Perceived adequacy of instrumental assistance: implications for well-being in later life

Effect of different patterns of home- and community-based services in Taiwan on the changes in physical function

Our study aimed to explore the impact of different home- and community-based service (HCBS) use patterns on older adults' physical function. The cohort data were drawn from two national datasets, the National Ten-Year Long-Term Care Plan 1.0 database and the National Health Insurance Program claims data. Participants were care recipients ages 65 and over, first evaluated and prescribed HCBS from 2010 through 2013 and evaluated again after 6 months (n = 32,392). Latent class analysis was used to identify subgroups with different HCBS use patterns. Multiple regression was used to examine the impact of different HCBS use patterns on change over time in disability related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The analysis was stratified by respondents' levels of disability. Four subgroups of HCBS recipients were identified, with patterns of home-based personal care, home-based personal care and medical care, home-based medical care and community care services. Older adults in the Home-based MpC had significantly more improvement in both ADL (p < 0.05) and IADL (p < 0.001) scores compared with adults in the other three groups, while the community care group regressed the most. In the stratified analysis of the severely disabled, the IADL outcome of the Home-based MC group was better than the home-based PC group (p < 0.001). Study findings shed light on the benefits of promoting the use of integrated HCBS that combines personal and medical care, especially for community care services.

Method and Description of the Aging in Manitoba Project: A 20-Year Longitudinal Study

The Aging in Manitoba (AIM) project includes nearly 9,000 seniors who have been interviewed. Three independent cross-sectional samples (i.e. 1971, 1976, 1983) were subsequently followed (1983–1984, 1990), producing cross-sectional and longitudinal data. A major goal of this paper was to examine non-response over time and representativeness of the panel of AIM survivors. This involved analysis of non-response, calculations of completion/response rates, and comparisons of demographic variables across the AIM sample and the broader Manitoba and Canadian populations. Non-response was very low (4.6% in 1983–1984, 5.0% in 1990) and did not appear to be dependent on such factors as location, gender, education level, or nationality descent. The 95.0 per cent completion rate compares favourably with other longitudinal studies, demonstrating the value of employing rigorous tracking procedures. These findings suggest that attempts to minimize bias and selective attrition in the AIM study have been successful.

Home care for older couples: "it feels like a security blanket . . ."

In this article, the authors explore the home care experience as described by older physically impaired individuals and their caregiving spouses. Separate face-to-face semistructured interviews were carried out with each spouse from nine couples. Analysis of the interview data revealed four themes. For care receivers the themes were Independence and Developing a Trusting Relationship With Home Care Workers. Relief and Continuity were voiced by the caregiving spouses. The authors show how these themes relate to the participants' sense of security, which emerged as a key underlying concept in the home care experience. This study adds to the home care and caregiving literature as it expands our understanding of the relationship between formal and informal caregiving, highlights issues and concerns older couples face as they receive home-based care, and includes both older spouse caregivers and their direct-care recipients.

Scales and tales: older women's difficulty with daily tasks

OBJECTIVES

Part of a 3-year study of the home care experience among 25 older women (aged 80-96), this research aimed to describe how the women understood difficulty relative to 20 basic and instrumental activity of daily living tasks.

METHODS

This was a qualitative study with a quantitative component. During open-ended interviews about living alone with help, participants rated difficulty with tasks on a 1-to-5 scale and talked about difficulty relative to tasks. I estimated concordance of the first two ratings and used a descriptive phenomenological method to discern how participants understood difficulty.

RESULTS

Concordance was satisfactory for all tasks other than climbing stairs. Six elements of the life-world of older women were descriptive of difficulty relative to tasks, including pinpointing my biggest/hardest job and having difficulty rating difficulty. Whether reporting difficulty or not, some women spoke of taking extra time, extra effort, or both.

DISCUSSION

The findings suggest a counterview to functional limitation models. Difficulty was posed as a theoretical construct, and the concept of subliminal difficulty was introduced. Various facets of difficulty warrant further descriptive work. Incorporating an opportunity to talk about difficulty, as well as to rate it, would be valuable in large-scale studies.

Does the source of support matter for different health outcomes? Findings from the Normative Aging Study

OBJECTIVES

This study investigated the differential relationships between different types and sources of social support and physical and mental health.

METHODS

Using data from the Normative Aging Study, 1,386 older men (median age = 62.7 years) were categorized into four groups separately for frequency of interaction with networks and perceived support.

RESULTS

More than half the sample reported high levels of support from both sources. One-way ANOVAs revealed that those with high perceived support from both sources reported better physical health and fewer depressive symptoms than those with low support from both sources or high support from family alone. Similarly, those with high perceived support from both sources had lower levels of depressive symptoms than those with low support from both sources, but frequency of contact was unrelated to physical health.

DISCUSSION

In general, those with high support from both family and friends reported the highest level of well-being.

Gender differences in the relationship between marital status transitions and life satisfaction in later life

This study examined life satisfaction among individuals who had undergone a transition in marital status and those whose marital status remained stable over a 7-year period. In particular, using data from a large-scale, longitudinal study we assessed life satisfaction as measured in 1983 and 1990 among 2,180 men and women between the ages of 67 and 102. Groups of individuals were identified on the basis of whether a spouse was present or absent at the two measurement points. This allowed for a classification of groups who experienced stability or transitions in marital status. Among those individuals whose marital status remained stable over the 7 years, women's life satisfaction declined and men's remained constant. Among those who experienced a transition--in particular, the loss of a spouse--a decline in life satisfaction was found for both men and women, decline being more predominant for men. In addition, men's life satisfaction increased over the 7-year period if they gained a spouse, whereas the same was not true for women. Generally, these findings imply that the relationship between marital status transitions or stability differs for men and women.

How many elders receive assistance? A cross-national comparison

OBJECTIVES

To examine models of informal support received by elders in the United States and Sweden and to test whether differences in informal support appear to stem from demographic differences between the nations alone or whether cultural and historical differences must also be considered.

METHODS

Samples with similar functional dependence, age 75 and older in the United States (n = 4,677) and Sweden (n = 1,378), were used to model cross-national differences in the association between country, age, sex, potential availability of kin support, and receipt of informal assistance.

RESULTS

Patterns of informal help were higher in the United States than in Sweden but were qualified by higher order interactions among age, sex, and availability of kin support.

DISCUSSION

Cultural differences predating current policies in both countries appear to influence informal support over and above what can be accounted for by demographic differences alone.

The influence of personal care and assistive devices on the measurement of disability

The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.