Jon Pynoos

Creating Elder-Friendly Communities: Preparations for an Aging Society

Summary Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. ‘Age-prepared communities’ utilize community planning and advocacy to foster aging in place. ‘Elder-friendly communities’ are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.

Aging in Place: Evolution of a Research Topic Whose Time Has Come

Over the past 30 years, policy makers and professionals who provide services to older adults with chronic conditions and impairments have placed greater emphasis on conceptualizing aging in place as an attainable and worthwhile goal. Little is known, however, of the changes in how this concept has evolved in aging research. To track trends in aging in place, we examined scholarly articles published from 1980 to 2010 that included the concept in eleven academic gerontology journals. We report an increase in the absolute number and proportion of aging-in-place manuscripts published during this period, with marked growth in the 2000s. Topics related to the environment and services were the most commonly examined during 2000–2010 (35% and 31%, resp.), with a substantial increase in manuscripts pertaining to technology and health/functioning. This underscores the increase in diversity of topics that surround the concept of aging-in-place literature in gerontological research.

Environmental Assessment and Modification as Fall-Prevention Strategies for Older Adults

This article discusses the role of home assessment and environmental modification in reducing the risk of falls and helping older adults and persons with disabilities live in the community. This article reviews the research on the efficacy of home environmental assessment and modification. Researchers agree that integrated risk-management programs that emphasize on multiple interventions, including professional home-hazard assessment, along with home modifications are most effective for improving function and reducing falls. Important steps for implementing home modifications for persons at risk of falling are discussed, including exploring fall-risk factors and the effects of home modifications, identifying what changes are needed through home assessments, identifying sources of payment, and finding qualified installers and products.

In-Home Interventions for Persons with Alzheimer's Disease and Their Caregivers

A multi-disciplinary pilot research project assessed the needs of persons with Alzheimers disease and their caregivers in the home, identified target areas for intervention, and implemented specific caregiver-selected interventions. An evaluation of the pilot project indicated that a majority of the interventions that caregivers considered initially effective still worked approximately seven to nine months later. This relative stability of initially-effective interventions continued for many caregivers despite progressive declines in the functioning of the persons with Alzheimers. The results also suggest the importance of enhancing the effectiveness of interventions when first introduced.

Assessing and Adapting the Home Environment to Reduce Falls and Meet the Changing Capacity of Older Adults

Falls in older adults are a serious problem for individuals, their families, and the health care system. This article describes research regarding fall risk assessment, risk reduction interventions, and public policy aimed at reducing the risk of falls for older adults in home settings. Assessments for frail older adults should include observations of not only the physical environment, but also the interactions among the environment, behavior, and physical functioning so that interventions are tailored to the specific situation of the individual. Home modification and technology can prove useful when designing interventions aimed at reducing fall risks. Problems such as cost, reluctance to adopt or implement suggestions, and a lack of knowledge may present barriers to effective home modification. Program and policy options for the future include improved training for service personnel who visit the homes of older adults, increased awareness of and coordination between programs or interventions aimed at reducing the risk of falls in older adults, new sources of funding, and building more housing that follows the principles of universal design.

Zoning, accessory dwelling units, and family caregiving: issues, trends, and recommendations.

Abstract This article explores the relationship between zoning regulations and co-residential family caregiving in the United States. It first provides an overview of U.S. housing policies, especially zoning. We then describe major changes in family structure and composition in the United States with their implications for caregiving and discuss how multigenerational housing options, particularly accessory dwelling units (ADUs) in single-family homes, can help support family caregiving. After an overview of zoning policies and actions that inhibit ADU production, we document current trends, incorporating information from a small non-random study of ADU activity we conducted in 2004. Finally, we present recommendations for promoting more multigenerational housing as a supplement to other family support programs (e.g., dependent care assistance, family caregiver payments) and as a source of affordable, supportive housing for those families choosing co-residence as their eldercare solution.

Evidence-Based Interventions in Fall Prevention

SUMMARY Falls and fall-related injuries, prevalent among older adults, not only have devastating consequences for older adults in terms of morbidity and mortality, but are also associated with high health care costs. Studies have found that multifactorial intervention strategies can effectively prevent and/or reduce falls among older adults. The purpose of this article is to describe evidence-based intervention strategies for community-dwelling older adults. Fall prevention efforts are clearly an important area of health promotion and injury prevention, and evidence presented in this article provides support for effective intervention strategies. Home health care professionals can play a significant role in such intervention strategies. However, further research is needed to clarify which groups will benefit most from specific intervention programs.

Friendship and Social Networks in a Continuing Care Retirement Community

This study presents qualitative and quantitative data describingfriendship and social interaction in a continuing care retirement community (CCRC), and social ties to persons living elsewhere. Structured interviews, including an adapted version of Fischers Social Network Index, were conducted with 50 residents (mean age = 80.9 years). On average, residents reported social networks of 8.2 members, comprising kin (2.46), nonkin residing in the CCRC (3.94), and nonkin residing elsewhere (1.76). The majority of residents (75%) relied primarily on others in the CCRC for regular social activity, and well elderly provided assistance and support to frail elderly. Family members were the preferred source of confidant relationships. Age was not related to the size of nonkin networks in the CCRC; however, older residents reported fewer social ties to nonkin living elsewhere. Living in a CCRC can therefore assist in maintaining social networks as one grows older.

The Cost and Financing of Home Modifications in the United States

Home modifications can aid in the performance of tasks and support independent living. However, obtaining funding in the United States is difficult for both individuals and home modification programs. For individuals, cost is an important factor in the decision of whether to obtain home modifications, along with the perceived need and perceived effectiveness of the modifications. Home modification programs face budget limitations and a lack of stable sources of funding. The public and private sources of financing are far from comprehensive and have confusing eligibility requirements. Several action steps by policymakers and practitioners will increase the availability of home modifications. Ideally, the future would bring a housing stock that incorporates visitability and universal design concepts.

Development of a Comprehensive Assessment for Delivery of Home Modifications

Modifying ones home is an important strategy to manage chronic health conditions, increase independence, and ensure safety of frail older adults. However, in many areas of the country home modifications are difficult to obtain due to either a lack of specialists or a comprehensive assessment tool that would enable specialists to diagnose problems and prescribe solutions without having to perform an on-site evaluation. The purpose of this project was to develop and validate an assessment protocol that provides sufficient information about an individual, his/her occupational performance, and environment such that specialists can prescribe appropriate modifications without having to perform an on-site assessment.