"That's the price of living in paradise:" coastal retirement and hurricanes.

Coastal Carolina is a popular retirement destination. Ten individuals, previously interviewed regarding their decision to retire here, were re-interviewed after Hurricane Florence. This sample of eight women and two men, mean age 74.4 (range = 68-88), provided a unique opportunity to learn about their hurricane experiences and to compare their pre- and post-responses about their choice to move to the coast. Nine evacuated, including one to a local shelter. Respondents reported a lack of preparations, but neighbors played an important supportive role. Issues about the shelter and for single women were identified. Results have implications for future disaster preparations.

Sense of community, loneliness, and satisfaction in five elder cohousing neighborhoods.

Data were collected at five elder cohousing neighborhoods to understand more about who lives in these communities, their reasons for moving, their satisfaction, and to explore the intersection between loneliness and sense of community. The average age of the predominantly white, female, and well-educated sample (n = 86, 56% response rate), was 68 ± 6.573 at move-in. Respondents moved in search of a sense of community and were generally satisfied with their experiences. Prevalence of loneliness was lower than the national average, but still affected 24% of the sample. Findings suggest that senior cohousing is delivering on the promise to promote sense of community.

A Mixed-Methods Approach to Understanding the Palliative Needs of Parkinson's Patients.

Parkinson's disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.

Using social exchange theory to understand non-terminal palliative care referral practices for Parkinson's disease patients.

BACKGROUND: A palliative approach is recommended in the care of Parkinson's disease patients; however, many patients only receive this care in the form of hospice at the end of life. Physician attitudes about palliative care have been shown to influence referrals for patients with chronic disease, and negative physician perceptions may affect early palliative referrals for Parkinson's disease patients. AIM: To use Social Exchange Theory to examine the association between neurologist-perceived costs and benefits of palliative care referral for Parkinson's disease patients and their reported referral practices. DESIGN: A cross-sectional survey study of neurologists. SETTING/PARTICIPANTS: A total of 62 neurologists recruited from the National Parkinson Foundation, the Medical Association of Georgia, and the American Academy of Neurology's clinician database. RESULTS: Participants reported significantly stronger endorsement of the rewards ( M = 3.34, SD = 0.37) of palliative care referrals than the costs ( M = 2.13, SD = 0.30; t(61) = -16.10, p < 0.0001). A Poisson regression found that perceived costs, perceived rewards, physician type, and the number of complementary clinicians in practice were significant predictors of palliative care referral. CONCLUSION: Physicians may be more likely to refer patients to non-terminal palliative care if (1) they work in interdisciplinary settings and/or (2) previous personal or patient experience with palliative care was positive. They may be less likely to refer if (1) they fear a loss of autonomy in patient care, (2) they are unaware of available programs, and/or (3) they believe they address palliative needs. Initiatives to educate neurologists on the benefits and availability of non-terminal palliative services could improve patient access to this care.

Resident-Managed Elder Intentional Neighborhoods: Do They Promote Social Resources for Older Adults?

Social isolation has serious negative public health impacts for older adults. Survey data were collected at three resident-managed elder intentional neighborhoods in the United States (n = 59), to determine if these neighborhoods, each based on the cohousing model, promote development of social resources for their residents. Social resources were measured on three dimensions: social networks, neighborly support, and satisfaction with the neighborhood community. Respondents were White, mean age of 73.3 (range = 63-91), primarily female (76.3%), and generally had high levels of education and self-reported health. Almost half (47%) were never married/divorced and 37% were childless. Inclusion of neighborhood ties ameliorated risk of social isolation. Satisfaction with support and a variety of neighboring behaviors were reported. These neighborhoods are meeting the needs of a potentially at-risk population as an avenue to promote social resources and reduce social isolation. The implications for gerontological social workers include a role in helping to mobilize and support these types of neighborhoods as a way to encourage mutual support among older adults. With the increase in the aging population, such models of proactive interdependence and communal coping have the potential to lessen or delay the demands that socially isolated elders place on social workers.

Family Caregiving and the Site of Care: Four Narratives About End-of-Life Care for Individuals with Dementia.

Little is known about end-of-life care for individuals with Alzheimer's disease and other dementias. Four case studies are presented, using data collected by qualitative interviews conducted with family caregivers who were closely involved with end-of-life care for relatives with dementia. The case studies are formatted in two pairs, with one reflecting two deaths occurring at home and the other pair representing two deaths in the nursing home. The cases reveal a range of end-of-life experiences, suggesting that there is not just one "good" path. The extent of care needed, the responsiveness of the individual, the health of the caregiver(s), and the residence and support situations, can all intersect in a variety of ways that make no one scenario the answer for all. Although most people say they would prefer to die at home, in some situations the nursing home can be a satisfactory choice, particularly if hospice is involved. These narrative case studies give the reader insight into the variety of the end-of-life experiences and suggest the environment should be considered as part of the care provision.

A conceptual model for aging better together intentionally.

UNLABELLED: Social networks and improved health outcomes are strongly connected, yet many elders face isolation and loneliness. This article presents a study of an elder cohousing community in which residents are dealing with aging-related stresses as a group and creating positive outcomes for themselves. The article posits a conceptual model of how this phenomenon of "aging better together intentionally" occurs and the resulting benefits. QUESTIONS: What happens when elders choose to live together in a community in which they consciously address aging collectively? Is it possible to age better together intentionally? If so, what does it look like, under what circumstances does it blossom, and how does it improve the aging experience? METHODS: In-depth interviews were conducted with 26 residents of an elder cohousing community in 2009. Respondents were white, mostly female, and averaged 73 years in age. Thematic analysis of interview transcripts led to a conceptual model of aging better together intentionally. To further explore the model, quantitative survey data were collected from the residents three years later. RESULTS: The framework of communal coping provided the mechanism of aging better together intentionally. Quantitative data supported the existence of mutual support, increased acceptance of aging, and feelings of safety/less worry/lessening of social isolation as benefits of this type of living arrangement. DISCUSSION: This research demonstrates the agency of older adults, the heterogeneity of the aging experience, and the value of older adults sharing their knowledge of the aging process with each other. Our conceptual model of aging better together intentionally could serve as a basis for interventions in other settings to provide a new way for people to age together with enhanced quality of life.

China: facing a long-term care challenge on an unprecedented scale.

Population ageing is occurring in China at a breathtaking pace and rapidly becoming a major public health issue. Due to the one-child policy, rural/urban migration and other societal changes, the family-dependent long-term care (LTC) of the past will no longer suffice. Barely existent now, both institutional and community-based services will need to expand to meet the growing need. China is still at an earlier stage in economic development and will be challenged to build these services and train staff. Furthermore, many elders are not yet covered by financial and insurance support. This massive demographic transition requires political efforts to develop integrated and sustainable national LTC systems.

How women in late midlife become caregivers for their aging parents.

Approximately 52 million Americans provide informal (unpaid) care to a family member or friend who is disabled or ill. The most common informal caregiving relationship is that of an adult child providing assistance to an aging parent. This article describes a qualitative study examining how adult daughters between the ages of 50 and 65 become caregivers to their parent or parent-in-law. Data were collected through in-depth, face-to-face interviews with 15 female caregivers. Analysis revealed that assistance provided to parents was initiated by one or more triggering event, after which participants became caregivers in either an emergent or deliberate manner.

A comparison of attitudes about cremation among Black and White middle-aged and older adults.

Social workers must be instrumental in educating elders and their families to make informed decisions about death and dying. As part of a larger qualitative study, we explored attitudes about cremation of 25 older and 25 middle-aged adults, evenly split between Black and White respondents. Major themes emerged about disposition of the body after death. Costs and land conservation influenced support for cremation; reasons against cremation include religious beliefs, lack of closure, and sense of place. Additionally, some respondents were against cremation primarily because of lack of exposure, as it was not their family tradition, suggesting a role for education.

A statewide status report on hospital-based palliative care programs.

The Center to Advance Palliative Care (CAPC) has attempted to identify hospitals providing palliative care services in its 2008 state-by-state report, and currently through the web-based Palliative Care Provider Directory of Hospitals. To augment those efforts for one state, a survey was conducted to explore how many hospitals reported having palliative care services and how well those services met consensus recommendations. Survey results show that a majority (82 %) of hospitals continue to lack palliative care programs, and even knowledge of palliative care was limited. More education and training for physicians, health care staff, and the general public was recommended strongly.

The validity of Nutrition Screening Initiative DETERMINE Checklist responses in older Georgians.

The Nutrition Screening Initiative DETERMINE Checklist (NSI) is used throughout the United States to assess nutrition risk of those requesting the services of the Older Americans Act Nutrition Program (OAANP). This study examined the ability of the NSI to evaluate nutrition risk by comparing the responses between NSI and matched comparable survey questions using the self-administered mail survey data that were collected among 924 new OAANP applicants in Georgia (mean age 75.0 ± 9.2 years, 68.8% women, 26.1% Black). Ninety-four percent of our sample provided at least one discordant response (i.e., disagreement between responses to the NSI and matched questions). Questions regarding food intake most frequently yielded discordant responses. Black participants were more likely to provide discordant responses for the meal frequency question. Food insecure individuals were less likely to provide discordant responses for food intake questions. Those who lived alone were less likely to provide discordant responses for the dairy intake question. Some NSI items may have limited ability to reliably assess nutritional risk of older adults. Further efforts are warranted to improve nutritional assessment tools for use in vulnerable older adults.

A cross-cultural comparison of hospice development in Japan, South Korea, and Taiwan.

By 2050, one out of four people in Eastern Asia will be aged 65 and above. Thus, preparing to care for an older population is imperative. Addressing quality care for elders includes consideration of palliative and end-of-life care. A comparative study of the development of hospice and palliative care services in Japan, South Korea, and Taiwan, is presented, based on an extensive literature review. Both commonalities and differences were found. This article provides information on the origins and administration of hospice services in these three cases, as well as the degree of government involvement. Cultural and religious aspects are also considered, and obstacles to the spread of hospice services are discussed. This review compares experiences with hospice services and identifies factors that influence people's perceptions and adoption of hospice. Stronger financial support for hospice and palliative care through the government and insurance programs would help increase the availability and use of services. Also, the need for continuing education of healthcare providers, patients, families, and the community is urgent. However, promotion of understanding of better pain management and the worth of hospice and palliative care must be conducted in ways that are sensitive to the cultural values and traditions in Japan, South Korea, and Taiwan. Only when hospice and palliative care can be viewed as an admirable choice for one's loved ones, overcoming issues of truth telling, filial piety, worries about how one is judged, and religious considerations, will it become more widely accepted.

Discussions by elders and adult children about end-of-life preparation and preferences.

INTRODUCTION: In the United States, 73% of deaths occur among people aged 65 years or older. Although most would prefer to die at home after a short illness, most actually die in institutions after prolonged declines. Despite this discrepancy, elders and their adult children often do not discuss end-of-life preferences. Use of advance directives has not been widespread, and people often avoid the subject until a crisis. This project focused on informal family communication about end-of-life preparation and preferences, about which little is known. METHODS: In May 2006, we conducted in-depth exploratory interviews with 15 older adults about their end-of-life preparation and preferences and with 15 younger adults about their parents' end-of-life preparation and preferences. The interview included an item rating the depth of discussion. RESULTS: Participants in both groups were primarily female and white. Mean age of older adults was 78.6 years (range, 70-88 years). Mean age of younger adults was 53.1 years (range, 42-63 years); mean age of their parents was 82.6 years (range, 68-99 years). Nine older adults reported discussing end-of-life preparation and preferences with their adult children; six had barely discussed the topic at all. Ten younger adults reported having talked with their parents about end-of-life preparation and preferences; five had not discussed it. Barriers to discussions about end-of-life preparation and preferences were fear of death, trust in others to make decisions, family dynamics, and uncertainty about preferences. Facilitators for discussion were acceptance of the reality of death, prior experience with death, religion or spirituality, and a desire to help the family. Successful strategies included casually approaching the topic and writing down end-of-life preparation and preferences. CONCLUSION: Knowing the obstacles to and facilitators for discussion can help health care and public health professionals target approaches to encouraging elders and their families to discuss end-of-life preparation and preferences before a crisis.

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.

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.

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.

Having the talk--and it's not about sex!

The end of life is a difficult time for individuals and their families; some families find it devastating. Although the majority of Americans express a desire to die at home, only 25% achieve this goal. This finding and others from the landmark Last Acts state-by-state report card suggest we can do more to help ease the end-of-life transition. Report card results are reported, highlighting the need for better communication between physicians and patients. Physicians have a key role to play in helping individuals and their families understand their choices and deal with end-of-life care issues. Resources and recommendations are offered to help facilitate planning discussions. Information about hospice use and eligibility is also outlined.