"100 Things I Wish Someone Would Have Told Me": Everyday Challenges Parents Face While Caring for Their Children With a Tracheostomy

Equitable access to appropriate care, emergency department services, and in-home support aids are needed to minimize the occurrences of adverse events that have a significant impact on families. However, many families of children with medical complexity (CMC) lack consistent care due to issues of health inequity. We conducted 11 qualitative interviews with primary caregivers who were asked about their experiences of providing care to children who have a tracheostomy and are supported by multiple life-saving machines at home. Guided by ecological systems theory, we identified three themes that contextualize the lived experiences of the participants who expressed needs that arose from poor interactions within the mesosystem. Findings convey participant frustrations that result from insufficient support, ineffective training, and inadequate healthcare coverage. Although each theme is organized systematically to emphasize specific concerns within the mesosystem, together these themes emphasize the inextricable relationship between daily needs with systemic barriers to care. We provide a discussion of these needs with a broader context that also impacts the perceived quality of care among families managing the needs of their children who are supported by life-saving technology. By addressing existing challenges and identifying opportunities for improvement within the healthcare system, we seek to contribute to the collective effort of advocating for ethical systemic change on behalf of CMC and their families.

Exploring Contextual Factors Associated with Suicide among Older Male Farmers: Results from the CDC NVDRS Dataset

Objectives: The purpose of this study was to explore how demographic, relationship, mental health, and life stressors are associated with suicide among older male farmers and to determine if these differ by age.Methods: We conducted exploratory analyses with Centers for Disease Control (CDC) National Violent Death Reporting System (NVDRS) 2003-2017 dataset. We identified individuals who completed suicide while working in agriculture (N = 2,106). We explored descriptive statistics for farmers who completed suicide and compared these by age using chi-square tests.Results: The majority of the sample was male, non-Hispanic, and White. Marital status differed significantly by age, with older farmers more likely to be married or widowed. Having a mental health issue was not statistically significant by age; however, depression was most prevalent among those 65+. Older farmers who completed suicide were also significantly more likely to report physical health problems.Conclusions: Results illustrate the vulnerability of individuals contemplating suicide and emphasize the need to consider the phenomenon from a holistic perspective that accounts for individuals nested within community.Clinical implications: We recommend health providers consider a systems approach to suicide prevention as our results indicate individual, familial, and societal factors contributing to the incidence of suicide completion among older farmers.

Narratives of Generativity and Resilience among LGBT Older Adults: Leaving Positive Legacies despite Social Stigma and Collective Trauma

The aim of many adults in middle to old age is to be generative. Generativity is the concern older adults direct toward the wellbeing of future generations. Being generative results in positive well-being during later life and is especially important to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults who have experienced lifelong discrimination. In this study, we identified stigmatizing social influences that both negatively and positively acted to inform understandings of generativity and the ability to leave a legacy for future generations. Using a narrative analysis methodology, we identified three overarching redemptive narratives from study participants: (1) experiences during the HIV/AIDS pandemic, (2) absence of positive role models, and (3) religious conviction. These life story narratives inform how generative contributions can contribute toward a legacy of resilience, despite social stigma and collective trauma.

Toward a Regional Gerontological Agenda: The Use of Empowerment Evaluation

This article describes the application of an empowerment evaluation approach to nurturing the growth and priority setting of a regional organization. A model is provided of the processes whereby the Southern Gerontological Society (SGS) identified research and service priorities by conducting a survey of stakeholder perceptions of regional needs. The survey goal was to identify important issues faced by older adults in the South as a prelude to refining SGS research and service priorities and developing its contemporary regional gerontological agenda. We trace how the survey findings were translated into actions including shaping the annual meeting program, creating new standing committees, and developing service activities. Underlying the process of developing and refining this agenda are a set of key principles that have come to characterize the operation of SGS. These principles are discussed and provide a model for comparable organizations seeking to develop agendas consistent with their mission and identity.

RECONSIDERING PROTECTIVE FACTORS OF SUICIDALITY IN OLDER ADULTHOOD: RESULTS FROM THE CDC NVDRS NATIONAL DATASET

Existing literature comprehensively addresses the issue of suicide; however, there is still much to be understood concerning this phenomenon in later life. For instance, suicide rates are particularly high for older agricultural workers, yet there remains considerable ambiguity concerning the factors contributing to this public health crisis. We conducted exploratory analyses with the Centers for Disease Control (CDC) National Violent Death Reporting System (NVDRS) 2003-2017 dataset. We identified a sample of individuals who committed suicide while working in the agricultural sector (N= 2,106). We coded “farmer” as anyone who worked in the agricultural sector at their time of death, or prior. The majority (>90%) of the sample was Caucasian male, and approximately 38% was age 65 and older. We also found that 40% of farmers were married (or in a domestic partnership) at the time of death. Specifically, of those 65 and older, 26% were married at the time of death (second largest majority as 70% were widowed). This finding is particularly interesting as marriage or long-term partnerships have been shown in the literature to be a protective health factor in later life, especially for older men. Our findings regarding marital status suggest that having a significant other may not be the most critical relationship for suicide prevention. Future mental health interventions should explore alternative social connections as a means to identify more effective methods of preventing suicide in this vulnerable population.

Complexity of care: Stressors and strengths among low-income mother-daughter dyads

Research on informal care for older adults tends to consider middle- and upper-class individuals. Consequently, less is known about caregiving among low-income families. We present findings from an exploratory qualitative study of low-income African American mothers (n = 5) and their caregiving daughters (n = 5). Guided by a feminist framework, we consider how individual, familial, and societal factors contribute to the intersectional complexities of caregiving. Despite the unavailability of formal resources, we found the 10 women positive in their outlook. Furthermore, this study contributes to a growing body of research that identifies both negative and positive aspects of caregiving among an underrepresented population.

A Practitioner's Guide to End-of-Life Intimacy: Suggestions for Conceptualization and Intervention in Palliative Care

Sexuality and intimacy, including contact, tenderness, and love, are important at every life stage. Intimate expression is especially vital at the end of life, when relationships with loved ones are time limited. Unfortunately, care providers often ignore the potential need for sexual expression, especially at the end of life. In this article, we consider current research on sexuality and end-of-life care and situate these two fields in an ecological framework. We explore how end-of-life sexuality and intimacy can be supported by practitioners in multiple nested contexts and provide suggestions for theoretically-driven interventions. We also provide reflexive considerations for practitioners.

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.