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Jang Y, Rhee MK, Park J, Ko JE, Park NS, Henwood BF, Schepens Niemiec SL, Chung S. Falls as a mental health risk among Korean-American residents in subsidized senior housing: mediating effect of fall-related self-efficacy. Aging Ment Health 2024:1-7. [PMID: 39318259 DOI: 10.1080/13607863.2024.2407586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 09/17/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVES The study examined the mediating role of fall-related self-efficacy in the association between falls and mental health among older Korean Americans living in subsidized senior housing in the greater Los Angeles area. We focused on serious fall incidents (i.e. multiple falls or any fall with a fracture) and used symptoms of depression and anxiety as indicators of mental health. METHOD Survey data from 315 participants (M age = 79.4 years) were used to examine the direct effects of serious fall incidents on mental health symptoms, as well as indirect effects through fall-related self-efficacy. RESULTS The mediating effect of fall-related self-efficacy was found to be significant in both models for depressive symptoms (B [SE] = 0.15 [0.07], bias-corrected 95% CI = [0.03, 0.31]) and anxiety symptoms (B [SE] = 0.11 [0.05], bias-corrected 95% CI = [0.02, 0.23]). CONCLUSION The mental health impact of serious fall incidents was shaped by older individuals' perceived concerns about falls and confidence in performance. The findings highlight the importance of addressing fall-related psychological responses in preventing falls and promoting mental health among senior housing residents.
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Affiliation(s)
- Yuri Jang
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
- Department of Social Welfare, Ewha Womans University, Republic of Korea
| | - Min-Kyoung Rhee
- Leonard Davis School of Gerontology, University of Southern California, USA
| | - Juyoung Park
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Jung Eun Ko
- Department of Counseling, Kyung Hee Cyber University, Republic of Korea
| | - Nan Sook Park
- School of Social Work, University of South Florida, USA
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, USA
| | - Stacey L Schepens Niemiec
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Soondool Chung
- Department of Social Welfare, Ewha Womans University, Republic of Korea
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2
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Kantz ME, Enah C, Abdallah LM, Koren A. Housing and Health in Older Adults With Low Income in the United States: An Integrative Review. J Gerontol Nurs 2024; 50:25-32. [PMID: 38417078 DOI: 10.3928/00989134-20240208-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
PURPOSE The current integrative review was conducted to understand the relationship between housing and health in older adults with low income in the United States. METHOD A literature search yielded 20 articles that met inclusion criteria. Key data elements were extracted from each article and a five-level social ecological model (SEM) was used as a framework to analyze the findings. RESULTS The analysis yielded themes associated with each SEM level: Interaction Between Housing and Personal Traits and Behaviors (individual level); Burdens and Benefits of Social Relationships (relational Level); Building Quality and Health (environmental level); Role of Housing Assistance (structural level); and Influence of Poverty and Structural and Systemic Racism (superstructural level). CONCLUSION/IMPLICATIONS Results clarify housing's role as a social determinant of health affecting older adults with low income and may help nurses tailor patient assessments and treatment plans to better identify and address housing-related health risks. [Journal of Gerontological Nursing, 50(3), 25-32.].
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Sutherland L, Dunkle RE, Pace GT. Enhancing social connections through an acting and improvisation course for older Americans in low-income housing. Arts Health 2024; 16:48-63. [PMID: 37157231 DOI: 10.1080/17533015.2023.2211085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Older adults living in subsidized housing may be at increased risk of social isolation. Applied theater, a participatory art program, can facilitate social connections among older adults. METHODS A professionally-facilitated 12-week acting and improvisation course was held in two federally subsidized buildings in an urban setting. The mixed-method design included thematic analysis of interviews, participant observation, field notes, and statistical analysis of change over time in social isolation, community belonging, and social exclusion. RESULTS Participants were motivated to meet other building residents, and the course included aspects that encouraged social bonding. CONCLUSIONS Although recruitment of socially-isolated older adults presented challenges, this study presents lessons on what motivates residents of low-income senior housing to enroll in an acting program and how to design a theater course in this setting that promotes group bonding.
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Affiliation(s)
- Laura Sutherland
- School of Social Work and Department of Anthropology, Wayne State University, Detroit, MI, USA
| | - Ruth E Dunkle
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Garrett T Pace
- School of Social Work, University of Nevada, Las Vegas, NV, USA
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Kantz ME, Enah C, Abdallah LM. The relationship between health and housing in low-income older adults: A secondary analysis of survey data. Public Health Nurs 2023; 40:931-939. [PMID: 37644887 DOI: 10.1111/phn.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/03/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To examine the health-housing relationship in low-income older adults, and differences by income and receipt of housing assistance. DESIGN Secondary analysis of longitudinal survey data. SAMPLE About 10,858 adults aged 62+ who completed at least one wave of the 2014 Survey of Income and Program Participation (SIPP) (n = 37,333 observations). MEASUREMENTS SIPP variables representing demographics and housing quality, affordability, stability, and neighborhood were analyzed. Low-income and higher-income participants were differentiated by the household income-to-poverty ratio. RESULTS Low-income participants were significantly more likely to be in poor health and report problems with housing quality, affordability, and neighborhood safety compared to higher-income participants (p < .001). Increased household size and problems with housing quality and neighborhood safety were associated with poor health in both groups (p < .05). Low-income participants who received housing assistance were significantly poorer, less healthy, and food insecure than participants not receiving assistance (p < .001); however, the health-housing relationship was not different in the two groups. CONCLUSIONS Results provide additional support for housing as a social determinant of older adult health. Though housing assistance programs reached a subset of low-income older adults, the results suggest a housing assistance shortfall. Implications for public health nurses and researchers are explored.
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Affiliation(s)
- Mary E Kantz
- Susan and Alan Solomont School of Nursing, University of Massachusetts Lowell, Lowell, USA
| | - Comfort Enah
- Susan and Alan Solomont School of Nursing, University of Massachusetts Lowell, Lowell, USA
| | - Lisa M Abdallah
- Susan and Alan Solomont School of Nursing, University of Massachusetts Lowell, Lowell, USA
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Abstract
Access to affordable housing is a rising concern, and social housing is one approach to support low-income, older renters. A scoping review was undertaken to understand the characteristics of older tenants and social housing services to identify strategies to promote aging in place. Seven peer review databases were searched to identify relevant articles. A total of 146 articles were included. Almost all examined socio-demographic and health characteristics of older tenants, while 72 per cent examined social housing services, including eligibility policies, staffing, and access to on-site services. This review points to a high vulnerability among older tenants and highlights the importance of co-locating services on-site with a tenant-facing support staff to identify vulnerable tenants and link them to services. More research on tenancy issues (e.g., unit condition, rental management) is needed to identify new opportunities for social housing landlords to help older tenants age in place.
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Access to Community Support Services among Older Adults in Social Housing in Ontario. Can J Aging 2022; 42:217-229. [PMID: 36373328 DOI: 10.1017/s0714980822000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Community support services are an integral enabler of aging in place. In social housing, older adult tenants struggle to access these services because of the siloed nature of housing and health services. This study examined the provision of government-funded community support services to 83 seniors’ social housing buildings in Toronto, Ontario. Although there were 56 different agencies operating within the buildings, only about one third of older tenants were actually receiving services. There was a subset of services that were available in more than 80 per cent of the buildings, and the most widely accessed services were food supports, crisis intervention, transportation, caregiver support, and hearing/vision care. There were also many cases in which multiple agencies offered duplicative services within the same building, suggesting that there are opportunities for improving service coordination. Practice recommendations for increasing access to community support services among low-income older adults in social housing are provided.
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Montoro-Rodriguez J, Hayslip B, Ramsey J. A Proactive Behavioral Activities Program (EWA) and the Influence of COVID-19 among Seniors in Congregate Living Communities. J Appl Gerontol 2022; 41:2214-2225. [PMID: 35694870 PMCID: PMC9198561 DOI: 10.1177/07334648221108279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/20/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Older adults in affordable housing are at risk for mental health problems, physical vulnerability, and isolation. We examine the role of an activities program in buffering the influence of life stressors on the mental health of seniors in congregate housing, using a non-experimental pretest-posttest study design. Results based upon repeated measures analyses (N = 29), found statistically significant (p < .05) program by time effects for depression, coping strategies, positive affect, isolation, and resident satisfaction. Analyses based upon independent samples of pretest and posttest measures (N = 60) were considerably less strong, but consistent in yielding similar patterns to those of the longitudinally gathered data. Our longitudinal findings substantiate the positive impact of the Engage with Age program in supporting older adults living in congregate housing. Researchers need to develop strategies to assess and support the mental health of older persons in low-income urban congregate living in the larger context of COVID-19.
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Affiliation(s)
| | - Bert Hayslip
- University of North
Texas, Murrells Inlet, SC, USA
| | - Jennifer Ramsey
- University of North Carolina at
Charlotte, Charlotte, NC, USA
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Sheppard CL, Gould S, Guilcher SJT, Liu B, Linkewich E, Austen A, Hitzig SL. "We could be good partners if we work together": the perspectives of health and social service providers on the barriers to forming collaborative partnerships with social housing providers for older adults. BMC Health Serv Res 2022; 22:313. [PMID: 35255919 PMCID: PMC8900424 DOI: 10.1186/s12913-022-07671-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many older adults are aging-at-home in social housing. However, the lack of integration between housing and health services makes it difficult for older tenants to access needed supports. We examined barriers and facilitators health and social service providers face providing on-site services to older tenants. METHODS We conducted semi-structured qualitative interviews and focus groups with health and social service professionals (n = 58) in Toronto, Canada who provide community programs in support of older tenants who live in non-profit, rent-geared-to-income social housing. Interviews examined the barriers they faced in providing on-site services to older tenants. FINDINGS Service providers strongly believed that collaboration with on-site housing staff led to better health and housing outcomes for older tenants. Despite the recognized benefits of partnering with housing staff, service providers felt that their ability to work effectively in the building was dependent on the staff (particularly the superintendent) assigned to that building. They also identified other barriers that made it difficult to work collaboratively with the housing provider, including staffing challenges such as high staff turnover and confusion about staff roles, a lack of understanding among housing staff about the link between housing and health, challenges sharing confidential information across sectors, and complex and inefficient partnership processes. CONCLUSION Older adult tenants are increasingly vulnerable and in need of supports but the housing provider has a long history of ineffective partnerships with service providers driven by complex and inefficient staffing models, and an organizational culture that questions the role of and need for partnerships. Findings highlight the need for more effective integration of housing and health services. Simplified processes for establishing partnerships with service agencies and more opportunities for communication and collaboration with housing staff would ensure that services are reaching the most vulnerable tenants.
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Affiliation(s)
- Christine L Sheppard
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Canada
| | - Sarah Gould
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Barbara Liu
- Regional Geriatric Program of Toronto and University of Toronto, Toronto, Canada
| | - Elizabeth Linkewich
- North & East Greater Toronto Area Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Andrea Austen
- Seniors Services and Long-Term Care, City of Toronto, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada. .,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.
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Sharpley CF, Murcell N, Anderson M, Bitsika V, Fourie PJ, Agnew LL. An exploration of recent life stress, psychological resilience, purpose in life, and optimism as correlates of depression in social housing residents in rural Australia. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021. [DOI: 10.1080/00207411.2021.1896079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Christopher F. Sharpley
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, Australia
| | | | - Mark Anderson
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, Australia
| | - Vicki Bitsika
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, Australia
| | - Phillip J. Fourie
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, Australia
| | - Linda L. Agnew
- Brain-Behaviour Research Group, School of Science and Technology, University of New England, Armidale, Australia
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10
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Elliott AF, Heskett M, Spiker C, McGwin G, Owsley C. Low rates of eye care utilization among visually impaired subsidized senior housing residents. Aging Ment Health 2021; 25:360-366. [PMID: 31694391 PMCID: PMC7202945 DOI: 10.1080/13607863.2019.1683813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the rate of self-reported vision impairment, eye disease, and eye care utilization among residents of subsidized senior housing (SSH) communities. METHODS In this cross-sectional, observational study, residents of 14 SSH communities in Jefferson County, AL, USA self-reported their vision status and eye care utilization as part of vision screening events held in their community. RESULTS Two hundred and thirty-seven residents self-reported their vision status, presence of eye disease, and eye care utilization. A third of participants (33.3%) reported difficulty with distance vision while 38% reported difficulty with near vision. Rates of eye disease among this sample were as follows: 40.3% reported having cataracts, 13.6% reported having glaucoma, 4.2% reported having age-related macular degeneration, and 5.5% reported having diabetic retinopathy. The majority of participants (52.8%) had not been to see an eye care provider within the last year. Persons with vision impairment were less likely to report having seen an eye care provider within the last year than those without impairment (p = .03). CONCLUSION This study illuminates the low utilization of eye care among socioeconomically disadvantaged older adults residing in SSH, especially among those with vision impairment and eye disease. Vision-related health care is important in maintaining both physical and mental health in older adults.
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Affiliation(s)
| | | | - Christopher Spiker
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
| | - Gerald McGwin
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham,Department of Surgery, School of Medicine, University of Alabama at Birmingham
| | - Cynthia Owsley
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham
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11
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Chai Y, Luo H, Yip PSF, Perlman CM, Hirdes JP. Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study. J Am Med Dir Assoc 2021; 22:2160-2168.e18. [PMID: 33454310 DOI: 10.1016/j.jamda.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS The LTC data were collected using Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and Resident Assessment Instrument-Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included. METHODS Adjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models. RESULTS Records were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31-25.40] for LTCF and 46.64 (44.24-49.12) for HC. In LTCF, the strongest risks were younger age (60-74 years vs 90+: HR, 6.00; 95% CI, 3.24-11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32-5.16; schizophrenia: 2.31; 1.47-3.62; depression: 2.29; 1.80-2.92), daily severe pain (2.01; 1.30-3.11), and daily tobacco consumption (1.78; 1.29-2.45). For those receiving HC, the strongest risk factors were younger age (60-74 years vs 90+: 2.54; 1.97-3.28), psychiatric disorders (2.20; 1.93-2.50), daily tobacco consumption (2.08; 1.81-2.39), and frequent falls (1.98; 1.46-2.68). All model interactions between setting and factors were significant. CONCLUSIONS AND IMPLICATIONS There was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.
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Affiliation(s)
- Yi Chai
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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12
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Schensul J, Reisine S, Grady J, Li J. Improving Oral Health in Older Adults and People With Disabilities: Protocol for a Community-Based Clinical Trial (Good Oral Health). JMIR Res Protoc 2019; 8:e14555. [PMID: 31850853 PMCID: PMC6939248 DOI: 10.2196/14555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background Low-income older adults experience disparities in oral health problems, including caries and periodontal disease, that can exacerbate already high levels of chronic and acute health problems. Behavioral interventions have been shown to improve oral health status but are typically administered in institutional rather than community settings. Furthermore, multiple simultaneous interventions at different levels in the locations where people live and work are likely to have more impact and sustainability than single interventions in clinical settings. Objective This paper outlines a protocol for conducting a bilingual 5-year community-based trial of a bilevel intervention that addresses community norms, beliefs, intentions, and practices to improve oral health hygiene of vulnerable older adults living in publicly subsidized housing. The intervention utilizes (1) a face-to-face counseling approach (adapted motivational interviewing [AMI]) and (2) resident-run oral health campaigns in study buildings. Methods The study’s modified fractional factorial crossover design randomizes 6 matched buildings into 2 conditions: AMI followed by campaign (AB) and campaign followed by AMI (BA). The total intervention cycle is approximately 18 months in duration. The design compares the 2 interventions alone (T0-T1), and in different sequences (T1-T2), using a self-reported survey and clinical assessment to measure Plaque Score (PS) and Gingival Index (GI) as outcomes. A final timepoint (T3), 6 months post T2, assesses sustainability of each sequence. The intervention is based on the Fishbein integrated model that includes both individual and contextual modifiers, norms and social influence, beliefs, attitudes, efficacy, and intention as predictors of improvements in PS, GI, and oral health quality of life. The cognitive and behavioral domains in the intervention constitute the mechanisms through which the intervention should have a positive effect. They are tailored through the AMI and targeted to building populations through the peer-facilitated oral health campaigns. The sample size is 360, 180 in each condition, with an attrition rate of 25%. The study is funded by National Institute of Dental and Craniofacial Research (NIDCR) and has been reviewed by University of Connecticut and NIDCR institutional review boards and NIDCR’s clinical trials review procedures. Results When compared against each other, the face-to-face intervention is expected to have greater positive effects on clinical outcomes and oral health quality of life through the mediators. When sequences are compared, the results may be similar but affected by different mediators. The arm consisting of the BA is expected to have better sustainability. The protocol’s unique features include the comparative effectiveness crossover design; the introduction of new emotion-based mediators; the balancing of fidelity, tailoring, and targeting; and resident engagement in the intervention. Conclusions If successful, the evaluated interventions can be scaled up for implementation in other low-income congregate living and recreational settings with older adult collectives. Trial Registration ClinicalTrials.gov NCT02419144; https://clinicaltrials.gov/ct2/show/NCT02419144 International Registered Report Identifier (IRRID) DERR1-10.2196/14555
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Affiliation(s)
- Jean Schensul
- Institute for Community Research, Hartford, CT, United States.,University of Connecticut School of Dental Medicine, Farmington, CT, United States
| | - Susan Reisine
- University of Connecticut School of Dental Medicine, Farmington, CT, United States
| | - James Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Jianghong Li
- Institute for Community Research, Hartford, CT, United States
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13
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Bazargan M, Smith JL, Cobb S, Barkley L, Wisseh C, Ngula E, Thomas RJ, Assari S. Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071175. [PMID: 30986915 PMCID: PMC6479964 DOI: 10.3390/ijerph16071175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - James L Smith
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Lisa Barkley
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University, Los Angeles, CA 90004, USA.
| | - Emma Ngula
- Department of public health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Ricky J Thomas
- Department of Emergency Medicine, UC Davis Medical Center, University of California, Davis, Sacramento, CA 95817, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
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Gonyea JG, Curley A, Melekis K, Lee Y. Perceptions of neighborhood safety and depressive symptoms among older minority urban subsidized housing residents: the mediating effect of sense of community belonging. Aging Ment Health 2018; 22:1564-1569. [PMID: 29125319 DOI: 10.1080/13607863.2017.1383970] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Older minority subsidized housing residents represent a population that is particularly vulnerable to depression. Although research suggests that neighborhood characteristics influence older adults' mental health, it has not been explored in this target population. Drawing on social disorganization and social capital theories, this study's aim was to explore if perceptions of neighborhood safety are associated with depressive symptoms; and, whether a sense of community belonging has a mediating effect on this potential relationship. METHODS The data are from interviews with 216 older adults (50% Black, 45% Latino/a) living in a U.S. urban subsidized housing development. RESULTS Among participants, 80% identified feeling 'very safe' during the day while 63% expressed feeling 'very safe' at night in their neighborhood. Approximately 60% possessed a stronger sense of community belonging and 26% had clinically relevant depressive symptoms. Hierarchical regression analyses revealed that perceptions of feeling less safe in one's neighborhood were significantly associated with elevated levels of depressive symptoms; however, a greater sense of community belonging buffered (or had a significant mediating effect on) this relationship. CONCLUSION The findings suggest the importance of continued exploration of the role of social capital in relation to feelings of safety in later life.
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Affiliation(s)
- Judith G Gonyea
- a Social Research Department, School of Social Work , Boston University , Boston , MA , United States
| | - Alexandra Curley
- b The American City Coalition (TACC) , Roxbury , MA , United States
| | - Kelly Melekis
- c Social Work Department , Skidmore College , Saratoga Springs , NY , United States
| | - Yeonjung Lee
- a Social Research Department, School of Social Work , Boston University , Boston , MA , United States
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15
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Shi Y, Sun F, Liu Y, Marsiglia FF. Perceived threat of Alzheimer's disease and related dementias among older Chinese Americans in subsidized housing: Through a cultural lens. DEMENTIA 2018; 19:1777-1793. [PMID: 30309253 DOI: 10.1177/1471301218805901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSES Low socioeconomic status and limited social support may put older residents in subsidized housing at high risk for developing fears of Alzheimer's disease or related dementias. This study examined the perceived threat of Alzheimer's disease or related dementias among older Chinese Americans in subsidized housing facilities in Phoenix, Arizona of the United States, and focused on the effect of cultural beliefs (i.e., beliefs toward Alzheimer's disease or related dementias, and beliefs toward intergenerational support) on the perceived threat of Alzheimer's disease or related dementias. METHOD Analyses were based upon a survey of 207 Chinese American older adults (Mage = 75.37, SD = 7.47) living in subsidized housing facilities in the Phoenix metropolitan area. Standardized survey questionnaires were delivered through face-to-face interviews. RESULTS Multivariate analyses suggest that fatalism related beliefs about Alzheimer's disease or related dementias, rather than stigmatization, were related to higher levels of concerns for developing Alzheimer's disease or related dementias, while beliefs in intergenerational support were related to lower levels of perceived threat of Alzheimer's disease or related dementias. However, the protective effect of beliefs in intergenerational support tended to diminish in those living with higher levels of depressive symptoms. DISCUSSION Cultural beliefs can entail both risks and strengths when low-income Chinese American elders attempt to comprehend the implications of Alzheimer's disease or related dementias. Health education or intervention programs need to address their fatalism beliefs toward Alzheimer's disease or related dementias, and facilitate the accessibility of intergenerational support for this group.
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Affiliation(s)
- Yan Shi
- School of Public Administration, Zhejiang Gongshang University, China
| | - Fei Sun
- Hugh Downs School of Human Communication, Arizona State University, USA
| | - Yanqin Liu
- School of Human Communication, Arizona State University, USA
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16
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Taylor HO, Wang Y, Morrow-Howell N. Loneliness in senior housing communities. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:623-639. [PMID: 29791279 PMCID: PMC6938254 DOI: 10.1080/01634372.2018.1478352] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Harry Owen Taylor
- The Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Yi Wang
- The Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Nancy Morrow-Howell
- The Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
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Gonyea JG, Curley A, Melekis K, Levine N, Lee Y. Loneliness and Depression Among Older Adults in Urban Subsidized Housing. J Aging Health 2018; 30:458-474. [PMID: 28553790 DOI: 10.1177/0898264316682908] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Depression is particularly prevalent in low-income and disabled older adults, and minority populations face a greater risk of poverty and earlier disability onset. Yet, little is known about the mental health of older subsidized housing residents, a population which is disproportionately composed of persons of color. The study's aim was therefore to explore the prevalence and correlates of depression in this target population, with a particular focus on the role of loneliness. METHOD Data are from interviews with 216 older subsidized housing residents, of which 50% identified as Black and 45% self-identified as Latino. RESULTS About 26% of participants met the criterion for depression. The hierarchical regression supported our hypothesis; after controlling for demographic, health, and stress variables, loneliness explained almost half of the total 49% of variance in depression. DISCUSSION Care models addressing social risk factors are needed to meet the aging-in-place challenges of subsidized housing residents.
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Ewen HH, Washington TR, Emerson KG, Carswell AT, Smith ML. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030330. [PMID: 28327507 PMCID: PMC5369165 DOI: 10.3390/ijerph14030330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.
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Affiliation(s)
- Heidi H Ewen
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Financial Planning, Housing, and Consumer Economics, The University of Georgia, Athens, GA 30602, USA.
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | | | - Kerstin G Emerson
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | - Andrew T Carswell
- Department of Financial Planning, Housing, and Consumer Economics, The University of Georgia, Athens, GA 30602, USA.
| | - Matthew Lee Smith
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
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Ivey SL, Kealey M, Kurtovich E, Hunter RH, Prohaska TR, Bayles CM, Satariano WA. Neighborhood characteristics and depressive symptoms in an older population. Aging Ment Health 2016; 19:713-22. [PMID: 25316114 DOI: 10.1080/13607863.2014.962006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We explored relationships between depressive symptoms and neighborhood environment measures including traffic safety, crime, social capital, and density of businesses in community-dwelling older adults from four different regions of the United States. METHOD The Healthy Aging Research Network walking study is a cross-sectional study of 884 adults aged 65+, which included a 10-item Center for Epidemiologic Studies Depression scale of depressive symptoms, demographics, self-reported neighborhood perceptions, and objective neighborhood data. RESULTS After adjusting for individual covariates, reports of neighborhood crime, unsafe traffic, and unwillingness of neighbors to help each other were significantly positively associated with depressive symptoms among participants. CONCLUSION This research suggests an association between self-reported depressive symptoms and the social and built environment; examining causal association requires additional longitudinal research in diverse populations of older adults.
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Affiliation(s)
- Susan L Ivey
- a Community Health and Human Development, School of Public Health , University of California , Berkeley , CA , USA
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20
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Overcoming Recruitment Barriers in Urban Older Adults Residing in Congregate Living Facilities. PSYCHIATRY JOURNAL 2015; 2015:824672. [PMID: 26106598 PMCID: PMC4461771 DOI: 10.1155/2015/824672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022]
Abstract
Background. Participation of minority older adults in mental health research has been limited by mistrust, transportation difficulties, lack of knowledge, and insufficient community partnership. We describe strategies utilized to overcome these recruitment barriers. Methods. Our target population included 553 public housing residents of older adult high-rise buildings in Rochester, NY. We had a two-stage cross-sectional study: Stage 1 was a health survey for all residents and Stage 2 was a psychiatric interview of English-speaking residents aged 60 years and older. Recruitment occurred through mailings, onsite activities, and resident referrals. Results. Stage 1 had 358 participants (64.7% response) and Stage 2 had 190 (61.6% target population response), with higher participation among African Americans. We found some strategies effective for overcoming recruitment barriers. First, we partnered with a community agency and organized onsite educational activities to improve residents' trust. Second, the study occurred entirely onsite, which facilitated participation of functionally impaired residents. Third, onsite activities allowed the residents to learn about the study and complete surveys in person. Fourth, we provided immediate incentives that resulted in many study referrals. Conclusions. Although recruitment of minority older adults presents unique challenges, a multifaceted community-tailored approach mitigated several recruitment barriers in this mental health study.
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Shin JY, Sims RC, Bradley DL, Pohlig RT, Harrison BE. Prevalence of depressive symptoms and associated factors in older adult public housing residents. Res Gerontol Nurs 2014; 7:249-55. [PMID: 25036530 DOI: 10.3928/19404921-20140708-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to identify the prevalence of and risk factors associated with depressive symptoms among older adult residents of a public housing apartment. Self-reported depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) 8. A self-report questionnaire was used to collect data on risk factors of sociodemographic information, cardiovascular health history, and history of depression. Fifty-eight of 171 residents responded, and 31% of residents met the CES-D 8 criterion for depression (total score ≥7). Sequential multiple regression models identified age, loss of loved ones in the past year, and financial worries as significant predictors of CES-D 8 scores. These study results have implications for future studies of depressive symptoms in older adults, suggesting that grief and financial assistance programs may help reduce risks associated with depressive symptoms among community-dwelling older adults living in public housing.
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Simning A, Conwell Y, van Wijngaarden E. Cognitive impairment in public housing residents living in Western New York. Soc Psychiatry Psychiatr Epidemiol 2014; 49:477-85. [PMID: 23708200 PMCID: PMC3796150 DOI: 10.1007/s00127-013-0712-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Many older adults in the USA live in public housing facilities and have characteristics that may place them at risk for cognitive impairment. Cognitive impairment has been largely unexamined in this socioeconomically disadvantaged population, however. We therefore aim to characterize its prevalence and correlates, which may help determine which residents could benefit from additional assistance to optimize their ability to function independently. METHODS We interviewed 190 English-speaking public housing residents aged 60 years and older in Rochester, a city in Western New York, to assess socio-demographics, mental health, physical health and disability, coping strategies and social support, and service utilization. The Mini-Cog dementia screen evaluated cognitive status. RESULTS Twenty-seven percent of residents screened positive for cognitive impairment. In bivariate analyses, older age, less education, greater duration of residence, worse health, less reliance on adaptive coping strategies, and greater utilization of health services were associated with cognitive impairment; age and worse health remained correlated with cognitive impairment in multivariable analyses. Anxiety, depression, and history of substance misuse were not associated with cognitive impairment. CONCLUSIONS The high level of cognitive impairment in public housing could threaten residents' continued ability to live independently. Further examination is needed on how such threats to their independence are best accommodated so that public housing residents at risk for needing higher levels of care can successfully age in place.
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Affiliation(s)
- Adam Simning
- University of Rochester School of Medicine and Dentistry, Department of Psychiatry
| | - Yeates Conwell
- University of Rochester School of Medicine and Dentistry, Department of Psychiatry
| | - Edwin van Wijngaarden
- University of Rochester School of Medicine and Dentistry, Department of Public Health Sciences
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Pickett YR, Bazelais KN, Bruce ML. Late-life depression in older African Americans: a comprehensive review of epidemiological and clinical data. Int J Geriatr Psychiatry 2013; 28:903-13. [PMID: 23225736 PMCID: PMC3674152 DOI: 10.1002/gps.3908] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/16/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The population of older African Americans is expected to triple by 2050, highlighting the public health importance of understanding their mental health needs. Despite evidence of the negative impact of late-life depression, less is known of how this disorder affects the lives of older African Americans. Lack of studies focusing on how depression presents in older African Americans and their subsequent treatment needs lead to a gap in epidemiologic and clinical knowledge for this population. In this review, we aim to present a concise report of prevalence, correlates, course, outcomes, symptom recognition, and treatment of depression for these individuals. METHOD We performed a literature review of English-language articles identified from PubMed and Medline published between January 1990 and June 2012. Studies included older adults and contained the key words 'geriatric depression in African Americans', 'geriatric depression in Blacks', and 'geriatric depression in minorities'. RESULTS Although in most studies, older African Americans had higher or equivalence prevalence of depression compared with Caucasian Americans, we also found lower rates of recognition of depression and treatment. Many studies reported worse outcomes associated for depression among older African Americans compared with older Caucasians. CONCLUSIONS Serious racial and ethnic disparities persist in the management of older African Americans with depression. Understanding their unmet needs and improving depression care for these individuals is necessary to reduce these disparities.
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Affiliation(s)
- Yolonda R. Pickett
- Weill-Cornell Medical College, Department of Psychiatry,Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences
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Cummings SM, Cooper RL, Johnson C. Alcohol misuse among older adult public housing residents. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2013; 56:407-422. [PMID: 23767794 DOI: 10.1080/01634372.2013.790868] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n = 187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.
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Affiliation(s)
- Sherry M Cummings
- College of Social Work, University of Tennessee-Knoxville, Nashville, Tennessee 37210, USA.
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25
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Coman EN, Iordache E, Schensul JJ, Coiculescu I. Comparisons of CES-D depression scoring methods in two older adults ethnic groups. The emergence of an ethnic-specific brief three-item CES-D scale. Int J Geriatr Psychiatry 2013; 28:424-32. [PMID: 22674637 DOI: 10.1002/gps.3842] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 05/01/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the reliabilities and convergent validities of five CES-D (Center for Epidemiologic Studies Depression) composite scores in two ethnic/racial groups of community-dwelling older adults. DESIGN CES-D measurement equivalence was tested with Structural Equation Modeling in Puerto-Rican (PR) and African American (AA) older adults, then reliabilities of five composite scores and their convergent validities were compared. FINDINGS Bayesian CES-D scores had the highest reliabilities, followed by software estimated factor scores, the unit weight, and the weighted scores. Bayesian CES-D scores, factor scores, and surprisingly a group-specific three-item brief CES-D score exhibited better convergent validity than the unit-weight and weighted CES-D scores. CONCLUSIONS An ethnic group-specific three-item brief CES-D score emerged as a reliable CES-D measure in PR and AA older adults. We conclude that practitioners could emphasize three main symptoms in individual older adults in screening for depression, and researchers can model with confidence the relationships between the CES-D brief scale and its correlates.
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Affiliation(s)
- Emil N Coman
- Institute for Community Research - Evaluation, Hartford, CT, USA
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Abstract
OBJECTIVES Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. DESIGN Cross-sectional study. SETTING Public housing high-rises in Rochester, New York. PARTICIPANTS One hundred ninety residents aged 60 years and older. MEASUREMENTS Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. RESULTS Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. CONCLUSIONS Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.
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Simning A, Conwell Y, Fisher SG, Richardson TM, van Wijngaarden E. The characteristics of anxiety and depression symptom severity in older adults living in public housing. Int Psychogeriatr 2012; 24:614-23. [PMID: 22018393 PMCID: PMC3752311 DOI: 10.1017/s1041610211001979] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anxiety and depression are common in older adult public housing residents and frequently co-occur. To understand anxiety and depression more fully in this socioeconomically disadvantaged population, this study relies on the Social Antecedent Model of Psychopathology to characterize anxiety and depression symptoms concurrently. METHODS 190 public housing residents aged 60 years and older in Rochester, New York, participated in a research interview during which they reported on variables across the six stages of the Social Antecedent Model. GAD-7 and PHQ-9 assessed anxiety and depression symptoms, respectively. RESULTS In these older adult residents, anxiety and depression symptom severity scores were correlated (r = 0.61; p < 0.001). Correlates of anxiety and depression symptom severity were similar for both outcomes and spanned the six stages of the Social Antecedent Model. Multivariate linear regression models identified age, medical comorbidity, mobility, social support, maladaptive coping, and recent life events severity as statistically significant correlates. The regression models accounted for 43% of anxiety and 48% of depression symptom variability. CONCLUSIONS In public housing residents, late-life anxiety and depression symptoms were moderately correlated. Anxiety symptom severity correlates were largely consistent with those found for depression symptom severity. The broad distribution of correlates across demographic, social, medical, and behavioral domains suggests that the context of late-life anxiety and depression symptomatology in public housing is complex and that multidisciplinary collaborative care approaches may be warranted in future interventions.
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Affiliation(s)
- Adam Simning
- University of Rochester School of Medicine and Dentistry, Department of Community and Preventive Medicine
| | - Yeates Conwell
- University of Rochester School of Medicine and Dentistry, Department of Psychiatry
| | - Susan G. Fisher
- University of Rochester School of Medicine and Dentistry, Department of Community and Preventive Medicine
| | - Thomas M. Richardson
- University of Rochester School of Medicine and Dentistry, Department of Psychiatry
| | - Edwin van Wijngaarden
- University of Rochester School of Medicine and Dentistry, Department of Community and Preventive Medicine
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Radda KE, Schensul JJ. BUILDING LIVING ALLIANCES: COMMUNITY ENGAGEMENT AND COMMUNITY-BASED PARTNERSHIPS TO ADDRESS THE HEALTH OF COMMUNITY ELDERS. ANNALS OF ANTHROPOLOGICAL PRACTICE 2011. [DOI: 10.1111/j.2153-9588.2011.01087.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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