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Journal article

Live-in versus live-out home care in Israel: satisfaction with services and caregivers’ outcomes

Authors:
AYALON Liat, GREEN Ohad
Journal article citation:
Gerontologist, 55(4), 2015, pp.628-642.
Publisher:
Gerontological Society of America

Purpose: This study provides a preliminary examination of the relationship between the type of home care services (live-in vs. live-out; i.e., round the clock vs. several hours per week), the caregiver’s satisfaction with services, and the caregiver’s burden, distress, well-being, and subjective health status within a conceptual framework of caregiving outcomes. Design and Methods: A random stratified sample of family caregivers of older adults more than the age of 70 who receive live-in (442) or live-out (244) home care services through the financial assistance of the National Insurance institute of Israel was selected. A path analysis was conducted. Results: Satisfaction with services was higher among caregivers under the live-in home care arrangement and positively related to well-being. Among caregivers, live-in home care was directly associated with higher levels of subjective health and indirectly associated with better well-being via satisfaction with services. Implications: The study emphasises the potential benefits of live-in home care services for caregivers of older adults who suffer from high levels of impairment and the importance of assessing satisfaction with services as a predictor of caregivers’ outcomes. (Edited publisher abstract)

Journal article

The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults

Authors:
AYALON Liat, GUM Amber
Journal article citation:
Aging and Mental Health, 15(5), July 2011, pp.587-594.
Publisher:
Taylor and Francis

This paper examined the relationship between exposure to discrimination and mental health in three racial groups in the United States. Data from the Health and Retirement Study identified 6,455 White, 716 Latino, and 1,214 Black participants who completed a self-report psychosocial questionnaire in 2006. Thirty per cent of the general population and 45% of Blacks reported at least one type of discrimination. Latinos were significantly less likely to report any everyday discrimination. Blacks reported the greatest frequency of everyday discrimination. Whites reported the highest levels of life satisfaction and the lowest levels of depressive symptoms. Relative to major lifetime discrimination, everyday discrimination had a somewhat stronger correlation with mental health indicators. The relationships between discrimination and mental health outcomes were stronger for White compared to Black older adults. While Black older adults experience the greatest number of discriminative events, they experienced weaker associated mental health outcomes; perhaps because they had become accustomed to these experiences or benefited from social or cultural resources that serve as buffers

Journal article

Abuse is in the eyes of the beholder: using multiple perspectives to evaluate elder mistreatment under round-the-clock foreign home carers in Israel

Author:
AYALON Liat
Journal article citation:
Ageing and Society, 31(3), April 2011, pp.499-520.
Publisher:
Cambridge University Press

This study investigated the differences in the perceived occurrence of abuse and neglect between older care recipients, their family carers, and foreign home-care workers in Israel. Participants included 148 family members and foreign home-care workers and 75 care recipients, who completed a survey of abuse and neglect. Findings revealed significant discrepancies in their reports of neglect, with 66% of foreign home-care workers more likely to identify neglect, 28% of the older adults, or 30% of their family members. The different participants assigned the responsibility for the abuse to different perpetrators. Overall, the results suggest that even with round-the-clock home care, the basic needs of many older adults are not met, and that many experience substantial abuse. In conclusion, better education regarding elder abuse and neglect may lead to more accurate and consistent reports, and using data from all three sources may improve the early identification of abuse and neglect.

Journal article

Do you think you suffer from depression? Reevaluating the use of a single item question for the screening of depression in older primary care patients

Authors:
AYALON Liat, GOLDFRACHT Margalit, BECH Per
Journal article citation:
International Journal of Geriatric Psychiatry, 25(5), May 2010, pp.497-502.
Publisher:
Wiley-Blackwell

The majority of older adults prefer to receive their mental health treatment in primary care. However, despite efforts to integrate depression treatment into primary care, depression often remains undetected. There is therefore a need to identify appropriate screening tools for depression. The goal of this study was to compare a single item screening for depression to 3 existing depression screening tools. The participants were a cross sectional sample of 153 older primary care patients in 2 clinics in Israel who completed the following depression-screening measures: a single depression screen, Patient Health Questionnaire-9, Major Depression Inventory, Visual Analogue Scale. The measures were evaluated against a depression diagnosis made by the Structured Clinical Interview for DSM-IV. The results showed that overall 3.9% of the sample was diagnosed with depression. The most notable finding was that the single-item question, ‘Do you think you suffer from depression?’ had as good or better sensitivity (83%) than all the other screens. Nonetheless, its specificity of 83% suggested that it has to be followed up by a thorough diagnostic interview. Additional sensitivity analyses concerning the use of a single depression item taken directly from the depression screening measures supported this finding.

Journal article

A typology of new residents’ adjustment to continuing care retirement communities

Authors:
AYALON Liat, GREED Ohad
Journal article citation:
Gerontologist, 56(4), 2016, pp.641-650.
Publisher:
Gerontological Society of America

Purpose of the study: The study was designed to examine the diverse experiences of older adults upon their transition to continuing care retirement communities (CCRCs). Design and methods: As part of a larger qualitative study on CCRC residents and their adult children, the first wave of interviews with 59 CCRC residents located in 12 different CCRCs was analysed. A line-by-line analysis was followed by constant comparisons within each interview and across interviews in order to identify commonalities and differences. Subsequent to the identification of major thematic categories, whole interviews were analysed to identify unique response-patterns across interviews. Findings: Three major themes emerged: (a) continuity versus discontinuity in life experiences following the transition to the CCRC; (b) time-orientation (e.g., past, present, or future); and (c) place attachment (e.g., within the CCRC or in the larger community). These 3 themes distinguished among four different types of CCRC residents: “shades of grey,” “still searching after all these years,” “disapprover,” and “I finally found it.” Implications: The study offers a unique perspective on the adjustment process to CCRCs, by stressing the need to view qualitative differences in adjustment, rather than level of adjustment. Whereas CCRCs allow a segment of older adults to truly enjoy the opportunity for a new beginning in old age, for others, the transition does not pose a major change from past life experiences and is not viewed with the same level of enthusiasm. (Edited publisher abstract)

Journal article

A systematic review and meta-analysis of interventions designed to prevent or stop elder maltreatment

Authors:
AYALON Liat, et al
Journal article citation:
Age and Ageing, 45(2), 2016, pp.216-227.
Publisher:
Oxford University Press

Background: Elder maltreatment is a major risk for older adults’ mental health, quality of life, health, institutionalisation and even mortality. Objectives: To perform a systematic review and meta-analysis of interventions designed to prevent or stop elder abuse. Methods: Studies that were posted between January 2000 and December 2014, written in English, specifically designed to prevent or stop elder maltreatment were included. Results: Overall, 24 studies (and four records reporting on the same participants) were kept for the systematic review and the meta-analysis. Studies were broadly grouped into three main categories: (i) interventions designed to improve the ability of professionals to detect or stop elder maltreatment (n = 2), (ii) interventions that target older adults who experience elder maltreatment (n = 3) and (iii) interventions that target caregivers who maltreat older adults (n = 19). Of the latter category, one study targeted family caregivers, five targeted psychological abuse among paid carers and the remaining studies targeted restraint use. The pooled effect of randomised controlled trials (RCTs)/cluster-RCTs that targeted restraint use was significant, supporting the effectiveness of these interventions in reducing restraint use: standardised mean difference: −0.24, 95% confidence interval = −0.38 to −0.09. Interpretation: the most effective place to intervene at the present time is by directly targeting physical restraint by long-term care paid carers. Specific areas that are still lacking evidence at the present time are interventions that target (i) elder neglect, (ii) public awareness, (iii) older adults who experience maltreatment, (iv) professionals responsible for preventing maltreatment, (v) family caregivers who abuse and (vi) carers who abuse. (Publisher abstract)

Journal article

Satisfaction with the relationship from the perspectives of family caregivers, older adults and their home care workers

Authors:
AYALON Liat, ROZINERA Ilan
Journal article citation:
Aging and Mental Health, 20(1), 2016, pp.56-64.
Publisher:
Taylor and Francis

Objectives: Given the increasing reliance on both formal (paid) and informal (unpaid) assistance for the care of older adults and the close relationships which are often formed with home care workers, the present study evaluated satisfaction with the relationship from the perspectives of the three members that make up the home caregiving triad: older adults, their family members and their home care workers. Methods: The authors relied on a representative sample of 223 complete caregiving triads composed of an older adult, a family member and a home care worker. Each of the members rated his or her level of satisfaction with all other members in the unit, using a seven-item self-report satisfaction with the relationship scale (e.g., satisfaction with communication, intimacy). The Social Relations Model (SRM) was used to partial out the specific variance associated with each of the members as either an actor (i.e., the average satisfaction as a rater, unrelated to whom the person rates) or a partner (i.e., the unique satisfaction level elicited by a person, which is consistent across all ratings of this person). Results: The structural equations model yielded acceptable results: χ2(3) = 6.94, p = .07. Our analysis revealed that the variability associated with the worker as partner was significantly greater than the variability associated with the older adult as partner (∆χ2[1] = 9.21, p = .002) or with the family member as partner (∆χ2[1] = 8.46, p = .004). Conclusions: The study highlights the importance of studying satisfaction with the relationship in the home care setting and calls for further examination of the entire caregiving triad. The home care worker plays a key role in ensuring the overall satisfaction in the caregiving triad.Satisfaction with the relationship from the perspectives of family caregivers, older adults and their home care workers (Edited publisher abstract)

Journal article

Re-examining ethnic differences in concerns, knowledge, and beliefs about Alzheimer's disease: results from a national sample

Author:
AYALON Liat
Journal article citation:
International Journal of Geriatric Psychiatry, 28(12), 2013, pp.1288-1295.
Publisher:
Wiley-Blackwell

The 2010 US Health and Retirement Study was used to evaluate the differences in concerns, knowledge, and beliefs about Alzheimer's disease (AD) in three ethnic groups of older adults (White, Latino, and Black). Data from 939 White, 120 Latino, and 171 Black respondents who completed a special module about AD concerns, knowledge, and beliefs were analysed for the study. Significant ethnic differences were found on 7 of 13 items. However, after the adjustment for education, gender, age, having a family member with AD, depressive symptoms, and medical comorbidity, only four items showed significant ethnic group differences; relative to White respondents, Black respondents were less likely to report that having a parent or a sibling with AD increases the chance of developing AD and that genetics was an important risk for AD. In addition, relative to White respondents, both Black and Latino respondents were more likely to perceive stress as a potential risk for AD. Latino respondents were less likely to perceive mental activity as a protective factor. The study found limited ethnic group differences, with most items showing a similar pattern across groups. Nevertheless, the nature of the ethnic group differences found might be associated with a differential pattern of health service use. (Edited publisher abstract)

Journal article

The prevalence and predictors of passive death wishes in Europe: a 2-year follow-up of the survey of health, ageing, and retirement in Europe

Author:
AYALON Liat
Journal article citation:
International Journal of Geriatric Psychiatry, 26(9), September 2011, pp.923-929.
Publisher:
Wiley-Blackwell

Using a cross-national longitudinal design, this study evaluated regional variations (South, Centre and North of Europe) in passive death wishes (wish to die) and predictors of passive death wishes. It used data from wave 1 (2004) and wave 2 (2006-2007) of the Survey of Health, Ageing and Retirement in Europe (SHARE), a survey of individuals aged over 50 years and their spouse of any age. The statistical analysis found that the rate of passive death wishes was significantly lower in Northern (4.6%) than in Southern (8.5%) and Central (7%) Europe. The article reports that older adults, women, and those reporting more depressive symptoms, more medical conditions and lower levels of hope in wave 1 were more likely to report passive death wishes in wave 2, that passive death wishes were associated with increased mortality risk, and that most predictors of passive death wishes functioned similarly across geographic regions.

Journal article

Examining satisfaction with live-in foreign home care in Israel from the perspectives of care recipients, their family members, and their foreign home care workers

Author:
AYALON Liat
Journal article citation:
Aging and Mental Health, 15(3), April 2011, pp.376-384.
Publisher:
Taylor and Francis

Live-in foreign home care for older adults is common in Israel; approximately 68% of older adults who are eligible for governmental financial assistance due to disability have a live-in foreign home care worker. This pilot study aimed to evaluate the satisfaction levels of all parties involved in this caregiving arrangement: older care recipients, their family members, and their foreign home care workers. A matched cross-sectional sample of 148 family members and foreign home care workers and 90 older care recipients completed a satisfaction survey. The results demonstrate that the foreign home care workers' satisfaction was directly associated with family members' and care recipients' satisfaction. In addition, the well-being of older care recipients and foreign home care workers was directly associated with their satisfaction with this arrangement. There was an inverse association between care recipients' cognitive functioning and family members' satisfaction. The study demonstrates the complex associations between the various stakeholders involved in this caregiving arrangement. The article suggests that better working conditions are likely to result in improved satisfaction with services of all parties involved.

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