Social Engagement of Frail Elders

BACKGROUND

Social isolation is a significant problem for frail older adults and the determinants of social engagement are poorly understood.

OBJECTIVES

This study explored the social engagement of frail elders to identify personal attributes associated with social engagement.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional sample of seventy-three people receiving home-based care in one town on the South Island of New Zealand (mean age 82 (7.2) yrs, n=51 Females, 21 Males).

MEASUREMENTS

Face-to-face semi-structured interviews and questionnaires. Functional independence was measured using Nottingham Extended Activities of Daily Living (EADL), self-efficacy by General Self Efficacy Scale, and 2 open-ended questions were piloted on social activities and helping others.

RESULTS

Regression models identified two statistically associated components of social engagement: social activities and civic involvement. Contributions to families and community organizations and exercise were important social activities. Personal attributes included perceived functional independence and self-efficacy.

CONCLUSIONS

In frail older adults, a measurement of social engagement should address activities older adults identify as important, including exercise. Independence, self -efficacy, and social engagement may interact in reinforcing cycles of empowerment and could play a role in developing interventions to retain and maintain function in frail older adults.

Managed care: a critical review

Widely perceived and accepted as the simplest way to control escalating health care costs, managed care is the way health care is now, and will continue to be, delivered in the foreseeable future. Growing numbers of Medicaid beneficiaries are required to participate in managed health care and Medicare beneficiaries are strongly encouraged to do so. In essence, America's poor and elderly are serving as the vanguard for health care reform. This article describes the evolution of managed care in the United States, then examines the implications of the transfer of financial risk to health care providers; the impact of managed care on existing inequalities in access to health care and services; the quality of managed care compared with fee-for-service arrangements; and the delivery of mental health services under managed care. We suggest that the role of the social work profession in managed care should be to mitigate the costs borne by clients, and offer specific suggestions for advocates in this arena.