The status of employee caregiver benefits.

The number of employee caregivers in the workforce is growing. This trend will impact on employers in both the public and private sectors.

Senior volunteerism policies at the local level: adaptation and leadership in the 21st century.

This study explores several key senior volunteerism policy issues that need to be addressed from a local perspective in order to meet the challenges of the twenty-first century. Using inputs from a national survey of Voluntary Action Centers, prominent volunteer agencies in the United States, this study examines the impact of the national economy on senior volunteerism, the status of funding, the relationship between local senior volunteerism and employment, the role of risk management, and the affect of an aging society of senior volunteerism.

Essential factors in a community college-nursing home partnership.

The community college-nursing home partnership has two major objectives: to develop nursing potential in long-term care settings and to influence the redirection of associate degree nursing education to include active participation in long-term care settings. Successful partnerships are built on a commitment to high quality education for students and high quality service for patients. Other essential factors to a successful partnership include collaborative planning, pragmatic goal setting, clear communication, and mutual respect.

The network trilogy project: linking aging, mental health and health agencies.

There is a striking disparity between the estimated need for mental health care by 18-25% of the nation's elderly, and the minimal utilization of private and publicly funded services by this age cohort. Recognition that the elderly are not well served by existing systems led a trilogy of major Philadelphia aging, mental health, and health organizations to form a partnership for the purpose of improving, expanding, and integrating service delivery for a segment of the population which has been overlooked. A training model was devised to overcome the organizational isolation of agencies serving mutual clients with interrelated problems. For training purposes, the city was divided into five sections. Consultants were recruited to organize staff development groups from the health, mental health and senior centers in the geographic areas to which they were assigned. This paper describes the interagency training experience, the receptivity of the participants, and discusses the issues which must be addressed to improve coordination of elderly services by the aging, health, and mental health systems.

Adaptive variation in structure and function of kidneys of speciating subterranean mole rats.

We report on kidney structure and function in subterranean mammals of four chromosomal species (2n=52, 54, 58 and 60) belonging to the Spalax ehrenbergi superspecies, in relation to their speciation and adaptive radiation from mesic (2n=52) to xeric (2n=60) environments in Israel. Structural variables measured involved: (1) Relative Medullary Thickness, (RMT); (2) Relative Kidney Weight. (RKW); and (3) Percentage of Kidney out of Body Weight (PKW). Functional variables involved: (i) Urine Solid Concentration, (USC); and (ii) Urine Osmotic Concentration (UOC). The results for chromosomal species 2n=52, 54, 58 and 60 indicated nonsignificant increase southward for RMT, but displayed significant increase along the same transect for RKW, PKW, and USC. The UOC was significantly lower in mesic 2n=52 as compared to the other three species when experimental animals were fed in the laboratory on regular carrot food. However, protein stress food (soybean) and salt stress of 0.45 mol NaCl, caused significant, three and a half fold increase of UOC in 2n=52, 54 and 58; but four and a half fold increase in 2n=60, significantly higher than in the other three species. We conclude that both structurally and functionally, the kidneys differentiated adaptively during the Pleistocene evolution of S. ehrenbergi in Israel, in accordance with aridity stress and halophyte food resources towards the desert. Nevertheless, Spalax generally shows clear upper limits in kidney structural and functional capacities, preventing it from colonizing the true desert, south of the 100 mm isohyete.

Adaptive energy metabolism in four chromosomal species of subterranean mole rats.

Gross energy intake and apparent dry matter digestibility of animals fed carrots ad lib in the laboratory, were measured in the four chromosomal species of the Spalax ehrenbergi superspecies in Israel. Gross energy intake of 132.8 and 155.9 kJ/day was measured for the 2n=52 and 2n=58 chromosomal "mesic" species, while in the 2n=54 and 2n=60 chromosomal "xeric" species it measured only 80.3 and 75.0 kJ/day, respectively. Dry matter digestibility ranged between 92.3 and 95.6% in thefour chromosomal species. The differences in gross energy intake between the "mesic" and "xeric" species, appeared to reflect adaptive energy metabolism variation associated with geographic variation in climate, habitat productivity, and food availability.

Survey of curriculum content related to geriatrics in physical therapy education programs.

We investigated the current status of the education of physical therapy students regarding elderly individuals. Data were collected through a questionnaire mailed to the directors of 101 accredited physical therapy education programs; the rate of return was 79%. Nearly all of the program directors (96%) affirmed a need to focus on the care of elderly individuals in their curricula. Currently, 92% of the programs teach aging-related material in six different course areas. The most frequently cited course area was professional physical therapy practice, followed by the behavioral-social sciences. Content on aging was incorporated primarily as parts of required courses, averaged 3 credits (representing 10-15 clock hours of study), and was taught primarily through didactic methods. The main obstacle to offering aging-related courses was a full curriculum. The results of our survey suggest that selective changes are needed, including additional course content that would enrich current education and provide physical therapy students with expanded capabilities to meet the health care needs of the elderly population.

The status of preventive care for the aged: a meta-analysis.

One response to the growing needs of the elderly is to expand the scope of preventive care from the younger and middle aged cohorts to include an emphasis on preventive care for older people. In the past it has been difficult to consider prevention and aging as concepts which could co-exist because we can neither cure nor prevent aging. The potential of preventive care to improve, maintain, or lessen decline in the quality of life of the elderly has not been included in the definition or mainstream of prevention activities. This study identifies and reviews research and programmatic activities which have been reported in the literature over the last ten years in the area of prevention and aging. Topical areas and methodological approaches are explored to define what has been considered appropriate preventive care for the elderly. An evaluation process, meta-analysis, is used to assess the therapeutic effect and overall effectiveness of techniques in prevention and aging. These findings can be used in formulating future initiatives related to aging and prevention.

Meeting the mental health needs of the aged: the role of psychiatric emergency services.

The mental health emergency service is a critical triage point for making decisions about the delivery of a variety of services needed by an increasingly large elderly population. This study explores the roles of two mental health emergency services in providing services and linking elderly clients with elements of the health, mental health, and long-term care systems. A data base was established by a retrospective review of 350 records of elderly clients treated at two urban mental health emergency facilities over a one-year period. Key findings are presented about the demographic characteristics of users age 60 and over, diagnoses, referral and disposition patterns, repeater usage, and emergency versus nonemergency usage. Recommendations are made on the future role of mental health emergency services in meeting the complex health and mental health needs of the elderly in the community.

Creating comprehensive gero-psychiatric care in the community.

The aged increasingly need a comprehensive system, a central access point, and coordinated care in order for their acute and chronic, health and mental health needs to be met. This research reviews and analyzes the structure, function, and operation of a model demonstration geriatric emergency service which functioned as an access point and coordinator of care for the elderly in a network of health, mental health, and long term care services. The findings of this study indicate the important contribution a geriatric emergency service can make to creating comprehensive gero-psychiatric care in the community.

Community mental health centers and the elderly: a time for expansion of planning, research, and demonstration projects.

The purpose of this paper is to acquaint persons working in Community Mental Health Centers with federal funding resources which support planning, research, and demonstration projects related to mental health and aging. The significance of exploration by CMHCs into the aging area is suggested by the legislative histories of CMHCs and aging programs, our expanding aging population which requires increasing health and mental health services, and the growing number of resources available for the development of services related to aging. Principal funding sources related to mental health and aging are: Alcohol, Drug Abuse and Mental Health Administration, National Institutes of Health; Administration on Aging; and Health Care Financing Administration. Each funding source is presented through a review of five key items: 1) name of program; 2) objectives; 3) funds awarded; 4) legislative mandate; and 5) contact person and address. Program areas for each funding source are discussed. Knowledge of these funding resources should enable CMHCs to plan services and to expand capabilities to serve the growing over-60 population.

Building a comprehensive geriatric health care system: a case study.

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.