Food insecurity and loneliness amongst older urban subsidised housing residents: The importance of social connectedness.

Food insecurity and loneliness are shockingly large and growing problems in the older population in the U.S. and globally. Thus, the study's primary aim was to investigate the prevalence as well as the association between these two social determinants of health in the marginalised and often underserved population of older residents of urban subsidised housing (also referred to as social housing or affordable housing). Of particular interest was whether a greater sense of loneliness increases the risk of older residents being food insecure. The study uses survey data gathered through in-person interviews conducted onsite in English or Spanish with 216 of the 300 older adults (72% response rate) living in a subsidised housing community in a central neighbourhood of a U.S. northeastern city. Amongst the 216 participants, 50% identified as Black and 45% identified as Latino. In addition to food insecurity and loneliness, the survey assessed participants' health, food access challenges, and sociodemographic characteristics. Results revealed a 34% food insecurity prevalence rate amongst the participants which is higher than the estimate of slightly less than 10% of the U.S. older population being food insecure. The participants' 34% loneliness rate was also higher than the 19%-29% prevalence range in U.S. older population studies. Bivariate analyses highlighted the interrelatedness or intertwining of food insecurity, loneliness, poor health and food access challenges whilst a series of logistic regressions further explored the significant association of loneliness with food insecurity. Loneliness increased the odds ratio of food insecurity in the binary (unadjusted) regression (p < 0.001, OR = 3.1) and the multivariate (adjusted) regression that included all covariates (p < 0.05, OR = 2.4). Overall, the findings underscore the need for greater awareness of loneliness as a public health threat as well as future research exploring how loneliness may intensify the health consequences of food insecurity in later life.

Religious coping and psychological well-being in Latino Alzheimer's caregivers.

OBJECTIVES: Prior research has demonstrated the benefits of religion on caregiver well-being; however, less research exists on the processes underlying this relationship, particularly in Latino Alzheimer's disease (AD) families. This study's aim was therefore to explore the direct and indirect influences of positive religious coping (RC-P) and negative religious coping (RC-N) on caregivers' experiences of depression and anxiety. METHODS: The data are from the Circulo de Cuidado Study baseline interviews; participant eligibility criteria were that the person identifies as being Latino, providing at least 5 h of care weekly, and their relative has an AD diagnosis and neuropsychiatric symptoms. In person at-home interviews were conducted in Spanish with 67 caregivers. Religious coping was assessed with the Brief RCOPE; depression and anxiety were measured with the Center for Epidemiological Studies Depression Scale-Spanish version and State Anxiety Inventory. Multivariate regression analyses, controlling for caregiving stressors, were used to test our core hypotheses. RESULTS: As hypothesized, RC-N had significant direct effect on depression (p < 0.001) and anxiety (p < 0.001) as well as partially mediated the relationship between caregiver subjective stressor and depression (p < 0.01) and anxiety (p < 0.01). However, contrary to our hypothesis, RC-P did not have a direct or indirect effects on psychological well-being. CONCLUSIONS: Our findings are consistent with other studies linking RC-N to poorer caregiver outcomes. Caregivers who questioned God's power, perceived God punishing them, or felt abandoned by God reported greater levels of depression and anxiety. The results suggest that caregivers experiencing religious distress may feel overwhelmed and view a more hopeless future.

Social work involvement in palliative care heart failure research: a review of recent literature.

PURPOSE OF REVIEW: The aim of the review is to examine the findings of empirical studies of palliative care interventions for patients with heart failure in which a social worker was identified as a key member of the interprofessional clinical team. RECENT FINDINGS: Our systematic review of the empirical literature from January 2016 to August 2019 found five palliative care interventions with heart failure patients that cited involvement of a social worker as a key team member. The reviewed studies highlighted social workers' roles in the areas of psychosocial assessments and support, advance care planning, and patient-medical team communication. SUMMARY: Palliative social workers possess the knowledge and skills to provide expertise in psychological, social, and cultural care within palliative care domains of practice. Given this primary and critical role, more studies that include the assessment of outcomes linked to the social worker's role should be pursued. Our review unearthed several important studies that highlight the role of the palliative social workers in heart failure models of care.

Perceptions of neighborhood safety and depressive symptoms among older minority urban subsidized housing residents: the mediating effect of sense of community belonging.

OBJECTIVES: Older minority subsidized housing residents represent a population that is particularly vulnerable to depression. Although research suggests that neighborhood characteristics influence older adults' mental health, it has not been explored in this target population. Drawing on social disorganization and social capital theories, this study's aim was to explore if perceptions of neighborhood safety are associated with depressive symptoms; and, whether a sense of community belonging has a mediating effect on this potential relationship. METHODS: The data are from interviews with 216 older adults (50% Black, 45% Latino/a) living in a U.S. urban subsidized housing development. RESULTS: Among participants, 80% identified feeling 'very safe' during the day while 63% expressed feeling 'very safe' at night in their neighborhood. Approximately 60% possessed a stronger sense of community belonging and 26% had clinically relevant depressive symptoms. Hierarchical regression analyses revealed that perceptions of feeling less safe in one's neighborhood were significantly associated with elevated levels of depressive symptoms; however, a greater sense of community belonging buffered (or had a significant mediating effect on) this relationship. CONCLUSION: The findings suggest the importance of continued exploration of the role of social capital in relation to feelings of safety in later life.

Loneliness and Depression Among Older Adults in Urban Subsidized Housing.

OBJECTIVE: Depression is particularly prevalent in low-income and disabled older adults, and minority populations face a greater risk of poverty and earlier disability onset. Yet, little is known about the mental health of older subsidized housing residents, a population which is disproportionately composed of persons of color. The study's aim was therefore to explore the prevalence and correlates of depression in this target population, with a particular focus on the role of loneliness. METHOD: Data are from interviews with 216 older subsidized housing residents, of which 50% identified as Black and 45% self-identified as Latino. RESULTS: About 26% of participants met the criterion for depression. The hierarchical regression supported our hypothesis; after controlling for demographic, health, and stress variables, loneliness explained almost half of the total 49% of variance in depression. DISCUSSION: Care models addressing social risk factors are needed to meet the aging-in-place challenges of subsidized housing residents.

The Effectiveness of a Culturally Sensitive Cognitive Behavioral Group Intervention for Latino Alzheimer's Caregivers.

PURPOSE OF THE STUDY: Demographic projections suggest that the older Latino population will experience the fastest growth among all racial/ethnic groups; and by 2050 will constitute 20% of the nation's seniors. Yet, Latino Alzheimer's elders and their families remain underrepresented in the health care system and caregiver intervention studies. To address this gap, this study tested the effectiveness of Circulo de Cuidado, a culturally-sensitive, cognitive behavioral (CBT) group intervention, in supporting Latino families' ability to manage the disease's neuropsychiatric symptoms and improve caregiver well-being. DESIGN AND METHODS: Using a randomized controlled trial design, 67 caregivers were assigned to the CBT experimental condition or the psychoeducational (PED) control condition and interviewed at baseline, post-group, and 3 months follow-up. The 2 manualized interventions had the same structure: 5 weekly 90-minute group sessions, followed by telephone coaching at 3, 6, 9 and 12 weeks post-group. RESULTS: Repeated measures analysis of covariance revealed significant group by time interaction effects. Compared with the PED participants, CBT participants reported lower neuropsychiatric symptoms in their relative, less caregiver distress about neuropsychiatric symptoms, a greater sense of caregiver self-efficacy, and less depressive symptoms over time. IMPLICATIONS: Our findings offer preliminary evidence that a culturally tailored, CBT group intervention targeted toward neuropsychiatric symptom management has positive psychological benefits for Latino caregivers.

Fractured Identity: A Framework for Understanding Young Asian American Women's Self-harm and Suicidal Behaviors.

Despite the high suicide rate among young Asian American women, the reasons for this phenomenon remain unclear. This qualitative study explored the family experiences of 16 young Asian American women who are children of immigrants and report a history of self-harm and/or suicidal behaviors. Our findings suggest that the participants experienced multiple types of "disempowering parenting styles" that are characterized as: abusive, burdening, culturally disjointed, disengaged, and gender-prescriptive parenting. Tied to these family dynamics is the double bind that participants suffer. Exposed to multiple types of negative parenting, the women felt paralyzed by opposing forces, caught between a deep desire to satisfy their parents' expectations as well as societal expectations and to simultaneously rebel against the image of "the perfect Asian woman." Torn by the double bind, these women developed a "fractured identity," which led to the use of "unsafe coping" strategies. Trapped in a "web of pain," the young women suffered alone and engaged in self-harm and suicidal behaviors.

Improving health care delivery to aging adults with disabilities: social work with dual eligibles in a climate of health care reform.

Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.

Baby Boomers and the shifting political construction of old age.

Employing the political construct of "target" populations, we suggest that the Boomers in old age will constitute a conceptually distinct population from that represented by either their parents or grandparents. A fourfold typology organized along the dimensions posited by Schneider and Ingram (1993) yields categorizations of target populations as Dependent, Deviant, Advantaged, or Contender. Although these authors labeled the aged as Advantaged, categorizations of target populations can and do change over time. Using historical analysis, we explore, first, the transformation of the aged from Dependent to Advantaged and the more recent transformation to Contender status. This latest shift is reinforced by the perceived characteristics of the Boomer cohort itself now entering old age and by economic and political circumstances severely constraining policy agendas and options. We argue that the combination of weakened legitimacy in the face of pressing needs among many of the Boomer population may result in a fracturing of elders' longstanding singular political imagery. More affluent Boomers will continue to fight for their benefits as Contenders, whereas vulnerable Boomers may be relegated back to the Dependent categorization.

The complexities of elder homelessness, a shifting political landscape and emerging community responses.

Despite their growing numbers, homeless older adults remain largely invisible in society and there has been a pervasive lack of public focus on elder homelessness. In this article, we seek to shine light on this forgotten population and deepen understanding of difficult challenges they confront in regaining housing security. We also examine the shifting political climate regarding homelessness, particularly the enactment and subsequent reauthorizations of the McKinney-Vento Homeless Assistance Act, and how these shifts are influencing community responses to elder homelessness. Finally, future challenges and policy directions for breaking the cycle of elder homelessness in the U.S. are discussed.

Adult daughters and aging mothers: the role of guilt in the experience of caregiver burden.

Although guilt is often identified as being a common emotion experienced by family caregivers in the clinical literature and in small descriptive studies, it has only recently emerged as a construct in the empirical research focused on identifying predictors of caregiver distress. Using Pearlin's stress process model, and based on data from 66 midlife adult daughters caring for aging mothers, we explored the extent to which guilt contributes to caregiver burden. Hierarchical regression analysis revealed that guilt was positively correlated with burden and that it accounted for a significant amount of the variance in caregiver's sense of burden even after contextual and stressor variables were controlled. Our research suggests the importance of clinicians seeking to understand how individuals judge their caregiving performance and targeting negative self-appraisals, which affect individuals' mental health, for change. The challenge for clinicians is to help guilt-ridden caregivers revise their evaluative standards and engage in self-forgiveness and self-acceptance.

Project CARE: a randomized controlled trial of a behavioral intervention group for Alzheimer's disease caregivers.

PURPOSE: The neuropsychiatric symptoms associated with Alzheimer's disease are a major contributor to caregiver distress and burden. Despite recent efforts to teach caregivers skills to manage neuropsychiatric symptoms and reduce burden, there continues to be limited evidence that these strategies have helped caregivers of individuals with Alzheimer's disease to effectively manage neuropsychiatric symptoms. We report here on Project CARE, a randomized controlled trial designed to test the effectiveness of a caregiver-based multicomponent behavioral intervention aimed to reduce caregiver distress related to neuropsychiatric symptoms, as well as general caregiver burden, and to decrease neuropsychiatric symptom severity among individuals with Alzheimer's disease. DESIGN AND METHODS: The behavioral intervention involved five weekly sessions designed to teach caregivers specific techniques for managing patient neuropsychiatric symptoms in the home environment. Through the use of a randomized control trial, 80 caregivers were assigned to either the behavioral intervention group or a psychoeducational control group and were assessed both before and after the intervention. RESULTS: Compared with caregivers in the control group, caregivers in the behavioral intervention group displayed significantly greater reductions in caregiver distress related to neuropsychiatric symptoms (p=.005). Global caregiver burden, however, did not decrease significantly for caregivers in either group (p>.05). Although it was not statistically significant, there was a trend toward greater reductions in care recipients' neuropsychiatric symptom severity in the intervention group (p=.10). IMPLICATIONS: The current findings suggest that targeted, group-based behavioral interventions are effective for reducing distress related to neuropsychiatric symptoms among caregivers of individuals with Alzheimer's disease and for reducing care recipients' neuropsychiatric symptoms.

Subjective appraisal of Alzheimer's disease caregiving: the role of self-efficacy and depressive symptoms in the experience of burden.

Most studies investigating correlates of Alzheimer's disease (AD) caregiver burden have focused on the role of objective factors as opposed to subjective factors. Although objective variables (e.g., caregiver age, patient dementia severity, functional status) have been shown to be significantly associated with burden, the correlations generally are modest and explain relatively little of the variability in caregiver outcomes. Moreover, many of these objective variables are not modifiable and are of limited use in the development of caregiver interventions. Thus, there continues to be a need to identify powerful and modifiable determinants of caregiver burden. This study examined the role of two subjective factors-self-efficacy and depressive symptoms-as predictors of AD caregiver burden. Based on a sample of 80 AD caregivers, hierarchical regression analyses revealed that self-efficacy and depressive symptoms each had a significant independent effect on the experience of burden even after accounting for objective factors. These findings suggest that caregiver interventions aimed to reduce burden may benefit from the incorporation of specific strategies to increase self-efficacy and decrease depressive symptoms.