Adapting the serious illness conversation guide for unhoused older adults: a rapid qualitative study.

BACKGROUND: Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients' values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH. METHODS: We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: "SICG interpretation" and "SICG feedback". For providers, we used domains from the Toolkit of Adaptation Approaches: "collaborative working", "team", "endorsement", "materials", "messages", and "delivery". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement. RESULTS: The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses' and social workers' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations. CONCLUSIONS: The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.

Conversations about Community, Connection to Place, and Housing Preferences among Aging Adults in Lexington, Kentucky.

While many researchers have called for housing to be addressed in age-friendly cities and communities, little research exists to guide communities through this process. To maximize the potential for adults to age in place, researchers partnered with a local Age-Friendly community initiative to conduct focus groups and learn more about residents' preferences related to housing and residential space. The focus group data offered a glimpse into aging residents' perspectives on housing to inform planning and development of housing in a mid-size city. This second phase of a sequential mixed methods study included qualitative focus groups with 19 aging individuals. Focus group sessions sought to better understand previously identified housing preferences, aging adults' sense of community, and their connection to place. Findings suggest that aging participants cared not only about the physical structure of their home, but also the community-based aspects of where they live. Study implications suggest that social workers, working with and alongside community members and aging-service providers who have local knowledge, can support age-friendly housing models that consider the housing preferences of older residents, as well as the resources and limitations of their community.

"Just like Jail": Trauma Experiences of Older Homeless Men.

People experiencing homelessness often have a history of trauma, and losing one's home is a traumatic event. The trauma of living in emergency shelters and on the streets uniquely impacts older adults, whose experiences of homelessness increase the likelihood of multiple health conditions and premature aging. This paper includes data from 18 men, aged 50 and older, who had experienced multiple instances of homelessness, as part of a larger study to understand the return path to homelessness from permanent housing. When participants spoke with us about their failure to be in housing, their inability to free themselves from reoccurring homelessness could not be discussed without talking about their trauma. Participants spoke of trauma in early life, perhaps precipitating homelessness, as well as traumatic experiences while homeless. The men discussed feeling imprisoned by the systemic issues around homelessness, facing mistreatment by service providers, and being exposed to external threats in their lives on the streets, including violence. Findings from this study lend themselves to the explicit need for trauma-informed care and supportive services that are sensitive to the urgency of homelessness as it is experienced by men in late life.

Being "easy": Women's desire to accept help in later life.

This article examines the concept of being "easy" as a quality that female caregivers aspire to as they envision their potential care in later life. It draws on data from a qualitative study exploring the significance of caregiving to adult daughters' perspectives and plans for their own aging. Caregivers' experiences differ based upon their perception of how easy or difficult it was to care for their loved one. The former exemplifies a positive way to approach aging and the receiving of care. Being easy describes an attitude that these caregivers desired for their own later life.

Geriatric Case Managers' Perspectives on Suicide Among Community-Dwelling Older Adults.

It has been suggested that clinical screening for suicide, along with firearm assessment and safety counseling, are important in service provision to older adults. It is unclear, however, how geriatric case managers respond to these issues. This study surveyed geriatric case managers (n=161) from Area Agencies on Aging in Ohio on their knowledge, attitudes, and behaviors related to suicide, firearm assessment, and safety counseling. Results indicated that the majority of respondents (70%) agree their clients are at risk for suicide. However, few (30%) in this study reported that they assess for firearms and less than half (48%) discuss firearms with their clients/family members when specifically assessing for suicide. Analyses identified barriers that contribute to the decreased likelihood that routine firearm assessment and safety counseling would occur, such as lack of training and time. Implications include the need for training with geriatric case managers that addresses barriers to suicide, firearm assessment and safety counseling as a means to decrease these population risks.

"Keep dignity intact": exploring desires for quality long-term care among midlife women.

The purpose of this qualitative study was to provide in-depth descriptions of preferences for receipt of long-term care among a small sample of information-rich cases. The participants in this study, women in late midlife caring for a parent or parent-in-law, expressed where they would prefer to receive care, who they would want to provide care, and personal traits that would be important in a caregiver. A major theme centered personal characteristics these women would want in a caregiver, traits such as empathy, sensitivity, and knowledgeable about elder care. Implications for social work practice are discussed.

Use of Oral History Methods in Social Work: A Scoping Review.

PURPOSE: Oral history as a method of understanding the lived experience spans multiple disciplines including education, women and gender studies, history, and disability studies. Oral histories can be a vehicle for people on the periphery to tell their stories, a method well suited to pursuits related to social justice and social work. The purpose of this manuscript is to report on a scoping review that was conducted to better understand how oral history methods have been used in social work. MATERIAL AND METHODS: To answer our review question, we use an established scoping review framework. Based on eligibility criteria, 23 manuscripts were identified - all published in peer-reviewed English language journals between 2005 and 2023 and written by social work-credentialed authors. RESULTS: The authors identified three themes that reflect the uses of oral history studies in social work: oral history used as a teaching tool in social work education, oral history used to document the experiences and knowledge of social service trailblazers, and commentaries about using oral history and other biographical methods in social work. DISCUSSION: This review highlights how oral history, as a method, has contributed to social work research and scholarship. CONCLUSION: Recommendations are made as to the usefulness of oral history to address social problems and practice issues important to the field of social work.

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.

Becoming a Caregiver: Experiences of Young Adults Moving into Family Caregiving Roles.

While the vast majority of family caregivers struggle to find balance between different roles in their lives, young adult caregivers are faced with the atypical challenge of caring for family member while simultaneously accomplishing developmental tasks typical of this stage in life (e.g., establishing career, developing romantic relationships). This exploratory, qualitative study examined strategies used by young adults to adopt family caregiving roles. These strategies can be described as embracement, compromise, and integration. While each approach allowed for the young adult to facilitate their caregiving role, additional research is needed to understand how the strategy affects the emerging adult's development.

"I Just Feel Like I Always Did": Inotropic Dependency at End of Life.

BACKGROUND: Patients not considered for mechanical circulatory support or heart transplant may be dependent on inotropic therapy at end of life. End-of-life conversations in advanced heart failure can be challenging for providers, but guidelines recommend frequent goals-of-care conversations when inotropes are used as a palliative treatment. The purpose of this study was to identify aspects of care pertinent for health-care professionals working with patients in end-stage heart failure who are receiving continuous inotropic support. METHODS: Qualitative analysis was used to examine 3 audio-recorded semistructured interviews with 1 patient, her family, and her cardiologist. The selected patient was an older adult, diagnosed with advanced heart failure, and dependent on continuous inotropic therapy with no other advanced treatment options available. RESULTS: The analysis revealed that (1) reliance on others, (2) contending with uncertainty, and (3) deciding when to discontinue inotropic support were identified as themes central to the patient's and provider's experience. CONCLUSION: This study offers insight into how to best support and communicate with patients having advanced heart failure who are dependent on continuous inotropic therapy at end of life.

Development of the Older Adult Prescription Drug Assessment Questionnaire for Case Workers.

Instruments assessing geriatric case managers' perceptions of prescription abuse are limited. Based on a review of current literature and pilot testing feedback, 22 items were initially assembled to form an older adult Prescription Drug Assessment Questionnaire (PDAQ). Case managers ( N = 161) at an older adult agency located in a Midwestern state were surveyed using the instrument. Data were subjected to exploratory factor analysis using principal axis factoring (PAF) and Promax rotation, and Horn's parallel analysis determined the number of extracted factors. PAF generated a final 11-item three-factor model accounting for 51% of total variance explained: Standard Assessment (Factor 1; four items; ∞ = .83), Assessment Belief (Factor 2; three items; ∞ = .74), and Problem Scope (Factor 3; four items; ∞ = .62). The older adult PDAQ is a brief, data-driven instrument with acceptable psychometric properties for assessing perceptions of prescription drug abuse and misuse assessment and counseling.

Depression Literacy Among American Indian Older Adults.

Older American Indians experience high rates of depression and other psychological disorders, yet little research exist on the depression literacy of this group. Depression literacy is fundamental for individuals seeking help for depression in a timely and appropriate manner. In the present study the authors examine levels and predictors of knowledge of depression symptoms in a sample of rural older American Indians (N = 227) living in the Midwestern United States. Data from self-administered questionnaires indicate limited knowledge of depression and negative attitudes toward seeking help for mental health problems. Additional findings and implications for social work practice and policy are discussed.

Evidence-based practice knowledge and utilization among social workers.

In this study the researchers examined the knowledge, skills, and use of Evidence-Based Practice in a sample of social workers from different practice settings. Using an electronic survey, data were collected from a group of social work practitioners (N = 200). Participants in their 30s and 40s demonstrated the most knowledge and use of Evidence-Based Practice. In addition, a high percentage of social workers reported to be knowledgeable about social work research databases; a smaller percentage actually used online resources in their practice. Through this study the researchers add to what is currently known about social workers' perceptions, knowledge, and use of Evidence-Based Practice.