Mitigating Caregiver Distress in South Western Ontario: Perspectives on Role, Community, and Care

The former South West Local Health Integration Network (SW LHIN) of Ontario, which is in a predominantly rural region, regularly reports the lowest rates of caregiver distress in the province. Caregivers from rural communities regularly face challenges related to the access, applicability, and availability of supports and services, This qualitative case study describes perspectives of caregiving from the region, and explores how role construction and expectations of caregivers might both mitigate distress and influence service support use. Thematic analysis identified five themes: anticipated care, gendered caring, service support assumptions, confidence in community, and the "line in the sand": care decisions for evolving needs. Using the lens of caregiver identity theory, the findings suggest that these caregivers conceptualize identity as an extension of their primary role, to include caregiving obligations and responsibilities. We also noted a steadfast confidence in community and perceived service support assumptions across the region, with no notable rural-urban divide.

Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States

OBJECTIVES

To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status.

METHODS

Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics.

RESULTS

Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier.

DISCUSSION

Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.

Age-Friendly Approach Is Necessary to Prevent Depopulation: Resident Architectural Designers and Constructors' Evaluation of the Age-Friendliness of Japanese Municipalities

Japan has the world's largest old population ratio; thus, aging is an urgent societal issue. As global trends seem to be following Japan's social changes, there is an emphasis on municipalities becoming more age-friendly. Hence, we examine the age-friendliness of 135 Japanese municipalities, selecting 240 resident architectural designers and constructors to assess their municipalities using the Age-Friendly Cities and Communities Questionnaire (AFCCQ). The findings indicate that Japan lacks "outdoor spaces and buildings". Additionally, the evaluation of "housing", "community support and health services", and "transportation" in populated municipalities in the past five years was found to be significantly higher than that in depopulated ones. Age-friendliness is significantly affected by the AFCCQ total score (hereafter, Score) based on "housing", "social participation", "community support and health services", "transportation", and "financial situation" evaluations. High specificity (0.939) was found when the score was treated as a marker of depopulation; an age-friendly approach is a necessary condition for preventing depopulation. Furthermore, a lack of "communication and information" was observed in municipalities with a higher rate of single-person households aged 65 years and older. Therefore, resident architectural designers' and constructors' assessments, combined with the AFCCQ, will be a powerful tool for evaluating the age-friendliness of municipalities.

Co-Reasoning With the Significant Other(s): How Childless Older Adults in Rural China Make Residential Decisions

Applying the concept of residential co-reasoning, this research explored the role of the next of kin in the residential decision-making of childless older adults in rural China. We examined research questions regarding who, if anyone, had been the significant other(s) during the residential decision-making, and how they conducted the co-reasoning process. A constructivist grounded theory approach was applied, with 27 childless older adults being interviewed. We found that participants tended to choose to age in place if they had a continuous, reliable, and trustworthy relationship with certain members of next of kin, which they referred to as "I have someone at home." Acquiring care from kin was an ongoing negotiation process. Participants applied three types of negotiations: exchanging properties for care from kin; maintaining relational intimacy with kin; and counting on the filial obligation of kin. Otherwise, if care from kin was unavailable, participants tended to relocate to rural institutions.

Multi-Dimensional Social Relations and Mental Health among Rural Older Adults

To date, knowledge of the association between social-relational patterns and health among rural elders in non-Western social and cultural contexts is scant. Using regional population data in rural South Korea, this study examines comprehensive social relations among rural elders, and the extent to which heterogeneous patterns of social relations were associated with cognitive impairment and depression. Using comprehensive social-relational indicators with (a) the structure of social relations (b) the quality of social relations, we applied latent class analysis identified four subgroups of social relations among rural older adults: Restricted, Spouse Focused-Ambivalent, Community Engaged-Positive, and Diverse. We found that the Community-Engaged group was less likely to be depressed as well as have co-ocurring problems of cognitive impairment and depression.

Identification of Functional, Social, and Health Needs of Older Residents in Nonurban Settings: A Community Risk Assessment

Objectives: We examined functional, social, and health needs and service delivery gaps among a geographically expansive and economically diverse population of older adults to identify service priorities. Methods: We conducted analyses based on 1280 respondents aged 60 years and older surveyed for an 8-county needs assessment. Results: We identified three distinct risk profiles using two-step cluster analysis. ANOVA and chi-square analyses revealed significant differences between risk profiles on a range of health and social service needs. Discussion: Identifying high-risk residents can support community providers' efforts to help older adults age in place. Community-based organizations are well-positioned to respond early to social determinants of health needs. Targeting services and supports that reduce risk, extend independence, and prevent avoidable adverse healthcare situations to improve health and achieve health equity among historically underserved and hard-to-reach populations and prioritizing low-cost community interventions can reduce the need for high-cost interventions (e.g., emergency care and hospitalizations).

"The Ugly Face of Old Age": Elders' Unmet Expectations for Care and Support in Rural Ethiopia

As migration, urbanization, and aging accelerate in developing nations, traditional family supports for elders are diminishing. With these trends in mind, hermeneutic phenomenology was used to examine the experiences of 10 rural Ethiopian elders of age 70 and older. Narrative data from in-depth interviews revealed three prominent themes: the "good old days," drained happiness, worry and pessimism. Elders felt devalued by their children, grandchildren, and youth in general. Compared to how they treated their own parents, elders believed that their children's sense of filial obligation was weak and unreliable. Interactions were described as undermining, embarrassing, and abusive. Elders were pessimistic about the prospect of reliable caregivers, even expressing a wish to die before they become dependent on others for care. Despite such challenges, participants viewed aging as a privilege. New cooperative models of community-based care are needed to ensure that elders in developing nations can expect adequate care throughout their lives.

A National Examination of Caregiver Use of and Preferences for Support Services: Does Rurality Matter?

Objective: The objective of this study was to assess rural-urban differences in caregiver use of and preferences for support services. Method: Using the 2015 Caregiving in the U.S. survey data (n = 1,389), we analyzed rural-urban differences by caregiver residence in use of and preferences for support services. We analyzed bivariate differences in service use and preferences, as well as in sociodemographic and caregiving relationship characteristics. We also assessed the correlates of service use using stratified ordered logistic regression models. Results: Approximately one third of all caregivers had used no supportive services, with few differences in service use and preference by location. For caregivers in both locations, having more financial strain was associated with greater use of services. Discussion: This article identifies broad needs for caregiver support across all geographic locations. Targeted efforts should be made to ensure access to supportive services accounting for unique barriers by geography.

Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes

OBJECTIVE

To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes.

METHOD

We examined the relationship between access to care and diabetes management, as measured by HbA_1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA_1c levels.

RESULTS

In bivariate analyses, out-of-pocket costs were associated with higher HbA_1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models.

DISCUSSION

Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.

Childhood Circumstances and Mid-Life Functional Mobility

OBJECTIVES

We examine the cumulative long-term role of childhood health and socioeconomic status in affecting functional health at ages 50 to 59.

METHOD

Data on 2,233 respondents to The Irish Longitudinal Study of Aging (TILDA) are used to examine functional health measured by the timed-up-and-go (TUG) test of lower-body mobility. We examine the association of father's education, childhood rural residence, and childhood self-evaluated health with TUG and examine respondent's education, adult health behaviors, measured health, and cognition as mediators of the association of childhood characteristics and TUG.

RESULTS

Father's education, rural residence, childhood health, and education are associated with TUG times at ages 50 to 59. While health behaviors mediate most of the rural residence and education associations, the association with childhood self-evaluated health is direct.

DISCUSSION

Early life circumstances play substantial direct and indirect roles in molding functional level in late mid-life.

Toward the Development of a More Integrated Aged Care Assessment Process for Rural Older Australians: Practitioners' Perspectives

There is an identified need for more effective assessment processes in rural Australia, with prior research revealing little knowledge sharing and even duplication across existing services. This article aims to explore the challenges to more closely integrated assessment processes, drawing on interview data with practitioners from three agencies located in the same rural region. Findings highlight the challenges of rural assessment, both demand-driven (more older people with complex needs, geographic isolation) and supply issues (time and distance, funding formulae, workforce shortages). The need for closer collaboration is recognized but significant systemic issues require addressing if it is to be achieved.

Older persons' views and experience of elder abuse in South Western Nigeria: a community-based qualitative survey

OBJECTIVES

Conventionally, existing information on elder abuse has been institution based, professionally driven, and in high-income countries. This study addresses the prevailing gap in knowledge through direct consultation of older persons in the community about their perceptions of elder abuse.

METHOD

Eight focus group discussions were carried out among males and females aged 60 years and above in a rural and an urban community in south western Nigeria. Data were transcribed and analyzed based on emergent themes.

RESULTS

Findings from the study show that the perception of abuse by the respondents included the standard typologies except sexual abuse as well as societal issues such as disrespect and lack of recognition.

DISCUSSION

Our study revealed a high level of awareness and experience of elder abuse among the participants in both communities. Effective social welfare and health services aided by targeted government policies are needed to improve the quality of life of the elderly.

Traditional and commercial herb use in health self- management among rural multiethnic older adults

This study analyzes the role of traditional and commercial herbs in older adults’ health self-management based on Leventhal’s Self-Regulatory Model conceptual framework. Sixty-two African American and White adults age 65 and older completed qualitative interviews describing the forms of herbs currently being used, sources of information about them, interpretations of health (acute symptoms or chronic conditions) that led to their use, and the initiation and suspension of use. Traditional herbs are native to the region or have been traditionally cultivated, usually taken raw or boiled to produce tea, and used for treating mild symptoms. Commercial herbs are prepared as pills, extracts, or teas; they are purchased at local stores or ordered by catalog or Internet and used for health promotion, illness prevention, or treatment of chronic conditions. Herbs are widely used among older adults; this analysis differentiates the types of herbs they use and their reasons for herbs use.

Older adults' self-management of daily symptoms: complementary therapies, self-care, and medical care

OBJECTIVES

To describe older adults' use of complementary therapies, self-care practices, and medical care to treat daily symptoms and to delineate gender, ethnic, age, and education differences.

METHOD

A total of 200 African American and White participants (age 65+) selected using a site-based procedure complete a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. The percent of older adults using a therapy and the frequency with which therapies are used are considered.

RESULTS

The use of complementary therapies to treat daily symptoms, though important, is substantially less than the use of self-care practices and medical care. Participants differed by age, ethnicity, and education in the use of therapies.

DISCUSSION

In considering the percentage of individuals who use a therapy and the frequency with which therapies are used, this analysis adds a new dimension to understanding how older adults manage daily symptoms. Older adults are selective in their use of health self-management.

Ethnic variation in oral health and social integration among older rural adults

This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, White) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do White older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, whereas the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian, and White elders. More research on the ways oral health affects the lives of older adults is warranted.

Calling the doctor: a qualitative study of patient-initiated physician consultation among rural older adults

OBJECTIVE

Guided by Leventhal's self-regulatory model and Cockerham's theory of health lifestyles, we explore two questions regarding physician consultation among elderly rural adults: What symptom characteristics prompt patient-initiated physician consultation? Do participants' accounts of responses to symptoms, including the decision to consult a physician, incorporate descriptions of change over time?

METHOD

We analyze data from semistructured in-depth interviews with 62 older rural adults.

RESULTS

Accounts of decisions to initiate contact with physicians support prior research. Some symptoms encouraged immediate consultation; others prompted periods of monitoring and lay management. Physicians were most often contacted if changes were new, unusually severe, persisted or worsened, or failed to respond to lay treatment.

DISCUSSION

We characterize participants' responses to symptoms as bricolages to highlight their construction from available materials. Incorporating the integrating concept of bricolage and Cockerham's emphasis on both general dispositions and symptom-specific responses represents an important extension of Leventhal's conceptualization of illness behavior, including patient-initiated physician consultation.