The Origins and Evolution of the Journal of Aging and Social Policy.

In this essay the current and previous editors discuss the history of the Journal of Aging & Social Policy. In reviewing the past thirty years of publishing the Journal, one can see three phases: Phase 1 took pace during the first decade (1989-1997), Phase 2 covered the next decade and a half or so (1998-2015), and Phase 3 reflects the past five years, a period of continuing growth and success (2016-Present). Despite its inevitable challenges, the Journal of Aging & Social Policy overcame each and has arrived. Today, it is a well-respected Journal that attracts excellent scholarship from around the world, that is well-cited, and that has earned the Journal a commendable impact factor. The editors are proud of that evolution. However, success is never final. The Journal will require continued effective stewardship as it looks to the next thirty years and beyond.

The Role of Outcome Forecasts in Patients' Treatment Decisions--Evidence from a Survey Experiment on Knee Replacement Surgery.

OBJECTIVE: To analyze the effect of personalized outcome probabilities on treatment decisions. DATA SOURCE: American Life Panel. STUDY DESIGN: We designed an experimental survey that respondents answered by recommending replacement surgery for hypothetical patients diagnosed with knee osteoarthritis. The primary manipulation was whether respondents were given personalized outcome probabilities for the patients. PRINCIPAL FINDINGS: Patient-specific outcome forecasts significantly influenced decisions, with effect sizes comparable to those of physicians' opinions and patient testimonials. The presentation format also affected the probabilities' influence on choices. We did not find evidence that the educational level of subjects affected the weight that they give to outcome probabilities in making recommendations. CONCLUSION: Our study points to a need for more research on the use of patient-specific outcome forecasts.

Contributions of Second Opinions, Outcome Forecasts, and Testimonials to Patient Decisions about Knee Replacement Surgery.

BACKGROUND: Decision aids are now a well-established means of supporting patients in their medical decision making. The widespread use of decision aids invites questions about how their components contribute to patient decisions. OBJECTIVE: The objective of this study was to measure the importance of second opinions, patient-specific outcome forecasts, and patient testimonials relative to patient clinical and socioeconomic factors and the primary physician recommendation on the decision to undergo full knee replacement surgery to treat knee osteoarthritis. METHODS: Middle-aged and older members of the RAND American Life Panel (N = 1616) chose whether to recommend surgery as a treatment for each of 3 hypothetical patients (vignettes) presented in a video-enhanced internet survey. Vignettes randomly sampled levels of scenario attributes. RESULTS: Second opinions, person-specific outcome forecasts, and 2 consistent patient testimonials strongly affected respondents' decision making; a single testimonial, however, did not significantly affect decisions. CONCLUSIONS: Information provided in a decision aid, including person-specific outcome forecasts and testimonials, can affect patient choices. The strong effect of testimonials and respondents' interest in reviewing them reinforces concerns about unwanted influence when testimonials are biased.

Diffusion of the property tax work-off program for senior homeowners in Massachusetts.

Property tax work-off programs (TWOPs) provide senior homeowners with relief from some of their property tax obligations in exchange for services provided to local governments. These programs are offered by some county and municipal governments at their own discretion in a number of states. Through a qualitative study comparing municipalities in Massachusetts that participate in the program with similar communities that do not participate, the authors sought to learn the reasons for both participation and nonparticipation. They interviewed local officials in eight participating and six nonparticipating communities. Mohr's theory for adoption and Roger's theory for diffusion are used for the conceptual framework of the study. Local leaderships' motivation, financial or political resources and obstacles, senior homeowners' awareness, communication between communities, and perceived benefits of the program were the major factors in adoption and diffusion of TWOPs in Massachusetts.

Productive activity clusters among middle-aged and older adults: intersecting forms and time commitments.

OBJECTIVE: This study investigated the latent structure of productive activity among middle-aged and older adults. Whereas most researchers have examined forms of productive activity as discrete behaviors, our approach captured the reality that many persons engage in more than one activity and commit varying degrees of time to these activities. METHODS: We took the data for this study from the Americans' Changing Lives survey. The activities examined include formal volunteer work, informal help to others, unpaid domestic work, caregiving, and paid work. We describe the complex clusters of activities and time commitment to those activities using latent class cluster analysis. RESULT: Our results demonstrated that a four-cluster model fit the data well. Specifically, the findings showed that middle-aged and older adults fell into four clusters: helpers, home maintainers, worker/volunteers, and super helpers. We also show how individual characteristics (e.g., age, gender, race) are associated with the likelihood of being in one of these four groups. DISCUSSION: This measurement strategy provides a foundation for future research into how experts can employ productive activity clusters to understand better well-being across the life course. This is important because our results show that many activities do not occur independently but rather are linked in patterned ways.

Caregiving and volunteering: are private and public helping behaviors linked?

OBJECTIVE: The purpose of this study was to examine the relationship between two forms of helping behavior among older adults--informal caregiving and formal volunteer activity. METHODS: To evaluate our hypotheses, we employed Tobit regression models to analyze panel data from the first two waves of the Americans' Changing Lives survey. RESULTS: We found that older adult caregivers were more likely to be volunteers than noncaregivers. Caregivers who provided a relatively high number of caregiving hours annually reported a greater number of volunteer hours than did noncaregivers. Caregivers who provided care to nonrelatives were more likely than noncaregivers to be a volunteer and to volunteer more hours. Finally, caregivers were more likely than noncaregivers to be asked to volunteer. DISCUSSION: Our results provide support for the hypothesis that caregivers are embedded in networks that provide them with more opportunities for volunteering. Additional research on the motivations for volunteering and greater attention to the context and hierarchy of caregiving and volunteering are needed.

Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations.

This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.