Daphna Gans

Beyond solidarity, reciprocity and altruism: moral capital as a unifying concept in intergenerational support for older people

ABSTRACT The purpose of this article is to review, contrast and synthesise several major intellectual streams that have guided theoretical development and empirical research in the area of intergenerational family support to older people: (a) normative-integrative approaches that focus on cohesion between family members based on bonds of solidarity and norms of filial obligation, and (b) transactional approaches that are primarily concerned with identifying motives for resource transfers across generational lines. We propose the concept of moral capital – defined as the stock of internalised social norms that obligate children to care for and support their older parents – the transmission of which lies at the intersection of self-interest (for parents) and altruism (for children). Using data from a multigenerational family study, we present an empirical analysis showing that a strong positive correspondence in the filial obligations of adult children and their older mothers – arguably the result of intergenerational transmission – elevated the supportive behaviour of children. We suggest that moral capital may be a useful unifying concept that bridges disciplinary and theoretical divides in the study of intergenerational transfers to elderly people by helping resolve the paradox of how self-interest and selflessness can co-exist within families.

Intergenerational Support and the Emotional Well-being of Older Jews and Arabs in Israel

This investigation examined the cultural context of intergenerational support among older Jewish and Arab parents living in Israel. The authors hypothesized that support from adult children would be more positively consequential for the psychological well-being of Arab parents than of Jewish parents. The data derived from 375 adults age 65 and older living in Israel. Psychological well-being was measured with positive and negative affect subscales of the Positive and Negative Affect Schedule. Overall, positive affect was highest when filial expectations for support were congruent with whether or not instrumental support was received. Findings by cultural background revealed that, among older Jews, receiving instrumental support raised positive affect and stronger filial expectations lowered it. Among older Arabs, receiving financial support raised positive affect and receiving instrumental support lowered it. Culture appears to serve as a potent force in determining which types of intergenerational support functions are expected and accepted means of serving the everyday needs of older parents.

Impact of a pediatric palliative care program on the caregiver experience

California’s pediatric palliative care program Partners for Children uses family-centered care coordination to offer hospice-like therapeutic, respite, and pain management services for children delivered concurrently with curative care and regardless of the child’s life expectancy. As an early implementer of concurrent care for children, the program provides evidence of the impact of concurrent care on children and their families. Program impact on caregivers’ perceptions of their levels of stress and worry was measured using random effect growth curve models that included survey wave, caregivers’ perceived family support, and the child’s age and disease severity. All other data were descriptive and subject to univariate analysis. Worry and stress improved in the overall study population between the baseline and follow-up surveys. Family support was predictive of reductions in stress and worry. Disease severity was predictive of stress. Family-centered care coordination is a promising tool to enhance care for children with life-threatening health conditions and reduce caregiver stress and worry. Program strategies, including individualized care planning, access to a 24/7 nurse line, and a focus on the entire family, can be a model for other states as the need for integration of pediatric palliative care for seriously ill children becomes a national public health priority.

Team-Based Interprofessional Competency Training for Dementia Screening and Management

As many as 50% of people satisfying diagnostic criteria for dementia are undiagnosed. A team‐based training program for dementia screening and management was developed targeting four professions (medicine, nursing, pharmacy, social work) whose scope of practice involves dementia care. An interprofessional group of 10 faculty members was trained to facilitate four interactive competency stations on dementia screening, differential diagnoses, dementia management and team care planning, and screening for and managing caregiver stress. Registrants were organized into teams of five members, with at least one member of each profession per team. The teams rotated through all stations, completing assigned tasks through interprofessional collaboration. A total of 117 professionals (51 physicians, 11 nurses, 20 pharmacists, 24 social workers, 11 others) successfully completed the program. Change scores showed significant improvements in overall competence in dementia assessment and intervention (very low = 1; very high = 5; average change 1.12, P < .001), awareness of importance of dementia screening (average change 0.85, P < .001), and confidence in managing medication (average change 0.86, P < .001). Eighty‐seven participants (82.9%) reported feeling confident or very confident using the dementia toolkit at their home institution. In a survey administered 3 months after the session, 48 respondents reported that they had changed their approach to administering the Mini‐Cog test (78%), differential diagnosis (49%), assessment of caregiver stress (74%), and accessing community support and services (69%). In conclusion, team‐based interprofessional competency training is a team teaching model that can be used to enhance competency in dementia screening and management in medical, nursing, pharmacy, and social work practitioners.

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care—Preliminary Data

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6‐month intervention with five components: facilitated collection of MDS 3.0 nine‐item Patient Health Questionnaire (PHQ‐9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ‐9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self‐appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self‐ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ‐9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH‐prevalent syndromes is possible.

Geriatric Workforce Development for the Underserved: Using RCQI Methodology to Evaluate the Training of IHSS Caregivers

Caregivers play an important role in the in-home care of community dwelling older adults living with Alzheimer’s disease or related dementias (ADRD); however, many of these caregivers lack training in caring for this vulnerable population. In 2015, we developed and implemented an interactive, community-based, knowledge and skills-based training program for In-Home Supportive Services (IHSS) caregivers. This report shares the results of a process evaluation of this training program as it evolved over the course of three training sessions in Riverside County, California. Our iterative evaluation process reveals the unique needs of training and assessing a population of demographically diverse adult learners and provides guidance for those planning to implement similar training in underserved communities. Factors such as reliance on self-reported abilities, language readability level, and test anxiety may have confounded attempts to capture learner feedback and actual knowledge gains from our caregiver training program.