Philip A. Rozario

Research as Resistance: Critical, Indigenous, and Anti-oppressive Approaches

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Role Enhancement or Role Strain: Assessing the Impact of Multiple Productive Roles on Older Caregiver Well-Being

Proponents of productive aging claim that occupying productive roles is beneficial to the self and others. The authors use the role enhancement and role strain perspectives to examine the impact of multiple productive roles on the well-being of older caregivers. Using three waves of the America Changing Lives Study, the authors controlled for invariant and time-variant factors to test the effects of occupying multiple productive roles on the three well-being indicators of 270 older caregivers. Older caregivers who worked and/or volunteered reported better self-rated health, supporting the role enhancement hypothesis. No evidence of role strain was found. For caregivers without multiple productive roles, high informal social integration was related with low functional impairment. This study suggests that productive roles may have a positive effect on older caregivers and finds no evidence of any negative effects. The implications of these findings in policy, research, and program development are discussed.

Comparing the Congruency of Self-Report and Provider Records of Depressed Elders' Service Use by Provider Type

Background:An accurate accounting of service use is necessary to understand use patterns and outcomes. Yet such an accounting remains challenging, in part because of the reliability and validity of the collection method and sources. Objectives:This study describes 2 methods of data collection: self-report and the retrieval of provider records. We report on the effort, yield, and challenges of retrieving records. Then, we compare the congruency and completeness of 2 methods: self-report and provider records. Finally, we examine the impact of various patients’ characteristics on congruency rates. Method:Our sample of depressed older participants was recruited from an inpatient geropsychiatry unit before they were discharged into the community. We interviewed participants at 3 points during a 6-month period. Provider records were obtained across provider type, based on self-report and snowballing technique. We calculated congruency rates and examined completeness of either data source on 91 participants with completed provider records. Using logistic regression, we examined the differences in congruency by provider type as well as factors related to the congruency. Results:The record retrieval process is labor-intensive and challenging. We found that congruency rates were statistically higher for pharmacy and hospital providers and lower for physicians. We also found higher counts of service use, higher depression levels, and being married were significantly related with lower congruency between self-report of service use and provider records. Discussion:Although we found relatively high congruency rates between self-report and service records, the choice of methods depends on the purpose of the research and breadth of provider types.

An examination of the measurement adequacy of the CES-D among African American women family caregivers.

The Center for Epidemiologic Studies Depression Scale (CES-D) has been used extensively in community-based surveys to describe and explain the prevalence of depression in the general population. Yet, questions have been raised regarding its adequacy for use among ethnic minority because of its factor variance. Employing a within-gender and race approach, we test the validity of the CES-D for use among a sample of African American women family caregivers. Using data from a cross-sectional community sample of 521 urban and rural African American women family caregivers, this study examines the dimensionality of the CES-D by testing four different measurement models through confirmatory factor analyses. Among the four measurement models tested using Weighted Least Squares estimation, our findings support previous research that has identified four dimensions in the CES-D: depressed affect, positive affect, somatic complaints, and interpersonal relations for our sample. Additionally, a three-factor (somatization) model and a four-factor model were shown to be equivalent. Implications for further measurement and model testing, and the use of the CES-D for research among African American women caregivers are discussed.

Doing it ‘right’ by your parents in Singapore: A political economy examination of the Maintenance of Parents Act of 1995

Singapore is expected to experience a demographic revolution in its ageing population in the coming decades. In an effort to deal with this projected burgeoning need, the Singapore Parliament enacted the Maintenance of Parents Act in 1995. The Act legislates the financial responsibility of adult children towards their indigent aged parents. Using archival data, including parliamentary debates, official reports, and print media records, this study examines the Act’s underlying ideologies and cultural assumptions. The authors move beyond the rhetoric of filial piety and draw on the political economy of ageing perspective to uncover the contradictions that are inherent in the Act’s stated and unstated functions. This paper contextualizes the enactment of the Act within the larger governmental goals of nation-building, regime maintenance and wealth accumulation, and notes the Act’s coherence with other governmental ideologies, namely self-reliance and pragmatism.

Post-acute dispositions of older adults hospitalized for depression.

This study addressed factors associated with six-month post-acute dispositions (continuous community stay, medical hospitalization, psychiatric rehospitalization, nursing home placement, death) for older adults hospitalized for depression and discharged to the community. The sample included 199 older adults; and data were collected via medical records, interviews with discharge planners, patients, and family members. Over half of the sample remained in the community throughout the observation period; 23% experienced psychiatric re-admission and 10% entered a nursing home. Several factors associated with nursing home placement were identified: less improvement in depression during the hospitalization, lower Global Assessment of Functioning (GAF) scores at discharge; and less mental health service use in the post-acute period. Those at higher risk of psychiatric re-admission had more previous psychiatric hospitalizations and were marginally more likely to be married and have lower Brief Psychiatric Rating Scale (BPRS) scores at discharge. Differentiating those at risk for nursing home placement may be easier than differentiating those at risk of psychiatric readmission.

‘He was your father, he raised you’: Examining helping professionals’ narratives on filial piety in Singapore

Filial piety provides cultural justifications for the enactment of the Maintenance of Parents Act (MPA), which aims to address late life financial security. Under the Act, indigent older parents may sue their adult children in a special tribunal for their financial maintenance. Although social workers are not directly involved in these adjudications, their professional functions are heavily influenced by considerations of filial piety and the provisions of the MPA. Using Foucauldian concepts of surveillance, control, and resistance as well as the narrative approach, this qualitative study uncovers professional characterizations of their elderly clients/patients and their families as either villains or victims. Social workers inevitably surveil their elderly clients and families to ensure compliance with the precepts of filial piety that undergird the MPA. Finally, this study discusses the disciplining functions of the MPA in ensuring that indigent elderly clients rely on their adult children for their financial well-being.

Implementing a Gero-Infused Curriculum in Advanced-Level MSW Courses in Health, Mental Health and Substance Abuse: An Evaluation

This article presents evaluation results from a curricular innovation aimed at increasing the capacity of social work graduates to serve older adults in health, mental health, and substance abuse settings. Working as a team, faculty developed, incorporated, and evaluated gerontology-infused syllabi and teaching modules in multiple sections of the 3 courses, with 2 sections serving as a comparison group. Results indicated that students exposed to the gero-infused curriculum increased their age-related knowledge and self-competence from pre- to posttest, and achieved a greater increase in knowledge than did the comparison group. Implications of the findings to social work education are discussed.

Elders with First Psychiatric Hospitalization for Depression

Little is known about the first psychiatric hospitalization episode of older adults with depression. The purpose of this study is to describe the proportion and characteristics of first‐time inpatients admitted for late‐life depression.

When the Private Sphere Goes Public: Exploring the Issues Facing Family Caregiver Organizations in the Development of Long-Term Care Policies

SUMMARY Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the governments position on their role in addressing issues related to the “private spheres.” In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.