Noelle L. Fields

The Effectiveness of Adult Day Services for Older Adults A Review of the Literature From 2000 to 2011

Adult Day Service (ADS) centers offer a variety of services to meet the needs of older adults and their caregivers. During the last decade, ADS has received increased attention due to shifts in policy toward home and community-based services for an aging population. This article reviews the effectiveness of ADS from 2000 to the present, with particular attention given to caregiver and participant outcomes, health care utilization, and future directions in ADS research. Multiple databases were searched to identify relevant research and 61 articles were selected for review based on inclusion criteria. The results of this review emphasize the need to implement and test more specific interventions targeting the needs of the ADS population.

How Does Bereavement Get Under the Skin? The Effects of Late-Life Spousal Loss on Cortisol Levels

OBJECTIVES We used data from the Changing Lives of Older Couples, a prospective multiwave study of 1,532 married individuals aged 65 and older, to investigate the extent to which spousal loss and death-context characteristics are associated with the stress hormone cortisol at 6 (W1) and 18 (W2) months postbereavement. METHOD We used ordinary least squares regression models to estimate the effects of death-context characteristics (forewarning, caregiving, and postloss numbness, reported at W1) on cortisol levels (at W1 and W2). We included age and gender and evaluated a two-way interaction term between gender and death circumstances. RESULTS Bereaved spouses who reported prolonged forewarning of the death evidenced higher cortisol levels at W1 than those who did not experience prolonged forewarning. Bereaved women had higher cortisol levels than bereaved men at W1. A two-way interaction between gender and emotional numbness was statistically significant, where men (but not women) who experienced postloss numbness had elevated cortisol levels at W2. DISCUSSION Our findings reveal that stressful life events are associated with stress-related neuroendocrine reactions for longer durations than researchers have previously documented. The specific death-related stressor affecting cortisol varies by gender. Implications for research and practice are discussed.

Understanding the Impact of Early-Life Trauma in Nursing Home Residents

Reactions to early life trauma can reemerge or be exacerbated in later life as coping resources and abilities are compromised by age-related changes and declines in health. For newly admitted nursing home residents, this can impact their receptiveness to assistance with care and elicit challenging reactions to environmental and situational triggers. Unfortunately, current assessment tools fail to account for reactions to early-life trauma. In this article, we review existing literature on early-life trauma and aging and introduce a hypothetical case to illustrate the importance of identifying nursing home residents with past trauma experiences.

Ready or Not: Transitioning from Institutional Care to Community Care

Federal legislation has moved toward the support and expansion of home- and community-based alternatives to nursing home placement. Despite the seemingly positive nature of these efforts, the question remains as to whether individuals, families, and communities are prepared for this shift in long-term care. Furthermore, there has been a lack of attention to the impact of nursing home transition programs on family caregivers, community resources, and the availability of appropriate housing alternatives. Although nursing home transition programs offer a promising alternative to institutional care, the authors suggest a closer examination of the policies and practicality of these transitions is needed.

Inclusion or Exclusion? Exploring Barriers to Employment for Low-Income Older Adults

Faced with economic uncertainty and declining retirement security, older adults have increasingly tried to remain in, or return to, the workforce in recent years. Unfortunately, a host of factors, such as ageism and changing skill requirements, present challenges for older adults seeking employment. Low-income older adults, in particular, may lack necessary education and skills and have limited access to job opportunities and training. In this review, we examine factors that inhibit and support employment for low-income older adults and explore the role of social work in facilitating their inclusion in the workforce.

Older adult and family member perspectives of the decision-making process involved in moving to assisted living

The decision to move into assisted living (AL) can be viewed as a life-changing process for older adults and their families; and each may possess differing views of this process. This qualitative study examined the AL decision-making process as described by twenty-two older adult and family member dyads. Participants described emotional and logistical components related to the AL moving decision. Further, fifteen of twenty-two dyads expressed conflicting or differing views of the AL moving decision. Our discussion examines the need for future studies to explore the impact of family and older adult disagreements on the older adult’s AL adjustment; the necessity for community-based agencies and AL settings to provide social services over the duration of the decision-making process; and the importance of employing social workers skilled in family practice in the AL setting.

Beyond Respite: The Role of Adult Day Services in Supporting Dementia Caregivers

Adult day services (ADS) are the leading provider of community-based care for persons with dementia and their caregivers. While the provision of caregiver respite is well-documented, little is known about the provision of other forms of dementia caregiver support. Logistic regression analyses of ADS providers (N = 297) in the MetLife Study indicated that the number of hours of social work support was a significant predictor of case management services, while nonprofit status was a significant predictor of caregiver education and support groups. These findings have implications for practice and policy related to this growing provider of dementia services.

Marital Status and Persons With Dementia in Assisted Living

Despite the prevalence of dementia among residents in assisted living (AL), few researchers have focused on the length of stay (LOS) in AL among this population. Little is known about the factors that may contribute to LOS in these settings, particularly for residents with dementia. In the current study, a sub-set of AL residents with dementia (n = 112) was utilized to examine whether marital status was associated with LOS in AL as this has received sparse attention in previous research despite studies suggesting that marital status influences LOS in other health-care and long-term care settings. The Andersen-Newman behavioral model was used as a conceptual framework for the basis of this study of LOS, marital status, and dementia in AL. We hypothesized that persons with dementia who were married would have longer LOS than unmarried persons with dementia in AL. Cox regression was used to examine the association between marital status and LOS in AL of residents with dementia and whether activities of daily living were related to discharge from AL settings among married and unmarried residents with dementia. Main effects for marital status and the interaction between marital status and mobility with LOS were examined. Study findings provide information related to the psychosocial needs of AL residents with dementia and offer implications for assessing the on-going needs of vulnerable AL residents.

Pathways to age-friendly communities in diverse urban neighborhoods: Do social capital and social cohesion matter?

ABSTRACT Using a social capital and social cohesion lens, we reposition the concept of civic engagement among older adults to examine pathways for building age-friendly communities. We analyzed data drawn from a Community-Based Participatory Research study in the Southern U.S. that explored lived experiences of older adults, age 55 and above, who participated in individual interviews (n = 15) and six focus group discussions (n = 45) to examine their perceptions of social identity, social connectedness, and civic engagement geared toward an age-friendly city. Findings indicated that several older adults had access to social networks and socially invested resources, thereby having opportunities for civic engagement and building age-friendly neighborhoods. However, social, cultural, linguistic, and structural barriers were more evident among certain diverse ethnic populations. Marginalized low-income minorities and immigrants, such as Hispanic participants, felt the lack of social cohesion among the larger society limited their ability to give back, thus decreasing their civic engagement activities. In contrast, Caucasian and African-American older adults were able to contribute to the political process through more civic participation activities. We provide implications for examining the role of social capital and social engagement to bolster civic engagement among older adults in building age-friendly communities.

Sizing up assisted living: an examination of long-term care ombudsman complaint data

ABSTRACT Long-term care ombudsmen are resident advocates who receive, investigate, and resolve complaints relating to quality of care and violations of resident rights in assisted living (AL). More research is needed to understand systemic differences in source, type, and number of ombudsman complaints in AL. Ombudsman complaint data (n = 5,705 complaints) in small, medium, and large ALs in Dallas, Texas were analyzed using proportion Z tests. Findings suggest that all facilities had a high number of environmental complaints. Compared to larger facilities, small ALs have a disproportionately high number of complaints, a significantly higher number of complaints related to access to information, visitors, and ombudsmen, lower number of complaints related to care and staffing, family are less likely to complain, and residents are least likely to voice concerns. We recommend strategies for ombudsmen and AL providers to better meet residents’ needs. We conclude with a call to action underscoring the increasing importance of the role of the ombudsman in AL.