Cultural Differences in Advance Care Planning and Implications for Practice.

This study examined cultural differences in advance care planning (ACP) and various strategies that social workers use to initiate conversations on ACP. We conducted qualitative interviews with 12 social workers in South Korea and the US and a thematic content analysis of the transcribed data. Our findings show that different cultural norms and generational viewpoints surrounding death and health-related decision-making influence how people prepare for end-of-life care (EOLC). Whereas principles of self-determination and autonomy guide ACP practices in the US, decisions regarding EOLC are more often made in consultation with family members in Korean and Korean-American communities. Nevertheless, social workers in both countries identified relationship-building, empowerment, and individualized approaches as common strategies in initiating discussions on ACP.

Active Aging In Long-Term Care Facilities In Korea : Beyond The Lexical Meaning.

The discourse of active aging, as introduced by the WHO, aims at optimizing older adults' opportunities for health, participation, and security that could eventually enhance their social integration and quality of life. Considering that even those with frailty could strive for active aging in the given circumstances, we examined the meaning of active aging in long-term care settings and care strategies to promote it based on the WHO's framework. We conducted interviews with a total of 35 participants. The interpretative analyses revealed that the activities taken place in LTCFs have various scopes depending on older adults' physical and cognitive functional ability, and it captures the forms of activities that go beyond its lexical meaning. By defining being "active," the present findings could contribute to an understanding of how the three elements of active aging can be carried out in LTCFs.

Moderating effect of cognitive reserve on the association between grey matter atrophy and memory varies with age in older adults.

BACKGROUND: Educational attainment and verbal intelligence, which indirectly reflect an individual's cognitive reserve (CR), is suggested to buffer the effect of late-life brain degradation on cognitive performance outcome. We aimed to explore how the relationship between whole grey matter volume (GMV) and episodic memory function is altered by CR proxy as well as age in healthy older adults. METHODS: Elderly Verbal Learning Test (EVLT) and structural magnetic resonance imaging were administered to 110 community-residing older adults. Moderated moderation model tested whether the association between whole GMV and episodic memory was moderated by both CR and chronological age. RESULTS: The results showed that the moderating effect of CR on Immediate Recall, Short-delay Recall, and Recognition scores of EVLT differed across age groups. The elderly with higher CR showed steeper GMV effect on EVLT at the Age-Younger condition, while such moderating effect was reversed in the Age-Older condition, suggesting an alleviated brain atrophy effect in higher CR elderly. CONCLUSION: These findings suggest that although higher CR elderly may exhibit earlier GMV-related memory decline, the buffering effect of CR on the cognitive decline due to brain atrophy would become more evident in old-old elderly people who are likely to have accumulated more neuropathological changes. This study underscores chronological age as an important moderating factor in examining the moderating role of CR in late-life memory function.

Risk of Social Isolation among Older Patients: What Factors Affect the Availability of Family, Friends, and Neighbors upon Hospitalization?

OBJECTIVES: To examine the prevalence of social isolation among older patients admitted to a hospital, and the effects of sociodemographic and health-related factors on the availability of their family, friends, and neighbor networks. METHODS: Analyses are based on interviews with a sample of 2,449 older patients admitted to an urban academic medical center in the United States. A nine-item version of Lubben's Social Network Scale was developed and used to assess the availability of different social networks. RESULTS: About 47% of the sample was at risk of social isolation. The oldest old and non-White older adults showed greater risk. The availability of family networks was associated with age, sex, marital status, and prior hospitalization; friend networks with age, race, education, prior hospitalization, and functional limitations; neighbor networks with race, education, marital status, and functional limitations. CONCLUSIONS: The risk of social isolation and the availability of social support for hospitalized older adults varies by both patient and network characteristics. Health professionals should attend to this risk and the factors associated with such risk. CLINICAL IMPLICATIONS: By assessing the availability of various types and frequency of support among older patients, health professionals can better identify those who may need additional support after discharge. Such information should be used in discharge planning to help prevent unnecessary complications and potential readmission.

Telling life stories: a dyadic intervention for older Korean couples affected by mild Alzheimer's disease.

ABSTRACTBackground:Dementia has negative consequences for both persons with dementia and their family caregivers. Dyadic interventions in which both groups participate together have shown an effective and promising approach. The Couples Life Story Approach (CLSA) that was recently developed for older couples dealing with dementia in the USA was adapted and implemented for the older Korean population in this study. The purpose of this paper is to understand how older Korean couples dealing with dementia experienced the CLSA. METHOD: Fifty six couples (n = 102) completed the five-week intervention from December 2013 to October 2015. The participants completed a survey including open-ended questions one week after finishing the intervention. A thematic content analysis was conducted to analyze the responses. RESULTS: Qualitative analysis revealed benefits and challenges in the experience of CLSA. Themes related to benefits were: (1) emotional benefits of reminiscing; (2) positive evaluation of life as a couple; (3) gratitude toward spouse; (4) changes in communications or activities with spouse; and (5) changes in relationship quality. Couples' experience varied, with some having mixed feelings about the intervention. Challenges perceived by participants included revival of bitterness and identification of loss. CONCLUSIONS: Findings suggest the CLSA contributes to enhancing the quality of life for couples affected by Alzheimer's disease and improving their relationship. Challenges that emerged in the CLSA will guide future research to identify the sub-population that is appropriate for the couple-oriented intervention in dementia care.

Cultural Adaptation of a Dyadic Intervention for Korean Couples Coping with Alzheimer's Disease.

OBJECTIVES: The Couples Life Story Approach (CLSA) was recently developed in the U.S. for older couples dealing with dementia to improve their quality of life. The purpose of this article is to describe how the CLSA was adapted to be culturally appropriate for older Korean couples and to discuss cultural themes that emerged during the implementation process. METHODS: The intervention was adapted using the Cultural Adaptation Process Model. The revised materials were implemented on 56 Korean couples. A multiple case study method was used to analyze the clinical data. RESULTS: Four cultural themes were identified: (1) dealing with negative memories in early years of marriage; (2) communication styles and patterns; (3) ways to incorporate difficult life events into the Life Story Book; and (4) complex dynamics of heirarchy in the relationship between older couples and the interventionist. With each theme, case examples are described that illustrate relevant issues. CONCLUSIONS: Cultural adaptation can be conducted systematically to improve the delivery of the CLSA for different populations. CLINICAL IMPLICATIONS: Cliniocians working with older Korean couples affected by dementia should consider cultural uniqueness in a life-story approach.

Impact of the nursing home scale on residents' social engagement in South Korea.

BACKGROUND: This study aimed to describe the levels of social engagement and to examine the relationship between the nursing home scale groups and social engagement in nursing homes in South Korea. METHODS: A total of 314 residents were randomly selected from rosters provided by 10 nursing homes located in three metropolitan areas in South Korea. The outcome variable was social engagement measured by the Revised Index of Social Engagement (RISE), and the key independent variable was the nursing home scale (small, medium, and large). Individual factors (age, gender, activities of daily living and cognitive function, and depressive symptoms) and organizational factors (location, ownership, and staffing levels) were controlled in the model as covariates. Multilevel logistic regression was used in this study. RESULTS: About half of the residents (46%) in this study were not socially engaged in the nursing home (RISE=0) where they resided. Controlling for individual- and organizational-level factors, the nursing home facility size was a significant factor to predict the likelihood of residents' social engagement, with that the residents in large-scale nursing homes being less likely to be socially engaged than those in medium-scale nursing homes (odds ratio = 0.457; p-value = 0.005). CONCLUSION: This study supports evidence from previous studies that smaller-scale nursing homes are likely to provide more person-centered care compared to larger-scale nursing homes. Subsequent quality studies are needed to examine how the mechanisms for how smaller-scale nursing homes can enhance residents' social engagement in terms of care delivery processes.

The Effect of Widowhood on Parent-Child Relationships in Korea: Do Parents' Filial Expectations and Geographic Proximity to Children Matter?

Although previous research based on data from the U.S. suggests that parents' widowhood is associated with increased emotional support from children, little is known about the impact of late-life widowhood on intergenerational relationships in other cultures. Using data of Korean older adults, this paper examined: (1) the effect of widowhood on both positive and negative aspects of parent-child relationships and (2) whether these effects are moderated by older adults' expectations about children's filial responsibilities and the geographic proximity to their children. Analyses are based on data from the Hallym Aging Study, a stratified multi-stage probability sample of older adults living in the cities of Seoul and Chuncheon in Korea. Compared to married older adults, widowed persons in this sample reported higher levels of ambivalence, lower levels of positive interactions, and higher levels of negative interactions with their children. Parents' notion about filial responsibilities did not have a significant moderating effect, whereas geographic proximity to children was a significant moderator. Findings suggest that widowhood is associated with greater strain in intergenerational relationships in Korea. Helping widowed older adults forge constructive relationships with their children may enhance both bereaved older adults' and their children's well-being in this cultural milieu.

Impact of Mid-Life Symptoms of Alcoholism on the Health and Wellbeing of Aging Parents of Adults with Disabilities.

The study examined the effect of adult children's disability on parents' physical health in later life and the extent to which parents' symptoms of alcoholism in mid-life moderates the link between children's disability and later life parental health. Analyses are based on data from the Wisconsin Longitudinal Study. The analytic sample included parents of children with developmental disabilities (n = 145) or mental health problems (n = 200) and 2,432 parents of unaffected children. The results showed that the negative health consequences in later life of having a child with a developmental disability were greater for those who showed more symptoms of alcoholism in mid-life. However, symptoms of alcoholism in mid-life did not significantly moderate the impact of an adult child's mental health problems on parents' later life physical health. The findings suggest a potential area where gerontological social workers could intervene, given the negative impact of symptoms of alcoholism on the health of aging parents of children with a disability who may be significantly more susceptible to the negative health impacts of alcohol compared to their younger counterparts.

Double Emulsion-Mediated Delivery of Polyphenol Mixture Alleviates Atopic Dermatitis.

Although the polyphenols have been studied to alleviate inflammation, there are still challenges to delivering the polyphenols with stabilized formulation due to their low water solubility and susceptibility to oxidation. Herein, the transdermal delivery system of polyphenol mixture (PM), including quercetin (Q), phloretin (P), and ellagic acid (E), is developed using double emulsion for applying to atopic dermatitis (AD). Through the in vitro anti-degranulation assay, the optimal molar ratio of each polyphenol (Q:P:E = 5:1:1) is obtained, and the PM shows at most a 43.6% reduction of degranulation of immune cells, which is the primary factor of AD. Moreover, the water-in-oil-in-water double emulsion (W/O/W) enhances the PM's stability and has a higher anti-degranulation effect than the oil-in-water emulsion (O/W). In the in vivo 1-chloro-2,4-dinitrobenzene (DNCB)-induced mice AD model, PM reduces more AD symptoms than every single polyphenol. The PM-encapsulated W/O/W (PM_W/O/W) shows the most effectiveness in AD by decreasing dermatitis score, i.e., skin/ear thickness, mast cells, and serum IgE level. Finally, this suggests that the findings on the optimal ratio of PM and double emulsion-based delivery would be beneficial in treating AD and can be applied to other allergic diseases.

Disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions for people with disabilities: the Korean National Health and Nutrition Examination Survey.

OBJECTIVE: To examine how disability status is related with health disparities in South Korea. DESIGN: The study compared 3 indicators of health (health-risk behaviors, preventive health care utilizations, and chronic health conditions) according to the presence of disabilities using the Third Korean National Health and Nutrition Examination Survey, 2005 (KNHANES III). SETTING: We obtained data from the KNHANES III, which is the third nationwide representative study using a stratified, multistage probability sampling design. PARTICIPANTS: Subjects (N=5475) aged 20 years or older were included in the study; persons with disabilities (n=218) and persons without disabilities (n=5257). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Nonconditional multiple logistic regression and adjusted mean were used to identify health disparities in health-risk behaviors, preventive health care utilizations, and chronic health conditions. RESULTS: Subjects with disabilities were more likely to be physically inactive (adjusted odds ratio [AOR]=3.06; 95% confidence interval [CI], 1.71-5.48 for no physical activity; AOR=1.70; 95% CI, 1.19-2.43 for insufficient physical activity) than those without disabilities. Women aged 40 years or older with disabilities were less likely to receive cervical cancer screening services (AOR=0.52; 95% CI, 0.27-0.98). Adults with disabilities had higher proportion of osteoporosis (AOR=2.41; 95% CI, 1.50-3.88), underweight (AOR=2.14; 95% CI, 1.07-4.28), suicidal thoughts (AOR=1.86; 95% CI, 1.35-2.56), and had impaired quality of life (95% CI of adjusted mean, 60.89-65.35 compared to 69.95-70.84 in adults without disabilities). CONCLUSIONS: There exists substantial disability-related health disparities in South Korea. People with disabilities may be the underserved subpopulation demonstrating health disparities. The findings in this study underscore the continued needs in order to reduce health problems and disparities for people with disabilities.

Relationship between spouse/partner support and depressive symptoms in older adults: gender difference.

Based on data from the National Social Life, Health, and Aging Project, Wave 1, the purpose of this study was to examine possible gender difference in the relationship between the level of spouse/partner support and depressive symptoms in late life. Depressive symptoms were measured by the 11-item, four-point Center for Epidemiologic Scale for Depression (CES-D), and spouse/partner support was measured by a four-item scale, an abbreviated version of the original spouse support/strain scale developed by Schuster, Kessler, and Aseltine (1990). The results from regression analyses show that low perceived spouse/partner support, as opposed to unavailability of the support, was associated with higher CES-D scores among women only, while high spouse/partner support was associated with lower CES-D scores for both genders. These relationship patterns were found in both younger and older groups of men and women.

Moderators in the relationship between social contact and psychological distress among widowed adults.

OBJECTIVES: This study examines: (1) the effect of widowed persons' frequency of contact with friends and relatives on their depressive and grief symptoms six months following spousal loss and (2) the extent to which the effects of social contact are contingent upon the degree of emotional support received from these relationships and the congruence between widowed persons' preferred and actual levels of social contact. METHOD: Analyses are based on the Changing Lives of Older Couples (CLOC) study, a prospective study of a two-stage area probability sample of 1532 married men and women aged 65 or older. Depressive and grief symptoms, six months after spousal loss, were regressed on social contact, support, and congruence between preferred and actual social contact. RESULTS: Frequency of contact did not have a significant influence on psychological distress when contextual factors are controlled. Social support and the incongruence between preferred and actual social contact were significantly associated with decreased psychological distress for several outcomes. As for the moderating effects of social support and incongruence on the link between social contact and distress, those who had high social contact and high social support experienced less anger and fewer intrusive thoughts than their counterparts; and those who had low social contact but preferred high social contact experienced greater anger. CONCLUSION: The findings highlight the importance of understanding the quality of widowed persons' relationships as well as the congruence between their preferred and actual social contact.

Parenting a Child with a Disability: The Role of Social Support for African American Parents.

This paper examines: (1) the impact of having a child with a disability on parents' mental and physical health among urban-dwelling African Americans and (2) the extent to which positive and negative social interactions with family other than the spouse moderate the impact of child's disability on parental adaptation. Analyses are based on a probability sample of African Americans living in Milwaukee, Wisconsin. The analytic sample includes 48 parents of a child with a disability and 144 comparison group parents of non-disabled children. Results showed that having a child with a disability is associated with more somatic symptoms. However, the negative consequences of the child's disability on parents' mental health are reduced when parents receive greater positive support from family.

Lessons learned from the statewide implementation of the Music & Memory program in nursing homes in Wisconsin in the USA.

The movement of evidence-based interventions into institutional settings such as nursing homes is challenging. Among ecopsychosocial interventions to address behavioral problems of nursing home residents with dementia, Music and Memory, a popular intervention that provides individualized music listening, has shown potential to improve residents' quality of life. In Wisconsin in the USA, the Music and Memory program has been implemented in nursing home facilities statewide. In the present study, to examine facilitators and barriers related to implementation and sustainability of the Music and Memory program, all nursing homes in Wisconsin were invited to participate in a survey (online or mail). A total of 161 facilities participated, representing a response rate of 41%. Descriptive statistics and content analysis were conducted. Over 80% of responding facilities were providing the Music and Memory program, and 86% of those facilities planned to continue its use. The majority of respondents found Music and Memory to be beneficial to residents, but they also reported that the program was not equally effective for everyone and that it was time and labor intensive. Barriers to sustainability included lack of buy-in by direct care staff, use of technology, costs of equipment, inconsistency of volunteers, and families not supportive or helpful. Facilitators included support of facility personnel, family, and volunteers; observing positive effects of program; Music and Memory training provision and support; and accessibility of equipment. For the program to be successful, facilities must identify the residents most likely to benefit from it, realistically estimate its costs and required labor, and ensure staff buy-in.

The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea.

BACKGROUND AND OBJECTIVES: We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS: Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS: CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.

Longitudinal changes in well-being of parents of individuals with developmental or mental health problems.

RATIONALE: A large body of work demonstrates the impact of caregiving burden on the well-being of parents of individuals with developmental conditions or mental health problems. However, a relative dearth of research examines this impact longitudinally into parents' older age. OBJECTIVE: The current study examines (1) longitudinal changes in the effect of having a child with a developmental or mental health problem on parental negative affect, psychological well-being, and somatic symptoms, (2) age and gender moderations on these effects, and (3) the unique impact of factors related to the child's condition. METHOD: This study employs hierarchical linear regression models to examine longitudinal survey data from midlife adults (N = 1,101) from two waves of the National Study of Midlife in the United States (MIDUS). RESULTS: Models revealed some evidence for age attenuation of the impact of caregiving stress. Parents of children with developmental problems still had higher negative affect, poorer psychological well-being, and more somatic symptoms on average than parents in a comparison sample, whereas parents of children with mental health problems only showed evidence of higher negative affect compared to this sample. Within-group analyses also revealed differences between each parenting group into later adulthood. CONCLUSIONS: Parents of individuals with developmental or mental health problems may be at risk for poorer well-being late in life. Yet, age and gender differences as well as diagnostic group differences nuance these findings.

The effect of widowhood on intergenerational ambivalence.

OBJECTIVE: The purpose of this study was to examine (a) the extent to which widowhood affects older adults' ambivalence about their adult children, (b) the role of intergenerational dependence in explaining the effect of widowhood on parent-child ambivalence, and (c) temporal changes in the effects of widowhood on ambivalence. METHODS: We based analyses on Changing Lives of Older Couples, a prospective study of 1,532 married individuals aged 65 and older. We used ordinary least squares regression models to estimate the direct effect of widowhood and the mediating effects of dependence on intergenerational ambivalence 6 and 18 months after spousal loss. RESULT: Widowhood was associated with a decrease in ambivalent feelings toward adult children 6 months after spousal loss, which was partially explained by a reduction in the extent to which children were dependent upon their bereaved parents. However, at 18 months, widowhood did not exert any significant influence on intergenerational ambivalence. DISCUSSION: Our findings suggest that major life events such as widowhood influence intergenerational ambivalence. The results shed light on the mechanisms by which parent-child dependence contributes to intergenerational ambivalence.

Age and gender differences in the well-being of midlife and aging parents with children with mental health or developmental problems: report of a national study.

Using data from the Study of Midlife in the United States (MIDUS), this article examines: (1) the effect of having children with developmental or mental health problems on parents' mental and physical health, (2) the extent to which this effect varies by parental age and gender and (3) the effects of disability-related factors on the well-being of parents of children with disabilities. Compared to parents of non-disabled children, parents of disabled children experienced significantly higher levels of negative affect, marginally poorer psychological well-being, and significantly more somatic symptoms, controlling for sociodemographic variables. Mothers did not differ from fathers in their well-being. Older parents were significantly less likely to experience the negative effect of having a disabled child than younger parents, suggesting an age-related attenuation of the stress of non-normative parenting.

Subjective Memory Problems and Availability of Emotional Support.

This study examines (1) whether subjective memory problems (SMP) influence perceived emotional support from and frequency of contact with family and friends; and, (2) the extent to which this relationship is moderated by gender, education, and functional limitations. We use the 2014 wave of the Health and Retirement Study, a nationally representative panel survey of adults aged 51 and over in the United States. While SMP does not affect perceived emotional support for younger group (YG; aged 51-64), in older group (OG; aged 65+), SMP is associated with reduced perceived support from friends. Also, SMP is predictive of fewer writing-based contact with children and friends among OG but not among YG. Lastly, we find that the effect of SMP on support from children is contingent upon activity of daily living (YG) and gender (OG), while the effect of SMP on writing-based contact with both children and friends is contingent upon education (YG only).