Haim Hazan

The Effect of Homebound Status on Older Persons

OBJECTIVES: To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization.

Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights

BACKGROUND Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study. METHODS Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness. RESULTS Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear. CONCLUSIONS Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.

Homebound older persons: Prevalence, characteristics, and longitudinal predictors

The current study examines the prevalence and correlates of homebound status aiming to elucidate the predictors and implications of being homebound. Analyzed sample was drawn from two representative cohorts of older persons in Israel, including 1191 participants (mean age=83.10 ± 5.3 years) of the first wave of the Cross-Sectional and Longitudinal Aging Study (CALAS) and 418 participants (mean age=83.13 ± 5.2 years) of the Israeli Multidisciplinary Aging Study (IMAS). Cross-sectional and longitudinal analyses were conducted. Homebound prevalence rates of 17.7-19.5% were found. Homebound participants tended to be older, female, have obese or underweight body mass index (BMI), poorer health, lower functional status, less income, higher depressed affect, were significantly lonelier (in CALAS), and more likely to have stairs and no elevators, than their counterparts. Predictors of becoming homebound include low functional IADL status, having stairs and no elevator (in both cohorts), old age, female gender, and being obese or underweight (in CALAS). The study shows that homebound status is a prevalent problem in old-old Israelis. Economic and socio-demographic resources, environment, and function play a role in determining the older persons homebound status. Implications for preventing homebound status and mitigating its impact with regards to the Israeli context are discussed.

The Old, Old-Old, and the Oldest Old: Continuation or Distinct Categories? An Examination of the Relationship between Age and Changes in Health, Function, and Wellbeing

This study aims to examine whether old age, old-old age, and oldest-old age comprise distinct categories via comparing persons aged 75–84, 85–94, and 95+ on demographics, health, function, and wellbeing. The sample was drawn from a representative longitudinal cohort of older persons in Israel. Matched cohort comparisons found a significant decline in Activities of Daily Living (ADL), instrumental ADL, cognitive function, percent of participants who go outside their home, and physical activity, with an increase in physical and mobility difficulties, and no difference in depressed affect or loneliness. Longitudinal results showed increased widowhood, institutionalization, comorbidity, physical and mobility difficulties, loneliness, and depressed affect, as well as decreased subjective health and physical activity over time. In the absence of changes in social support as manifested by marital status and community living, there was no decline in wellbeing. Current evidence of various gradual quantitative differences suggest that in most respects old age may be better conceptualized as a single phase marked by a continual quality.

The home over the hill: Towards a modern cosmology of institutionalization

Abstract The cosmology of modernity is invoked to comment on the linkage between anthropology and gerontology. Several ethnographic case studies are enlisted to describe the process of constituting the old as the ultimate other through gradual erosion of space, time, and self itself. The cultural image of old age is understood as an inevitable consequence of macrosocial forces manifested in everyday situations, which in turn create a phenomenologically “given” world devoid of socially legitimate subjectivity old age.

Profiles of functioning as predictors of mortality in old age: the advantage of a configurative approach.

This study proposes the concept of functioning profile, by which ones status is summarized across essential functioning domains, and validates its efficiency in predicting mortality. The study analyzed data of two cohorts of community-dwelling Israelis aged 75 and over, nationally sampled in 1989 (N=1200) and 1999 (N=421), respectively. Eight groups with differential profiles reflected higher versus lower levels of functioning in three domains: physical (activities of daily living), cognitive (Orientation-Memory-Concentration test=OMC) and affective (depressive symptoms). The analyses predicted mortality within 4 years, adjusting for sociodemographic and health variables. Relative to the optimal profile, most functioning profiles represented groups having elevated mortality risks of considerable consistency across cohorts. Physical functioning was the most predictive component in the profiles, but its combinations with cognitive and affective functioning produced unique contributions to mortality prediction. The study suggests that the functioning profile, representing a person-centered configurative approach (i.e., one that considers the persons combined standing on key factors), is a useful concept for delineating risk groups in late life and evaluating risk factors in predicting mortality.

Gerontological autism: terms of accountability in the cultural study of the category of the Fourth Age

ABSTRACT This paper poses an epistemological challenge to students and researchers of old age. It argues that people in deep old age are a testimony to the failure to generate a language by which to comprehend extra-cultural phenomena, which aborts a meaningful dialogue between researchers and subjects. The arguments put forward are based on an analysis of the unique position of the very old as an ultimate, unconstructable ‘other’, as they appear in the relevant anthropological discourse, and maintains that cultural standing of that category is anchored in a symbolic and existential space that prevents communication with its inhabitants. The social processes that lead to this state of absent translation and a deadlock of interpretation are analysed by using examples a longitudinal study of the oldest old conducted by the Herczeg Institute on Aging in Israel. An alternative option for a new conceptual articulation of ways of understanding ageing is proposed; one that is free of conventional but ineffectual paradigms.

Essential others: anthropology and the return of the old savage

Purpose – Old age, in its most intense and extreme aspects involving frailty, dementia, Alzheimers and death, is more often ignored rather than discussed in contemporary anthropology, remaining largely inaudible and invisible. This paper explores the marginal position of the study of old age in contemporary anthropology against the backdrop of the prominence of the post‐colonial agenda. The purpose of this paper is to discuss the comparison between the neglected Third Age and the abundantly discussed Third World in the context of the anthropological discourse on others.Design/methodology/approach – This is a theoretical paper on ageing.Findings – This paper explores the marginal position of the study of old age in contemporary anthropology against the backdrop of the prominence of the post‐colonial agenda. The comparison between the neglected Third Age and the abundantly discussed Third World is discussed in the context of the anthropological discourse on others. Studying the old‐as‐other reveals two typ...

A Comparison of Three Types of Autobiographical Memories in Old-Old Age: First Memories, Pivotal Memories and Traumatic Memories

Background: Autobiographical memory enables us to construct a personal narrative through which we identify ourselves. Especially important are memories of formative events. Objective: This study describes autobiographical memories of people who have reached old-old age (85 years and above), studying 3 types of memories of particular impact on identity and adaptation: first memories, pivotal memories and traumatic memories. In this paper, we examine the content, characteristic themes and environments, and structural characteristics of each of the 3 types of memory. Methods: The participants were 26 persons from a larger longitudinal study with an average age of 91 years; half were men and the other half women. The study integrated qualitative and quantitative tools. An open-ended questionnaire included questions about the participants’ life story as well as questions about the 3 types of memories. The responses were rated by 3 independent judges on dimensions of central themes and structural characteristics. Results: First memories had a more positive emotional tone, more references to characters from the participant’s social circle, a stronger sense of group belonging, and a more narrative style than the other types of memories. Pivotal and traumatic memories were described as more personal than first memories. Conclusion: The 3 types of memories reflect different stages in life development, which together form a sense of identity. They present experiences from the past on select themes, which may assist in the complex task of coping with the difficulties and limitations that advanced old age presents. Future research should examine the functional role of those memories and whether they enable the old-old to support selfhood in the challenging period of last changes and losses.

Terms of Visibility Eldercare in an Aging Nation State—The Israeli Case

Viewed within a sociohistorical context, eldercare in Israel is examined as a cultural construct evolving from invisibility of the old to growing visibility. Visibility is a function of the presence of eldercare in the public discourse that changes in correspondence with societal transformations such as globalization, fundamentalistic orientations, and post-Zionist trends. Three ethnographic case studies are analyzed to demonstrate the effects of these processes on alternative conceptions of eldercare. It is suggested that the symbolic languages of eldercare in Israeli culture are embedded in a unitary mode of exchange, namely, generalized reciprocity. The properties of these communal vocabularies are ascertained in an attempt to advance an argument interlinking care, identity, memory, and symbolic immortality.