Cessation of Care for Frail Older Adults: Physical, Psychological and Economic Outcomes for Family Carers.

Global population aging and increased longevity are making family care a nearly universal experience. Caregiving is a dynamic process that varies over time and in intensity but often takes a physical and emotional toll on carers and may inflict financial costs by attenuating their labor market participation. The study explores the implications of the 'cessation of care' of frail elders by adult (middle-aged and older) kin by comparing two ethnic groups in Israel with respect to their health and their psychological and economic life. Using secondary data analyses based on SHARE-Israel data for persons aged 50+, it is found that subjective health assessment and financial capability are significantly higher among those who stop providing care than among those who continue to do so, while carers report a downturn in life satisfaction after they stop giving care. Those who continue are younger than the others, and their labor force participation rate is higher. Significant implications of cessation of care for all three areas studied-psychological, health, and economic-are found as well: the subjective rating of health and financial capability improve whereas life satisfaction decreases. Furthermore, a cessation of care moderates the relation between individuals' age and their self-rated health, which is better among those who continue to provide care. These results emphasize and deepen our understanding of the cessation-of-care phase as a key component of the process of care for frail older adults by family members.

The Role of Affect as a Mediator between Coping Resources and Heart Rate Variability among Older Adults.

BACKGROUND: Heart rate variability (HRV) has been suggested as an indicator of capacity to adapt effectively to physiological or environmental challenges and of physical and psychological health in old age. AIMS: The study assessed levels of high-frequency HRV (HF-HRV) among older adults in relation to positive and negative affect and the mediating role of positive and negative affect in the association between coping resources (perceived social support and sense of mastery) and HF-HRV. METHOD: Participants were 187 men and women in three assisted-living residences who were independent in activities of daily living (93.4% participation rate). The participants completed sense of mastery, multidimensional scale of perceived social support, and positive and negative affect questionnaires. HF-HRV was derived from electrocardiography data measured by a Holter monitoring device for 15 minutes. RESULTS: The empirical model showed good fit indices indicating that higher HF-HRV was associated with lower negative affect, and negative affect mediated the association between perceived social support and HF-HRV. In addition, perceived social support and sense of mastery were associated with higher positive affect and lower negative affect. CONCLUSIONS: Although this was a cross-sectional study, it suggests that HF-HRV may be a link between affect and health in old age. It also suggests the importance of identification and intervention with older adults and their support systems to reduce negative affect.

Exclusion from Social Relations in Later Life: Micro- and Macro-Level Patterns and Correlations in a European Perspective.

Older adults face particular risks of exclusion from social relationships (ESR) and are especially vulnerable to its consequences. However, research so far has been limited to specific dimensions, countries, and time points. In this paper, we examine the prevalence and micro- and macro-level predictors of ESR among older adults (60+) using two waves of data obtained four years apart across 14 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE). We consider four ESR indicators (household composition, social networks, social opportunities, and loneliness) and link them to micro-level (age, gender, socioeconomic factors, health, and family responsibilities) and national macro-level factors (social expenditures, unmet health needs, individualism, social trust, and institutional trust). Findings reveal a northwest to southeast gradient, with the lowest rates of ESR in the stronger welfare states of Northwest Europe. The high rates of ESR in the southeast are especially pronounced among women. Predictably, higher age and fewer personal resources (socioeconomic factors and health) increase the risk of all ESR dimensions for both genders. Macro-level factors show significant associations with ESR beyond the effect of micro-level factors, suggesting that national policies and cultural and structural characteristics may play a role in fostering sociability and connectivity and, thus, reduce the risk of ESR in later life.

Law and Intergenerational Relationships.

BACKGROUND: In any aging society, the sociolegal construction of intergenerational relationships is of great importance. This study conducts an international comparison of a specific judicial issue: whether active labor unions have the legal right to strike for the purpose of improving the benefits given to nonactive workers (specifically, pensioners). METHOD: A comparative case law methodology was used. The texts of three different Supreme Court cases-in the United States, Canada, and Israel-were analyzed and compared. FINDINGS: Despite the different legal outcomes, all three court rulings reflect a disregard of known and relevant social gerontology theories of intergenerational relationships. CONCLUSION: Social gerontological theories can play an important role in both understanding and shaping judicial policies and assisting the courts in choosing their sociojudicial narratives.

Generational Solidarity in Europe and Israel.

This study explored various dimensions of generational relationships between older parents and their adult children using the second wave of SHARE (Survey of Health, Ageing and Retirement in Europe), comparing it to Dykstra's and Fokkema's (2011) analyses of the first wave. Results were further compared to the OASIS study (Old Age and Autonomy: The Role of Service Systems and Intergenerational Solidarity). The intergenerational solidarity model served as the main conceptual framework. Analyses yielded four family relationship types present in all countries, albeit with different frequencies. Around half of the respondents in the 11 countries were identified with close ties and flow of support. Four conclusions were drawn: (1) importance of personal resources; (2) cultural differences and meanings for families; (3) highlighting within-country difference; and (4) strength of intergenerational solidarity. The importance of understanding generational relationships in the current era with higher longevity and changing family structures is emphasized and explicated.

Developing a Research Agenda on Resident-to-Resident Aggression: Recommendations From a Consensus Conference.

This article provides an overview of the development of a research agenda on resident-to-resident aggression (RRA) in long-term care facilities by an expert panel of researchers and practitioners. A 1-day consensus-building workshop using a modified Delphi approach was held to gain consensus on nomenclature and an operational definition for RRA, to identify RRA research priorities, and to develop a roadmap for future research on these priorities. Among the six identified terms in the literature, RRA was selected. The top five priorities were: (a) developing/assessing RRA environmental interventions; (b) identification of the environmental factors triggering RRA; (c) incidence/prevalence of RRA; (d) developing/assessing staff RRA education interventions; and (e) identification of RRA perpetrator and victim characteristics. Given the significant harm RRA poses for long-term care residents, this meeting is an important milestone, as it is the first organized effort to mobilize knowledge on this under-studied topic at the research, clinical, and policy levels.

A German-Israeli comparison of informal and formal service use among aged 75+.

The paper focuses on filial norms and attitudes of older people about the care system of welfare states. It is a further investigation of the OASIS cross national study and examines three questions: First, what do older people in Israel and Germany consider to be the proper balance between the family and the welfare state regarding elder care? Second, what are the responsibilities of the family, the welfare state and other caregivers? Third, in what way do values, filial norms and personal resources relate to actual service use? The empirical data is based on information gathered from respondents living in Israel and Germany, aged 75+. The results of the study indicate that familial help has not been fully replaced by welfare state services. These findings support the complementary perspective. The results also show that most respondents favour a shared responsibility between the welfare state and the family. The findings indicate that familial norms are stable and strong as expressed by elders in both countries. The health situation is the main factor for receiving welfare services and familial help in Israel. In Germany the strong effect of living alone for receipt of welfare services underscores the influence of older adults' social and personal resources on actual service use. The article discusses the findings referring to the importance of a combined mix of the different sources of help for social policy implications.

Intergenerational Support and the Emotional Well-being of Older Jews and Arabs in Israel.

This investigation examined the cultural context of intergenerational support among older Jewish and Arab parents living in Israel. The authors hypothesized that support from adult children would be more positively consequential for the psychological well-being of Arab parents than of Jewish parents. The data derived from 375 adults age 65 and older living in Israel. Psychological well-being was measured with positive and negative affect subscales of the Positive and Negative Affect Schedule. Overall, positive affect was highest when filial expectations for support were congruent with whether or not instrumental support was received. Findings by cultural background revealed that, among older Jews, receiving instrumental support raised positive affect and stronger filial expectations lowered it. Among older Arabs, receiving financial support raised positive affect and receiving instrumental support lowered it. Culture appears to serve as a potent force in determining which types of intergenerational support functions are expected and accepted means of serving the everyday needs of older parents.

The living arrangements of older immigrants from the former Soviet Union: a comparison of Israel and the United States.

With the unprecedented emigration from the former Soviet Union (FSU) during the 1990s as context, this study described the living arrangements of older FSU immigrants living in Israel and the US. Living arrangement choices represented an important strategy for coping with the migration process. Census data from Israel and the US were employed to examine the relationships among living arrangements (independent households, multigenerational households, and extended households) and personal characteristics, including duration of residence, Jewish identity, education, and home ownership. Results showed that the less time older immigrants lived in the host country, the more likely they lived in a multigenerational or extended household. The residency length and household relationship was stronger in Israel than in the US. Also, older FSU immigrants who owned their own home and who lived in a metropolitan area were more likely to live in a complex household than in an independent household. We discussed how the economic and social environments in each country contributed to the variability in living arrangement options among these older immigrants.

Employers' knowledge and attitudes regarding organizational policy toward workers caring for aging family members.

The study examined employers' knowledge of and attitudes toward working carers who care for aging family members. The study was based on the ecological model. One hundred employers were interviewed using structured questionnaires and 13 employers by additional in-depth interviews. Both research instruments included areas of disruption to the organization, existing policies, and feasibility as to developing appropriate policies to support working carers. Results show that caregiving caused a disruption in workers' functioning mainly by being absent, leaving work early, and coming to work late. Usually, there was "no policy," and half of the employers did not support introducing such a policy. Women managers in public organizations, who had less seniority and less previous experience with working-carers, tended to be more positive about supportive policies. Recommendations are included.

European report on preventing elder maltreatment

Elder maltreatment is pervasive throughout the WHO European Region: at least 4 million elderly people are estimated to experience maltreatment in any one year and 2500 of them will die each year. Most countries in the Region have an ageing population, putting increasing numbers of people at risk. This report highlights the biological, social, cultural, economic and environmental factors that influence the risk of being a victim or perpetrator of elder maltreatment, as well as the protective factors that can help prevent it. There is some evidence of effective interventions, including psychological programmes for perpetrators and programmes designed to change attitudes towards older people, improve the mental health of caregivers and, in earlier life, to promote nurturing relationships and learn social skills. The evidence base needs to be strengthened, but surveys show that the public and policy-makers are already concerned about the problem. This report proposes a set of actions for Member States, international agencies, nongovernmental organizations, researchers, practitioners and other stakeholders to strengthen the policy response and devote adequate resources to the issue.

Motivation to provide help to older parents in Norway, Spain, and Israel.

We explore from a cross-national perspective three motivations in adult children to provide help to older parents: affectual solidarity, parental need for care, and filial norms. The sample is 1,055 adult children from Norway, Spain, and Israel, countries selected because they represent different family cultures and welfare regimes. Affectual solidarity and parental need for care was found to influence amount of help in all three countries, whereas filial norms was found to have no effect. Country context had a differential impact. In Israel, affectual solidarity was more strongly associated with amount of help. In Israel and Norway, parents' need for care was related to amount of help; in Spain help provided was high, regardless of parents' need for care. We demonstrate the universality of motivations to provide help to older parents and the influence of cultural context on these motivations, taking into account within-country differences.

Older Parent - Child Relationships in Six Developed Nations: Comparisons at the Intersection of Affection and Conflict.

Intergenerational solidarity and ambivalence paradigms suggest that emotional relationships between generations consist of both positive and negative sentiments. We applied latent class analysis to measures of affection and conflict in 2,698 older parent - child relationships in 6 developed nations: England, Germany, Israel, Norway, Spain, and the United States (Southern California). The best fitting model consisted of 4 latent classes distributed differently across nations but with a cross-nationally invariant measurement structure. After controlling for demographics, health, coresidence, contact, and support, the following classes were overrepresented in corresponding nations: amicable (England), detached (Germany and Spain), disharmonious (United States), ambivalent (Israel). We discuss policy and cultural differences across societies that may explain why the prevalence of particular emotional types varied by nation.

Is elder abuse and neglect a social phenomenon? Data from the First National Prevalence Survey in Israel.

This article discusses findings from the First National Survey on Elder Abuse and Neglect in Israel, conducted during 2004-2005 under the sponsorship of The Association for Planning and Development of Services for the Aged in Israel (ESHEL) and the National Insurance Institute. The goals were to examine the prevalence and severity of various forms of abuse and neglect from the victims' perspective, to examine correlates and predictors, and to develop profiles of elders at risk. Data were collected through personal interviews from a national representative sample of community urban dwellers age 65 and older, using cluster sampling techniques and sampling proportionately both Arab and Jewish elders. The sample was composed of 392 males and 650 females, 89% were Jews and 11% were non-Jews. The instrument included sociodemographic data, health and activities of daily living (ADL), a measure of safety, and a battery to examine seven types of abuse (physical, emotional, verbal, limitation of freedom, financial exploitation, sexual, and neglect). Findings indicate that 18.4% of the respondents were exposed to at least one type of abuse during the 12 months preceding the interview, the highest form being verbal abuse followed by financial exploitation. The rates were quite similar between Jews and Arabs. Women were more exposed to physical violence and Arab women were the most vulnerable. Physical, emotional, verbal, limitation of freedom, and sexual abuse occurred mostly among partners. The rates of physical, sexual, and limitation of freedom abuse, however, were relatively low. Financial exploitation was mostly inflicted by adult children. Partners as perpetrators had more chronic health problems and physical and mental disabilities. Children as perpetrators were unemployed, had various mental health problems, and were substance abusers, often in a process of separation or divorce and tended to live with the victims. Neglect in answering primary needs was found among 20% of the sample, regarding the 3 months preceding the interview. This high rate might be related to elders tending to avoid seeking help or sharing their needs with their families. When victims sought help it was mostly from medical and health services. The findings thus corroborate that elder abuse and neglect is a social problem in Israeli society and has to be addressed in policy discourse and service developments.

Elder abuse and neglect--"old phenomenon": new directions for research, legislation, and service developments. (2008 Rosalie S. Wolf Memorial Elder Abuse Prevention Award--International Category Lecture).

This article poses the question: Is elder abuse and neglect a social problem, showing that it is. Elder abuse, though, is still the most hidden form of mistreatment and a key to governmental responses to an ageing population. It is an important facet as a family violence problem, an intergenerational concern, as well as a health, justice and human rights issue. Because the phenomenon of elder abuse and neglect is so complex and multi-dimensional, it has to be addressed by multi-professional and inter-disciplinary approaches. Raising awareness is a fundamental prevention strategy and an important step in causing changes in attitudes and behaviors. This has been accomplished by INPEA and the article was developed from the lecture given by the author on receiving the International Rosalie Wolf Award from INPEA. The discussion focuses on elder abuse as a product of global ageing, stemming from population ageing, which is consistent with an increased prevalence of abuse of all vulnerable groups, older people among them. It is pointed out that baseline and trend data on the nature and prevalence of senior abuse are crucial to policy responses and the development of appropriate programs and services. Difficulties in assessing the scope of the phenomenon, though, are due to: problems in definitions and methodology, which create difficulties in comparing data from various countries; lack of social and familial awareness; isolation of some elders, especially migrants; elder abuse as a 'hidden issue' that usually occurs in the privacy of the home and is viewed as a family affair; limited access to institutional settings. Difficulties also exist in constructing a unifying research framework in order to study the phenomenon due to a lack of comparison groups, a lack of representative national surveys and difficulties in measurement. There is currently, however, an increase in prevalence and incidence studies from both sides of the Atlantic and especially from Europe. But while prevalence studies provide base-data on numbers, little is known about key conceptual issues for policy, practice and the understanding of different forms of abuse and neglect. Theoretical under-development hampers the collection of systematic cumulative knowledge which is based on universally agreed upon and standardized tools, and reduces the ability to discover unifying themes and their relationship to local idiosyncrasies existing in the field. Additionally, there has been no attempt to develop theoretical knowledge grounded in data from the study of elder abuse itself. The following vehicles for action are, thus, suggested: Developing international, national and regional research agendas and data bases; developing policy and legislation; developing services and interventions and developing educational programs.

Times of transition: elder abuse and neglect in Israel.

The present paper addresses the advancement of research, policies, legislation, and practice experiences designed to deal with the phenomenon of elder abuse and neglect in Israel in times of transition. The paper presents a short overview of the demographic scene, reflecting population characteristics and needs that impact care giving as well as elder abuse and neglect. The developments of scientific knowledge and its accumulation, especially the empirical data from the first national survey on elder abuse and neglect are discussed. Further, legislative developments relating to four generational laws and the advancement of policies and innovative practice experiences are described and analyzed. Finally, future challenges in the field are identified.

Addressing a nation's challenge: graduate programs in gerontology in Israel.

Like other developed nations, Israel has rapidly aged. This demographic revolution has created new challenges for Israeli society. We describe the societal background, including the emerging societal needs, solutions, and problems, as well as the professional principles, which guided us in developing the first two Israeli academic programs in gerontology in Beer-Sheva and Haifa. We further discuss the structures of both programs and their accomplishments. Although both programs were guided by identical needs and principles, geared toward the same multidisciplinary target population, and are dynamic and responsive to the emerging needs and difficulties, they differ in structure. While Haifa's program is flexible, Beer-Sheva's program is structured and divided into three distinct programs, of which only one-the research track-is designed and tailored to the students' interest. The two programs have contributed to increasing interest and research in aging in Israel, enhancing professional cooperation within the universities and with the international scientific community, opening the labor market for the programs' graduates, creating fruitful collaborations with community services, and accelerating the improvement of elderly quality of care.