Working With LGBT Baby Boomers and Older Adults: Factors That Signal a Welcoming Service Environment.

Many providers recognize the importance of creating culturally competent services for lesbian, gay, bisexual, and transgender (LGBT) older adults. Although multiple resources list steps to make professional practices more LGBT-welcoming, these resources provide no empirical data to support their recommendations. LGBT older adults (N = 327) were asked to describe what signals that a provider is LGBT-welcoming. Six of the top 10 signals related to provider behavior and suggest the importance of staff training; the balance included display of signage and rainbow flags, use of inclusive language on forms and the presence of LGBT-identified staff. Results provide evidence-based recommendations for working with LGBT older adults.

Working with LGBT older adults: an assessment of employee training practices, needs, and preferences of senior service organizations in Minnesota.

As the population ages and LGBT older adults become more visible among senior service providers, the need for cultural competency training will grow. Although this training is a relatively new phenomenon, curricula exist. These are generally in person for 2- to 8-hr durations. Training to Serve embarked on a study to investigate preferences in cultural competency format and duration. One-hundred and eighty-four Minnesota service providers participated in the online survey. The majority (90%) were interested in participating in LGBT cultural competency training. Results suggest a preference for shorter duration and online formats. Implications for curricula development and future research are included.

Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults.

The study examines the frequency and nature of the informal caregiving experience for midlife and older lesbian, gay, bisexual, or transgender (LGBT) adults. Responses from a Twin Cities Metropolitan Area LGBT aging needs assessment survey were analyzed for social supports, current caregiving activity and availability of a caregiver. The majority of respondents identified a primary caregiver who was not a legal relation; and compared to the general population were (a) less likely to have traditional sources of caregiver support and (b) more likely to be serving as a caregiver and caring for someone to whom they were not legally related. Implications of the findings for enhancing resources to more fully support the 10% of caregivers that are caring for non-kin are discussed.

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults.

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.

Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women.

OBJECTIVES: To test the effectiveness of an education and counseling intervention on reducing environmental hazards in the homes of older women. DESIGN: Secondary analysis from a randomized, controlled trial with two arms: fall prevention program and health education program (control). Environmental hazards were assessed at baseline and immediately posttreatment (12-weeks). SETTING: Participants' homes. PARTICIPANTS: Two hundred seventy-two community-dwelling women aged 70 and older at risk for falling. INTERVENTION: The fall prevention program involved a comprehensive fall risk evaluation, exercise, education, individualized counseling, and referrals. The health education program included topics unrelated to fall prevention. With the exception of the fall risk evaluation conducted by a nurse practitioner, baccalaureate-prepared nurses carried out the interventions. MEASUREMENTS: Summed and individual scores for hazards related to the bathroom, floor surfaces, lighting, furniture, stairways, and storage areas. RESULTS: Environmental hazards were found in all homes, with a baseline mean+/-standard deviation of 10.7+/-2.6 total hazards and range of four to 17 hazards. Analysis of within-group changes indicated that the fall prevention group had significantly fewer bathroom, lighting, and total hazards after the intervention, whereas the health education group had significantly fewer bathroom hazards but more floor hazards. At follow-up, the fall prevention group had significantly fewer lighting hazards and total hazards than the health education group. CONCLUSION: Education and counseling have only modest effects in helping older women make recommended home modifications. To be most effective in reducing environmental hazards, fall prevention programs may need to provide and install safety devices.

Measuring the direct healthcare costs of a fall injury event.

BACKGROUND: Falls are a leading cause of injury in older adults. Obtaining cost data for a randomized controlled trial aimed at preventing falls was problematic, and an approach was needed to obtain these data on a relatively small sample of women who used healthcare services. APPROACH: The study population was 272 community-dwelling women aged 70 and over who were participants in a fall prevention trial. Fall incident reports and billing records were used to obtain costs associated with outpatient visits, emergency department visits, acute care hospitalizations, nursing home stays, home healthcare visits, rehabilitation visits, and ambulance use. Average time and costs for obtaining fall-related healthcare cost data also were estimated. RESULTS: The mean age of those with falls requiring healthcare utilization was 78.9 years (SD = 5.1 years). Billing records were obtained for 47 of 55 injurious falls (85%). Costs ranged from $63 to $85,984, with a mean cost of $6,606 and a median cost of $658 per fall-related injurious event. The average time it took to collect the data was just over 5 hr per fall, with an estimated data collection cost of $170 per fall. DISCUSSION: The mean cost of falls was higher than seen in other studies, although methods differ. Collecting cost data related to a specific fall injury event directly from study participants was feasible, practical, and relatively inexpensive. Direct costs of injurious falls are greater than have been estimated in previous studies.

Use of time studies for determining intervention costs.

BACKGROUND: Cost-effectiveness analyses are increasingly recommended to evaluate the effectiveness of health interventions. Determining the costs associated with delivery of a particular intervention is essential in conducting a cost-effectiveness analysis. Yet, there are few guidelines available to assist investigators in how to assess intervention costs associated with the personnel portion of an intervention. OBJECTIVES: To describe the use of time studies in calculating the program costs of personnel for use in future cost-effectiveness analysis of health interventions. METHODS: The literature on calculating intervention costs for use in cost-effectiveness analyses is reviewed. The process for conducting a time study for determining personnel costs in delivering an intervention and a step-by-step example from a time study are used to illustrate how personnel costs associated with delivery of the intervention can be separated from those costs associated with implementation of research procedures in the determination of research costs. CONCLUSIONS: Time studies provide a good estimate of part of the cost of implementing an intervention that is often difficult to determine-personnel time. The design of the time study should consider intervention components, staff involvement, and the time period for data collection.