The effect of ethnicity and economy upon intergenerational coresidence: northern Norway during the last part of the nineteenth century.

During the last part of the nineteenth century, Finnmark province and the northern part of Troms experienced a decline in intergenerational coresidence. This article discusses what impact ethnic affiliation and economic activity had on the living arrangements of the elderly, and what contributed to the change. Logistic regression shows that ethnicity played a role but its effect disappears after controlling for economic activity. Intergenerational coresidence was positively associated with being a married Sámi male with an occupation in farming or combined fishing and farming. As such a person grew older, he was increasingly likely to live separately from an own adult child. This pattern changed toward the end of nineteenth century. By the close of the century, ethnic differences had disappeared, and headship position, irrespective of marital status, was strongly related to coresidence.

Housing Plus Services, IADL Impairment, and Healthcare Expenditures: Evidence From the Medicare Current Beneficiaries Survey.

BACKGROUND AND OBJECTIVES: Despite enthusiasm for the potential cost savings of embedding supportive services in senior housing, few population health studies have empirically examined such associations. We investigated the extent to which associations between housing plus services in senior housing and healthcare expenditures depend upon residents' instrumental activities of daily living (IADL) impairment and the level of services available. RESEARCH DESIGN AND METHODS: We used data from 2,601 participants aged 65 or older in the 2001-2013 Medicare Current Beneficiary Survey, who reported living in senior or retirement housing. Based on survey self-reports, we created a measure of housing with different levels of services, including the categories of housing without services, housing plus services (i.e., assistance with IADLs, but not with medications), and housing plus enhanced services (i.e., assistance with IADLs including medications). Administrative and survey data were used to create measures of healthcare expenditures paid by all sources. We estimated generalized linear models based on pooled data from participants across the 13 years of data collection. RESULTS: Residents with IADL impairment-who lived in housing plus enhanced services-had lower total healthcare expenditures than their counterparts in housing without services and housing plus services. Upon examining component healthcare costs, this pattern of results was similar for inpatient/subacute care, as well as ambulatory care, but not for home health care. DISCUSSION AND IMPLICATIONS: Findings indicate the importance of studies on the cost savings of housing-based service programs to consider resident IADL status and the types of services available.

A Cluster Randomized Trial of Tai Chi vs Health Education in Subsidized Housing: The MI-WiSH Study.

OBJECTIVES: Tai Chi (TC) may benefit older adults with a variety of diseases and disabilities. We tested the hypothesis that TC improves physical function in older adults living in low-income housing facilities. DESIGN: Cluster randomized controlled trial. SETTING: Subsidized housing facilities in Boston, Massachusetts, and neighboring communities. PARTICIPANTS: Volunteers were recruited from 15 facilities. The 180 randomized participants were 60 years of age or older, able to understand English and participate in TC, expected to remain in the facility for 1 year, and able to walk independently. INTERVENTION: TC classes were conducted in the housing facilities twice/week for 1 year and compared with monthly health promotion educational classes and social calls. MEASUREMENTS: The primary outcome was physical function measured by the Short Physical Performance Battery (SPPB). Secondary outcomes included other aspects of physical and cognitive function, and falls. RESULTS: An interim analysis revealed less improvement over 12 months in SPPB scores among TC participants (+.20 units; 95% confidence interval [CI] = -.20 to +.60; P = .69) vs control participants (+.51 units; 95% CI = +.15 to +.87; P = .007), a difference of -.31 units (95% CI = -.66 to .04; P = .082). This met the criterion for futility, and the Data Safety Monitoring Board recommended trial termination. No differences were found in 6- or 12-month changes favoring TC in any secondary outcomes or adverse events. CONCLUSION: In older adults with multiple chronic conditions living in subsidized housing facilities, 6 and 12 months of twice/week TC classes were not associated with improvements in functional health. J Am Geriatr Soc 67:1812-1819, 2019.

Housing assets and the socio-economic determinants of health and disability in old age.

The influence of socio-economic determinants among the elderly is a complex subject. Although they rely on pension income, the wealth that they have accumulated over their lifetime (primarily housing assets), jointly with housing-related determinants, could have a more significant effect on health production. Hence, owning a house has more potential than income for reducing health inequalities. This study makes use of a representative cross-sectional database on the Spanish population aged 55 or over. Using a continuous variable to measure health and a measure of disabilities in old age, the study explores some socio-economic determinants of health and disability and provides a breakdown of inequalities in socio-economic status and in aggregate individual health. The study's findings indicate that housing equity overrides the effect of income as a determinant of health and (absence of) disability in old age. Furthermore, housing assets account for more than 90% of socio-economic inequalities and 54% of inequalities in disability.

Future housing plans and funding for the care of older people.

The Government recently launched a housing strategy for older people, which promises more inclusive housing and community design. Yet more needs to be done to ensure the strategy makes a real difference to older people's lives. Joe Oldman explains the situation for The British Journal of Community Nursing.

Differential Aging in Place and Depressive Symptoms: Interplay Among Time, Income, and Senior Housing.

OBJECTIVE: We examined cumulative and differential experiences of aging in place. METHOD: Data came from the 2002 and 2010 wave of the Health Retirement Study. We modeled the trajectory of later-life depressive symptoms, and how senior-housing environments moderate the negative association between economic disadvantages and depressive symptoms. RESULTS: At baseline, economically disadvantaged older adults were more likely to exhibit depressive symptoms. However, detrimental effects of income group (non-low income vs. moderate income; non-low income vs. low income) on depressive symptoms did not significantly change over time. The age-leveler hypothesis may account for nonsignificant effects of disadvantaged income groups over time. DISCUSSION: Findings suggest that moderate-income seniors may experience positive differentials if they age in place in a supportive senior-housing environment. Moderate-income seniors may have broader opportunities in senior housing compared to private-home peers. Senior housing might partially counter risks such as low mental health, emerging from life-course disadvantage.

Affordable rental housing for older people in Australia: what do older people want?

This study aims to determine the perspectives of older community members and service providers in relation to design and location of affordable rental housing in a coastal retirement area of NSW, Australia. This was achieved by holding focus groups and interviews with older community members (n = 21) and service providers (n = 43). All participants reported a shortage of affordable rental housing suitable for older people in the area. The preferred option was for cluster units, possibly with an on-site carer, located in or close to town. Participants agreed that if choice was limited to "one-bedroom with large living area" or "two-bedrooms with small living area," the majority of single older people would choose the former option, provided there was adequate storage. The importance of asking the "right" question was demonstrated by responses to options for one- or two-bedroom units. Further research is needed to identify what baby boomers think will meet their need for future affordable housing.

Availability of services in registered retirement villages in Queensland, Australia: A content analysis.

OBJECTIVE: The study investigates and compares the services available in different types of registered retirement villages in Queensland (QLD). METHODS: A content analysis based on official websites of 175 registered villages in QLD, Australia, is presented. RESULTS: This study identifies 82 services, with activity organisation, emergency response, hairdressing and transportation being most frequently available to residents. The number of services available is associated with the village size and financial type, with residents living in large private villages having access to significantly more services. CONCLUSION: The research findings reveal the state of the art of current industry practice. They provide useful implications for stakeholders. For instance, residents who prefer to get access to various services should focus more on large private villages. Developers can check their service delivery environment to confirm its balance with residents' competencies. The government can propose innovative initiatives to promote the delivery of appropriate services in villages.

A project in Pennsylvania.

Through collaboration, Mercy Health Partners (MHP) of Southwest Ohio, Cincinnati, and Catholic Social Services (CSS) of the Diocese of Scranton, PA, built a housing complex for low-income seniors and developed a variety of supportive services for residents. St. Catherine's Manor aims to meet elder adults' social and medical needs through offerings such as on-site health assessments, meal services, and transportation help. In order for the collaboration to be a success, MHP, CSS, and their partners had to trust one another. They also had to be clear and deliberate about their roles and responsibilities, thereby establishing expectations well in advance of the project. Their partnership was enhanced because they shared a common culture.

Promoting health, building community.

As part of its mission to honor human dignity and to care for the poor and vulnerable, Catholic Healthcare Partners (CHP), Cincinnati, has made a systemwide commitment to address housing needs in the communities it serves. A priority for the system is providing safe, affordable housing options for the low-income elderly. CHP's approach goes beyond "bricks and mortar," however. The system aims not only to provide a home for senior adults but also to enrich their lives. Through various activities and support services, CHP's senior living complexes in Kentucky, Ohio, Pennsylvania, and Tennessee offer residents an opportunity to live in a vibrant community. CHP facilities have developed a variety of initiatives to enhance residents' lives. Among these are: spiritual care services, nurses who serve as a resource to low-income elders, a short-stay shelter for seniors in transition, a service referral program, and therapy to help elders remain independent. In order to offer these comprehensive services to senior adults, CHP relies on partnerships with a variety of organizations and on funding from both the federal government and private investors. Especially as the nation's population ages, CHP continues to make its housing ministry a strategic priority.

Resident medical care utilization patterns in continuing care retirement communities.

This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts: one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533).

Comparison of waste composition in a continuing-care retirement community.

OBJECTIVE: To determine the composition of wastes generated in a continuing-care retirement community (CCRC) and to analyze the effects of source-reduction activities and meal delivery system change on the amount of waste generated in the facility. DESIGN: A waste stream analysis was conducted at the same CCRC during spring 1994 (period 1: baseline), spring 1995 (period 2: source reduction intervention), and fall 1995 (period 3: service delivery intervention). Weight, volume, and collapsed volume were determined for food and packaging wastes. SETTING: Tray service and wait staff service are provided to 70 residents in a health care unit, and family-style service is an optional service available to 130 residents in the independent-living units. A mean of 229 meals are served per day. INTERVENTION: Intervention included the implementation of source-reduction activities and a change in a service-delivery system in periods 2 and 3, respectively. STATISTICAL ANALYSIS PERFORMED: Descriptive statistics were used to determine the composition of waste. Analysis of variance and a multiple comparison method (least significant difference) were used to compare mean weight and volume of waste generated in period 1 with data collected during periods 2 and 3. RESULTS: Mean waste generated per meal by weight and volume ranged from 0.93 to 1.00 lb and 1.44 to 1.65 gal, respectively. Significantly less production waste by weight (0.18 lb/meal) and volume (0.12 gal/meal) was generated in period 2 than in period 1 (0.32 lb/meal and 0.16 gal/meal, respectively). Significantly less service waste by weight (0.31 lb/meal) and volume (0.05 gal/meal) was discarded in period 3 than in period 1 (0.37 lb/meal and 0.15 gal/meal, respectively). Significantly less total waste and plastic by weight was disposed of after the interventions. The study conclusions indicated that implementing source-reduction practices and changing the meal-delivery system affected the composition of waste generated. APPLICATIONS: Knowledge of waste stream composition can help other foodservice professionals and consulting dietitians identify waste-reduction activities and recycling opportunities. The quantity and type of waste generated should be considered when operational decisions are made relative to market form of food, menu choices, service-delivery systems, and production forecast and controls.

Reverse mortgages and the economic status of elderly women.

Data from the 1990 Census of Population and Housing are used to estimate the potential demand for reverse mortgages among elderly women householders. A reverse mortgage product is simulated using parameters based on the Home Equity Conversion Mortgage insurance demonstration, and its effect on poverty and income distribution among this group is calculated. Approximately 1.8 million women with low incomes and home equity of $40,000 and above could see a significant increase in income under such a program.

Generation: a corporate-sponsored retiree health care program.

Generation is a geriatric clinic program sponsored by Southern California Edison Company for the company's retirees and their dependents. This innovative program uses a multidisciplinary team approach, including a comprehensive health and psychosocial assessment, complete medication review, retiree advisors, health promotion programs, and case management services. In its pilot phase, Generation has served more than 175 Edison retirees and dependents aged 53-96. In addition to traditional medical care, participants receive aggressive intervention regarding polypharmacy problems, health education workshops, individual and group counseling, and access to community resources. Ongoing research seeks to evaluate the program's effectiveness in providing high-quality health care services while containing costs.