Volunteering Served as a Transitional Role That Enhances the Well-Being and Cognitive Health Among Older Adults With Cognitive Impairments.

OBJECTIVES: We examined whether volunteering among older adults with cognitive impairments serves as a transitional role that can enhance these older persons' well-being and cognitive health. METHODS: Using data from the Health and Retirement Study, we selected older adults with cognitive impairments (N = 472) and developed linear mixed models to assess associations between volunteering and health outcomes. RESULTS: Volunteers in our sample were mostly females, non-Hispanic whites, those with higher income, and those with a high-school diploma. Volunteering was associated with higher levels of self-rated health, and consistent participation in volunteer work was related to stronger feelings of purpose in life. Cognitive health slightly improved over time only among those who volunteered. DISCUSSION: We demonstrate that cognitive impaired older adults' participation in the volunteer role can benefit cognitive health while strengthening their late life resilience.

Utilizing the Senior Companion Program as a platform for a culturally informed caregiver intervention: Results from a mixed methods pilot study.

To address the need for accessible, affordable, and sustainable Alzheimer's disease and related dementia caregiver interventions with minority populations, we developed the Senior Companion Program Plus, a three-phase pilot study that used a mixed methods experimental design. The intent was to determine if participation in a lay provider, peer-led psychoeducational intervention designed for African American Alzheimer's disease and related dementia caregivers (N = 16) improved caregiver burden and/or stress, coping skills, and social support. Focus groups with Senior Companions informed the intervention design. Quantitative results indicated that caregivers experienced improvement in their overall level of social support and well-being in meeting basic needs. Qualitative findings suggested that caregivers experienced improvement in their knowledge about the disease, experienced increased coping with Alzheimer's disease and related dementia caregiving, and reported benefits of using a lay provider model. Overall, the data suggest that the Senior Companion Program Plus is a promising intervention for African American Alzheimer's disease and related dementia caregivers.

The Senior Companion Program Plus: A culturally tailored psychoeducational training program (innovative practice).

A purposive sample of African American Senior Companions (N = 23) participated in a 5-day, 20-hour psychoeducational training designed to address the unique cultural needs of African American dementia caregivers. Previous studies have not utilized lay caregiver volunteers such as Senior Companions in dementia research in the United States. Pre- and post-tests were administered to determine whether African American Senior Companions increased their knowledge of Alzheimer's disease after participating in the Senior Companion Program Plus. Results from both the quantitative and qualitative data suggest that participants improved their understanding of Alzheimer's disease. Findings from the Senior Companion Program Plus pilot warrant further study for its potential as cost effective, culturally tailored training for Senior Companions who serve persons with dementia and their family caregivers.

Providing Care for Persons with Dementia in Rural Communities: Informal Caregivers' Perceptions of Supports and Services.

Dementia is one of the costliest and most time-consuming diseases among older persons. Although informal caregivers provide the majority of care for persons with dementia, little is known about the self-perceived need for social services of caregivers of persons with dementia within rural areas. This pilot study examined the knowledge, access and intent of the practice-oriented service model of caregivers of persons with dementia in rural communities in the Midwest U.S. After a systematic training, researchers interviewed 11 rural caregivers of persons with dementia (n = 11). Data were analyzed using thematic analysis. Although similarities with other caregivers of persons with dementia were found, important differences suggesting unique issues among these rural caregivers of persons with dementia. Many participants found strength in their community, which often served as a safety net of support. Consistent with existing literature, participants expressed financial concerns, geographic barriers and lack of dementia-specific services when using formal services. The need for more specialized formal services in rural areas to supplement existing informal care networks is discussed. Policies and services based on rural caregivers' unique concerns and challenges and that build upon their existing care networks are recommended.

Marital Status and Persons With Dementia in Assisted Living.

Despite the prevalence of dementia among residents in assisted living (AL), few researchers have focused on the length of stay (LOS) in AL among this population. Little is known about the factors that may contribute to LOS in these settings, particularly for residents with dementia. In the current study, a sub-set of AL residents with dementia (n = 112) was utilized to examine whether marital status was associated with LOS in AL as this has received sparse attention in previous research despite studies suggesting that marital status influences LOS in other health-care and long-term care settings. The Andersen-Newman behavioral model was used as a conceptual framework for the basis of this study of LOS, marital status, and dementia in AL. We hypothesized that persons with dementia who were married would have longer LOS than unmarried persons with dementia in AL. Cox regression was used to examine the association between marital status and LOS in AL of residents with dementia and whether activities of daily living were related to discharge from AL settings among married and unmarried residents with dementia. Main effects for marital status and the interaction between marital status and mobility with LOS were examined. Study findings provide information related to the psychosocial needs of AL residents with dementia and offer implications for assessing the on-going needs of vulnerable AL residents.

Living Alone With Cognitive Impairment.

Although most individuals experiencing cognitive impairment (CI) reside with a caregiver, an estimated 800,000 live alone. Such individuals may have an increased risk for injury to self or others through self-neglect as a result of the CI symptoms. While persons living alone with CI have been identified as an important area for needed research, few studies have been able to examine this population due to the challenges of identifying and recruiting study participants. By using the National Health & Aging Trends Study data set, the researchers explored the characteristics to describe this population. The results of this study indicated that the majority of persons living with CI were older, widowed females who were not diagnosed with Alzheimer's or dementia but tested positive on cognitive screening measures. Further, the majority of persons living alone with CI relied on adult children and paid professionals as the primary care providers.

The relationships among perceived discrimination, self-perceptions of aging, and depressive symptoms: a longitudinal examination of age discrimination.

OBJECTIVES: This study examined the relationship between changes in perceived discrimination and changes in depressive symptoms among older people. The association between perceived age discrimination and depressive symptoms was also analyzed longitudinally along with tests to determine whether self-perception of aging mediates this association. METHOD: Data from two waves (2008 and 2012) of the Health and Retirement Study were used. Longitudinal models were tested using a nationally representative sample of 3921 participants who responded to psychosocial questionnaires in both waves and answered questions about perceived everyday discrimination and attributions of discrimination in 2008. RESULTS: Changes in perceived discrimination was significantly associated with changes in depressive symptoms over time. Perceived age discrimination was significantly related to a change in depressive symptoms over four years and self-perceptions of aging mediated the relationship between perceived age discrimination and depressive symptoms. CONCLUSION: Findings demonstrate the importance of recognizing perceived discrimination and negative self-perceptions of aging as well as how the negative effects of age discrimination on self-perceptions of aging can be risk factors for the development of depressive symptoms in late life.

How Does Bereavement Get Under the Skin? The Effects of Late-Life Spousal Loss on Cortisol Levels.

OBJECTIVES: We used data from the Changing Lives of Older Couples, a prospective multiwave study of 1,532 married individuals aged 65 and older, to investigate the extent to which spousal loss and death-context characteristics are associated with the stress hormone cortisol at 6 (W1) and 18 (W2) months postbereavement. METHOD: We used ordinary least squares regression models to estimate the effects of death-context characteristics (forewarning, caregiving, and postloss numbness, reported at W1) on cortisol levels (at W1 and W2). We included age and gender and evaluated a two-way interaction term between gender and death circumstances. RESULTS: Bereaved spouses who reported prolonged forewarning of the death evidenced higher cortisol levels at W1 than those who did not experience prolonged forewarning. Bereaved women had higher cortisol levels than bereaved men at W1. A two-way interaction between gender and emotional numbness was statistically significant, where men (but not women) who experienced postloss numbness had elevated cortisol levels at W2. DISCUSSION: Our findings reveal that stressful life events are associated with stress-related neuroendocrine reactions for longer durations than researchers have previously documented. The specific death-related stressor affecting cortisol varies by gender. Implications for research and practice are discussed.

The biopsychosocial model and quality of life in persons with active epilepsy.

BACKGROUND: Despite a long recognized need in the field of the importance of the psychological and social factors in persons with epilepsy (PWE), the medical community has continued to focus primarily on seizures and their treatment (the biological-biomedical model). From the biopsychosocial perspective, a person's lived experience needs to be incorporated into the understanding of quality of life. While the biopsychosocial model has gained prominence over the years, it has not been studied much in epilepsy. METHODS: The study sample included 1720 PWE from the 2003 and the 2005 Canadian Community Health Survey (CCHS). Data were analyzed using set correlation, as it allows for the examination of the relative contribution of sets of independent variables (biological, psychological, and social domains) and a set of dependent variables (quality of life) of interest, defined as self-rated health status, self-rated mental health status, and life satisfaction. RESULTS: Results provide strong evidence that the full biopsychosocial model explained a significantly larger amount of variance in quality of life (R(2) = 55.0%) compared with the biological-biomedical model alone (R(2) = 24.8%). When the individual domains of the biopsychosocial model were controlled for, the psychological (R(2) = 24.6%) and social (R(2) = 18.5%) domains still explained a greater amount of the variance in quality of life compared with the biological-biomedical model (R(2) = 14.3%). CONCLUSIONS: While seizure freedom will continue to be an important treatment goal in epilepsy, the psychological and social domains are an important consideration for both interventional programs and clinical research designed to improve quality of life in PWE. Better integration of social workers and psychologists into routine care may help address these disparities.

Inclusion or exclusion? Exploring barriers to employment for low-income older adults.

Faced with economic uncertainty and declining retirement security, older adults have increasingly tried to remain in, or return to, the workforce in recent years. Unfortunately, a host of factors, such as ageism and changing skill requirements, present challenges for older adults seeking employment. Low-income older adults, in particular, may lack necessary education and skills and have limited access to job opportunities and training. In this review, we examine factors that inhibit and support employment for low-income older adults and explore the role of social work in facilitating their inclusion in the workforce.

Length of caregiving and well-being among older widowers: implications for the dual process model of bereavement.

The intent of this study was to examine if length of caregiving was associated with older widowers' adjustment to bereavement and to identify factors, based on principles underlying the Dual Process Model of Bereavement, that might mitigate the potential adverse effects of time spent caring. Two-hundred men over the age of 60 and in the second year of bereavement were identified from death records of older women who had died within a 12-month period. Interviews lasted about 2 hours and focused on widowers' experiences surrounding their wives' deaths along with questions about social support, health, retirement, and other demographic information. The Bradburn Affect Scale was used to measure positive and negative affect. Restoration-oriented coping, such as starting new relationships and activities were measured. These variables included extent of family contact, number of friends, having a confidante, involvement with neighbors, and participation in sports and clubs. Time since death and demographic variables were used as controls. Hierarchical linear regression was conducted on positive and negative affect after which potentially moderating effects were analyzed. Results indicated that the most important influences on negative affect were time since death, ethnicity, and participation in clubs while for positive affect the most significant factors included length of caregiving, number of friends, and having a confidante. Although no interaction effects were significant, patterns emerged. Implications for applying the DPM with older bereaved men are made.

Simulating age-related changes in color vision to assess the ability of older adults to take medication.

OBJECTIVE: To determine if simulated, age-related changes in color vision can adversely affect one's ability to properly take medication as simulated by bead selection. DESIGN: Randomized controlled study. SETTING: University site. PARTICIPANTS: University students 18 to 26 years of age without eye disorders that would affect color vision. INTERVENTIONS: Yellow-lens glasses to represent age-related color vision changes. MAIN OUTCOME MEASURES: The number of correct beads selected and rating of task difficulty. The secondary outcomes were participants' responses based on which colors and color pairs were most difficult to discern and strategies they might have used to select beads. RESULTS: The control group had no difficulties in selecting the appropriate beads, while the experimental group had significantly more mistakes, particularly with colors in the blue-violet spectrum. Average scores for the total number correct for the control and experimental groups were 36 (100%) and 27 (74.4%), P < 0.001, respectively, out of a possible 36 correct. CONCLUSION: Declines in color vision with age can adversely affect an individual's abilities to appropriately select medications. For patients taking several medications, declines in color vision should be considered when counseling older persons on strategies for compliance. Although more studies are still needed to further generalize these findings to the geriatric population, this study has shown color vision can adversely affect medication compliance.

The dying role.

BACKGROUND: Roles are relevant during the last stage of the life cycle, as at any other stage. Awareness and an understanding of the dying role have the capacity to guide the process. Lack thereof can impede good deaths and may have been in part responsible for the intense and often futile interventions provided to many dying patients in the past. OBJECTIVE AND DESIGN: We describe relevant aspects of role theory and recent scholarship and then examine the dying role, describing three key elements: the practical element, which involves concrete tasks of preparation; the relational element, which involves engaging with others; and the personal element, which involves tasks that foster personal growth and finishing one's life story. We also identify some barriers to and misuses of the dying role that appear to limit productive engagement with it, and offer suggestions for how clinicians can assist patients with the dying role. RESULTS AND CONCLUSION: The described elements of the dying role, and appreciation of how to avoid barriers and facilitate its implementation, can help patients access the unique quality of life that can occur near the end of life.

A dual process model of grief counseling: findings from the Changing Lives of Older Couples (CLOC) study.

This paper tests Stroebe and Schut's Dual Process Model of Bereavement using data from the Changing Lives of Older Couples (CLOC), a prospective study of 1,532 married persons over the age of 65. This analysis focused on a weighted sample of 104 widowers and 492 widows at six months, 18 months, and four years later. Bradburn's Affect Balance Scale was used as the dependent variable, and the independent variables were based on Stroebe and Schut's bereavement model. The multiple regression analyses revealed that loss- and restoration-oriented activities were important throughout bereavement. Implications for bereavement counseling are discussed.

Driving cessation and consumption expenses in the later years.

OBJECTIVES: This study examined the association between consumption and driving status among older persons within the context of selected variables, including self-rated health and functional status. METHODS: The data were from the 1998, 2000, and 2002 Health and Retirement Study and the 2003 Health and Retirement Study Consumption and Activities Mail Survey. We conducted Tobit regression analyses on five consumption categories of basic needs (such as food) and higher order needs (such as trips and dining out). RESULTS: Consumption and driving status were significantly associated, showing that driving cessation was related to a 46% to 63% reduction in spending on trips, tickets, and dining out. Another significant relationship emerged between consumption and having never driven. Driving cessation was minimally related to consumption of basic needs (such as food and clothing) and was more strongly associated with higher order needs (such as trips). DISCUSSION: The findings demonstrate the association between older people's driving status and consumption, specifically higher order activities. Older persons who drive and, presumably, have more opportunities to go to stores, restaurants, and other outside events, spend more on food, tickets, and dining out than those who cease driving or have never driven. Although the direction of causality remains unclear, these findings have implications for those concerned with alternative transportation resources for older adults.

An analysis of an older driver evaluation program.

OBJECTIVES: To identify elements of an older driver evaluation program that predict driving performance in older adults. SETTING: Outpatient medical clinic in an academic medical center. DESIGN: A retrospective analysis. PARTICIPANTS: Six hundred sixty-four older adults who were referred to an older driver evaluation program. MEASUREMENTS: A physician trained in geriatric medicine and a clinical geriatric nurse specialist oversaw an experienced driving evaluator and an occupational therapist who conducted assessments of older persons' functional status; reaction time; driving skills; and cognitive, hearing, and vision abilities. Self-report data along with a medical history submitted by patients' primary care physicians supplemented the clinical assessments. RESULTS: A multinomial logistic regression revealed that the Mini-Mental State Examination (MMSE), cues needed with the Trail Making Test, Part B, grip strength, and an interaction effect between the MMSE and reaction time constituted the most parsimonious model for predicting on-the-road performance. A receiver operating characteristic analysis indicated that this index had good sensitivity but low specificity. A binomial regression comparing imperfect and perfect drivers demonstrated the significance of the Traffic Sign and Visual Perception tests. CONCLUSION: Clinicians should employ a multilevel screening process that includes initial cognitive tests, such as the MMSE and the Trail Making Test, Part B, although more studies of driving evaluation programs in medical settings that include random samples of older drivers are needed.