Late-life drinking among women.

Although alcoholism exists among older people, the number of cases is unknown, and many alcoholics, particularly women, are unidentified. Late-onset alcoholism is a risk condition for older women. Nurses are in a strategic position to recognize this underidentified condition and to assist affected women in understanding what caused them to rely on alcohol.

Epidemiologic transition theory and aging: Hispanic populations of North America and the Caribbean.

As the forces of social and economic development combine with epidemiological transitions, population aging will continue to impact world health status and the provision of health services. Epidemiology provides an interdisciplinary link to the traditional study of population change by enhancing the demographic parameters of fertility, life expectancy, and migration, with specific measures of mortality and morbidity in order better to predict the pace and concentration of aging within a population. In this article, the authors examine three theoretical models of epidemiological transition and offer historical (1950-1995) and projection (1995-2050) data for the development patterns in Cuba, Dominican Republic, Puerto Rico, and Mexico. They contrast trends in fertility, life expectancy ratios, and gender differences in these countries with the Hispanic population of the United States. Central to this study are the cause of death statistics presented to identify the model occurring in each country. Shifts in the gender mix at older ages are presented due to the decline in fertility and death associated with childbearing years and the timing of the transition from high mortality to infectious disease to high mortality from chronic and age-related disease.

Perceptions of do-not-resuscitate orders.

Do-not-resuscitate (DNR) orders have differing meanings for persons depending on their age, training, and personal beliefs. In this paper we explore these meanings as expressed in the attitudes about do-not-resuscitate orders of three groups: university students in a health-related discipline of social work, university students in a non-health related discipline, and persons over the age of sixty. Findings from analysis of the three groups suggest a strong interest in issues surrounding resuscitation. Social and nonmedical factors are important in the decision to resuscitate and therefore should be given careful consideration. Next to their spouse, respondents named their physician as the person they most wanted to talk with about withholding resuscitation. Yet, studies of physicians cited earlier indicate many physicians are hesitant to discuss end of life decisions with their patients. With the added help and support of the family, concerned friends, and social workers, individuals can make the best possible DNR decision and avoid unnecessary pain and suffering.

Demographic transition and population aging with Caribbean nation states.

This paper considers the role which the demographic parameters of fertility, mortality and migration will play on the pace and concentration of aging within the context of a developing region. This paper examines the demographic transition and analyzes historic and projected data for the development patterns of the anglophone nation states of the Caribbean. Trends in fertility, mortality, and migration are contrasted among the larger (Guyana, Jamaica, Trinidad/Tobago), mid-sized (Bahamas, Barbados, Belize) and smaller (Antigua/Barbuda, Dominica, Grenada, St Kitts/Nevis, St Lucia, and St Vincent/Grenadines) states. The paper then goes on to consider shifts in the structure of population at older ages due to the decline in fertility and mortality and points to some of the policy considerations that these relatively small and newly independent states will need to deal with during the next several decades.

Jackson county partnership: developing an effective coalition.

The Community Partnership Demonstration Program allows a community to develop and carry out a long-range, comprehensive, and self-sustaining alcohol and other drug abuse prevention program. A case study that shows the use of coalition building to carry out a prevention program is presented. The case study is followed by a discussion of the principles involved in forming and maintaining a coalition. Discussion about using the coalition method for implementing health promotion and prevention programs in rural or underserved communities and the important role that health educators can play follow.

Long-term care policy and the American family.

This article examines current and proposed long-term care policies and the social values of American families by looking at the influence of policy on family behavior. The analysis asks two questions. First, have our policies in recent years supported or undermined family values regarding the care of older members? Second, are our existing family values compatible with home and community-based long-term care reform proposals? Aaron, Mann, and Taylor's (1994) model for policy and changing values provides direction throughout. Findings based on behavior as a proxy for values suggest that current policies influence family values, and in turn, family values influence policies. Future policy is discussed in light of changed values, American family structure, dysfunctional families, individualism and collectivism, and gender neutrality and justice.

Do HMOs restrict access to health care among the chronically ill?

Health Maintenance Organizations are enrolling an increasing number of people for the delivery of their health care. Observers are asking whether this trend has resulted in the underprovision of health care to vulnerable population groups. This study asks whether HMOs under-provide care to the chronically ill. We use Ronald Andersen's Behavioral Model to derive predictive expectations about the provision of hospital and physician services to the chronically ill. The results indicate that HMOs do not under-provide health care to the chronically ill, compared to traditional fee-for-service insurance arrangements. We further found that HMOs provide more physician services to those in excellent health, compared to those in fee-for-service arrangements.

The demography of aging in the industrializing portion of the Pacific rim: a case for gender justice.

PIP: The authors examine the impact of probable future trends in demographic aging on women's roles in the newly industrializing countries of the Pacific Rim (in Southeastern and east Asia). They also suggest that women will in all probability be expected to cope with additional household and family responsibilities due to demographic aging at a time when they are trying to change gender status and improve gender equity, and that these growing responsibilities could severely handicap women's efforts to play a larger role in the economy and in policy making.^ieng

Florida's Medicaid AIDS waiver: an assessment of dimensions of quality.

Some State Medicaid agencies have implemented home and community-based waiver programs targeting acquired immunodeficiency syndrome (AIDS) patients. Under these initiatives, State Medicaid agencies can provide home and community-base services to persons with AIDS (PWA) as an alternative to more costly Medicaid-covered institutional care. This article evaluates quality of care under the Florida Medicaid waiver for PWA along two dimensions: program effectiveness and client satisfaction. Clients are generally satisfied with their case managers and the range and availability of services. Case managers appear to be well trained. Moreover, the probability of turnover is quite low, despite heavy caseloads and high mortality. The major difficulty faced by clients adn case managers relates to the process of becoming Medicaid eligible.

Health care corporatization and the employment conditions of nurses.

There has been little study of the impact of the recent transition of ownership of hospitals and nursing homes, from voluntary and public to corporate, on the employment of nursing staffs. Non-state or non-federally owned hospitals and nursing homes in Florida were examined with regard to salaries, benefits, career advancement opportunities, and vacancy and turnover rates of the nursing staff. While salary levels were influenced primarily by local wage markets, significant differences were found in the benefit packages, career opportunities, staffing ratios, and vacancy and turnover rates among for-profit, not-for-profit, and publicly-owned facilities. Nurse administrators of corporate hospitals and nursing homes can lower the costs of high turnover rates in their nursing staffs by exploring improvements in benefit plans and career opportunities offered to their employees.

Health perceptions and lifestyles of the elderly.

Adoption of a healthy lifestyle can slow physical decline and improve well being of the elderly. The purpose of this study was to examine the relationship of six aspects of a healthy lifestyle (nutrition, exercise, stress management, self actualization, health responsibility, and interpersonal support) with selected demographic variables, perceived health status, and health locus of control in the well elderly. The sample consisted of 297 volunteers. Person product-moment correlations and stepwise multiple regression procedures revealed that perceived health status and health locus of control were significant predictors of healthy lifestyles. Demographic variables, posited as modifying factors, were found to be associated with perceived health and locus of control but were not predictive of lifestyle practices.