Racial differences in future care planning in late life.

Objectives: Although many older adults fear frailty and loss of independence in late life, relatively few make plans for their future care. Such planning is particularly limited among racial minorities. Given the benefits of future care planning (FCP), it is important to understand factors that facilitate or hamper FCP in late life. Our study explored racial, demographic, and dispositional influences on thinking about and engagement in FCP among community-dwelling older adults.Design: This study utilized data from the Elderly Care Research Center's longitudinal study of successful aging based on interviews with 409 older adults. Along with race, education and other demographic factors, we explored dispositional influences of optimism and religiosity on FCP using logistic regression.Results: African American older adults had significantly lower odds of executing FCP (ß = 0.36, p < .05) when compared to White older adults. However, this estimate was no longer statistically significant after controlling for education, disability status, optimism, and religiosity. Older adults with higher education had significantly higher odds of thinking about and executing FCP. Higher level of optimism was associated with lower odds of FCP.Conclusions: Limited educational resources and the greater prevalence of dispositions of religiosity and optimism among African American older adults may contribute to their reluctance to engage in FCP in comparison to their white counterparts. Our findings offer practice implications indicating a need for interventions to encourage older adults, particularly racial minorities, to recognize and actively plan for their future care needs.

Whose advocacy counts in shaping elderly patients' satisfaction with physicians' care and communication?

PURPOSE: The purpose of this article was to examine the relative importance of patients' self-advocacy and perceived physicians' advocacy for impacting patients' satisfaction in terms of physician communication and physician-patient relationship. We also examine the influence of physicians' emotional support and patients' demographic as well as health characteristics on patients' satisfaction. SAMPLE: Our sample includes interviews with 806 community dwelling older adults (mean age =77.82 years, SD=8.41). The sample included residents of a large retirement community in Clearwater, FL, USA. Respondents were also included from representative samples of older adults living in Orlando and Miami, FL, USA, and Cleveland, OH, USA. METHODS AND RESULTS: Using multiple hierarchical regression analyses, we found that patients' age and functional limitations were negatively associated with their care satisfaction. When compared with White patients, African-American patients were less satisfied with their physicians while Latino patients expressed greater satisfaction with their medical care. We found limited evidence of patients' self-advocacy and such advocacy did not serve as a significant predictor of satisfaction with physicians. In contrast, patients' perception of physicians' readiness to act as patient advocates was a significant predictor of patients' satisfaction. Emotional support of physicians was also associated with patients' satisfaction. CONCLUSION: These findings raise questions about consumer empowerment among older adults and underscore their desire for and appreciation of physicians' advocacy. Findings are discussed in the context of power imbalance between elderly patients and their doctors.

Beyond Ageist Attitudes: Researchers Call for NIH Action to Limit Funding for Older Academics.

Purpose: This article explores manifestations of ageism in response to a proposed National Institutes of Health (NIH) Emeritus Grant initiative aimed at funding older investigators. Design and Methods: Comments were requested by NIH in 2015, through a Request for Information (RFI) as well as a public blog regarding the merits of a proposed grant mechanism that would help older researchers transfer their labs to junior scientists and transition into retirement. This article reports content analysis of comments from 134 respondents to the blog. Results: We found consistent patterns of disapproval of the proposed NIH initiative, which was viewed by most respondents as an undeserved benefit for older scientists. Negative attitudes were also expressed toward senior investigators by a large majority of commenters. In addition to broad opposition to new grant funding for senior investigators, many commenters also advocated for other punitive actions toward older investigators, including forced retirement. These opinions were generally justified by negative appraisals of senior investigators' competence, productivity, and even their character. Ageist comments were not limited to younger researchers, suggesting potential internalized ageism by older investigators. Implications: We discuss manifestations of ageism and advocacy for age discrimination in the broader social context of modernization theory, intergenerational conflict and social closure. Our findings raise important questions about the limited value of higher education in counteracting prejudice toward older people. We propose potential remedies to reduce ageism in academia.

Elderly Cancer Survivors Reflect on Coping Strategies During the Cancer Journey.

PURPOSE: This paper focuses on perspectives of elderly cancer survivors on their experiences of coping with cancer during various phases of their illness journey, ranging from diagnosis phase to treatment and finally considering post treatment survivorship. Anchored in the stress paradigm, the purpose of this study was to explore the meaning of living with cancer and older adults' orientations to coping with stressors encountered during their cancer journey as reflected in narratives of elderly cancer survivors. METHODS: A nonclinical sample of 174 older adults who reported a cancer diagnosis were selected from a panel study of successful aging. In-depth interviews with respondents focused on perceived stressors and coping strategies at different phases of their cancer experience. Themes were derived from narratives based on consensus by two raters. RESULTS: Most of the elderly patients accepted their diagnosis without dismay. Resolve and determination during the diagnosis phase was followed by assuming a more passive role during the treatment phase, relying on expert medical care. During the longer term survivorship phase older adults looked back at the adaptations they found most useful. The majority reported valuing active coping styles. These include seeking social support and instrumental orientations to dealing with the illness followed by religious or spiritual approaches. CONCLUSIONS: The "on time" interpretation of having a cancer diagnosis in old age may diminish the stressfulness of the diagnosis and may enhance the patients' ability to proactively deal with the reality of their illness.

Patient Planning and Initiative Enhances Physician Recommendations for Cancer Screening and Prevention.

BACKGROUND: The growing population of older adults is at the highest risk for cancer, yet they are underserved in terms of cancer prevention and care. Discussions between patients and physicians that result in tailored recommendations are now called for by the U.S. Preventive Services Task Force. AIMS & METHOD: The current study explored the role of physician-patient relationships and of patient initiatives in health communication on primary care physicians' recommendations of cancer prevention and screening. Our data was collected from baseline questionnaires from elderly patients 60 years of age or older (N=360) who attended an adult community center where an educational intervention was administered. RESULTS: Our findings demonstrate the importance of elderly patients' advocacy, shown through planning and initiative in communication for eliciting doctor's cancer screening and cancer prevention recommendations in primary care settings.