William J. McAuley

Formal Home Care Utilization Patterns by Rural–Urban Community Residence

BACKGROUNDnWe examined formal home care utilization among civilian adults across metro and nonmetro residential categories before and after adjustment for predisposing, enabling, and need variables.nnnMETHODSnTwo years of the Medical Expenditure Panel Survey (MEPS) were combined to produce a nationally representative sample of adults who resided in the community for a calendar year. We established 6 rural-urban categories based upon Urban Influence Codes and examined 2 dependent variables: (a) likelihood of using any formal home care and (b) number of provider days received by users. The Area Resource File provided county-level information. Logistic and negative binomial regression analyses were employed, with adjustments for the MEPS complex sampling design and the combined years.nnnRESULTSnUnder controls for predisposing, enabling, and need variables, differences in likelihood of any formal home care use disappear, but differences in number of provider days received by users emerged, with fewer provider days in remote areas than in metro and several other nonmetro types.nnnCONCLUSIONSnIt is important to fully account for predisposing, enabling, and need factors when assessing rural and urban home care utilization patterns. The limited provider days in remote counties under controls suggest a possible access problem for adults in these areas.

The effect of home-delivered Dietary Approach to Stop Hypertension (DASH) meals on the diets of older adults with cardiovascular disease

BACKGROUNDnMany older adults with hyperlipidemia or hypertension participate in the Older Americans Act Nutrition Program, which serves meals in community settings and delivers meals to homes. However, there is little information regarding whether therapeutic meals designed around Dietary Approach to Stop Hypertension (DASH) principles have a beneficial effect on the diets of these older adults.nnnOBJECTIVEnThe objective of this study was to determine the degree to which dietary change is influenced by providing 7 home-delivered therapeutic meals weekly to adults aged > or = 60 y.nnnDESIGNnWe conducted a 1-y randomized controlled trial in 298 persons with hyperlipidemia or hypertension, in which 50% of participants received 7 therapeutic meals per week for 12 mo. Those in need of dietary change at baseline (n = 210) were examined. Changes in intermediate DASH accordance, DASH accordance, and the nutrients that make up the DASH diet were measured by using 24-h food recalls at baseline, 6 mo, and 12 mo. Chi-square tests, t tests, and multiple regression were used to examine the association between receipt of meals and dietary change over time.nnnRESULTSnParticipants who received meals were 20% (P = 0.001) more likely to reach intermediate DASH accordance at 6 mo and were 18% (P = 0.007) more likely to meet saturated fat accordance at 12 mo than were those who did not receive meals. When stratified by race and income, gains were marginally larger for whites and higher-income individuals.nnnCONCLUSIONnDelivery of 7 DASH meals per week was found to increase compliance with dietary recommendations among noncompliant older adults with cardiovascular disease.

Getting Out and About: The Relationship Between Urban Form and Senior Travel Patterns

As the overall U.S. population expands outward from the central city and core suburbs and as people age in place, more seniors will reside in suburban and exurban locations. This research seeks to determine whether older adults who live in areas with differing urban forms experience travel pattern variations under controls for other factors related to travel. We analyzed data from a telephone survey of a random sample of seniors aged 75 years and older and we employed a unique approach for establishing the urban form of their residential settings. The results show that urban form does influence travel patterns, including the number of trips and transportation mode, and suggest that the construction of compact, mixed-use communities where todays older adults can age in place may be part of the solution to addressing the mobility needs of our aging population.

Recruitment and Retention of Ethnically Diverse Long-Term Family Caregivers for Research

Abstract The inclusion of ethnically diverse long-term care family caregivers is significant in research, particularly in social work research because of the importance placed on diverse populations. However, the inclusion of diverse populations poses a set of unique recruitment and retention challenges for researchers. This process can be particularly complicated when multiple long-term care recruitment partners are utilized and when the project involves a multi-phase data collection plan with different minority recruitment needs for each phase. In our work we learned that: (a) research teams should plan for gender and ethnic differences in the ways that family caregivers think about and approach research involvement, (b) socioeconomic disadvantages and ethnic differences have both independent and interactive effects on research participation, (c) physical and emotional ’costs,’ as well as financial costs, of caregiver participation should be given more attention in informed consent procedures, and (d) agency collaboration for minority recruitment and retention requires continuous nurturing and sustained effort by all members of the research team.

Home Health Care Agency Staffing Patterns Before and After the Balanced Budget Act of 1997, by Rural and Urban Location

CONTEXTnThe Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary.nnnPURPOSEnWe examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies.nnnMETHODSnData were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year.nnnFINDINGSnAll staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties.nnnCONCLUSIONSnThe limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff.

Organizational factors associated with the use of telehospice

We investigated organizational factors associated with the use of telehospice (defined as the use of video technology by hospices). The investigation was based on the 2007 National Home and Hospice Care Survey. There were 695 hospice agencies, of which 6% used telehospice. Logistic regression was used to examine the relation between use of hospice and a number of organizational factors. The dependent variable was the use/non-use of video technology in patient monitoring or consultations with professionals. Most of the variables that were significantly associated with the use of telehospice were related to characteristics of the agency director. If the director had at least a Masters degree or had a longer tenure as director of the agency, there was a higher likelihood that the agency used telehospice. If the director was a nurse, the likelihood that telehospice was used was considerably lower. Organizations with inter-agency contracts were less likely to use telehospice. Providing financial, training and organizational support to agencies that recognize the potential benefits of telehospice would probably assist in its future introduction.

Participant Characteristics Predicting Voluntary Early Withdrawal from a Multidisciplinary Program Providing Home-Delivered Meals and Dietitian/Social Work Case Management to Homebound Elders

Abstract Participant Characteristics Predicting Voluntary Early Withdrawal from a Multidisciplinary Program Providing Home-Delivered Meals and Dietitian/Social Work Case Management to Homebound Elders meals and dietitian/social work case management to homebound seniors predicted voluntary early withdrawal. Sixty-nine participants voluntarily withdrew early and 111 completed the project. Six hypotheses were based on a conceptual framework incorporating (1) agreement between project elements and needs/preferences of individuals and (2) whether participants would improve and no longer require or desire the intervention. Three of the hypotheses were supported by means of logistic regression analysis. Voluntary early withdrawers at baseline: (1) were more mobile, (2) ate less often, and (3) responded that food tastes good less often. The results suggest that carefully considering the interaction of potential participant characteristics and project interventions will improve nutrition project retention.

Perceived Suitability of Residence and Life Satisfaction among the Elderly and Handicapped

This study examines the degree to which resources influence the extent of social and physical environments and also whether extensiveness of social and physical environments condition the relationship between preceived residential suitability and life satisfaction. Data were collected from a random sample of residents in two high-rise, rent-subsidized buildings designed for the elderly and handicapped in a Southeastern city. Correlation analysis suggests that resources such as income, physical health, personal transportation and perceived personal safety are positively associated with an expanded range of mobility but are not related to frequency of social contacts. Correlations between perceived residential suitability and life satisfaction are then examined within subgroups of respondents divided by extensiveness of social physical environments. The results offer support for the notion that environmental options condition the impact of residence on life satisfaction.

Access to bereavement services in hospice.

Hospice bereavement services, though often overlooked in hospice research, are an important area of study due not only to the potential value of bereavement support but also the emphasis placed on such services by the Centers for Medicare and Medicaid Services. Moreover, access to these services is seldom understood or researched. Therefore, using the patient public use file of the 2007 National Home and Hospice Care Survey, we explored the relationships between patient, informal caregiver, and agency characteristics as well as discharges from hospice to gain perspective into bereavement service access to informal caregivers. Findings suggested that death at discharge from hospice may be an important moderator variable between access to hospice bereavement support and many other factors. However, even under controls for death at discharge, two agency characteristics remain significantly associated with access. Bereavement access tends to be more likely in agencies that provide only hospice care as opposed to other services, and in micro-politan agencies. Furthermore, death at discharge is less likely among African Americans, suggesting the value of enhanced culturally-appropriate and more targeted hospice care and hospice bereavement support for this population. Future research should explore the strategies used to effectively deliver bereavement services and how these strategies may benefit from targeted and culturally sensitive approaches.

Practice Concepts Expansion to Practice Concepts and Policy Analysis

In keeping with The Gerontologist ’ s mission to offer a multidisciplinary understanding of human aging, including the impact of social policy, we are expanding the Practice Concepts section to include papers that specifi cally analyze public policy as it affects aging populations and aging processes. We believe that a more explicit focus on social policy analysis will fi ll a need for increased awareness and understanding of the role of older adults in the policy-making process, as well as the impact of public policy on the well-being of older populations at federal, state, and local levels. To that end, we invite scholars to submit manuscripts that analyze relevant policy to the Practice Concepts and Policy Analysis editor. The manuscripts must adhere to the current word limit of 4,000 words for a Practice Concepts piece. The chief purpose of a policy analysis is to explain and share the insights obtained in the examination of a policy problem. There are four major components of a Policy Analysis paper. The fi rst step in a policy analysis is to defi ne and describe a specifi c policy issue that affects older adults. Raising an interesting policy question that can be answered through data analyses, as does Binstock in “ Older voters and the 2008 Election ” ( Binstock, 2009 , pp. xx – xx), is another way to defi ne and delineate a specifi c policy issue. In this section of the manuscript, suffi cient background information should be presented so that readers understand the context in which the policy issue or question is situated. Such context can include the key historical aspects of the issue, as well as the various policies and policy networks (political fi gures or organizations, interest groups, think tanks) that exist to address the issue ( Patton & Sawicki, 1986 ). A brief discussion of the major stakeholders in the issue being featured is also appropriate. The second step in the policy analysis paper is to provide the readers with specifi c information about why this particular issue and an analysis of it are important to the fi eld of aging. Here, the author should offer a conceptual framework that will be used to guide the policy analysis. This section should contain a review of the relevant literature that will tie together key concerns raised with historical background on the topic, showing the reader some of the reasons why the issue has been diffi cult to resolve or is in need of additional policy-making efforts or change. What are the “ facts ” surrounding this issue and to what extent do the various stakeholders agree on these facts and the policies they have spawned to date? Next is the heart of the paper, an analysis of the issue. In this section, we will look for an in-depth description of the sample and data used (if a secondary data analysis), the methods of data collection and analysis carried out (if new data were collected), and the specifi c fi ndings of the analysis. We understand that in some instances, the “ data ” to be used