Frank J. Whittington

Functional Status and the Use of Formal Home Care in the Year before Death

A National sample of persons who died in 1986 was analyzed to obtain a valid estimate of the relationship between functional status and the provision of formal home care during the last year of life. Community-based care has become increasingly important as the size of the elderly population increases and the cost for institutional care rises. When people need help in caring for themselves because of illness, frailty, or disability, community-based care may be more appropriate than acute or institutional care. The year before death is often a time of dependence and a high intensity of health service consumption. Although care at home is provided primarily by families, formal home care is also a critical component in any continuum of care.

Pathways to Assisted Living: The Influence of Race and Class

This article examines how race and class influence decisions to move to assisted living facilities. Qualitative methods were used to study moving decisions of residents in 10 assisted living facilities varying in size and location, as well as race and socioeconomic status of residents. Data were derived from in-depth interviews with 60 residents, 43 family members and friends, and 12 administrators. Grounded theory analysis identified three types of residents based on their decision-making control: proactive, compliant, and passive/resistant. Only proactive residents (less than a quarter of residents) had primary control. Findings show that control of decision making for elders who are moving to assisted living is influenced by class, though not directly by race. The impact of class primarily related to assisted-living placement options and strategies available to forestall moves. Factors influencing the decision-making process were similar for Black and White elders of comparable socioeconomic status.

Senior Centers in America.

Preface Introduction Growth and Development: A Historical Overview Organizational Characteristics Programming Awareness, Attitudes, and Utilization Participants and Participation Linkages and the Community Services Network Programming and Policy Issues Summary and Conclusions Bibliography Index

Drug Use and Misuse among the Elderly

There is no dearth of speculation about the use and misuse of drugs among older persons in American society. Scattered reports have indicated that the elderly increasingly use and misuse a wide variety of drugs, and in very recent years much public attention and concern has been directed toward this problem in the older population. Factual information, however, particularly incidence of use and factors related to elderly drug misuse, is scarce. This paper presents both a review of the relevant literature and a summation of available research evidence with particular reference to patterns of use of legal drugs, the types and extent of misuse of legal drugs, and the issue of illegal drug abuse by the elderly. Conclusions are provided as to what is known at this time regarding elderly drug use and misuse as well as some suggestions regarding future research that might contribute to an understanding of drug-using behavior among the elderly.

Managing the Care Needs of Low-Income Board-and-Care Home Residents: A Process of Negotiating Risks:

Small, low-income board-and-care homes play a critical role in the long-term care system, serving a variety of at-risk groups, including chronically mentally ill individuals, frail elders, and developmentally disabled adults. Unfortunately, the supply of homes available to serve these populations is decreasing. The purpose of this study, based on an in-depth ethnographic case study of one small (13-bed) African American-owned and -operated home in metropolitan Atlanta, was to understand how and why some homes continue to operate despite significant challenges. Grounded theory analysis showed that the survival of this home and residents’ ability to remain in it involved a basic social process conceptualized as Negotiating Risks. This survival process often put participants at risk of losing their means of subsistence. Community support emerged as an important protective factor. Findings have implications for community interventions to increase these homes’ survival and improve resident care.

OLDER WOMEN: AN EXAMINATION OF POPULAR STEREOTYPES AND RESEARCH EVIDENCE*

The older woman in our society is socially devalued and is subject to a number of harmful, negative stereotypes that picture her as sick, sexless, uninvolved except for church work, and alone. Moreover, when researchers study the aged, they too often fail to analyze the data for females separately from that of males, thus glossing over the differences and losing valuable information. It is possible, however, using data from studies which have used sex as an independent variable, to demythologize the older woman somewhat by separating the characteristics which are uniquely female from those of males and those common to the sexes. This paper, then, examines stereotypical images of the older woman in three major areas: (1) health and longevity; (2) marital status and family roles; and (3) leisure activity. Several unresolved questions and areas for future research are suggested, and the implications of this analysis for such research is discussed.

Psychotropic Drug Use in a Nursing Home: A 6-Year Retrospective

The Omnibus Budget Reconciliation Act of 1987 (OBRA) was a public policy initiative intended to improve nursing home residents’quality of life by providing strict guidelines for the prescription of psychotropic drugs (PD) and physical restraints. This study documents and explains the use of PDs in one nursing home at three points in time: well before (1988), immediately before (1990), and well after (1994) OBRA implementation. In 1994, 64.5% of residents in the nursing home had prescriptions for PDs compared with 71% in 1988 and 1990, but those with a PD prescription had more than one (mean = 2.19). After OBRA implementation, antipsychotic and antidepressant use was higher than at earlier data collection points, whereas anti-anxiety medication prescription was at its lowest. In addition, diagnoses of depression and cognitive impairment had increased dramatically by 1994. Explanations for these findings are provided, including possible aging of residents, change in staffing levels, caregiver anomie, the impact of another legislative bill, and the introduction of the minimum data set.

Gerontology Education and Research in Kenya Establishing a U.S.-African Partnership in Aging

Abstract This article reprises four presentations on “Gerontology Education in Kenya,” a seminar at the 2004 Annual Meeting ofthe Association of Gerontology in Higher Education. It describes the process by which the Gerontology Institute of Georgia State University established a 3-year gerontology education and research partnership with Kenyatta University in Nairobi, Kenya, and the field experiences of two scholars who have conducted aging research in Kenya. We provide four key elements of cultural competence and recommendations for American gerontologists wishing to establish international linkages.

A Comparison of Functional Outcomes Following a Physical Activity Intervention for Frail Older Adults in Personal Care Homes

Purpose: The purpose of this study was to determine the effectiveness of 2 consecutive 10‐week exercise interventions for increasing functional ability of residents living in personal care homes (PCHs). Methods: Residents in 2 intervention homes (n = 15) participated in a series of exercise classes followed by a walking program. Residents living in 2 PCHs matched for demographic and environmental variables served as controls (n = 15). Pre‐ and post‐test measures (0 weeks and 21 weeks) included the Modified Barthel Index (MBI), the Tinetti Performance‐Oriented Mobility Assessment (POMA), and the Functional Reach Test (FRT). A General Linear Model was used to analyze group (control vs. intervention) by time (0 vs. 21 weeks) interactions as well as changes over time within the intervention group (0 vs. 10 vs. 21 weeks). Results: In comparing the 2 groups at the beginning and end of the intervention, the POMA Balance Subscale showed significant improvement (p = .04) for the intervention group. Within the intervention group, scores of the MBI and POMA increased after the 10‐week exercise class series, then declined exhibiting a significant quadratic relationship (p = .03). Conclusions: It is likely that without the intervention, the gradual decline noted in the control group would have occurred in the intervention group as well. Given that older adults who live in PCHs often experience declines in their activities of daily living (ADL) and independent activities of daily living (IADL) performance, it is critical that physical activity programs be available to residents to mitigate and/or reverse these declines.