Four subtypes of self-neglect in older adults: results of a latent class analysis.

OBJECTIVES: To determine whether there are subtypes of elder self-neglect (SN) with different risk factors that can be targeted using medical and social interventions. DESIGN: Cohort study using archived data of Adult Protective Services (APS) substantiated cases of elder SN between January 1, 2004, and December 31, 2008. SETTING: Houston, Harris County, Texas. PARTICIPANTS: Adults aged 65 and older with APS region VI substantiated SN between January 1, 2004, and December 31, 2008 (N = 5,686). MEASUREMENTS: Adult Protective Services caseworkers used the Client Assessment and Risk Evaluation (CARE) tool during home investigations, assessing risk of harm in the domains of living conditions, financial status, physical and medical status, mental health, and social connectedness. Latent class analysis was used to identify unique subtypes of elder SN. RESULTS: Four unique subtypes of elder SN were identified, with approximately 50% of individuals manifesting physical and medical neglect problems. Other subtypes included environmental neglect (22%), global neglect (21%), and financial neglect (9%). Older age, Caucasian descent, and mental status problems were more strongly associated with global neglect behaviors. African Americans were more likely to experience financial and environmental neglect than Caucasians and non-white Hispanics. CONCLUSION: Elder SN consists of unique subtypes that may be amenable to customized multidisciplinary interventions. Future studies are needed to determine whether these subtypes impose differential mortality risks and whether multidisciplinary tailored interventions can reduce SN and prevent early mortality.

Rowe and Kahn's model of successful aging revisited: positive spirituality--the forgotten factor.

PURPOSE: We explain a new concept, positive spirituality, and offer evidence that links positive spirituality with health; describe effective partnerships between health professionals and religious communities; and summarize the information as a basis for strengthening the existing successful aging model proposed by Rowe and Kahn. DESIGN AND METHODS: A missing component to Rowe and Kahn's three-factor model of successful aging is identified, and we propose strengthening the model with a fourth factor, positive spirituality. RESULTS: We developed an enhanced model of successful aging based on Rowe and Kahn's theoretical framework. Evidence presented suggests that the addition of spirituality to interventions focused on health promotion has been received positively by older adults. IMPLICATIONS: Leaders in gerontology often fail to incorporate the growing body of scientific evidence regarding health, aging, and spirituality into their conceptual models to promote successful aging. The proposed enhancement of Rowe and Kahn's model will help health professionals, religious organizations, and governmental agencies work collaboratively to promote wellness among older adults.

Re-engaging the disengagement theory of aging: on the history and assessment of theory development in gerontology.

While "disengagement theory" is today largely discounted, it has an important place in the history of gerontological explanation. First we analyze the historical context of this theory. Second, we examine its long-term contributions and deficiencies in terms of finer criteria--standards which we suggest should be used in evaluating current, and future, theories in social gerontology.

Patterns of alcohol use and abuse among aging Civil War veterans, 1865-1920.

Given the extent of alcoholism among elderly people, it is remarkable how little is known about the biomedical and social dimensions of alcohol use and abuse in late life. In the absence of compelling longitudinal data drawn from contemporary sources, a historical perspective may help to illuminate the incidence and consequences of alcohol abuse among the elderly. Based on a study of 370 case histories drawn from the National Military Home in Dayton, Ohio, which around the turn of the century was the nation's largest old-age home, it appears that alcohol's social ramifications were more important than its pathological or physiological manifestations in late 19th-century America. Drinking habits among aging Civil War veterans varied considerably: moderate consumption was acceptable; too much of a good thing caused problems.

A historical perspective of research on the biology of aging from Nathan W. Shock.

This article describes some of the thoughts and the conceptual framework from which Nathan W. Shock prepared his last major presentation. This paper, written some 8 months following Dr. Shock's death on November 12, 1989, is based upon his extensive notes and discussions with one of the authors (George T. Baker). This presentation in no way is meant to encapsulate the long and distinguished career of Nathan Shock, but rather to provide a glimpse of his perspectives on the development of the field of aging. Furthermore, we believe that the scientific principles concerning aging research laid out by Dr. Shock in this publication are still valid today and may provide valuable insights for researchers in the field.

Becoming wise: a psycho-gerontological interpretation of the Book of Job.

The Book of Job, a prototypical "wisdom" text from the fifth or sixth century B.C.E., powerfully articulates a good man's struggle to understand unexpected misfortune. In coming to terms with his suffering and gaining understanding of his place in the universe, Job demonstrates the complex, dynamic yet integrative nature of growing wise. Drawing on our synthetic model of wisdom, we claim wisdom occurs in personality, cognition, and conation that transforms intrapersonal, interpersonal, and transpersonal experience. We discuss gender-specific obstacles that Job overcomes in attaining wisdom by analyzing modern interpretations of the text, which underscore its perdurance in a post-modern age.

The politics of aging: the geriatric imperative of the Department of Veterans Affairs.

Committed "to care for him who shall have borne the battle and for his widow and his orphans," the federal government through its veterans' programs has long been a pacesetter in meeting some of the income-security and health-care needs of older Americans. But the Department of Veterans Affairs is short of funds. Key policymakers are genuinely divided over how much more they want to invest in the care of aging veterans. This paper assesses four options and concludes that it makes sense to strengthen DVA's internal capacity to meet its geriatric imperative.

What does gerontology mean?

Despite growth in the field of gerontological research over the past 50 years, no consensus has emerged on either the definition of gerontology or on its scope and boundaries. This confusion is rooted historically in developments involving the origins and adoption of the term. These include the divergent agendas and world views of particular disciplines and gerontological institutions, as well as conflicts over both ideology and turf among major gerontologists. Speculation is offered on the potential, as well as the costs, of developing consensus-in the future.