Political Discourse and Aging in a Neoliberal Singapore: Models of Citizenship, Older Adults and Policy Initiatives.

Singapore now faces one of the fastest aging populations in the world, leading the country's political leaders to fear the implications of population aging for the country's economic viability. We analyzed National Day Rally speeches from 2011 to 2015 by Prime Minister Lee Hsien Loong to examine how policymakers conceptualized the challenges related to its aging population. Findings point to the government's manifest and latent emphasis on its economic viability when developing social policies to address the well-being of its aging population. Its approaches to welfare provision are informed by a neoliberalist agenda that requires its citizens to exercise personal responsibility and self-reliance, and to rely on their family and community for mutual assistance. Despite its highly interventionist approach, the government is clear about its residual role in the provision of safety nets. A neoliberalist reconceptualization of citizenship serves to restrict older citizen's claims to basic social assistance.

Activity Patterns Associated With Health Status in Later Life Among Singaporeans.

Research on activities overlooks the possibility that older adults engage in different activities contemporaneously. To address this gap, we used latent class analyses to identify activity patterns and then examined demographic and health correlates of these patterns among a nationally representative sample of older adults in Singapore. We identified four classes of activities: the family-focused instrumental activity (FIA) class, the social leisure activity (SLA) class, the multidynamic activity (MDA) class, and the passive activity (PA) class. Furthermore, the MDA members showed higher scores in their mental health. Worse physical functioning and higher depression scores also increased the likelihood of being in the FIA and PA groups. Significant demographics such as gender, ethnicity, marital status, education, employment, house type, and income were related to heterogeneity in older adults' activity patterns. Service providers might consider the impact of certain significant demographic and health-related correlates when planning programs to ensure greater reach and access.

Foreign Domestic Workers and Eldercare in Singapore: Who Hires Them?

In Singapore, policy makers expect families to remain actively involved in the care of their frail older relatives, as manifestly expressed in its Many Helping Hands approach to long-term care. To enable families to fulfill this expectation, the government has enacted policies that encourage the hiring of foreign domestic workers (FDWs) to complement or supplement informal caregiving efforts. Using the Andersen Behavioral Model, we were interested in identifying caregiver and care receiver characteristics that might predict the hiring of FDWs. With data from a convenience sample of 488 informal caregivers, we ran logistic regression regressing the hiring of an FDW on various predisposing, enabling, and need factors. Of interest, enabling factors such as household income, housing type, and educational level were predictive of hiring an FDW in the home. Only one need factor, time spent in caregiving, was predictive of the increased likelihood to hire an FDW. Policies that encourage the marketization of care are likely to favor those with financial means and inadvertently ignore the caregiving burdens of lower income families. In addition, we suggest research and policies to ensure the well-being and protection of FDWs who have become a key component of the long-term care policy and practice in Singapore.

Social Support and Self-Rated Health of African American Women Informal Caregivers: Urban and Rural Differences.

In this study, we examined how geographic location might differently influence social support and self-rated health for rural and urban African American women caregivers. We used cross-sectional data from 253 urban and 263 rural women primary caregivers. Controlling for key demographic factors, we regressed caregivers' self-rated health on social engagement, structural, and functional aspects of social support for urban and rural caregivers separately. The perception of family functioning was positively associated with urban and rural caregivers' self-rated health. Urban caregivers reported having significantly more contact with their family and more informal helpers compared to rural caregivers. Furthermore, church attendance, a measure of social engagement, was significant for urban caregivers' self-rated health, but not rural caregivers. Our findings affirmed the importance of foregrounding context and disaggregating social support, and point to the need for interventions targeting family functioning and paying attention to geographic location.

"Many Helping Hands": a review and analysis of long-term care policies, programs, and practices in Singapore.

Using the political economy perspective to examine key long-term care policies and provisions, we uncover some ideological underpinnings of policy-making in Singapore. Family involvement, an inherent part of the long-term care system, is overtly reinforced by legislations and policy imperatives. Further, the government encourages and expects the participation of nonstate actors in the provision of services as part of its Many Helping Hands approach to welfare provision. In our analysis, we argue that the government's emphasis of certain ideology, such as self-reliance and cultural exceptionalism, allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.

Selection, optimization, and compensation: strategies to maintain, maximize, and generate resources in later life in the face of chronic illnesses.

This qualitative study of 45 older adults examines how they allocate their resources in the face of chronic health conditions. Participants were recruited from 2 senior centers and interviewed about their repertoire of activities, any changes in those activities in later life, and meanings they ascribed to those changes. The Selection, Optimization, and Compensation model guided our analysis and interpretation of participants' responses. The findings demonstrate the complexity of participants' responses to age-related changes, particularly in how they adapted and negotiated both their perception and life goals when faced with changing social landscapes. We discuss some implications and nuances of our findings.

Implementing a gero-infused curriculum in advanced-level MSW courses in health, mental health and substance abuse: an evaluation.

This article presents evaluation results from a curricular innovation aimed at increasing the capacity of social work graduates to serve older adults in health, mental health, and substance abuse settings. Working as a team, faculty developed, incorporated, and evaluated gerontology-infused syllabi and teaching modules in multiple sections of the 3 courses, with 2 sections serving as a comparison group. Results indicated that students exposed to the gero-infused curriculum increased their age-related knowledge and self-competence from pre- to posttest, and achieved a greater increase in knowledge than did the comparison group. Implications of the findings to social work education are discussed.

An examination of the measurement adequacy of the CES-D among African American women family caregivers.

The Center for Epidemiologic Studies Depression Scale (CES-D) has been used extensively in community-based surveys to describe and explain the prevalence of depression in the general population. Yet, questions have been raised regarding its adequacy for use among ethnic minority because of its factor variance. Employing a within-gender and race approach, we test the validity of the CES-D for use among a sample of African American women family caregivers. Using data from a cross-sectional community sample of 521 urban and rural African American women family caregivers, this study examines the dimensionality of the CES-D by testing four different measurement models through confirmatory factor analyses. Among the four measurement models tested using Weighted Least Squares estimation, our findings support previous research that has identified four dimensions in the CES-D: depressed affect, positive affect, somatic complaints, and interpersonal relations for our sample. Additionally, a three-factor (somatization) model and a four-factor model were shown to be equivalent. Implications for further measurement and model testing, and the use of the CES-D for research among African American women caregivers are discussed.

'So forget how old I am!' Examining age identities in the face of chronic conditions.

This study examines the construction of age identity among older people with chronic conditions. Semi-structured interviews were conducted with 45 participants from two senior centres. Applying symbolic interactionism and the concept of stigma to participants' narratives, we identified three categories of age identities: definitely old; definitely not old; and ambivalent about their age identity. Further, we examined the metaphors of agelessness and the mask of ageing, the relationship between chronological age and age identity as well as the age-related stereotypes that older people offered in their narratives of their experience of old age. Ideas about the meaning of old age itself varied, with some focusing on predominantly negative descriptors, while others saw it positively, i.e. as a time allowing for more freedom and self-exploration. The influence of chronic conditions on older adults' age identities is more complex and nuanced than the characterisations promoted by ageist stereotypes.

When the private sphere goes public: exploring the issues facing family caregiver organizations in the development of long-term care policies.

Though family caregiving forms the backbone of the long-term care system in the United States, long-term care policies have traditionally focused on paid services that frail older people and people with disabilities utilize for their day-to-day functioning. Part of the exclusion of family caregiving from the long-term care discourse stems from the traditional separation of the private sphere, where family caregiving occurs, from the public sphere of policy making. However, the passage of the Family and Medical Leave Act (FMLA), the National Family Caregiver Support Program (NFCSP) and Medicaid waiver legislation may reflect recent changes in the government's position on their role in addressing issues related to the "private spheres." In this article, we explore the nature of family caregiving in the United States, the divide between the public and private spheres and provide an overview of family caregiving-related policies and programs in the U.S. In our review, we examine the provisions in the FMLA, NFCSP, and Medicaid waiver legislation that support family caregiving efforts. We also examine the roles of family caregiver organizations in making family caregiving an important element of long-term care policy and influencing policy-making.

Familism beliefs and psychological distress among African American women caregivers.

PURPOSE: Drawing from stress and coping models, we examined heterogeneity in the expression of familism (i.e., beliefs about the caregiving role) and its impact on psychological distress among African American women caregivers. DESIGN AND METHODS: We relied on data from the Black Rural and Urban Caregivers Mental Health and Functioning study, a cross-sectional study of 521 midwestern African American women family caregivers. First we used the ordinary least squares regression method to examine the factors predicting caregiving beliefs. Subsequently, using hierarchical linear regressions, we regressed caregivers' depressive symptoms and perceived stress on their familism beliefs while controlling separately for interpersonal, personal, and situational contextual factors. RESULTS: Wife caregivers, caregivers with lower levels of education, and caregivers with lower levels of mastery held significantly more traditional caregiving beliefs. Also, having poor caregiving relationships; being younger; being unemployed; and having lower levels of education, self-rated health, and mastery were all associated with higher levels of depression and perceived stress in caregivers. Traditional caregiving beliefs were also significant predictors of higher levels of depression and perceived stress. IMPLICATIONS: Although familism is culturally and socially popular, traditional beliefs in the caregiving role can lead to negative psychological consequences for African American women caregivers. Policies that support the realistic involvement of caregivers are needed to prevent negative consequences for caregivers.

The application of the Olmstead decision on housing and eldercare.

This article reviews the Supreme Court's interpretation of Title II of the Americans with Disabilities Act (ADA) and discusses its application for the frail older person. The parallels and differences between the societal ideas about, and the development of, community-based housing programs for younger populations of people with disabilities and for aging populations will be examined. This article explains how frail older people may be included in the ADA's definition of persons with disabilities. It then explains the Supreme Court's interpretation of discrimination in Olmstead v. L.C. ex rel Zimring (1999). Lastly, it examines the implications of the Olmstead decision for long-term care as it relates to housing for older people.

Changes in the SF-12 among depressed elders six months after discharge from an inpatient geropsychiatric unit.

Using the SF-12 to measure physical and mental functioning, the authors examine the intra-individual changes in health-related quality of life (HRQOL) 6 months post-discharge for depressed older adults. In addition, they examine three sets of predictors that might influence these changes. The sample of depressed older adults was recruited from an inpatient geropsychiatry unit. Although their physical and mental health scores on the SF-12 were lower than comparable norms, the sample showed an average increase in their mental functioning but a decrease in the physical functioning over the 6 months. Negative life-events were significant predictors of people who reported no change in their mental health functioning and decreases in their physical health functioning. Interestingly, those who experienced positive life events were more likely to report declines and younger participants were more likely to report no change in their physical functioning. The findings indicate that the effects of depression on HRQOL can have enduring effects on a sample of previously hospitalized older adults. The significance of life event changes might signify the importance of taking into account non-traditional areas of medical interventions. Further, the findings indicate the usefulness of the SF-12 quantifying HRQOL outcomes.

Comparing the congruency of self-report and provider records of depressed elders' service use by provider type.

BACKGROUND: An accurate accounting of service use is necessary to understand use patterns and outcomes. Yet such an accounting remains challenging, in part because of the reliability and validity of the collection method and sources. OBJECTIVES: This study describes 2 methods of data collection: self-report and the retrieval of provider records. We report on the effort, yield, and challenges of retrieving records. Then, we compare the congruency and completeness of 2 methods: self-report and provider records. Finally, we examine the impact of various patients' characteristics on congruency rates. METHOD: Our sample of depressed older participants was recruited from an inpatient geropsychiatry unit before they were discharged into the community. We interviewed participants at 3 points during a 6-month period. Provider records were obtained across provider type, based on self-report and snowballing technique. We calculated congruency rates and examined completeness of either data source on 91 participants with completed provider records. Using logistic regression, we examined the differences in congruency by provider type as well as factors related to the congruency. RESULTS: The record retrieval process is labor-intensive and challenging. We found that congruency rates were statistically higher for pharmacy and hospital providers and lower for physicians. We also found higher counts of service use, higher depression levels, and being married were significantly related with lower congruency between self-report of service use and provider records. DISCUSSION: Although we found relatively high congruency rates between self-report and service records, the choice of methods depends on the purpose of the research and breadth of provider types.

Effects of volunteering on the well-being of older adults.

OBJECTIVES: This study tests the effects of volunteering on the well-being of older adults, including the effect of level of engagement, the moderating effects of demographic and social factors, and the effects of the nature of the volunteer experience. METHODS: This is a secondary data analysis of three waves of data from the Americans' Changing Lives Study. Self-rated health, functional dependency, and depression are regressed on the well-being measures from the previous waves, other control variables and volunteer status, volunteer hours, type and number of volunteer organizations, and the perceived benefit to others of the volunteer work. RESULTS: Older adults who volunteer and who engage in more hours of volunteering report higher levels of well-being. This positive effect was not moderated by social integration, race, or gender. There was no effect of the number of organizations for which the older adult volunteered, the type of organization, or the perceived benefit of the work to others. DISCUSSION: This work contributes to a knowledge base that points to the development of social programs and policies that maximize the engagement of older adults in volunteer roles. The findings suggest that targeting efforts may not be warranted, in that there are not differential benefits according to personal characteristics of the volunteer. Future studies have to address the nature of the social institutions that will maximize the number of elders in these roles and the benefits that they accrue.