Older adults' perceptions of ageism, discrimination, and racism.

Older adults often experience different forms of discrimination, whether it be on the basis of their age, gender, race, or ethnicity (Rochon et al. 2021). Many older adults have stated they have experienced the health care system differently because of their race or ethnicity . Understanding older adults' experiences and their perceptions of ageism and racism can guide future work. This observational cross-sectional study captured community-dwelling older adults' perceptions about their experiences with ageism and racism. A few opened-ended questions were included in the cross-sectional survey. While results did not yield differences with respect to perceptions of ageism by race; there were statistically significant results in regard to perceived racism, with higher scores on the racism scales for individuals who self-identified as Black. Discussion and implications for practice, policy and research are explored.

The invisible gap: Older adults' communication with health care providers about concomitant use of alcohol and medications.

The purpose of this study was to assess the impact of a new educational intervention, Communicating with your Health Care Providers, which was designed to assist older adults in communicating with their physicians and other health care providers and improving their knowledge about concomitant alcohol and medication risks. A randomized control trial was conducted in older adult centers in an urban community. Participants were assigned to either the intervention group or a control group that received traditional services. The intervention group received educational material about health, physical and other aging changes, medication use and possible adverse interactions between alcohol and medications, as well as strategies to initiate communication with physicians and other health care providers. The outcomes measured were: (1) interest in communicating with physicians and health care providers; (2) perception of the importance of communication; and (3) knowledge about concomitant alcohol and medication use. MANCOVA tests indicated that the intervention group had greater knowledge about the risks of combining alcohol with prescription medications than the control group, as well as greater interest in having health care discussions with their physicians and other health care providers. These findings may be translated into future educational programming for community centers.

Interprofessional practice: Social work students' perspectives on collaboration.

As the value of interprofessional practice becomes increasingly recognized, it is critical to educate social work students so that they understand the importance of interprofessional practice, and the role that social workers play. The objective of this research was to understand social work students' experiences, attitudes, and perspectives toward interprofessional practice. A cross-sectional, non-probability convenience sample was used (N = 125), with data collected from students in a large school of social work in New York State in order to understand their experiences in the field and classroom. Results of a linear regression showed that overall, students had positive perspectives on interprofessional collaboration, with one of the strongest predictors being students' positive attitudes toward interprofessional practice. The results also point to students having limited experience in working in interprofessional teams and exposure to training, either on the job or in the classroom. To help students gain more experience and training, fieldwork opportunities in interprofessional practice can be expanded, and more courses can be offered, particularly collaborating with other academic disciplines.

A social work perspective: attitudes toward end-of-life planning.

This research examined social workers' attitudes toward end-of-life planning and related factors in a cross-sectional study (N = 844). Data were gathered on completion of a health care proxy, personal comfort, training experiences of social workers, and demographics. Attitudes toward end-of-life planning were related to personal completion of the health care proxy, personal comfort, and years of social work experience. These measures remained significant in all steps of the regression, regardless of practice grouping (health and aging or other than health and aging), suggesting the relative importance of personal rather than professional aspects. Respondents in the health and aging fields are older than those in other than health and aging, underscoring concerns about workforce issues in the field of aging.

Building on community assets to improve palliative and end-of-life care.

In this article, the authors describe the development of a multidisciplinary, interfaith, grassroots community group of professionals and laypersons who have created a replicable model to enhance palliative and end-of-life care. The Collaborative for Palliative Care leverages existing community assets and capacities within the health and social service programs of Westchester County, New York, resulting in a unique public-private partnership. It has played a critical role in changing the culture of care for residents of Westchester who are faced with the challenges of serious and terminal illness.

Older Latinos' attitudes toward and comfort with end-of-life planning.

The purpose of this study was to determine which of two educational interventions delivered in Spanish would influence Latino elders' attitudes toward and comfort with end-of-life planning in comparison with a control group receiving only standard information routinely provided. Using a posttest-only control group design, elders receiving home care services who agreed to participate were randomly assigned to one of three groups: Conversación A; Conversación B, with culturally relevant material added; and a control group. A one-way multivariate analysis of variance was conducted to determine the effect on the two dependent variables: attitudes toward end-of-life planning and comfort with end-of-life planning. Significant differences were found among the three groups on both outcome measures. Attitudes toward advance planning scores were significantly higher for both intervention groups compared with the control group. Although both intervention groups had higher comfort scores than the control group, only the Conversación A score was statistically different from that of the control group. The results of this study indicate that it may be possible to positively influence both attitudes toward and comfort with end-of-life planning among older Latinos receiving home care, through the use of a one-to-one protocol that is delivered in Spanish.

Event-exposure stress, coping, and psychological distress among New York students at six months after 9/11.

This study examines if event-exposure stress has a significant effect on the latent mediating factors of problem-based coping, emotion-based coping, and intrinsic religious motivation, as well as on psychological distress. The study used a single-group correlational design. Data were collected from graduate social work students (N=642) in the New York metropolitan area six months after September 11, 2001. In a structural equation model, event-exposure stress was found to be positively related to problem-focused coping. The model also supported that event-exposure stress had a positive direct effect on psychological distress. While both forms of coping were positively related to levels of distress, higher levels of intrinsic religious motivation were related to lower levels of psychological distress. Professionals should provide guidance to help individuals reduce psychological distress by building upon different coping strategies to best fit the person and the situation.

Social workers' and nurses' attitudes toward the health care proxy.

Since health care professionals play a critical role in discussing advance directives with patients, their own attitudes toward these directives are important. This study examined the factors associated with health care professionals' attitudes toward the health care proxy, one form of an advance directive. Social workers (n= 115) and nurses (n= 98) had generally positive attitudes toward the health care proxy. Factors that predicted attitudes included profession and training in end of life. Health care professionals who had prior training in end-of-life planning had more positive attitudes toward the health care proxy than those who did not have training. Implications for education of health care professionals are addressed.

Social work involvement in end of life planning.

This cross sectional study examined the factors associated with social workers' involvement in end-of-life (EOL) planning using a random sample of NASW members in health and aging. Of the 390 social workers who worked in EOL planning, the majority were involved in health care proxy discussions and counseling with patients. Respondents tended to see barriers to proxy completion as client-related. However, some system barriers were correlated with overall involvement. Factors that predicted social workers' involvement with the health care proxy included age, attitudes, perceptions of barriers, and perceived physician support. Social workers need to attend to the systems in which they operate as well as to client concerns.

"They don't want to hear us": Hispanic elders and adult children speak about end-of-life planning.

This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/ parents do not want to have these discussions.

Communication between older people and their health care agents: results of an intervention.

This study examined an intervention to help high-functioning community-dwelling older people communicate their wishes for care at the end of life with someone they would trust to make health care decisions for them if necessary. Groups consisted of dyads of older people and their potential or designated health care agents randomly assigned to the intervention (STEP program) or control group. STEP participants received three group sessions with educational and support components. For individual participants, there was a statistically significant difference between groups on knowledge of the health care proxy form and the roles and responsibilities of the agent. For the dyads of older people and their agents, there was a significantly higher mean communication score for the STEP participants than for the control group. The findings demonstrate that it is possible to affect advance communication about wishes at the end of life through a group intervention.