Assessing Age-Friendliness: Individualistic vs. Collectivistic Cultures.

A major task ahead for South Korea is to create age-friendly communities and environments that can support older residents' health, well-being, and quality of life. To that end, international partnerships have emerged to share information, assess need, and develop response strategies. In this study, the transferability of a US-developed age-friendly community resident survey, based on the WHO framework, was tested in two South Korean cities by comparing results to the same survey conducted in a US city. Descriptive, relational, and predictive analyses revealed the survey items were a better fit for the US city than the South Korean cities. Limited response variances collected in the Korean cities challenged the comparison of data between the Korean sites. Thus, a cultural lens was used to explain response patterns that reflect their understanding of social norms including avoiding disagreement and conflict in order to maintain social equilibrium and five cultural dimensions found in Western and Eastern societies (Individualism vs. collectivism, universalism vs. particularism, low vs. high power distance, low vs. high context, and inner vs, outer control). Recommendations for future assessments in South Korea include shifting focus away from the individual to the individual's social network and community to improve understanding of need.

Community Professionals' Response to Intimate Partner Violence Against Rural Older Women.

The purpose of this study was to examine rural community professionals' awareness, perceptions, and experience with intimate partner violence (IPV) in late life. Using standard focus group methodology, 87 community professionals were engaged in discussions about IPV in late life and their experience in providing support to victims. Responses were analyzed using an open coding process. Most professionals were not aware that IPV against older women was a problem in their communities, although were willing to offer support if asked. Support for older victims was provided within the purview of each profession. Referrals to other support services were made, although collaboration did not occur unless a health-related emergency arose in which professionals were mandated to work together. Findings provide the groundwork for further research on the education and training of community professionals on IPV in late life and the development of more integrated community-based service protocols to address this hidden, but widespread concern.

Intimate partner violence in late life: an analysis of national news reports.

Intimate partner violence (IPV) in late life takes various forms including physical harm, sexual assault, and murder. Using national newspaper reports of IPV among elders, we identified the types of violence reported most frequently in media and examined how the abuse was conceptualized by reporters. We found that most cases of IPV reported involved murder, with men as perpetrators and women as victims. Caregiving stress and health problems were frequently cited as contributing factors in the cases. Interpreting these findings from a feminist perspective, we suggest implications for practitioners working with older adults.

What Makes a City a Good Place to Live and Grow Old?

As increasing numbers of adults are living longer and remaining in their communities as they age, city planners and leaders are exploring how cities need to adapt to ensure their community is age-friendly and a good place for residents to age-in-place. Using secondary data collected from mid-Atlantic city residents aged 45+ years, quantitative analyses were conducted to determine what makes a community a good place to live and grow old. Path model analyses revealed significant relationships among self-reported quality of life and the beliefs that the City and the neighborhood were good places to live and grow old. Features of the built environment and perceived help from neighbors were significantly correlated to separate factors in the models, but not significant contributors to the models. Findings support conceptualizing age-friendly community models and community initiatives using a neighborhood-level lens and engaging older residents to capture the context of their lives and lived experiences.

Experiences With Involuntary Nursing Home Relocation: The Staff Perspective.

Although involuntary nursing home closures for operational and care-related reasons occur infrequently, few studies have examined the centrality of the actions of staff to facilitate residents' relocation adjustment. We interviewed 18 administrators and 43 staff working at 27 facilities about the relocation process for residents from two facilities that lost their Medicare and State Medicaid certification due to ongoing care deficiencies. Thematic analysis revealed three major themes throughout each aspect of the relocation process: (a) staff expectations were not met, (b) barriers/challenges were persistent, and (c) resident/family involvement was minimal. We offer proactive participant-derived recommendations for policy and practice to strengthen involuntary relocation processes to ensure a cooperative work environment and residents' well-being, regardless of the cause for involuntary closure.

A Scoping Review: Characteristics and Outcomes of Residents Who Experience Involuntary Relocation.

BACKGROUND AND OBJECTIVES: Relocation to a residential care facility has been described as the most significant relocation affecting older adults, yet subsequent relocations, like in the case of a facility closure, have received minimal attention in the scholarly research literature. This paper reviews the published literature on involuntary relocation, focusing on the experiences of residents, families, and staff and the effects of involuntary relocation on nursing home residents' health. RESEARCH DESIGN AND METHODS: We conducted a scoping review to identify peer-reviewed studies reporting on involuntary relocation of nursing home residents. A total of 28 quantitative, qualitative, and mixed-method articles met inclusion criteria. RESULTS: Researchers mostly relied on longitudinal designs and quantitative indicators of functional health, cognitive status, psychological and emotional well-being, environment, and relocation context to examine residents' mortality risk and health outcomes associated with involuntary relocation. Inclusion of qualitative and mixed-method approaches was infrequent, as were indicators of social engagement and perceptions of relocation. Residents' awareness of and preparation for involuntary relocation positively influenced their health and well-being. Family involvement was frequently hindered by communication challenges with facilities. Staff expressed concern about residents, experienced increased workload demands, and acknowledged challenges with planning and communication. DISCUSSION AND IMPLICATIONS: Based on the collective findings, we propose a conceptual model of critical factors at play during relocation for consideration for guiding future research and developing provisions to current policies guiding relocation processes. Facilities and policymakers need to consider procedures that enhance planning efforts and decision-making among this vulnerable population and their families.

Mastery and Longevity in Spousal Caregivers of Persons with Dementia.

OBJECTIVE: Researchers have consistently shown that providing care in a gradually deteriorating situation, such as dementia, can be stressful and detrimental to the caregiver's (CG) health. Although stressor appraisal is important in understanding variability in CG outcomes, the role of personal mastery, a coping resource, in shaping CG's health outcomes has not been considered. The primary goal of this paper was to determine whether personal mastery is associated with a survival advantage for spousal CGs of persons with dementia. METHODS: This study assessed the association of CG burden and personal mastery with longevity over a 10-year period in 71 spousal CGs of persons initially diagnosed with mild cognitive impairment. RESULTS: Over the 10 years, 16 of 71 CGs (23%) died. Cox regression models with right censoring of CGs' time to death showed that after adjusting for the health of family CG, spousal CGs who reported high levels of burden had an 83% reduced risk of death when they also reported high personal mastery (hazard ratio [HR] = 0.17, 95% confidence interval [CI] 0.04, 0.65). CONCLUSIONS: Findings have implications for support programs that help build personal mastery.

Medicaid waiver personal care services: results of a statewide survey.

Through a statewide telephone survey of 819 beneficiaries (or their proxies), we collected data regarding client and aide demographics, as well as clients' satisfaction, outcomes, perspectives on staff performance, and complaints associated with home-based personal care services provided under the Virginia Medicaid Elderly and Disabled (E&D) waiver. Most respondents indicated that services improved their lives, and they were generally satisfied. Opportunities for improvement exist, however, especially related to the amount of time spent with the client, the need for training, and communication issues. Ongoing use of client/family caregiver surveys is warranted to allow continued monitoring of service provision.

Decisions, Decisions.

African American families' experiences with mild cognitive impairment (MCI) have received little attention in the research literature. Guided by the life-course perspective, we analyzed qualitative interview data from members of 27 African American families including the person with MCI (PwMCI), a relative or friend who was highly involved in the PwMCI's daily life, and if available, a relative or friend who had at least monthly contact with the PwMCI. Findings uncovered variability in families' MCI awareness, assessment, and need for role changes; the importance of reaching out to trusted others; and honoring PwMCI's care preferences (e.g., who should provide care). Families held varying beliefs about engaging outside support; some families insisted on keeping all care within the family while others were open to the use of external services. We showcase how diagnosis acceptance and family decision-making are at the heart of how African American families respond to MCI.

Intimate partner violence in late life: a review of the empirical literature.

This integrated review of the empirical literature synthesizes a decade of scientific research across scholarly and professional publications addressing intimate partner violence (IPV) in late life. Deriving insights through a qualitative coding scheme and detailed analysis of 57 empirical sources, we discuss the theoretical frameworks, conceptual themes, and methodological approaches that cut across the literature. Based on these findings, we identify future research directions for improved understanding of late-life IPV as well as implications for policy development and refined community interventions.

Violence against rural older women: promoting community awareness and action.

AIM: To identify opportunities and challenges in promoting community support for rural older women experiencing intimate partner violence (IPV). METHODS: Using community-based participatory research principles, we engaged in an academic-community partnership to analyse the research literature, estimate IPV incidence and prevalence, ascertain professional and older IPV victim perspectives through focus groups and interviews, and develop a collaborative community response plan. This study took place from 2008 to 2010 in the USA. RESULTS: IPV in late life is underreported by victims and often unrecognised by the academic and service community. Professionals, while agreeable to collaborating to support older IPV victims, sought coordination and leadership from domestic violence agencies. Older victims stressed the need for improved professional sensitivity to their unique needs and more service options. CONCLUSIONS: The insights generated during this project produced a framework on which rural communities can build to address the hidden and growing problem of late life IPV.

Making sense of intimate partner violence in late life: comments from online news readers.

PURPOSE: The purpose of this study was to gain insight into public awareness of intimate partner violence (IPV) in late life by how individuals respond to incidents of IPV reported in the newspaper. DESIGN AND METHODS: Using grounded theory techniques, online news items covering 24 incidents of IPV in late life, and the reader comments posted to them were analyzed. The news items were examined for incident details, story framing, and reporting style. An open coding process (Charmaz, K. [2006]. Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage Publications.) was used to generate a comprehensive understanding of themes and patterns in the comments posted by readers. RESULTS: Few posters indicated that incidents were episodes of IPV. As many posters struggled to make sense of incidents, they attempted to remove guilt from the perpetrator by assigning blame elsewhere. Comments were influenced by personal assumptions and perspectives about IPV, relationships, and old age; reporting style of the news items; and comments posted by other posters. IMPLICATIONS: Altering public views of IPV in late life requires raising awareness through education, reframing the ways in which information is presented, and placing greater emphasis on the context of the violence. By engaging interactive news media, reporters, participatory journalists, and policymakers can enhance public recognition and understanding of IPV in late life.

Assuring quality care: exploring strategies of Medicaid E&D Waiver providers.

Implementing quality assurance (QA) programs in unregulated non-institutional settings remains a challenge for home- and community-based service providers. A sample of 65 Elderly and Disabled (E&D) Waiver providers were presented with eight problem scenarios commonly found in homecare services. Each of the respondents was able to identify strategies they would use to recognize and address each problem. Findings suggest providers currently use multiple mechanisms as part of their overall QA program. Discussion focuses on the strengths of using multiple approaches and on increasing provider awareness of complementary QA strategies and reducing the reliance on staff report as a major QA strategy.

Elderly and disabled waiver services: important dimensions of personal care from the client's perspective.

Twenty-five interviews were conducted (18 clients and seven family caregivers) to identify the consumer's most important dimensions of personal care provision. Respondents were generally satisfied with their current aides, but there are unmet needs, including care at additional times of the day or week, and problems, particularly aides arriving late. The most common problems reported from past experience with prior aides included aides who arrived late, did not show up, or who were viewed as lazy. Eight important dimensions were identified, including having aides who are reliable, honest, easy to be around, and who possess a good knowledge base.