George L. Maddox

Annual review of gerontology and geriatrics

The contributors to this volume provide an overview of each component of the acute and long-term care service continuum, including managed health care, subacute care, nursing homes, community care case management, and private case management. This volume is one of the first efforts to place these varied approaches side-by-side, highlighting the gaps and areas of duplication in the services delivery system. In addition, chapters address the emerging practices in long-term care financing and assisted living as well as the conceptual issues that need to be resolved to achieve acute and chronic care integration. This volume is of primary importance to professionals involved in long-term care, including administration, community nursing, social work, case management, discharge planning and policy.

The quality and quantity of social support : stroke recovery as psycho-social transition

The impact of various types and amounts of social support is examined in the context of recovery from first stroke. We conceptualize the rehabilitation process as a psychosocial transition. In a longitudinal design, 44 patients were followed for 6 months following first stroke. Growth-curve analysis (repeated measures MANOVA) was utilized to examine the impact of three types of social support on changes in functional status during recovery. While all three types of support (emotional, instrumental and informational) were shown to be significantly related to recovery of functional capacity, substantial differences were found in the nature of those effects. The impact of social support does not appear during the first month of rehabilitation, indicating the importance of longitudinal designs and longer observation. Patients reporting high level of emotional support showed dramatic improvement despite having the lowest baseline functional status. Instrumental support is most closely related to positive outcomes when provided in moderate amounts. Unlike the other two types, the effect of informational support is mediated by disease severity.

Trajectories of functional impairment in later life.

Functional impairment trajectories in late adulthood over a decade are characterized using the Longitudinal Retirement History Study (LRHS) data set. Non-linear patterns of age-related increase in impairment are documented with longitudinal data. Subsets of panelists from the initial large, nationally representative probability sample of employed males and unmarried employed females (N = 11,000) also exhibit differential non-linear trajectories of impairment by sex, income, and educational attainment. Concurrent analysis of the relationship over a decade among sex, SES, and functional impairment suggests that in health research, both sex and SES are broad proxy variables whose usefulness for understanding health outcomes and for policy analysis would be enhanced by the specification of components.

Self-assessment of health status a longitudinal study of selected elderly subjects☆

Abstract Two of three elderly subjects ( n = 176) displayed a reality orientation in their subjective evaluations of health status. Among the one subject in three who disagreed with the physicians assessment of his health, a pattern of social and attitudinal factors was found to distinguish between subjects with incongruous subjective assessments who were predisposed to be optimistic and those predisposed to be pessimistic. The relationship between these predispositions and the inappropriate rejection of the sick role remains to be investigated. A related issue for investigation is the implications of incongruity between medical and subjective assessment of health status for medical management.

Race, aging, and functional health

This article presents evidence of a Black/White crossover in functional health. Its existence supports the hypothesis, based on selective survival, that older members of socially disadvantaged populations are relatively more physiologically robust and thus exhibit relatively favorable functional capacities. Longitudinal data on 5,150 persons 70 years of age and older shows that within young-old age groups, Blacks are more likely to experience functional status decline over a 6-year period than Whites, whereas within oldest-old age groups, Blacks are less likely to experience decline. The authors also provide confirmation or modification of several hypotheses implicit in the literature on aging, race, and functional health. They find support for the hypothesis that racial differences in age-related changes in mean levels of functional health (i.e., self-care capacity and physical functioning) are age dependent, but do not find support for the hypothesis that social class fully accounts for racial differences in functional status change.

Community Partnerships for Older Adults: A Case Study

Over the past several decades, federal policy has made states and communities increasingly more responsible for providing long-term care for older adults. The Community Partnerships for Older Adults, a national program of The Robert Wood Johnson Foundation, saw this as an opportunity to explore new, sustainable ways to meet current and future needs for community-based long-term care. This initiative focuses on collaborative organizational partnerships, a distinctive philosophy of teaching and learning through the exchange of experience between communities, and program learning focusing on known factors promoting organizational sustainability Using principles that emphasize the development of social capital and collective efficacy, the authors present a case study of the early experiences of this initiative to address the challenges inherent in meeting the growing supportive service needs of older adults. The implications of this multisite community intervention for social work education and practice in aging are discussed.

Assessment of Functional Status in a Program Evaluation and Resource Allocation Model

Concern about the efficiency and effectiveness of increasingly costly health and welfare services for older persons stimulates interest in systematic evaluation of alterna tive programs. While a single, optimal system for program evaluation and resource allocation does not exist, a strategy developed at Duke University is promising. This strategy, which meets the conditions of a quasi-experiment, has three elements: (1) a reliable, valid procedure for assessing five dimensions of individual functioning; (2) a procedure for disaggregating complex service programs into standard generic units; and (3) a matrix which relates changes in func tioning over time to exposure to identified aggregates of generic services. Partial and complete applications of the strategy in two communities are illustrated.

TEENAGERS AND ALCOHOL: RECENT RESEARCH

What young people in this society think about and do with beverage alcohol is increasingly a matter of record. While all the answers are not yet in, systematic research over the pad quarter century allows some generalizations to be made with confidence (for references to all but the most recent research see Maddox, 1962 and Maddox, 1964a). We know, for example, that only rarely is a young person graduated from a high school without having had at least an experimental taste of alcohol. Among younger teenagers, abstainers do constitute a majority. But, with each succeeding year, experimental drinking becomes more common, and an increasingly large proportion of young people integrate a pattern of alcohol use into their life style. The earliest experimental drinking behavior is more likely to take place in the home in the presence of adults than in any other circumstance, Young people perceive correctly that for a majority of adults drinking is an integral aspect of their life style, and that, while alcohol may be used as a drug, it is much more commonly used as a social beverage, particularly in association with entertainment and the celebration of special evenits. Most young people, anticipating adulthood, expect to drink eventually, and there is every reason to expect that most of them eventually will. Alcohol use among young people appears to be quite moderate and sensible in the overwhelming majority of instances. Most young people do not drink very much. And even when they drink frequently and in quantity, they tend to take reasonable precautions in order to reduce the probability of accidental injury and irresponsible behavior. Alcohol is simply not the hub around which life revolves for them. Or, as Dr. Lolli might phrase it, the typical young person in this society maintains a reasonable balance in his inefficiency to efficiency ratio when he drinks. For a small minority of young people, drinking does appear to get out of hand, and attention will be given to this minority below. Most generalizations about teenagers require considerable qualification. Patterns of abstinence and drinking among teenagers display the same kinds of diversity observed among adults. Thus, whether a young person drinks and what, where, when, how, and with whom he drinks reflect differences in age, sex, socio-economic status, and subculture (ethnic, religious, regional). These differences make the teenager difficult to capture in facile stereotypes, and that is as it should be. The drinking behavior of most young people is best understood in a developmental framework. In this society, most children are abstinent; most adults drink at least occasionally. This means that, during the teen years, a majority of young people make a transition from the normative abstinence of childhood to the normative patterns of drinking characteristic of adulthood. Parents themselves, as well as the teenagers’ peers, are important figures in the determination whether and how and when drinking behavior becomes integrated into the life style of a teenager. First exposure to alcohol is most likely to be in the context of the home where parenfts are the role models, and many young people are exposed to parental law that permits some drinking under controlled conditions and that becomes increasingly permissive with the age of the young person. While

Drinking among Negroes. Inferences from the drinking patterns of selected Negro male collegians

Available research, although quite limited, suggests that American Negro males are almost universally drinkers, frequently heavy drinkers, and have a high incidence of trouble due to drinking. Among middle-status Negroes, self-derogation is said to be a concomitant of drinking. In a sample of Negro male collegians these generalizations are found to be applicable. Inferentially, the drinking behavior of these older youth provide evidence about the probable behavior of Negro male adults.

Behaviour and adaptation in later life.

The implications of three revolutions in current social scientific thinking about behaviour and adaptation in later life are discussed. A demographic revolution is occurring in all countries; the number of older persons is less important than their functional impairments. A knowledge revolution has laid the basis for realistic optimism about modifiability of aging processes. A revolution in expectations about the future of aging is occurring.