'An ant against an elephant': Retirement village residents' experiences of disputes and dispute resolution.

OBJECTIVE: To record Victorian retirement village residents' experiences of dispute management and satisfaction levels related to dispute resolution processes. METHODS: Survey distributed to 6500 retirement village residents. RESULTS: Surveys returned from 1876 residents (29% return rate). Most residents rated life in retirement villages as positive (mean 7.9/10), with an association between life satisfaction and management's ability to resolve disputes (rs = 0.44, P < 0.01). Almost 70% of respondents reported issues of concern to management were resolved satisfactorily; 38% were not resolved to residents' satisfaction. One-fifth reported contacting regional managers or higher personnel regarding issues affecting them, with two-thirds of these respondents reporting a negative outcome. Over 30% did not know if their village had dispute resolution processes in place. CONCLUSION: Despite finding retirement village life positive, residents of retirement villages found disputes and dispute resolution processes unsatisfactory and desired change to address these concerns.

LGBQ-Specific Elderly Housing as a "Sparkling Sanctuary": Boundary Work on LGBQ Identity and Community in Relationship to Potential LGBQ-Specific Elderly Housing in Sweden.

This study explored how boundaries in relationship to community and identity were created and negotiated among lesbian, gay, bisexual, and queer (LGBQ) people within the framework of picturing LGBQ-specific elderly housing as a housing alternative in older age, by applying focus group methodology. "An island as a sparkling sanctuary" was identified as a metaphor for how symbolic resources defining the LGBQ community can be manifested in LGBQ-specific qualities of elderly housing. The boundary work underlying this manifestation included elaborations on the dilemma between exclusiveness and normality. The findings illustrate further how symbolic resources and collective identities were developed through dialectic interplay between internal and external definitions. Further, the findings show how boundary work generated shared feelings of similarity and group membership. The associated symbolic and social resources not only served to deal with difficult situations but also to manifest LGBQ identity and sense of community as a "gold medal."

Live-in Care Workers in Sheltered Housing for Older Adults in Israel: The New Sheltered Housing Law.

Supportive housing schemes were historically aimed to provide group accommodation for older adults. With the aging of residents, facilities were required to enable them to receive care services in order to allow them to age in place. Thus, different countries and different facilities developed different models of housing with care, reflecting cultural and policy diversities. Despite all of the different models, there are many commonalities among the supportive housing schemes across countries. These include provision of dwelling units and care services provided by either the facility or by external agencies. The aims of this article are threefold: to describe the historical development of the ever-evolving supportive care housing phenomena; to point at variations in models of housing and care within the international context; and to present a new Israeli model that enables residents to privately hire live-in care workers to meet their care needs. This is a unique model in the international context that has not been reported before. The article describes the main ideas of the new model and discusses the challenges that it raises and pinpoints the unresolved issues associated with the presence of live-in care workers employed by residents of sheltered housing that should be addressed.

Predictors of smoke-free policies in affordable multiunit housing, North Carolina, 2013.

INTRODUCTION: Smoke-free policies can effectively protect nonsmokers from secondhand smoke (SHS) exposure in multiunit housing. We surveyed all affordable multiunit housing properties in North Carolina to determine the statewide prevalence of smoke-free policies and to identify predictors of smoke-free policies. METHODS: Representatives of affordable housing properties in North Carolina completed a mailed or online survey during June through October 2013. The primary outcome measure was presence of a smoke-free policy, defined as prohibiting smoking in all residential units. We used χ(2) analysis and multivariate logistic regression to identify correlates of smoke-free policies. RESULTS: Of 1,865 eligible properties, responses were received for 1,063 (57%). A total of 16.5% of properties had policies that prohibited smoking in all residential units, while 69.6% prohibited smoking in indoor common areas. In multivariate analysis, an increase in the number of children per unit was associated with a decrease in the odds of having a smoke-free policy at most properties. Newer properties across all company sizes were more likely to have smoke-free policies. Accessing units from interior hallways predicted smoke-free policies among medium-sized companies. CONCLUSION: More smoke-free policies in affordable multiunit housing are needed to protect vulnerable populations, particularly children, from SHS exposure. Public health professionals should continue to educate housing operators about SHS and the benefits of smoke-free policies at all properties, including older ones and ones where units are accessed from outside rather than from an interior hallway.

Sujeciones mecánicas y farmacológicas en servicios y centros geriátricos y gerontológicos / Physical and pharmacological restraints in geriatric and gerontology services and centers

Las sujeciones mecánicas y las farmacológicas constituyen un tema controvertido en la asistencia geriátrica por sus repercusiones morales, éticas, sociales y jurídicas y, pese a ello, no existe legislación específica a nivel estatal. El uso de las sujeciones se cuestiona cada vez más, ya que existen estudios que demuestran que no disminuyen las caídas ni sus consecuencias, sino que pueden aumentarlas, producir complicaciones, lesiones y accidentes potencialmente mortales. No siempre se utilizan racionalmente pese a comprometer un derecho fundamental de las personas, como la libertad, constitucionalmente protegido, además de afectar a valores y principios como la dignidad y la autoestima personal: hay centros en los se utilizan en más del 50 % de sus usuarios, y para las que en algunos casos, no cuentan con el consentimiento de sus representantes. En ocasiones, se utilizan para conseguir objetivos organizativos o ambientales, como el cumplimiento de horarios ajustados, y para disminuir o evitar la supervisión de personas que deambulan erráticamente; y a veces se usan indefinidamente. Mayor confusión aún existe con respecto al emergente concepto de las sujeciones químicas o farmacológicas, ya que no existe un marco conceptual basado en evidencia científica, suficientemente consensuado para los profesionales. En este contexto la Sociedad Española de Geriatría y Gerontología (SEGG), consciente de la importancia y trascendencia del tema e intentando, por un lado, preservar y garantizar las máximas libertad, dignidad y autoestima y, por otro, velar por las máximas integridad, seguridad legal y jurídica de las personas atendidas en servicios y centros geriátricos y gerontológicos, decidió crear un Comité Interdisciplinar de Sujeciones constituido por socios de diferentes disciplinas y miembros de algunos grupos de trabajo o comités de la SEGG, por profesionales externos de grupos, de entidades y asociaciones expertos en sujeciones e integrar en él a los principales movimientos «antisujeciones». Fruto de ello es el Documento de consenso sobre sujeciones mecánicas y farmacológicas, así como el Consenso sobre sujeciones mecánicas y farmacológicas, publicado por la SEGG, que debe suponer un salto cualitativo en la atención de los mayores, y servir como guía de buena práctica para los profesionales (AU)

Physical and pharmacological restraints are a controversial issue in the context of geriatric care due to their moral, ethical, social and legal repercussions and, despite this fact, no specific legislation exists at a national level. The use of restraints is being questioned with growing frequency, as there are studies that demonstrate that restraints do not reduce the number of falls or their consequences, but rather can increase them, cause complications, injuries and potentially fatal accidents. Restraints are not always used rationally, despite compromising a fundamental human right, that is, freedom, protected in the Constitution, as well as values and principles, such as dignity and personal self-esteem. There are centers where restraints are applied to more than 50 % of patients, and in some cases without the consent of their legal representatives. On some occasions, restraints are used for attaining organizational or environmental objectives, such as complying with tight schedules, and for reducing or avoiding the supervision of patients who walk erratically and, at times, are used indefinitely. Even greater confusion exists with respect to the emerging concept of chemical or pharmacological restraints, since no conceptual framework exists based on scientific evidence, and with sufficient consensus for guiding healthcare workers. In this context, the Sociedad Española de Geriatría y Gerontología (SEGG - Spanish Geriatrics and Gerontology Society), aware of the significance and transcendence of the issue, and in an attempt to preserve and guarantee maximum freedom, dignity and self-esteem, on the one hand, and to ensure the maximum integrity and legal certainty of the persons cared for in geriatric and gerontology services and centers, on the other, decided to create an «Interdisciplinary Committee on Restraints» made up by members from different disciplines and members of SEGG Working Groups or Committees, external health care workers, groups, organizations, and associations, who are experts in restraints, as well as the main «anti-restraint» movements. An outcome of this decision is the Consensus document on physical and pharmacological restraints, together with the Consensus on physical and pharmacological restraints, published by the SEGG, which should signify a qualitative leap forward in care for the elderly, and serving as a best practice guide for healthcare workers (AU)

El fenómeno de las caídas en residencias e instituciones: revisión del Grupo de Trabajo de Osteoporosis, Caídas y Fracturas de la Sociedad Española de Geriatría y Gerontología (GCOF-SEGG) / Falls in nursing homes and institutions: Update by the Osteoporosis, Falls and Fractures Working Group of the Spanish Society of Geriatrics and Gerontology (GCOF-SEGG)

Desde el Grupo de Trabajo de Osteoporosis, Caídas y Fracturas (GOCF) de la Sociedad Española de Geriatría y Gerontología (SEGG), se creó una comisión de trabajo con vistas a realizar una revisión de la evidencia en cuanto a la detección, los factores de riesgo y las herramientas de valoración de caídas, así como las pautas de actuación frente a las mismas en residencias e instituciones. Igualmente, se definen los distintos perfiles de usuarios de estas instituciones para efectuar una aproximación exhaustiva respecto a un fenómeno y a una subpoblación tan heterogéneos, ofreciendo una clasificación de riesgo y unas recomendaciones específicas de acuerdo a dicha clasificación(AU)

The Workshop on Osteoporosis, Falls and Fractures (GCOF) of The Spanish Geriatrics and Gerontology Society (SEGG) formed a committee in order to review the state of the art on the detection, risk factors and assessment tools for falls, and intervention protocols when falls occurs in nursing homes, long-term hospitals or medium-stay units. The different patient profiles are described in order to make a comprehensive approach to this heterogeneous topic and population, offering a risk classification and specific advice according to these categories(AU)

The effect of ethnicity and economy upon intergenerational coresidence: northern Norway during the last part of the nineteenth century.

During the last part of the nineteenth century, Finnmark province and the northern part of Troms experienced a decline in intergenerational coresidence. This article discusses what impact ethnic affiliation and economic activity had on the living arrangements of the elderly, and what contributed to the change. Logistic regression shows that ethnicity played a role but its effect disappears after controlling for economic activity. Intergenerational coresidence was positively associated with being a married Sámi male with an occupation in farming or combined fishing and farming. As such a person grew older, he was increasingly likely to live separately from an own adult child. This pattern changed toward the end of nineteenth century. By the close of the century, ethnic differences had disappeared, and headship position, irrespective of marital status, was strongly related to coresidence.

Housing and location choices of retiring households: evidence from France.

In this paper, a study is made of the mobility and housing choices of the elderly when retiring, using household data collected in France. From a theoretical viewpoint, individuals are likely to decrease their housing quantity because of an income loss when retiring, but they may also increase it to benefit from more housing comfort for leisure. Using the 1992 Trois Générations survey, it is first shown that housing mobility at retirement is substantial in France, with a variety of self-reported motives. Then, using the 1994­2001 French Europanel survey, evidence is found of both upsizing and downsizing for mobile recent retirees. In many cases, housing adjustments lead to a correction of the initial disequilibrium between the number of rooms and the number of occupants. However, a significant proportion of mobile recent retirees improve the quality of their dwelling.

The Environmental Cleanliness and Clutter Scale (ECCS).

BACKGROUND: Development of a scale to rate the degree and various aspects of uncleanliness will facilitate description and research in cases of severe domestic squalor. METHODS: Discussion with representatives of relevant agencies led to selection of various aspects of domestic uncleanliness and clutter to be assessed when describing cases of squalor. Rooms and areas with varying functions (toilet, kitchen, bedroom, etc.) were all to be rated, along with other indicators of squalor (e.g. odor, vermin). Trial use and further discussion resulted in reduction to ten items, each rated on a four-point scale, with succinct descriptions of anchor-points. Two experienced psychogeriatricians then used this new Environmental Cleanliness and Clutter Scale (ECCS) to rate independently 55 dwellings which had been reported by Aged Care staff as cluttered or unclean, and also rated overall degree of squalor. Reliability and indications of validity were analyzed. RESULTS: The inter-rater reliability for the ten items was considered satisfactory (kappa 0.48, varying from 0.31 to 0.58). Cronbach's alpha for the new scale was 0.94, demonstrating high internal consistency. Each author's ratings of degree of squalor (none to severe) matched well with the other's ratings on the scale; a score of >12 usually indicated moderate or severe squalor. CONCLUSION: The ECCS proved reliable and useful in rating cases where elderly people were living in severe domestic squalor.

How and when to intervene in cases of severe domestic squalor.

BACKGROUND: Little has been published concerning how best to intervene in cases of severe domestic squalor. METHODS: Background literature and reports on how best to intervene in cases of severe domestic squalor were reviewed. RESULTS: Reports by groups in London (Ontario), and Sydney (Australia) have provided recommendations for development of coordinated services to intervene in cases of squalor. Guidelines have been issued. Treatments for compulsive hoarding may contribute to improvement in cases where squalor is attributable to restricted access due to clutter. CONCLUSIONS: Effective interventions in cases of severe domestic squalor are commonly expensive and require good inter-agency collaboration. Budgetary support must be available to enable appropriate services to take on cases and provide case management.