Further Psychometric Evaluation of the Eight-Item Hospice Philosophy Scale: Results From a National Sample of Interdisciplinary Hospice Clinicians.

This study examined the psychometric properties of the eight-item Hospice Philosophy Scale (HPS-8) through confirmatory factor analysis; differential item functioning by age, gender, race, and professional discipline; and internal consistency reliability. We administered the HPS-8 to a national convenience sample of 471 interdisciplinary hospice clinicians. Confirmatory factor analysis results supported a one-factor model with an error correlation between two similarly worded items, χ2(19) = 48.38, p < .001 (RMSEA = .06, SRMR = .03, CFI = .98, TLI = .97). "Multiple indicators, multiple causes" model results indicated differential item functioning by age, race, and/or professional discipline on five items. However, subsequent uncorrected and differential item functioning-corrected models detected no statistically significant HPS-8 mean differences by grouping variables. Composite reliability results (CR = .82) demonstrated acceptable internal consistency reliability. Our results support the HPS-8 as a valid and reliable measure of attitudes toward the hospice philosophy of care in hospice clinicians.

Racial/ethnic/gender-Based Differences in Health Trajectories Among American Older Adults: 10-Year Longitudinal Evidence from the Health and Retirement Study.

Health disparity by race/ethnicity or gender has been well-documented. However, few researchers have examined health outcomes based on the intersection of individuals' race, ethnicity, and gender or investigated various health dimensions. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in trajectories of multiple health outcomes over a ten-year period among American older adults. Longitudinal data from the Health and Retirement Study (2004-2014) were used (N = 16,654). Older adults (65+) were stratified into six mutually-exclusive groups based on their race, ethnicity, and gender: Non-Hispanic (NH) White Men, NH White Women, NH Black Men, NH Black Women, Hispanic Men, and Hispanic Women. Growth curve models examined the trajectories of three health measures, including cognitive function, physical function limitations (i.e. activities of daily living and instrumental activities of daily living), and depressive symptoms. NH White men and women reported significantly better outcomes in cognition and physical function trajectories than racial/ethnic minority groups. Women in all racial/ethnic groups had more depressive symptoms but better cognition than men. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the worst physical function limitations. NH Black men/women were the most disadvantaged in cognition. Racial/ethnic/gender-based differences were stable over time in all health trajectories. Study findings highlight the utility of an intersectional framework in understanding how multiple social identities intersect to generate protective and/or risk effects on cognitive, mental, and physical health. Multilevel intervention strategies are warranted to reduce the persistent health inequity gap.

Who Cares for Older Adults? A Cross-National Study of Care Sources for Older Adults With Functional Limitations and Associated Determinants.

The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.

Using Voice and Touchscreen Controlled Smart Speakers to Protect Vulnerable Clients in Long-Term Care Facilities.

Background and Objectives: The Centers for Medicare and Medicaid Services restricted long-term care facility visitation to only essential personnel during the coronavirus disease 2019 pandemic. The Maryland Department of Human Services distributed Amazon Echoshow 8 voice and touchscreen controlled smart speakers (VTCSS) to a sample of their institutionalized guardianship clients to enhance caseworker access during the pandemic. Research Design and Methods: This pilot study focused on understanding VTCSS use challenges and the effects on clients' safety and well-being. Two focus groups were conducted with caseworkers (N = 16) who piloted the devices. The interviews were recorded, transcribed, and analyzed using open and axial coding. Results: Four themes were identified, including challenges to providing casework during the pandemic (e.g., facility technology gaps), challenges to device installation and use (e.g., privacy concerns), strategies for overcoming challenges (e.g., alert features), and benefits (e.g., stimulation, care monitoring) and uses (e.g., enhanced access, entertainment). Discussion and Implications: VTCSS show great promise to engage the client, maintain visual access, and monitor quality of care. However, facilitating access to such technology requires planning and training before installation.

Factors Associated With Attitudes Toward Older Adults in Social Work Students: A Systematic Review.

This systematic review examined the factors associated with social work students' attitudes toward older adults or working with older adults from the literature published in the last decade. Twelve peer-reviewed empirical studies published between 2011 and 2020 were included for review. Results suggest that both direct and indirect exposures to older adults positively changed social work students' attitudes. While infusing exposure to older adults into courses appeared effective in modifying students' attitudes, inconsistent measurement and lack of information across studies made it impossible to compare the effectiveness of interventions across studies. Implications for gerontological social work education are discussed.

Intersectional Discrimination Attributions and Health Outcomes Among American Older Adults: A Latent Class Analysis.

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged ≥50) from the Health and Retirement Study in 2014-2015 were included (N = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life.

Organizational Characteristics Associated With the Predicted Sustainability of Villages.

Guided by resource dependence theory, this mixed-methods study examined organizational characteristics contributing to the perceived sustainability of Villages, a rapidly proliferating grassroots approach for promoting social participation and service access for community-dwelling older adults. Surveys conducted with leaders of 86% of Villages in the United States in 2012 found that higher predicted confidence in their Village's 10-year survival was associated with greater financial reserves, human resources, number of Village members, formal policies and procedures, and formal collaboration agreements. Respondents' explanations of their confidence ratings revealed additional themes of organizational leadership and perceived community need. Member resource inputs were not found to be as salient for Village leaders' perceptions of sustainability as was anticipated given the Village model's emphasis on consumer involvement. Despite the lack of longitudinal prospective data, study findings suggest potential limitations of consumer-driven organizational models such as Villages, including the need for a more stable resource base.

The Relationship Between Depressive Symptoms and Health Services Utilization in U.S. Chinese Older Adults.

BACKGROUND AND OBJECTIVES: Depressive symptomatology is a significant predictor of increased health services utilization and health care cost in the general older adult population. However, there is scant information on the relationship between depressive symptoms and health service utilization among U.S. Chinese older adults. The objective of this study was to examine the relationship between depressive symptoms and physician visits, emergency department (ED) visits, and hospitalization. RESEARCH DESIGN AND METHODS: Cross-sectional data were derived from the Population Study of Chinese Elderly in Chicago (PINE) collected between July 2011 and June 2013 (N = 3,159). Depressive symptoms were measured by the nine-item Patient Health Questionnaire (PHQ-9). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between depressive symptoms and physician visits, ED visits, and hospitalization. RESULTS: U.S. Chinese older adults with depressive symptoms were more likely to have at least one ED visit (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 1.44-2.28) and hospitalization (OR = 1.9, 95% CI = 1.47-2.33) in the past 2 years than those without depressive symptoms, while adjusting for sociodemographic and health-related covariates. Other significant factors associated with health services utilization in this population included number of people in household, health insurance coverage, and acculturation. DISCUSSION AND IMPLICATIONS: Depressive symptoms are positively associated with hospitalization and ED visits among U.S. Chinese older adults. Routine screenings of depressive symptoms should be part of the clinical encounter in these care settings so that appropriate treatment or timely mental health service referrals could be provided to this population to ultimately optimize their utilization of health services.

Loneliness, Depressive Symptoms, and Cognitive Functioning Among U.S. Chinese Older Adults.

Objective: Loneliness has been associated with cognitive functioning in the general older adult population. Previous studies further indicate that loneliness has a strong association with depressive symptoms and the two constructs can reinforce each other to diminish well-being. However, such relationships have not been examined in U.S. Chinese older adults. This study attempts to bridge this knowledge gap. Method: Data were drawn from a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. Stepwise multivariate regression analyses were conducted to examine the relationship between loneliness, depressive symptoms, and global cognitive functioning. Results: Loneliness was associated with poor global cognitive functioning in U.S. Chinese older adults, though the relationship became nonsignificant after adjustment for depressive symptoms. The interaction term between loneliness and cognitive functioning was statistically significant (p < .01). The findings further highlight the importance of age, education, number of children, number of people in household, and length of residence in the U.S. in cognitive functioning among U.S. Chinese older adults. Discussion: The study findings indicate that loneliness and depressive symptoms act together to influence cognitive functioning in U.S. Chinese older adults. Research and clinical implications of the findings are discussed.

Identifying distinct risk profiles to predict adverse events among community-dwelling older adults.

Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p < 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults.

Variations on the Village Model.

Villages, which are community-based initiatives designed to help older adults age in place through a combination of services, participant engagement, and peer support, have expanded rapidly since their initial development in the early 2000s. Using a sample of Villages in the United States, we examined variations from characteristics of the Village model as portrayed by media and organizational leaders. Results indicate there is no uniform Village model that can be implemented and evaluated by policy makers, funders, service providers, and researchers. Based on the extent of member involvement, methods of service provision, and funding sources, we developed a conceptually and empirically informed typology of Villages that reflects the model's focus on consumer involvement. Descriptive analyses indicate potential differences in member, community, and organizational characteristics. This emerging typology has implications for understanding the implementation and sustainability of Villages, including whether specific Village types are best suited to certain community contexts.

Aging in Community: Developing a More Holistic Approach to Enhance Older Adults' Well-Being.

Public health advances have contributed to increased longevity; however, individuals are more likely to live longer with multiple chronic conditions. The existing health care system primarily focuses on treating disease rather than addressing well-being as a holistic construct that includes physical, social, and environmental components. The current commentary emphasizes the importance of supporting healthy active aging and aging in community. The barriers to aging in community and the state of the intervention science in response to this problem are discussed, and recommendations for future research are provided. Active aging is more than managing illness or care transitions-it promotes engagement, participation, dignity, self-fulfillment, self-determination, and support for older adults. To support aging in community and healthy active aging, a paradigm shift is needed in how the well-being of older adults is thought about and supported.

Perceived Challenges to the Sustainability of Community-Based Aging Initiatives: Findings from a National Study of Villages.

Concerns have been raised regarding the sustainability of Villages, a rapidly-expanding set of organizations that typically use a participant-directed approach to improve older adults' quality of life and ability to age in place. Using online survey and telephone-interview data from a 2013 follow-up study of Villages across the United States, this study examined organizational leaders' perceptions of the major challenges to sustainability. Major challenges identified included: (a) funding, (b) membership recruitment, (c) leadership development, (d) meeting members' service needs, and (e) limitations of the Village model itself. Findings point to a number of important considerations for the development, implementation, and sustainability of the Village model, including the role of social workers in addressing these challenges.

Understanding inequities in home health care outcomes: staff views on agency and system factors.

Results regarding staff perspectives on contributing factors to racial/ethnic disparities in home health care outcomes are discussed. Focus group interviews were conducted with home health care staff (N = 23) who represented various agencies from three Northeastern states. Participants identified agency and system factors that contribute to disparities, including: (a) administrative staff bias/discretion, (b) communication challenges, (c) patient/staff cultural discordance, (d) cost control, and (e) poor access to community resources. Participants reported that bias can influence staff at all levels and is expressed via poor coverage of predominantly minority service areas, resulting in reduced intensity and continuity of service for minority patients.

Does the Village model help to foster age-friendly communities?

This article explores the potential role of the Village model, a social initiative that emphasizes member involvement and service access, in helping communities to become more age-friendly. A survey of 86.3% of operational Villages examined activities designed to help members access a variety of supports and services consistent with the World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities program model, as well as other potential contributions to community age friendliness. Analysis revealed that 85.5% of Villages provided assistance with at least six of the eight WHO domains, but only 10.1% implemented features of all eight; more than one-third were engaged in direct or indirect efforts to improve community physical or social infrastructures or improve community attitudes toward older persons. These findings suggest that Villages and other social organizations may have untapped potential for enhancing their members' ability to age in place consistent with the goals of age-friendly initiatives while also promoting constructive changes in the overall community.

A tale of two community initiatives for promoting aging in place: similarities and differences in the national implementation of NORC programs and villages.

PURPOSE: Villages and Naturally Occurring Retirement Community (NORC) Supportive Service Programs (NORC programs) are among the most prominent community-based models for promoting aging in place. To advance systematic understanding of their development, this study examined how these models have been implemented nationally and the models' similarities and differences. DESIGN AND METHODS: A survey of program leaders representing 69 Villages and 62 NORC programs was conducted from January to June of 2012. Bivariate analyses compared measures of the initiatives' services/activities, beneficiaries, service delivery processes, and funding sources. RESULTS: Village members were reportedly more likely than NORC program participants to be younger, to be less functionally impaired, to be more economically secure, and to reside in higher socioeconomic communities. Reflecting these differences in populations served, NORC programs reported offering more traditional health and social services, had more paid staff, and relied more on government funding than Villages. IMPLICATIONS: Findings indicate that Villages and NORC programs both aim to promote aging in place by offering a diverse range of supports and services to older adults within a locally defined geographic area. Nevertheless, key differences were found in the means through which they seek to achieve these aims, as well as the populations likely to benefit from their efforts. These differences raise questions regarding the models' inclusivity, sustainability, expansion, and effectiveness and have implications for community aging in place initiatives more broadly.

The Outcome and Assessment Information Set (OASIS): a review of validity and reliability.

The Outcome and Assessment Information Set (OASIS) is the patient-specific, standardized assessment used in Medicare home health care to plan care, determine reimbursement, and measure quality. Since its inception in 1999, there has been debate over the reliability and validity of the OASIS as a research tool and outcome measure. A systematic literature review of English-language articles identified 12 studies published in the last 10 years examining the validity and reliability of the OASIS. Empirical findings indicate the validity and reliability of the OASIS range from low to moderate but vary depending on the item studied. Limitations in the existing research include: nonrepresentative samples; inconsistencies in methods used, items tested, measurement, and statistical procedures; and the changes to the OASIS itself over time. The inconsistencies suggest that these results are tentative at best; additional research is needed to confirm the value of the OASIS for measuring patient outcomes, research, and quality improvement.

Racial/ethnic disparities in home health care: charting a course for future research.

Racial/ethnic disparities in health have been well-documented. However, we know little about the existence of or mechanisms that contribute to disparities in home health care. This article proposes a conceptual framework, based on a comprehensive review of the literature, to guide research to understand whether and how disparities emerge in home health care. The framework outlines the patient, agency, practice, and system factors that have been shown to or theoretically could contribute to disparities. Enhanced parity in home health care will impact society by reducing health costs due to morbidity, while directly benefiting minority patients.