A social work perspective: attitudes toward end-of-life planning.

This research examined social workers' attitudes toward end-of-life planning and related factors in a cross-sectional study (N = 844). Data were gathered on completion of a health care proxy, personal comfort, training experiences of social workers, and demographics. Attitudes toward end-of-life planning were related to personal completion of the health care proxy, personal comfort, and years of social work experience. These measures remained significant in all steps of the regression, regardless of practice grouping (health and aging or other than health and aging), suggesting the relative importance of personal rather than professional aspects. Respondents in the health and aging fields are older than those in other than health and aging, underscoring concerns about workforce issues in the field of aging.

Older Latinos' attitudes toward and comfort with end-of-life planning.

The purpose of this study was to determine which of two educational interventions delivered in Spanish would influence Latino elders' attitudes toward and comfort with end-of-life planning in comparison with a control group receiving only standard information routinely provided. Using a posttest-only control group design, elders receiving home care services who agreed to participate were randomly assigned to one of three groups: Conversación A; Conversación B, with culturally relevant material added; and a control group. A one-way multivariate analysis of variance was conducted to determine the effect on the two dependent variables: attitudes toward end-of-life planning and comfort with end-of-life planning. Significant differences were found among the three groups on both outcome measures. Attitudes toward advance planning scores were significantly higher for both intervention groups compared with the control group. Although both intervention groups had higher comfort scores than the control group, only the Conversación A score was statistically different from that of the control group. The results of this study indicate that it may be possible to positively influence both attitudes toward and comfort with end-of-life planning among older Latinos receiving home care, through the use of a one-to-one protocol that is delivered in Spanish.

Rethinking needs assessment in planning services for older adults.

Needs assessments are widely used in the field of aging, and are considered valuable tools for planning service responses to unmet and undermet needs of older adults. This article describes a comprehensive needs assessment of Bermuda's older population and presents some of its findings to illustrate concerns about needs assessments that emerged from this experience. We suggest that even when needs assessments are carefully planned and adhere to generally recognized best practice principles, they may not be able to fully provide desired information. A revision of key assumptions about needs assessment is offered for researchers, planners, and community workers.

Social work involvement in end of life planning.

This cross sectional study examined the factors associated with social workers' involvement in end-of-life (EOL) planning using a random sample of NASW members in health and aging. Of the 390 social workers who worked in EOL planning, the majority were involved in health care proxy discussions and counseling with patients. Respondents tended to see barriers to proxy completion as client-related. However, some system barriers were correlated with overall involvement. Factors that predicted social workers' involvement with the health care proxy included age, attitudes, perceptions of barriers, and perceived physician support. Social workers need to attend to the systems in which they operate as well as to client concerns.

"They don't want to hear us": Hispanic elders and adult children speak about end-of-life planning.

This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/ parents do not want to have these discussions.

Communication between older people and their health care agents: results of an intervention.

This study examined an intervention to help high-functioning community-dwelling older people communicate their wishes for care at the end of life with someone they would trust to make health care decisions for them if necessary. Groups consisted of dyads of older people and their potential or designated health care agents randomly assigned to the intervention (STEP program) or control group. STEP participants received three group sessions with educational and support components. For individual participants, there was a statistically significant difference between groups on knowledge of the health care proxy form and the roles and responsibilities of the agent. For the dyads of older people and their agents, there was a significantly higher mean communication score for the STEP participants than for the control group. The findings demonstrate that it is possible to affect advance communication about wishes at the end of life through a group intervention.

Motivational strategies with alcohol-involved older adults: implications for social work practice.

Social workers and other health care professionals address problem drinking by older adults inconsistently. Reasons include client-related variables (for example, denial and poor information), practitioner-related factors (for example, inadequate knowledge about addictive behaviors, underdeveloped assessment tools, and limited empirically validated treatment options), and societal factors associated with "ageism." This article explores the nature and extent of problem drinking among older adults and barriers to assistance. The article outlines practice strategies that draw on motivational interviewing principles and a client's motivational readiness to change for reaching out to older adults, assessing their needs, and encouraging them to seek assistance.