Iveris L. Martinez

Experience Corps: A dual trial to promote the health of older adults and children's academic success

Background As the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact childrens academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers. Methods Dual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio. Outcomes For older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults. Summary This trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.

Elder Abuse: Risk Factors and Use of Case Data to Improve Policy and Practice

ABSTRACT Countering the generally reactive community approach to prevention and treatment of elder abuse, this study employs analysis of local elder abuse case data to estimate the incidence of elder abuse, neglect, and exploitation and to measure the risk factors, including co-location of other forms of abuse, that predict elder abuse in Miami-Dade County, Florida. The authors also compare the model of intervention used in Florida and elsewhere to best practice models that incorporate elements of domestic violence treatment models. They present a series of specific recommendations for improving local abuse data-collection, analysis, and training so that local policy makers, planners, and practitioners can make proactive, community-specific, culturally-sensitive preventive efforts effective. The findings and recommendations have direct relevance for policy and practice in any community in the United States.

Assessing Health Concerns and Barriers in a Heterogeneous Latino Community

Introduction. Major health issues and barriers to health services for Latino immi- grants were identified through community-based participatory research in Baltimore city. Methods. In collaboration with community partners, five focus groups were conducted among Latino adults from 10 countries and health service providers. Findings. Priorities across groups included chronic diseases, HIV/AIDS and STDs, mental health, and the need for ancillary services. Community members and providers did not always agree on what health matters were of primary concern. Participants expected to receive health information at the point of service. Barriers to receiving health services and information span linguis- tic, financial, logistical, legal, and cultural matters. Conclusions. This formative research illustrates the complexity and interrelatedness of health priorities and barriers created by social issues such as employment, legal status, and related stressors.

Invisible Civic Engagement among Older Adults: Valuing the Contributions of Informal Volunteering

There is a growing call for civic engagement, largely in the form of formal volunteering, among older adults in America. This call is a response to the aging of the baby boom population, believed to be the healthiest and wealthiest cohort of older adults to date. It also coincides with the devolution of welfare programs. We argue that current discussions of civic engagement are too narrow and may exclude important informal contributions that older adults make to civic society, and put undue stress on, and devalue those who may not contribute to society due to poor health, poverty or other barriers. We draw on data collected from older adults of lower socio-economic status and diverse ethnic backgrounds in Baltimore City using focus groups to explore their definitions of volunteering and barriers which they face. Through a discussion of existing barriers and motivators for engagement, we critically assess the use of these terms and advance discussions on how to facilitate and value contributions of all older adults. We conclude that civic engagement includes more than formal volunteering and that significant barriers need to be removed to facilitate greater participation of all elders in both formal and informal activities.

Examining functional and social determinants of depression in community-dwelling older adults: Implications for practice

Coping with declining health, physical illnesses and complex medical regimens, which are all too common among many older adults, requires significant lifestyle changes and causes increasing self-management demands. Depression occurs in community-dwelling older adults as both demands and losses increase, but this problem is drastically underestimated and under-recognized. Depressive symptoms are often attributed to physical illnesses and thus overlooked, resulting in lack of appropriate treatment and diminished quality of life. The purpose of this study is to assess prevalence of depressive symptoms in community-dwelling older adults with high levels of co-morbidity and to identify correlates of depression. In this sample of 533 homebound older adults screened (76.1% female, 71.8% white, mean age 78.5 years) who were screened using the Geriatric Depression Scale (SF), 35.9% scored greater than 5. Decreased satisfaction with family support (p << 0.001) and functional status (p ≤ 0.001) and increased loneliness (p < 0.001) were significant independent predictors of depression status in this sample; thus, these factors should be considered when planning care.

Addressing the Challenges of Latino Health Research: Participatory Approaches in an Emergent Urban Community

BACKGROUND Challenges to recruitment of Latinos in health research may include language, cultural and communication barriers, trust issues, heterogeneity of legal status, and a high percent of uninsured when compared to the US population. This paper highlights the community-based participatory research (CBPR) process and expands on the applicability of these principles to Latino communities. METHODS We review steps taken and describe lessons learned in using a participatory approach to broadly assess and address the health of urban-dwelling Latinos in Baltimore, Maryland, through the adaptation of CBPR principles. FINDINGS We identified health priorities, access barriers, and community resources (eg, Latin American trained nurses who were not currently working in the health field, immigrant networks) using a participatory approach. Suggestions for improving trust, research participation, and access to care ranged from not collecting data on legal status, and regular attendance and presentations of ongoing research at community provider meetings, to referral to free or low-cost health care services at screening events. CONCLUSION Despite growing interest in CBPR, limited guidance exists on how to apply CBPR principles to conduct health research among Latinos. Incorporating a participatory process can help address Latino community concerns, enrich quality and relevance of research, and empower community members.

Ethnic and Class Variations in Promoting Social Activities Among Older Adults

Engagement in social activities impacts the health outcomes of older adults, especially as regards mortality and physical and cognitive disability. Participation and its benefits vary by socioeconomic gradient and ethnicity. This research aims to identify activities of interest to diverse older adults and factors that influence participation (barriers, motives, perceived benefits, and role expectations). We conducted five focus groups throughout Baltimore City with nonactive elders stratified by class, gender, and ethnicity. Activities, motives, and barriers varied across groups. Differences may exist in the challenges and facilitators for maintaining socially active lifestyles among different groups of older adults. Common barriers were found across the groups, in particular the absence of adequate transportation and financial resources, as well as health in the form of mobility difficulties. Nuanced differences among the groups described may help target interventions to particular groups as needed and create opportunities for engagement where extrinsic barriers might exist. Findings were disseminated to community partners to improve awareness of social factors in developing health-promoting strategies for active and meaningful roles for older adults.

Perspectives on Latino Lay Health Promoter Programs: Maryland, 2009

OBJECTIVES We examined common barriers and best practices in the design, implementation, monitoring, and evaluation of Latino lay health promoter programs. METHODS Ten lay health promoter program coordinators serving Maryland Latinos were recruited in 2009 through snowball sampling for in-depth semistructured interviews with a bilingual and bicultural researcher. Program coordinators were asked about recruitment, selection, training, and supervision; key program elements; and evaluation. Analyses were conducted to identify common themes. RESULTS Respondents had worked up to 13 years in programs focused on such areas as awareness of healthy lifestyles and reducing risk of illness. Coordinators looked for Latino leaders with team-building skills and a desire to help the community. Six programs compensated promoters with stipends; 4 paid an hourly wage. Promoters were usually trained in monthly meetings that actively engaged them. Most programs conducted site visits, practice sessions, and performance evaluations. CONCLUSIONS Our findings indicate that successful health promoter programs require needs assessments, formation of a target population advisory board, identification of appropriate promoters, and a significant amount of training. These findings can be used to guide future programs in the identification, recruitment, and training of health promoters as well as in program monitoring.

Twelve tips for teaching social determinants of health in medicine

Abstract Background: There has been a recent movement towards social accountability in medical schools, which includes integrating the social, economic, and cultural determinants of health into the curriculum. Medical schools and their guiding bodies have met this challenge of educating future physicians to provide effective care to diverse populations with varying response and successes. Because these topics have not been systematically taught in most medical school curricula, strategies are needed to teach them alongside clinical sciences. Aim and method: We provide 12 tips on how to teach social determinants of health and cultural competency to undergraduate medical students. These recommendations are based on a review of the literature and our experience in developing and delivering a longitudinal course over the last five years. Conclusion: Medical students must be taught to think critically about the social and cultural issues impacting health, and the intersection with the basic biology and clinical skills. Teaching social determinants of health in medicine requires keeping the material concrete and applicable. Educators must engage students in active learning strategies, reflection, and focus on how to make the material relevant to the clinical care of patients.

Equity and systems of intergenerational transfers in Latin America and the Caribbean

Las transferencias intergeneracionales deben formar parte de la discusion sobre la equidad en el contexto del rapido envejecimiento de la poblacion de America Latina y el Caribe (ALC), especialmente alli donde los recursos sean escasos. Aunque hay datos que muestran la existencia de cierto grado de intercambio entre las viejas y las nuevas generaciones, el numero creciente de adultos en comparacion con las personas mas jovenes puede crear tensiones en esta relacion. El numero de personas de 60 anos o mas aumentara en los paises de ALC de 42 millones en el ano 2000 a 97 millones en el 2025 y a 181 millones en el 2050. Como proporcion de la poblacion total, el crecimiento sera del 8% en el ano 2000, del 14% en el 2025 y del 23% en el 2050. Este crecimiento creara una tension sin precedentes en las familias, asi como en los sistemas de seguridad social, los servicios de salud y otros servicios sociales. A medida que aumente la incapacidad de las familias para hacer frente a las necesidades economicas y sociales del numero creciente de ancianos, habra una demanda cada vez mayor de mecanismos formales de apoyo entre cohortes, tales como los sistemas de seguridad social y los programas de pensiones. Sin embargo, estos mecanismos son inexistentes o insolventes en muchas naciones de ALC. Una posible solucion, la capitalizacion privada de los programas de pensiones, necesitaria mas de dos decadas para ser viable y dejaria fuera a los segmentos mas vulnerables de la poblacion, como los que trabajan en el sector informal. Dadas estas tendencias, los derechos e intereses de los ancianos deben incorporarse cada vez mas a las agendas politicas, sociales y economicas de los paises de ALC.