Informal and formal support among community-dwelling Japanese American elders living alone in Chicagoland: an in-depth qualitative study

Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial

BACKGROUND

In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only.

METHODS

A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data.

RESULTS

Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention.

CONCLUSION

Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention.

TRIAL REGISTRATION

This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.

Effect of Social Determinants of Health Interventions on Adults Living with Disabilities: A Scoping Review

OBJECTIVE

To investigate social determinants of health (SDoH) interventions on individual health outcomes, population health, and cost for persons in the United States over age 18 living with disabilities and receiving long-term services and supports (LTSS) in noninstitutional settings.

DATA SOURCES

A review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted of literature from PubMed, PsycINFO, REHABDATA, and Web of Science Core Collection published between January 1997 and July 2020.

STUDY SELECTION

Search terms were based on the primary SDoH domains identified by the Centers for Medicare and Medicaid's Accountable Health Communities Model. A total of 5082 abstracts were screened based on identification criteria of persons age 18 and above living in non-institutional, community-based settings receiving LTSS.

DATA EXTRACTION

During Level 2 review, articles were reviewed based on population focus, type of LTSS (personal assistance services, home care, adult day care, home modification, durable medical equipment, community transition services, caregiver supports and/or prevention services related to home- and community-based care), SDoH intervention and association with health outcomes, population health and/or cost. A total of 1037 abstracts underwent Level 2 review, yielding 131 publications or 1.3% for full review.

DATA SYNTHESIS

Studies (n=33) designed a priori to test outcomes of interventions were rated according to Grading Recommendations Assessment Development and Evaluation (GRADE) criteria. Qualifying articles that did not include interventions (n=98) were included in our summary of the literature but were not assessed by GRADE.

CONCLUSIONS

The preponderance of research surrounding SDoH and health outcomes has focused on older adults living with disabilities, and most interventions scored low or very low using GRADE criteria. Evidence is limited to the extent SDoH interventions are measured against outcomes for persons of all ages living with disabilities. Robust evaluation of models that feature SDoH interventions in partnership with community-based organizations is recommended as home and community-based care infrastructure expands in response to the American Rescue Plan Act of 2021.

A Study on Supply-Demand Satisfaction of Community-Based Senior Care Combined with the Psychological Perception of the Elderly

Based on Maslow’s hierarchy of needs theory and customer satisfaction theory, we constructed a satisfaction model for supply–demand satisfaction for community-based senior care (SSCSC) combined with the psychological perspective of the elderly, and four dimensions of basic living needs (BLNs), living environment (LE), personal traits (PTs), and livability for the aged (LA) were selected to construct the model. The data were obtained from 296 questionnaires from seniors over 50 years old (or completed by relatives on their behalf, according to their actual situation). Twenty-two observed variables were selected for the five latent variables, and their interactions were explored using structural equation modeling. The results showed that LA was the most significant factor influencing SSCSC, and it was followed by BLNs and LE. PTs did not show a direct effect on LA, but they could have an indirect effect on SSCSC through influencing BLNs and LE. Based on the current state of community aging satisfaction, we propose to establish a community elderly care service system based on the basic needs of the elderly population, providing differentiated and refined elderly care services and improving the level of aging-friendly communities. This study provides references for the government to formulate relevant policies and other supply entities to make strategic decisions and has important implications for further enhancing community elderly services to become an important part of the social security system for the elderly.

The barriers and enablers to service access for older women living alone in Australia

Older women living alone are at risk of being socially and financially disadvantaged, which impacts their wellbeing. Currently there is a significant gap in knowledge relating to older women living alone. This study aimed to identify the barriers and enablers to service access in this group. We undertook a qualitative study comprising semi-structured interviews in metropolitan Melbourne, Australia. Thematic analysis was conducted to elucidate key themes. Thirty-seven women were interviewed between May and August 2017. Six key themes were identified: financial; mental and emotional health; mobility and ability; transport; social connections; and knowledge. Access issues for older women living alone are multifaceted and interconnected. Barriers and enablers to service access, as well as their intersections with gender and living situation, should be considered in service design and re-design.

Getting Old Well in Sub Saharan Africa: Exploring the Social and Structural Drivers of Subjective Wellbeing among Elderly Men and Women in Uganda

While literature attempts to explain why self-reported subjective wellbeing (SWB) generally increases with age in most high-income countries based on a social determinants of a health framework, little work attempts to explain the low levels of self-report SWB among older persons in sub-Saharan Africa. Using the 2013 Uganda Study on Global Aging and Health with 470 individuals, this research examines (i) direct and indirect effects of age on SWB through social and structural determinants, and (ii) how direct and indirect effects vary by gender. Results show a significant direct and negative effect of age on SWB (β = 0.42, p = 0.01). Six indirect paths were statistically significant and their indirect effects on wellbeing varied by gender. Providing support, education, working status, asset level, financial status and financial improvement were significantly positively associated with men’s SWB, whereas younger age, providing community support, participating in group activities, number of close friends/relatives, government assistance and all socio-economic variables were significantly positively associated with women’s SWB. Strategies to address gendered economic, social and political inequalities among and between elderly populations are urgently needed.

A new conceptual model of experiences of aging in place in the United States: Results of a systematic review and meta-ethnography of qualitative studies

OBJECTIVES

The purpose of this systematic review was to synthesize the evidence on experiences of aging in place in the United States.

DESIGN

Systematic review and meta-ethnography of qualitative studies.

DATA SOURCES

We searched six bibliographic databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, Sociological Abstracts), with no limits on publication date. Eligible studies reported peer-reviewed qualitative research on experiences of aging in place in the United States with full-text available in English.

REVIEW METHODS

Three reviewers independently used Covidence software to screen titles and abstracts followed by full texts. We assessed quality and risk of bias using a modified version of the Joanna Briggs Institute Checklist for Qualitative Research. Qualitative data analysis was conducted using meta-ethnography, following Noblit and Hare's seven-step method of translation and synthesis to generate a novel conceptual model.

RESULTS

Of 2659 papers screened, 37 unique studies were eligible for inclusion, reported in 38 publications. The studies were conducted in 16 states and published between 1994 and 2018. The included samples represented 1199 participants in total, with mean ages ranging from 48 to 91 years. The gender of the samples ranged from 20% to 100% female, with a median of 77%. One-third of the included studies did not report participants' race/ethnicity, and half of the remaining study samples were at least 90% white; however, 20% of the studies focused exclusively on experiences of racial/ethnic minority older adults. Using meta-ethnography, we developed a new conceptual model of aging in place in the United States as a dynamic process of balancing threats and agency in relation to experiences of identity, connectedness, and place. We found that people aging in place were engaged in significant work to cope with unpredictable needs and challenges by changing their mindset, adapting their home environment to accommodate new needs, and finding different ways to connect with important people in their lives. Agency was shaped by resources and restrictions on choice, and where threats to aging in place outweighed an individual's sense of agency, the consequences included feelings of uncertainty, isolation, and dislocation.

CONCLUSIONS

To the best of our knowledge, this is the first systematic review of qualitative studies to evaluate experiences of aging in place in the United States. The findings of our meta-ethnographic synthesis led to the development of a new conceptual model of aging in place highlighting the dynamic tensions involved in balancing threats and agency.

Depression among older Japanese Americans: The impact of functional (ADL & IADL) and cognitive status

PURPOSE

The objective of this article is to investigate the relationship between activities of daily living, instrumental activities of daily living, cognitive impairment, and depression among Japanese American elders.

METHODS

A cross-sectional study of 207 older Japanese Americans (68 years and older) was conducted in Los Angeles, California and Honolulu, Hawaii. Independent variables included activities of daily living, instrumental activities of daily living, and cognitive functioning. Age, gender, marital status, and income were also identified. Depression was the dependent variable.

RESULTS

Descriptive analyses were done to show group differences in terms of gender, age and marital status. Gender (male) and marital status (married) were the determinants of lower rates of depression. Lower rates of IADL and cognitive functioning were significant determinants of higher rates of depression among older Japanese Americans.

CONCLUSIONS

This study provides empirical evidence that physical and cognitive functioning are directly associated with depression in older Japanese Americans. Social workers need to provide the services of ethnic-based via formal agencies in order to prevent depression of older Japanese Americans. Also, it is important to have sensitivity and competency to assess depressive symptoms and refer elders to an appropriate mental health agency.

Vietnamese Refugee Elderly Women and Their Experiences of Social Support: A Multiple Case Study

This study sought to address the gaps in the literature on Asian American gerontology with a multiply marginalized group in terms of gender, immigration status, and context. Guided by a multiple case study approach, we sought to explore how social support was experienced by four Vietnamese elderly refugee women residing in different living arrangements (i.e., alone, with spouse, with adult children, or in a multigenerational household). Within-case analyses were conducted to yield descriptive information about each individual. Additionally, three overarching themes emerged across each of the living arrangements: (1) Burden of care-taking, (2) Distinguishing family from nonfamily help, and (3) Ambivalence toward government-sponsored services. Our findings provide a contextualized understanding of social support to explain the inconsistencies that have been found in the literature on Asian American gerontology and family support. The benefits of living alone are described, along with the potential risks of coresidency.

The mediating effect of neighbor relationship between community social support and elderly's subjective well-being in China

This study aimed to investigate the relationship between community social support, neighbor relationship, and the subjective well-being of the elderly in China. Structural equation modeling was used to test the hypothesized model based on a sample of 2732 senior adults from 2010 Chinese General Social Survey. Results showed that community social support could indirectly affect the subjective well-being of the elderly through the complete mediating effect of neighbor relationship, although there was no significant correlation between community social support and the elderly's subjective well-being. Implications for theory, social work, and social policy were discussed.

Medical Foster Homes: Can the Adult Foster Care Model Substitute for Nursing Home Care?

OBJECTIVE

To compare characteristics, healthcare use, and costs of care of veterans in the rapidly expanding Veterans Health Administration (VHA) medical foster home (MFH) with those of three other VHA long-term care (LTC) programs.

DESIGN

Descriptive, unmatched study.

SETTING

VHA MFHs, home-based primary care (HBPC), community living centers (CLCs), and community nursing homes (CNHs).

PARTICIPANTS

Veterans newly enrolled in one of the four LTC settings in calendar years 2010 or 2011.

MEASUREMENTS

Using VA and Medicare data from fiscal years 2010 and 2011, demographic characteristics, healthcare use, and costs of 388 veterans in MFHs were compared with 26,037 of those in HBPC, 5,355 in CLCs, and 5,517 in CNHs in the year before and the year after enrollment.

RESULTS

Veterans enrolled in the MFH program were more likely to be unmarried than those in other LTC programs and had higher levels of comorbidity and frailty than veterans receiving HBPC but had similar levels of comorbidity, frailty, and healthcare use as those in CLCs and CNHs. MFH veterans incurred lower costs than those in CNHs and CLCs.

CONCLUSION

MFHs served a distinct subset of veterans with levels of comorbidity and frailty similar to those of veterans cared for in CLCs and CNHs at costs that were comparable to or lower than those of the VHA. Propensity-matched comparisons will be necessary to confirm these findings.

Support from Neighbors and Aging in Place: Can NORC Programs Make a Difference?

PURPOSE OF THE STUDY

There is growing enthusiasm for community-level efforts to strengthen supportive relationships among neighbors to enhance aging in place. However, there is little research on how older adults perceive support from neighbors in terms of helping them to remain in their own homes and communities safely and comfortably, particularly in the face of later life challenges. There also is little systematic study of ways in which community initiatives might influence these relationships.

DESIGN AND METHODS

Qualitative interviews were conducted with 41 older adults from seven Naturally Occurring Retirement Community Supportive Service Program (NORC program) catchment areas in the greater New York City area. A grounded theory approach was used to identify themes and develop an empirically grounded account of NORC programs, support among neighbors, and aging in place.

RESULTS

Participants identified several ways in which NORC programs influenced support among neighbors, such as by serving as a conduit for information sharing and helping older adults to broaden their private networks of social relationships. Overall, however, participants more consistently described limitations of the NORC programs' influence on support within these relationships. Participants also described how other sources of support were necessary in addition to support from neighbors to help people overcome major challenges to aging in place.

IMPLICATIONS

Results suggest the importance of neighbors-helping-neighbors approaches to promote aging in place as a complement, rather than substitute, to other efforts, such as those that focus on enhancing access to formal providers and strengthening care within families.

Uncovering the Meaning of Home Care Using an Arts-Based and Qualitative Approach

The need for home care is increasing in Canada, yet little is known about the home care experience of clients and their families. Uncovering the meaning of the home care experience is an important step towards developing understanding and public awareness. We explored the experiences of home care using arts-based methods and individual interviews with 11 participants (one client and 10 family caregivers). Participants discussed the numerous ways formal home care and family caregiving affected their lives, how they coped with these effects, their experiences in hospitals or assisted living facilities, and aspects of the home care experience they liked or disliked. Participants agreed that home care facilitated a better quality of life for families and clients, although they acknowledged some challenges with it. The artistic outputs produced by participants facilitated interview dialogue and fostered understanding of key themes within the research team.

Continuity and Change in Relationships with Neighbors: Implications for Psychological Well-being in Middle and Later Life

OBJECTIVES

There is growing enthusiasm for community initiatives that aim to strengthen neighbor relationships to promote well-being in later life. Nevertheless, few studies have examined the extent to which relationships with neighbors are associated with better psychological well-being among midlife and older adults.

METHODS

We used data from 1,071 noninstitutionalized, English-speaking adults, aged 40-70 years, who participated in both waves of the 1995-2005 National Survey of Midlife Development in the United States. Lagged dependent regression models were estimated to examine associations between changes in two dimensions of neighbor relationships (contact and perceived support) and psychological well-being.

RESULTS

Few associations were found between relationships with neighbors and negative or positive affect. In contrast, having continuously low levels of contact with neighbors, or losing contact with neighbors over the 10-year study period, was associated with declining levels of eudaimonic well-being. Associations between contact and this aspect of well-being were explained, in part, by less perceived support from neighbors.

DISCUSSION

Results suggest that continuity and change in relationships with neighbors is especially important for more developmental aspects of psychological well-being. Implications for future research on the meaning of neighbor relationships and aging in community are discussed.

Colorectal cancer knowledge, attitudes, screening, and intergenerational communication among Japanese American families: an exploratory, community-based participatory study

Adults of Japanese descent (Nikkei) in the United States have higher risk for colorectal cancer (CRC) than their white counterparts. Family norms toward CRC screening may influence screening behaviors of Nikkei adults. This community-based participatory research study explores if mailing educational pamphlets to Nikkei families can influence CRC knowledge, attitudes, and screening adherence; and trigger intergenerational communication about CRC. Among 56 parent-offspring dyads contacted, 24 were eligible (e.g., no prior CRC screening/diagnosis) and were randomized into 3 cohorts defined by the "target recipient(s)" of study pamphlets about CRC screening: parent only, offspring only, and both parent and offspring. Among the 19 completed dyads (79.2 % = 19/24), results showed that CRC knowledge of most pamphlet recipients increased in all cohorts; however, some misinformation and attitudinal barriers persisted. Although some parent-offspring communication about CRC increased after mailing pamphlets to offspring, only spousal communication occurred after mailing pamphlets to parents. Additional benefits were not observed in increasing parental screening intent/behavior after mailing pamphlets to both parent and offspring. At the end, among the 10 parents who reported developing CRC screening intent or having scheduled a CRC screening, 8 attributed to study pamphlets and 2 to communication with their offspring. Self-reported barriers preventing screening and parent-offspring communication about CRC were identified. This exploratory study describes preliminary findings that will inform future research aimed to promote CRC screening and reduce racial/ethnic disparities at the community level by enhancing intergenerational communication among Nikkei families.