic interviews by trained mental health providers, especially for the two important problems of major depression and panic disorder. …

Gays and Lesbians Older and Wiser (GLOW), a support group sponsored by a geriatric medical clinic in the midwest, is described. GLOW has been meeting monthly for 7 years. Scheduling, professional involvement, and special attention to social support seem critical for the group's success. Older gay men and lesbians often have unique support needs that may not be met by either general services to the elderly or by gay organizations, which typically cater to a younger population. We conclude that carefully designed support groups can meet some support needs for this older population.

The purpose of this pilot study was to assess the attenuating effects of physical, psychological, and social resources on the relationship between stress and mental health among the oldest old. Physical resources include perceived health and independence in functional and instrumental activities of daily living, while psychological resources include mastery, self-esteem, and coping. Social resources are measured by frequency of social interaction and size of the social network. Among the 124 women and 31 men (M = 89 years), greater independence in IADLs and greater perceived control of events significantly attenuated the adverse effects of strain on psychological well-being.

The authors explored whether gender moderated the influence of other factors on solo spousal caregiving. The subsample ( n = 452) from the Asset and Health Dynamics Among the Oldest Old study included elderly care recipients (CRs) receiving assistance with instrumental activities of daily living (IADLs) and their spouses. Logistic regression was used to model the likelihood of solo spousal IADL care. Gender moderation was tested by product terms between CRs’ gender and measures of partners’ health, potential helpers, and sociodemographic characteristics. As numbers of CRs’ IADLs and couples’ proximate daughters increased, wives less often received care solely from their husbands, but husbands’ receipt of care from their wives was unaffected. Age differences between spouses and CRs affected solo spousal caregiving to wives and husbands in opposite ways. Regardless of gender, CRs’ numbers of limitations in activities of daily living and spouses with limitations in IADLs or activities of daily living reduced the likelihood of solo spouse care. Identifying circumstances influencing solo spouse caregiving differently among couples with frail wives and husbands facilitates gender-sensitive services.

Research on families dealing with mental illness has considered either positive or negative aspects of intergenerational family relationships. The current study extends this work by using intergenerational ambivalence theory to examine aging mothers’ contradictory expectations toward adult daughters who are mentally ill. This study focuses on interviews obtained from a sample of 22 mothers aged 52–90 who expressed considerable sociological ambivalence in relation to their grown daughters. Four strategies of managing ambivalence are identified: excusing behaviors, reducing expectations, adjusting help-giving, and confronting. The implications are that practitioners should be aware of intergenerational ambivalence, help aging parents identify their ambivalence management strategies, and assess the extent to which these strategies are adaptive. Future research directions in this area are also discussed.

This article draws on data collected from a very old parent and two of her or his adult children in 20 older families to show how different strategies for analyzing data produce different images of families. The findings produced by means of five different analytical techniques are presented and compared. The degree to which each captures the reality of these older families is evaluated. The intent of the article is not to present findings but to show how different methods of data colletion and anlaysis create different images of older families.