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.

Depressive symptoms in the frail elderly: physical and psycho-social correlates.

The elderly who suffer from chronic illness are at unusually high risk of depression and depressive symptoms. This study was conducted to describe the prevalence of depressive symptoms in a sample of chronically-ill elders and to examine the relationship between physical illness and depression, both as it is illuminated in a regression model and as it is understood by the respondents themselves. Interviews were conducted with a random sample of 100 clients in a community-based care program for low-income elderly at risk of nursing home placement. Over one-third of the sample (36%) reported significant depressive symptoms, as measured by the CES-D. Multiple regression analysis identified functional limitations, cognitive impairment and self-perception as significant correlates of depression in a model that explained 30 percent of the variance in CES-D scores.

Self-concepts of low-income older women: not old or poor, but fortunate and blessed.

This article examines the extent to which low-income older women define themselves in stigmatizing terms, then explores the strategies they use to preserve a positive sense of self. Instead of considering themselves "old" or "poor," the sixty-two women interviewed defined themselves as "fortunate" and/or "blessed." The ability to see oneself as fortunate may be a significant component of successful aging.

Programming for family care of elderly dependents: mandates, incentives, and service rationing.

In response to a demographic imperative, many countries have established policies to increase family involvement in the care of their dependent elderly relatives. Reflecting fiscal constraints and cultural norms, these policies are often designed to place the burden of care on family rather than government. This article offers a survey and critique of three approaches to increasing family care of elderly people: filial support legislation, incentives for family caregivers, and service rationing provisions. Drawing in part on the results of a survey with respondents from 33 countries, it concludes that policies that require or encourage relatives to provide care may have adverse consequences for elderly people and their families. Human services advocates should support policies and interventions that provide universal access to a continuum of care alternatives that facilitate rational health care decision making by families and that empower and sustain family members who choose to care for elderly relatives.

Gender differences in caregiving: why do wives report greater burden?

Women typically report greater burden associated with caregiving than do men. We used data from interviews with 131 older spouse caregivers to explore potential explanations for this difference. A linear regression model explained 35% of the variance in caregiver burden. The patient's cognitive and behavioral difficulties emerged as the most important predictor of burden, followed by caregiver age, unpleasant social contacts, caregiver sex, and overall coping effectiveness. Findings suggest that age differences in male and female caregivers contribute to the observed differences in burden.