[What influences life satisfaction in old age? Representative study for home health care and custodial support in German-speaking Switzerland]. / Was beeinflusst die Lebenszufriedenheit im hohen Alter? Repräsentative Studie zur ambulanten Altenpflege und -betreuung in der Deutschschweiz.

BACKGROUND: Most older adults wish to stay in their own homes even after the onset of care dependency, which is enabled by different care arrangements. General life satisfaction can serve as a criterion for assessing the functionality of these arrangements. METHODS: The study is based on a standardized survey (face-to-face interviews; n=712) performed in 2009/2010. The population consisted of persons aged ≥70 years, with a need for care, living in one of three selected Swiss German-speaking cantons. The dataset is a representative sample of the population. RESULTS: The following results were found with regard to the surveyed target group of persons aged ≥70 years, living at home and receiving formal and/or informal care: the need for care of persons ≥80 is not greater than that of persons aged 70-79 years and is not decisive for general life satisfaction. Strength of social network, presence (or absence) of pain, and satisfaction with care are more important. The odds of being satisfied with life are greater with increasing age. The social network of persons ≥80 is weaker than that of persons aged 70-79 years but contributes nonetheless to satisfaction with life.

A custódia e o tratamento psiquiátrico no Brasil. Censo 2011 / The psychiatric treatment and custody in Brazil. Census 2011

Este livro apresenta o censo de uma população invisível - os loucos infratores habitantes dos 26 estabelecimentos de custódia e tratamento psiquiátrico no Brasil em 2011. São 3.989 homens e mulheres vivendo em regime de clausura para tratamento psiquiátrico compulsório por determinações judiciais: um contingente temido, pois são indivíduos tidos como perigosos para a vida social.

Foster care, residential care and public care placement patterns are associated with adult life trajectories: population-based cohort study.

OBJECTIVES: Childhood experiences of public care may be associated with adult psychosocial outcomes. This study aimed to evaluate the associations of four public care exposures: type of placement, length of placement, age at admission to care and number of placements, as well as the reasons for admission to public care with emotional and behavioural traits at age 30 years. METHODS: Participants included 10,895 respondents at the age 30 survey of the 1970 British Cohort Study (BCS70) who were not adopted and whose care history was known. Analyses were adjusted for individual, parental and family characteristics in childhood. RESULTS: Cohort members with a public care experience presented lower childhood family socio-economic status compared with those in the no public care group. After adjusting for confounding, exposure to both foster and residential care, longer placements and multiple placements were associated with more extensive adult emotional and behavioural difficulties. Specifically, residential care was associated with increased risk of adult criminal convictions (OR = 3.09, 95% CI: 2.10-4.55) and depression (1.81, 1.23-2.68). Multiple placements were associated with low self-efficacy in adulthood (OR = 3.57, 95% CI: 2.29, 5.56). Admission to care after the age of 10 was associated with increased adult criminal convictions (OR = 6.03, 95% CI: 3.34-10.90) and smoking (OR = 3.32, 95% CI: 1.97-5.58). CONCLUSION: Adult outcomes of childhood public care reflect differences in children's experience of public care. Older age at admission, multiple care placements and residential care may be associated with worse outcomes.

The vulnerablility for elder abuse among a sample of custodial grandfathers: an exploratory study.

Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.

The role of a rural sobering-up centre in managing alcohol-related harm to Aboriginal people in South Australia.

There is a paucity of literature on the topic of sobering-up centres (non-custodial safe overnight accommodation for the publicly intoxicated). This paper presents findings of a retrospective longitudinal case study of a sobering-up centre in regional South Australia over the ten years 1991 to 2000. There were 6,486 admissions during this period, 97.1% of which were of Aboriginal people. We collated and analysed primary data including demographic details of admissions and re-admissions, and qualitative and quantitative measures of intoxication. The findings from this case study, considered together with contextual understandings from a wider social study in this region by three of the authors, provide supporting evidence of the important role of sobering-up centres in averting the known harms of a custodial response to public drunkenness, as well as avoiding the potential harm of alcohol-related injury among vulnerable Aboriginal people.

What price do we pay to prevent alcohol-related harms in Aboriginal communities? The Alice Springs trial of liquor licensing restrictions.

This paper analyses the trial of alcohol restrictions that was implemented in Alice Springs in the Northern Territory from April 2002 to June 2003. The trial included a ban on alcohol in containers greater than 2 litres and reduced take-away trading hours. The history of the trial, its findings, and the different interpretations placed on trial data is discussed. Particular emphasis is placed on evidence indicating a link between alcohol price and consumption. Data from the evaluations of the Alice Springs trial are reviewed. The trials adds substantial new evidence to the strength of the relationship between alcohol price, consumption and harm as the restrictions led to a 1000% increase in the sale of the cheapest form of alcohol-2-litre port. Recent proposals for supply reduction strategies such as a tiered volumetric tax on alcohol and a trial of alcohol restrictions based on a minimum price benchmark demand further consideration by policy makers, especially in regions marked by a excessive alcohol consumption and a high burden of alcohol-related harms such as Alice Springs.

Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations.

This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.

Low-care residents in nursing homes: the impact of market characteristics.

Approximately 30% of nursing home residents were recently identified as low-care cases; that is, residents with low levels of acuity. Other institutional venues, board and care homes and assisted living facilities, for example, are often recommended as alternative domiciliaries providing more appropriate and less expensive care for these residents. In this investigation the effect of nine market factors on the prevalence of low-care residents in 14,646 nursing homes are studied. Government regulations, competition from other providers, and the overall munificence of the market are found to influence their prevalence. These results are discussed along with several issues inherent to channeling low-care residents to other care setting.

Residence differences in formal and informal long-term care.

This study, using a large, nationally representative sample of noninstitutionalized disabled older persons, found that urban residents were much more likely than rural residents to receive formal assistance in every ADL and IADL considered. Rural residents were more likely to receive informal assistance and to receive two-thirds more person days of informal assistance per week. No residence differences in unmet need for care were identified.

Acute and custodial care among impaired aged.

The authors surveyed a community-based population of 628 persons who were 65 and over and who lived either in a rural Maryland county or in Baltimore. For each subject, the number of different medical problems, the subject's capacity to perform physical tasks, and the ability to function were assessed. The number and type of medical problems tended to be the best predictors of whether or not hospital or physician's office care were used, and of the volume of physician's office visits for subjects who sought outpatient care. The subject's ability to function was the best predictor of whether or not the subject used a paid home aide and the volume of family caregiving. Implications for research on association between need and use of long-term care are discussed.