Elena Portacolone

The notion of precariousness among older adults living alone in the U.S.

This paper argues that older adults living alone in the U.S. face a set of unique challenges, as they are likely to experience a sense of precariousness. The term precariousness points to an intrinsic sense of instability and insecurity stemming from a lack of, or difficulty to, access essential resources. During a two-year ethnography of 47 older solo dwellers, this term captured one of the distinctive traits of the experience of living alone in older age in the U.S. The findings from semi-structured interviews and participant observation highlight the emergence of the notion of precariousness along three levels of analysis. First, on the micro and subjective level of analysis, older solo dwellers may struggle to perform the chores related to their household as they may deal with a failing body, faltering memory, and fixed if not shrinking income. Second, on the meso and institutional level of analysis, older adults living alone need to navigate the complex, scattered, and ever-changing landscape of services and understand their eligibility criteria, accessibility, fees, and conditions. At the same time they may have to deal with family issues. Finally, the macro level examines the pressure on older solo dwellers of a prevalent ideology that prizes independent behaviors and personal responsibility. In conclusion, the notion of precariousness illustrates the unique position of older adults living alone as they face different type of challenges on a micro, meso, and macro dimension. The paper ends with an invitation to create social policies that accommodate the needs of a growing number of older adults living alone.

“Move or Suffer”: Is Age-Segregation the New Norm for Older Americans Living Alone?

Despite ethical claims that civic societies should foster intergenerational integration, age-segregation is a widespread yet understudied phenomenon. The purpose of this study was to understand the reasons that led community-dwelling older Americans to relocate into senior housing. Qualitative data were collected through participant observation and ethnographic interviews with 47 older adults living alone in San Francisco, California. Half of study participants lived in housing for seniors, the other half in conventional housing. Data were analyzed with standard qualitative methods. Findings illuminate the dynamics that favor age-segregation. Senior housing might be cheaper, safer, and offer more socializing opportunities than conventional housing. Yet, tenants of senior housing may also experience isolation, crime, and distress. Findings suggest that rather than individual preference, cultural, political, and economic factors inform the individual decision to relocate into age-segregated settings. Findings also call for an increased awareness on the ethical implications of societies increasingly segregated by age.

Older Americans Living Alone The Influence of Resources and Intergenerational Integration on Inequality

The number of older adults living alone in Western societies has steadily increased. Despite this trend, little is known about the overall experience of this population. In this article, I examine the condition of living alone in old age in urban America by drawing upon two years of participant observation and ethnographic interviews with older Americans living alone, as well as with participant observation. Findings contribute to the literature on inequality, with particular attention to the theory of cumulative disadvantage over the life course. First I reveal the reasons that make living alone in old age a unique condition. Then I discuss four profiles of older adults living alone based on observed empirical patterns: the resourceful, the precarious, the segregated, and the gated elite. A comparison of these profiles suggests that intra-cohort inequalities stem from the combination of resources available and degree of intergenerational integration.

Time to reinvent the science of dementia: the need for care and social integration

Objectives: The increasing number of older adults with dementia is a large and growing public health problem. Alzheimers disease, the prevailing form of dementia, is projected to quadruple worldwide. To date, the care and social integration of individuals with dementia is complicated by limited collaborations between biomedicine and other disciplines. The objective of this paper is therefore to reflect on the orientation of biomedicine with regard to the science of dementia, and to articulate a path for moving forward. Methods: The authors drew upon, and expanded, the insights of an interdisciplinary, international workshop entitled ‘Bioethics and the Science of Aging: The Case of Dementia’ held in October 2012 at the University of California in Berkeley.Results: The care of individuals with dementia compels solid interdisciplinary collaborations. There are several issues affecting the care of individuals with dementia: (1) an evolving definition of dementia; (2) the ambiguous benefits of the diagnosis of dementia; (3) ethical conflicts concerning consent processes and clinical trials; and (4) a limited understanding of the perspective of the person with dementia.Conclusion: We argue that it is time for a renewed dialogue between biomedicine and other disciplines -- particularly public health, the social sciences, the medical humanities and bioethics. This interdisciplinary dialogue would facilitate a process of self-reflection within biomedicine. This dialogue will also provide the foundation for equitable public health interventions and will further prioritize the values and preferences of individuals with dementia, as well as their care and social integration.

Maggie Kuhn: social theorist of radical gerontology

Purpose – The purpose of this article is to explore Maggie Kuhns theoretical and analytical contributions to social gerontology and more broadly to the advancement of critical and public sociology.Design/methodology/approach – This paper is an theoretical exploration of ageing. Maggie Kuhns and the Gray Panthers theoretical contributions include analyses of, and related to: identity politics, intersectionality, cultural and media studies and the cognitive sciences, the forces and factors in the developing political economy of ageing including critiques of the ageing enterprise and the medical industrial complex, the sociology of knowledge of gerontology and globalization and world imperialism. The concluding section argues that the post‐retirement career of Maggie Kuhn was one of a Public Sociologist.Findings – Maggie Kuhn fulfils the promise of the Project of Public Sociology, which “is to make visible the invisible, to make the private public, to validate these organic connections as part of our socio...

Structural Factors of Elders’ Isolation in a High-Crime Neighborhood: An In-Depth Perspective

Older residents of high-crime areas are likely to be socially isolated; in practical terms, they have limited meaningful social ties (Victor, Scambler, Bond, & Bowling, 2000). In a recent study published by The Gerontologist we identified factors that contribute to the social isolation of older residents of Richmond, California, a city with elevated crime rates adjacent to Berkeley and surrounded by the affluent East Bay Area of San Francisco (Portacolone, Perissinotto, Yeh, & Greysen, 2017). The isolation of study participants stemmed from their personal characteristics (e.g., poor health and poverty), as well as structural factors such as the physical and social environment of their immediate neighborhood. Social factors included the immersion of participants in an environment with dense crime, weak norms of reciprocity, and toxic relations with family and acquaintances. Physical factors included the physical decay of building and streets in their neighborhood and a paucity of appropriate health care and social services. An unexpected finding was that study participants consistently longed for company and social integration. This finding was unexpected because studies of social isolation often emphasized the inclination of socially isolated individuals to have limited social ties (Cloutier-Fisher, Kobayashi, & Smith, 2011). Another unforeseen finding that we have not yet explored in depth concerned specific features of the geographic location of study participants (as elaborated in the discussion section). Here, we present a case study that permits a more in-depth and pragmatic discussion of the findings of the Richmond investigation. It is our hope that these data will inform public policies aimed at enhancing the wellbeing of older residents of high-crime neighborhoods.

A Tale of Two Cities: The Exploration of the Trieste Public Psychiatry Model in San Francisco

According to the World Health Organization (WHO), the “Trieste model” of public psychiatry is one of the most progressive in the world. It was in Trieste, Italy, in the 1970s that the radical psychiatrist, Franco Basaglia, implemented his vision of anti-institutional, democratic psychiatry. The Trieste model put the suffering person—not his or her disorders—at the center of the health care system. The model, revolutionary in its time, began with the “negation” and “destruction” of the traditional mental asylum (‘manicomio’). A novel community mental health system replaced the mental institution. To achieve this, the Trieste model promoted the social inclusion and full citizenship of users of mental health services. Trieste has been a collaborating center of the WHO for four decades with a goal of disseminating its practices across the world. This paper illustrates a recent attempt to determine whether the Trieste model could be translated to the city of San Francisco, California. This process revealed a number of obstacles to such a translation. Our hope is that a review of Basaglia’s ideas, along with a discussion of the obstacles to their implementation, will facilitate efforts to foster the social integration of persons with mental disorders across the world.

PRIORITIES AND CONCERNS OF OLDER AFRICAN AMERICANS LIVING ALONE WITH COGNITIVE IMPAIRMENT: AN IN-DEPTH PERSPECTIVE

O4-08-05 PRIORITIES AND CONCERNS OF OLDER AFRICAN AMERICANS LIVING ALONE WITH COGNITIVE IMPAIRMENT: AN INDEPTH PERSPECTIVE Elena Portacolone, Kenneth Covinsky, Robert Rubinstein, Jessica Ortez-Alfaro, Jodi Halpern, Julene Johnson, University of California San Francisco, San Francisco, CA, USA; University of Maryland, Baltimore County, Baltimore, MD, USA; University of California Berkeley, Berkeley, CA, USA; University of California, San Francisco, San Francisco, CA, USA. Contact e-mail: elena.portacolone@ ucsf.edu

THE PERSPECTIVE OF PEOPLE WITH COGNITIVE IMPAIRMENT ON THERAPEUTIC ALLIANCES: A CASE STUDY

IOPPN, London, United Kingdom; IOPPN, King’s College London, London, United Kingdom; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, United Kingdom; King’s College London, London, United Kingdom; Pharmacy Department, South London & Maudsley NHS Foundation Trust, London, United Kingdom. Contact e-mail: delia.bishara@slam.nhs.uk

Health and Development: the Role of International Organisations in Population Ageing

Dona Barbara never had a chance to save for old age. She and her husband are subsistence farmers living in the high plains of Bolivia. Dona Barbara is entitled to a small annual pension, but she has no birth certificate, so has not been able to make a claim. Dona Barbara and her husband have stomach pains because of their poor diet. Health is a constant worry. They are entitled to free healthcare but there are no doctors within reach. Their daughters help when they can, but they live far away from them (HelpAge International 2006).