Ramraj Gautam

Leisure and religious activity participation and mental health: gender analysis of older adults in Nepal

BackgroundInvolvement in activities has been found to be beneficial for improving quality of life and successful aging for older adults. Little is known, however, about the involvement in activities and depression of older adults in Asian developing countries. This study explores whether participation in leisure social and religious activities are related to depression and satisfaction with life in older adults of Nepal. Gender differences are also explored.MethodsThe study sample was derived from a survey which aimed to determine the intergenerational relationships between older adults and their married sons. A cross-sectional quantitative study of older adults sixty years and over in Nepal was conducted with face-to-face interviews using structured instruments. A convenience sample of 489 community dwelling older adults, 247 men and 242 women, were included in the study. The dependent variables, depression and satisfaction with life, were measured by the Geriatric Depression Scale (GDS) and Satisfaction With Life Scale (SWLS) respectively. Age, gender, marital status, education, perceived health, financial satisfaction, social support received and provided by older adults, and social activity were independent variables in the study.ResultsSaying prayers (B = -2.75; p < 0.005), watching television and listening to the radio (B = -1.88; p < 0.05), and participating in physical activity (B = -1.05; p < 0.05) correlated to lower depression for older men, but only watching television and listening to the radio (B = -2.68; p < 0.005) related to lower rates of depression for women. Socializing with others (B = 1.22; p < 0.05) was related to higher satisfaction with life for men, but for women visiting friends (B = 1.29; p < 0.05), socializing with others (B = 1.45; p < 0.005), and watching television and listening to the radio (B = 0.92; p < 0.05) related to improved satisfaction with life. Activity engagement significantly improved mental health in older adults.ConclusionSpecific activity participation was a significant correlate of lower levels of depression and higher levels of satisfaction with life among older adults in Nepal. The findings explore the need for further research on activity participation in developing countries so that it can be useful for health care practioners and those involved with the activities of aged populations in developing countries.

Social interactions and depressive symptoms among community dwelling older adults in Nepal: A synergic effect model

In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.

Custodial Grandparents Raising Grandchildren: Lack of Legal Relationship Is a Barrier for Services

In the United States, the majority of custodial grandparents are raising their grandchildren without a legal relationship. The lack of a legal relationship (i.e., foster care, custody, adoption) is a barrier for obtaining services and has resulted in limited access to information and public services, inadequate financial assistance, and difficulty providing medical and educational consent. This situation arises not only as a consequence of eligibility criteria, but also because children being raised by custodial grandparents remain outside the child welfare system. Federal and state policies were not designed for this population; subsequently, the majority of grandparent caregivers remain without access to services and support. In this article, perceptions of custodial grandparents concerning family obligations and the child welfare system as a barrier to pursuing a legal relationship are reviewed. Challenges with existing financial and health services, educational needs of grandparents and providers, and suggestions for policy changes are presented.

A Medicare Current Beneficiary Survey–Based Investigation of Alternative Primary Care Models in Nursing Homes: Functional Ability and Health Status Outcomes

This study assessed how the health status and functioning of Medicare beneficiaries residing in nursing homes varies systematically with nurse practitioners (NPs) and physician assistants (PAs) providing primary care services. A secondary analysis was conducted using data from the 2006, 2007, and 2008 Medicare Current Beneficiary Surveys. The study sample included 433 participant-year observations within one of three cohorts: (a) medical doctor (MD)-only, those who received primary care services exclusively from a physician; (b) MD-dominant, those who received some primary care services from an NP or PA, but those visits accounted for less than one half of total primary care visits; and (c) NP/PA-dominant, those who received more than one half of their primary care visits from an NP or PA. Participants in the MD-only cohort had significantly less orientation and independence in activities of daily living compared to participants in the NP/PA-dominant cohort. Other study variables did not vary significantly by practice model. Although the study provides some evidence that NP/PA involvement is associated with improved functioning, it is premature to draw strong inferences.

A Medicare Current Beneficiary Survey-Based Investigation of Alternative Primary Care Models in Nursing Homes: Cost and Utilization Differences

The current study used the Medicare Current Beneficiary Survey-Based (MCBS) Cost and Use files for 2006-2008 to investigate whether health care costs and service utilization of nursing home residents varied with nurse practitioner (NP) and physician assistant (PA) involvement, compared to the use of medical doctors (MDs) only. The sample included Medicare beneficiaries 65 and older residing in a nursing home for the entire study year (433 annual observations). A generalized estimating equations procedure was used to assess whether health care cost and utilization measures varied by cohort. Point estimates indicated that the annual per-person cost of non-institutional services (total medical cost less the cost of the nursing home itself) was

Long-Term Care in the United States and Finland: Policy Lessons to be Learned

3,847 and

Bhutanese Older Adult Refugees Recently Resettled in the United States: A Better Life With Little Sorrows:

3,170 more for individuals in the MD-only and MD-dominant cohorts, respectively, compared to those in the NP/PA-dominant cohort. [Res Gerontol Nurs. 2016; 9(3):115-122.].

Long-term care insurance in Japan: implications for U.S. long-term care policy.

Gerontological nurses are crucial members of long-term care (LTC) policy development teams as they work toward the provision of quality, equitable, seamless, and affordable LTC for all. When developing LTC policies in the United States, it is useful to explore such services in other countries. This policy brief provides an overview of LTC services in Finland to examine possible policy lessons for U.S. LTC service and delivery. Finland provides LTC to its older adult population under a universal program whereby services are provided as part of their universal health care and social services coverage. The U.S. system provides LTC primarily under Medicaid along with some coverage financed under Medicare. The challenges in the U.S. system include fragmented LTC delivery and financing, increasing LTC costs, and maintaining quality of care. Although difficult to compare the LTC costs in these two countries, available data suggest that Finland spends less on LTC the older adult population.

Geriatric Depression Scale for community-dwelling older adults in Nepal

Purpose: This study explores the experiences and adjustment process among older Bhutanese refugees resettled in the United States and identifies their unmet health and social service needs. Design: This phenomenological study design included the conduction of nine in-depth semistructured interviews in the respondents’ native language. The researchers adhered to the steps outlined by Moustakas for data analysis. Results: The five identified themes included the following: a better life but with little sorrows, cultural tensions related to adaptation, language as a barrier to success in the United States, isolation and loneliness, and worries about citizenship and its impact on the future. Discussion/Implications for Practice: Psychological adjustment to life in the United States can have profound impact on the health of Bhutanese older adults. Nurses and health care providers should integrate culturally congruent health care, raise awareness of the unique needs, and advocate for policy changes that will benefit this group of older adult refugees whose lives have frequently been upended.