Systematic review of the physical home environment and the relationship to psychological well-being among community-dwelling older adults.

Older adults with functional impairments are at risk of being excluded from participation in day-to-day life. This exclusion can have detrimental effects on psychological well-being. The physical home environment is a potential force for both enhancing and limiting participation for this population. This systematic review of literature examined relationships between the physical home environment, functional impairment, and psychological well-being among older adults who live in community settings. The Ecological Model of Aging served as the guiding framework for this review. Results suggest that knowledge of the relationships between these constructs is still in the early stages. While associational relationships are established, the nature of these relationships is clouded by the inconsistency of measurement across studies, as well as design challenges. Objective and subjective features of the physical home environment are linked to psychological well-being throughout the literature. A growing body of evidence demonstrates that personal competence serves as a moderator of those relationships.

Predictors of depression among caregivers of older adults with severe mental illness.

Caregivers of older persons with severe mental illness (SMI) contend with the double challenge of providing assistance related to both the psychiatric condition and older age of their family member. Study explored factors influencing negative psychological outcomes experienced by caregivers (n = 96) of older adults with SMI. One-quarter of caregivers scored at or above the clinical point for depression. Low income, care recipient gender, poor health, problems dealing with care recipient's symptoms and the interaction of health and problems dealing with symptoms were associated with higher rates of depression. Implications for service provision and future research are discussed.

Alcohol misuse among older adult public housing residents.

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n = 187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.

Alcohol diagnoses among older Tennessee Medicare beneficiaries: race and gender differences.

BACKGROUND: These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups. METHODS: We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered. RESULTS: Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups. CONCLUSIONS: Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs.

Aging with a severe mental illness: challenges and treatments.

Severe mental illness (SMI) impacts many different facets of individuals' lives. As they age, those with SMI experience increased physical illnesses, functional impairment, cognitive deficits, and social disability. To promote more effective social work practice with this population, this article highlights the major biopsychosocial and family issues of aging with a psychiatric diagnosis. In addition, intervention approaches that have demonstrated efficacy are summarized along with ways to coordinate services across multiple service delivery sectors. Finally, future directions in practice and research are presented to develop additional methods of support for older adults with SMI and their families.

Formal and informal support for older adults with severe mental illness.

OBJECTIVES: This study sought to examine the combination of formal and informal services supplied to older adults with severe mental illness, to assess the adequacy of services received, and to determine factors predictive of formal and informal service provision. METHODS: A cross-sectional research design was employed. Seventy-five older adults diagnosed with a SMI were recruited through local community mental health center. Data was collected through face-to-face interviews using the Camberwell Assessment of Needs for the Elderly. RESULTS: Clients most frequently received services from formal sources for psychiatric distress, physical health, information, and dangerous behavior needs while informal sources provided the greatest amount of assistance for self-care, psychiatric distress, and money management needs. Appropriate assistance was most often not provided for benefits, sight/hearing, and incontinence. Formal services were predicted by group residence and dangerous behavior, physical illness, medication, and daily activity needs. Assistance from informal sources was predicted by private residence, self-care, mobility, and money management needs. DISCUSSION: While formal and informal sources provided adequate services for certain client needs, over 70% of the clients did not receive the correct type of help for some of their needs. Greater communication between mental health care staff and informal caregivers, and the integration of aging network services, is essential for the adequate provision of care to older severely mentally ill (SMI) adults. Education and greater linkages among care providers are necessary so that all service providers are aware of and are able to appropriately respond to the complex multi-level needs experienced by older SMI adults.

The influence of religiosity on depression among low-income people with diabetes.

People with diabetes experience depression at a significantly higher rate than do their nondiabetic counterparts. The purpose of this study was to examine the impact of multiple dimensions of religiosity on depression among a lower income population of people with diabetes. Using a cross-sectional design, the study focused on a combined clinical and community sample of people with diabetes from low-income neighborhoods. On the basis of previous studies and confirmatory factor analyses of study data, five distinct dimensions of religiosity emerged: religious belief, reading religious materials, prayer, religious attendance, and engaging others in religious discourse. Bivariate correlation and hierarchical linear regression revealed robust and inverse associations between four of the five dimensions of religiosity and level of depression. Prayer, religious reading, religious attendance, and religious belief proved protective against depressive symptoms. Although it correlated with the other measures of religiosity, engaging in religious discourse was not distinctly associated with levels ofdepression. The analyses suggest that religious resources increase psychological resiliency among those managing the chronic stress of diabetes. Pedagogical and practice implications are discussed.

Treating older persons with severe mental illness in the community: impact of an interdisciplinary geriatric mental health team.

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.

Overview of evidence-based practice with older adults and their families.

Over the past decade, there has been tremendous growth in the movement to enhance the delivery of quality services through the use of evidence-based interventions. While a growing number of reviews have examined the effectiveness of pharmacological interventions for older adults, few have examined the status of psychosocial interventions for the older population. The purpose of this special volume is to increase researchers' and practitioners' knowledge of evidence-based treatments for older adults and their family members. To this end, a thorough review of the extant research on psychosocial interventions available to address the varied health, mental health/cognitive, and social role challenges faced by older adults and family caregivers is provided.

Substance abuse.

Alcohol abuse poses special risks for increased morbidity and mortality among older adults, contributing to the heightened use of medical resources and the related increase in medical costs. Although the prevalance of alcohol use disorders in the older adults is generally less than that found in younger groups, it is expected to increase with the aging of the "baby-boom" generation. In spite of this, little attention has focused on developing, and evaluating the efficacy of, treatment programs for older adults with alcohol related disorders. This article discusses the availability of effective treatment strategies for older alcohol abusers and reviews the epidemiological and outcomes research literatures related to alcohol abuse and older adults. The few empirical studies that examine outcomes associated with the treatment of older substance abusers reveal positive outcomes, especially when "age-specific," cognitive-behavioral, and less confrontational treatment approaches are employed.

Evidence-based interventions with older adults: concluding thoughts.

Taken collectively, the articles in this volume provide a method to assess psychosocial outcome research in aging. Although the outcome literature on effective interventions with older adults is uneven across condition and treatment approaches, there are some particular intervention methods that have received consistent research support. This article condenses the rich analyses presented by the volume authors and summarizes the interventions for which some evidence base exists by life issue/condition (health, mental health/cognitive and social rules) and outcomes achieved.

Perceptions of biopsychosocial services needs among older adults with severe mental illness: met and unmet needs.

This study sought to identify the psychiatric, physical, and social services needs experienced by older adults with severe mental illness (SMI) and to examine factors influencing their experience of need and service provision adequacy. Seventy-five older adults with SMI were recruited from a community mental health center to participate in the study. The typical client experienced a need for care in 10 areas, with the greatest needs occurring in the areas of psychological pain, physical illness, social contacts, looking after the home, and daily activities. The total number of unmet needs ranged from zero to 10, with the typical client having an average of 2.3 unmet needs (SD = 2.4). The highest proportions of unmet needs were in the areas of social contact, benefits, sight or hearing difficulties, and intimate relationships. Linear hierarchical regression analyses revealed that clients with lower income, greater impairments in independent daily living skills, and higher levels of depression experienced increased needs for care. Older clients who lived in private homes or apartments had higher levels of depression, and those who required assistance in the areas of intimate relationships and benefits experienced higher levels of unmet needs. Research and practice implications are discussed.

Impact of an infusion model on social work students' aging knowledge, attitudes, and interests.

This study sought to provide data regarding the use of infusion of gerontological materials throughout curriculums to enhance students' attitudes toward older adults, their knowledge of aging-related issues, and their perceptions of gerontological social work. A quasi-experimental design was used to compare outcomes for graduate social work students who were and those who were not exposed to gerontological infusion. Results indicated that exposed students experienced a greater improvement in their view of aging-related career opportunities and in their belief in the importance of gerontological social work. Treatment group students also showed greater gains in self-rated aging knowledge. Both treatment and control group students had significant gains in a test of aging-related knowledge. Pedagogical implications are discussed.

Functional impairment as a predictor of depressive symptomatology: the role of race, religiosity, and social support.

The study discussed in this article examined the relationship between depression symptomatology and functional impairment among white and African American elderly people and investigated the effect of race, religiosity, and social support on this relationship. Study results indicate that although African American elderly people were more impaired in the performance of activities of daily living (ADL) and instrumental activities of daily living (IADL) than white elderly people, they did not experience higher levels of depression. However, African Americans did report significantly higher levels of religiosity and social support.

Predictors of psychological well-being among assisted-living residents.

Assisted-living facilities are a rapidly growing source of supportive housing for frail elderly people. This study examined the psychological well-being of elderly assisted-living residents and factors associated with well-being. Participants were nondemented elderly residents of an assisted-living community in the urban southeast. Depression, life satisfaction, and demographic, health, and social support variables were measured through face-to-face interviews. A sizeable minority of the residents reported high levels of depressive symptoms and low life satisfaction. Female gender, self-reported health, functional impairment, perceived social support, and participation in activities were significantly associated with well-being. The predictive value of gender and health variables were reduced when social support was introduced. Implications for policy and social work practice are discussed.