Old Age: An Artifact?

Social Support and Social Action Organizing in a “Grey Ghetto”: The Tenderloin Experience

The Tenderloin Senior Outreach Project (TSOP) is presented as a case study of effective community-based organizing among the isolated elderly in one of America's large “grey ghettos.” Based on the theoretical underpinnings of social support theory and Freire's “education for critical consciousness,” the Project has attempted to address the interrelated problems of poor health, social isolation and powerlessness endemic among the elderly in Single Room Occupancy hotels.

The Project's metamorphosis is traced from a university-sponsored community development effort to a community-controlled organization focused on broad social action objectives. The transference of leadership from health education facilitators to indigenous elderly leaders within the hotels is examined, as are some of the strategies employed in increasing Project visibility, preventing burn-out, and facilitating replication in other areas.

Community Mediation Centers

We introduce the concept of community mediation centers as alternatives to the traditional, adversarial, and less humanistic court system. We make the case that mediation is indeed a humanistic dispute resolution process by first describing the benefits of the process and then by sharing results of a study we conducted using archival cases from an actual mediation center. The study examines the disputing person's Maslowian levels both before and after the mediation hearing. We found that need levels are higher in the Maslowian hierarchy after the hearing than before the hearing. We also address limitations of our study as well as suggest future directions for more research.

Social Support and Social Action Organizing in a “Grey Ghetto”: The Tenderloin Experience

The Tenderloin Senior Outreach Project (TSOP) is presented as a case study of effective community-based organizing among the isolated elderly in one of America's large “grey ghettos.” Based on the theoretical underpinnings of social support theory and Freire's “education for critical consciousness,” the Project has attempted to address the interrelated problems of poor health, social isolation and powerlessness endemic among the elderly in Single Room Occupancy hotels. The Project's metamorphosis is traced from a university-sponsored community development effort to a community controlled organization focused on broad social action objectives. The transference of leadership from health education facilitators to indigenous elderly leaders within the hotels is examined, as are some of the strategies employed in increasing Project visibility, preventing burn-out, and facilitating replication in other areas.

Physical Restraint Use and Cognitive Decline among Nursing Home Residents

OBJECTIVE

This study investigated the association between physical restraint use and decline in cognition.

DESIGN

Cohort analytic study describing changes in resident characteristics.

SETTING

Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area.

PARTICIPANTS

437 nursing home admissions, with 201 remaining at 1 year.

MAIN OUTCOME MEASURES

Cognitive status was measured by geropsychiatrists, using the Folstein Mini-Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year.

RESULTS

Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non-ambulatory but without dementia and having strong social support.

CONCLUSIONS

These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.

Memory Perceptions and Memory Performance in Adulthood and Aging

Evidence is accumulating to suggest that peoples' perceptions of their own memories are important for understanding memory functioning in later life. This paper reviews two questionnaires designed to measure such perceptions, and identifies several research questions requiring further study. In general, memory perceptions appear to be multidimensional and involve belief and affective components as well as knowledge components. In addition, the relationship between memory perceptions and memory performance appears to differ as a function of age and type of task. Salient issues for future research include the extent to which older adults' memory perceptions show systematic state-like fluctuations over time, and the extent to which these perceptions represent an accurate picture of individuals' memory abilities.

Community organizing among the elderly poor in the United States: a case study

This case study demonstrates the role of community organizing as a vehicle for enhancing individual and community-level empowerment. Building on social support theory, Freire's "education for critical consciousness," and the principles and strategies of community organization practice, the 12-year-old Tenderloin Senior Organizing Project reflects the World Health Organization definition of health promotion as a means of helping individuals and communities to take increasing control over the factors influencing their health. Through the Project, low-income elders have successfully identified and addressed shared problems in such areas as crime and safety, undernutrition, and tenants rights. They further have developed ongoing tenants' associations and other community-based organizations that have provided continuity over time and contributed to the development of a "competent community." Problems in areas such as funding, evaluation, and volunteer burnout are discussed, as are the potentials for project replication in other settings.

The politics of Alzheimer's disease: a case study in apocalyptic demography

Catastrophic projections of the burden to society of an increasing aging population abound. The prevailing belief is that an increasing dependent aging population means increasing demands on the resources of society, including health care resources, in the face of competing interests and diminishing, or at best finite, resources. But how justified is this "apocalyptic demography"? This article presents one challenge to the apocalyptic scenario by considering the politics surrounding the most publicized, although not the most prevalent, disease of elders: Alzheimer's disease. The recent emergence of Alzheimer's disease as the "fourth or fifth leading cause of adult deaths" is critically examined, and the evidence for the social construction of Alzheimer's disease in terms of the "biomedicalization of aging" discussed. The author considers that it is, in part, the response of the health care system (as it is currently constituted) to changes in demography and disease distribution--and not, as is commonly asserted, the numbers of elders or their increasing "morbidity"--that drives up health care costs.

The significant of an ill spouse for assessing health differences in an elderly population

In a survey of 678 elderly residents of Alameda County, California, it was found that respondents who reported their spouses as being ill in the last six months were more likely to report their own health as poor than those respondents whose spouses were not previously ill. The spouse's health was found to be the best predictor of the respondent's health. Research in this area may lead to a better understanding of the elderly spouse as a source of social support and may provide geriatricians with new insights into the health risks facing the married elderly.

Health promotion in long-term care: a contradiction in terms?

While health promotion potentially could play a significant role in improving the health and quality of life of nursing home residents, several major changes must take place if this concept is to hold relevance for the elderly in the long-term care environment. First, interpretations of the concept of health promotion must be broadened to include a focus on macro- as well as micro-level change and on a diversity of target groups including, importantly, policy makers and providers. Second, the "youth bias" inherent in many conventional health promotion efforts must be overcome, so that goals such as decreasing functional dependence in the frail elderly are seen as legitimate and appropriate health promotion foci. Third, viable alternative to nursing home placements must be developed and adequately funded for the many frail elders who would be better served in less intense care environments. And fourth, the dependency producing nature of institutional long-term care must undergo major changes compatible with the goals of promoting individual autonomy and enhancing quality of life. Nutrition, drug use and misuse, mental health, and staff training and retention are four areas examined in a closer look at specific changes needed to create nursing homes amenable to health promotion. Such changes on the institutional level, coupled with a strong national commitment to nursing home reform, are in keeping with Green et al.'s broad definition of health promotion as encompassing a variety of interventions on multiple levels designed to facilitate behavioral changes conducive to health. It is within this larger context that health promotion is seen as holding considerable promise for improving the health and quality of life of the institutionalized elderly.

Mental illness and the aged stranger

Sociological investigations of mental illness in older populations have been largely concerned with the causes and consequences of morale and life satisfaction. Satisfaction with life and "good morale" are widely viewed as reasonable indicators of mental health. Apart from the definitional problems inherent in this approach, the focus on morale has effectively diverted greater research attention from more serious issues of mental health in older populations, such as schizophrenia, personality disorders, and depression. The intent of this paper is to evaluate the dominant mental health paradigms within social gerontology; to synthesize some existing threads of a political economy/social control approach to these issues; and, finally, to argue that the act of growing old in capitalist societies brings increased risk of mental illness not because of drift, selection, or stress but, rather, because of the exclusion of the aged from labor markets and the physical and ideological "strangeness" of the aged.