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Journal article

Perceived challenges to the sustainability of community-based aging initiatives: findings from a National study of villages

Authors:
LEHNING Amanda, et al
Journal article citation:
Journal of Gerontological Social Work, 58(7-8), 2015, pp.684-702.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Concerns have been raised regarding the sustainability of villages, an 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 organisational 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. (Edited publisher abstract)

Journal article

The relevance of Marjory Warren’s writings today

Authors:
ST. JOHN Philip D., HOGAN David B.
Journal article citation:
Gerontologist, 54(1), 2014, pp.21-29.
Publisher:
Gerontological Society of America

Marjory Warren was one of the initial geriatricians in the United Kingdom. She established specialised geriatric units, held important administrative positions, and wrote influential papers where she argued for the need of the specialty of geriatric medicine and outlined principles for inpatient care of older adults with chronic illness. The authors compare and contrast Warren’s early papers describing these principles with contemporary models for improving inpatient care of older adults and the need for the specialty of geriatrics. Warren’s writings on the inpatient care of older adults presage the principles of both Hospital Elder Life Programs and Acute Care of the Elderly units. The importance of multidisciplinary teams, the physical environment, attention to diverse issues (medical, social, functional), early ambulation, and the active involvement of the older person in their daily routine are present in Warren’s writings and in contemporary approaches. Warren’s arguments for both the specialty of geriatric medicine and increased training of nonspecialist physicians and other health professionals are remarkably similar to those made in a recent Institute of Medicine report. Across time and place, there has been consistency in the general principles perceived as required for the effective cares of older persons, but challenges persist in implementing and sustaining them. (Publisher abstract)

Journal article

Rotational field placements: integrative review and application to gerontological social work

Authors:
GOUGH Heather R, WILKS Scott E.
Journal article citation:
Social Work Education (The International Journal), 31(1), 2012, pp.90-109.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Increasing numbers of social work schools in the United States are replacing year-long field placements with rotational field placements (RFP), particularly for gerontology students, during which students move between 2 or more field internship sites within a given academic year. The rapid growth of RFP programmes reflects changing ideas about field education and social work student training needs. In the context of gerontology, RFP programme goals are multi-fold: maximising student exposure to the continuum of care across multiple service settings; increasing student experience working with diverse client populations; and facilitating development of the cross-disciplinary team collaboration skills frequently required of gerontological social workers. RFP models represent a decisive break from traditional field practicum models, raising fundamental questions with regards to educational outcomes and student experience. The purpose of this article is to provide a review of the available empirical data on social work RFP programmes, summarising their benefits, risks and problem areas. It aims to provide a foundation for informed debate on the design, benefits and costs of adopting such a model across contexts. The article further includes strategies for minimising potential risks with such placements, as well as discussion of research limitations and suggestions for future research.

Journal article

An emerging typology of community aging initiatives

Authors:
LEHNING Amanda, SCHARLACH Andrew, WOLF Jennifer Price
Journal article citation:
Journal of Community Practice, 20(3), 2012, pp.293-316.
Publisher:
Taylor and Francis
Place of publication:
Philapelphia, USA

Although the majority of older people would like to remain in their own homes, many have to leave for nursing homes or other care facilities. In order to help older persons meet their long-term care needs and age in place, a growing number of initiatives have been implemented across the United States aiming to bring about comprehensive changes in community physical and social environments. The aim of this study was to develop a typology of community ageing initiatives and examine variations in these initiative types including the methods they use, roles of participants, funding sources, and challenges. Community ageing initiatives nationwide were identified through an online search and contact persons at these initiatives were invited to participate in an online survey. The final sample consisted of 124 community ageing  initiatives. These initiatives were grouped into 5 categories: community-wide planning; consumer-driven support networks; cross-sector systems change initiatives; residence-based support services; and single-sector services. It is hoped that this emerging typology may serve as a useful organising framework from which to develop future evaluations of the effectiveness and sustainability of these initiatives.

Journal article

Resilience and coping as predictors of general well-being in the elderly: a structural equation modeling approach

Authors:
TOMÁSA José Manuel, et al
Journal article citation:
Aging and Mental Health, 16(3), April 2012, pp.317-326.
Publisher:
Taylor and Francis

Well-being is a complex construct concerning optimal experience and functioning. One of the constructs that can determine well-being is coping. This study aimed to explore the relationships between problem-focused coping, emotion-focused coping and resilience with well-being in the elderly. Hypotheses about these relationships are tested within a structural modelling framework. The aims of this article are: to test for the validity of the 3 constructs involved in the structural model; to test for the effects of both coping strategies and resilient coping on well-being in a sample of elderly, by means of a structural model with latent variables; and to empirically study whether a brief scale of resilient coping could predict well-being over and above that predicted by the coping resources. The study participants comprised 225 non-institutionalised elderly people living in the city of Valencia, Spain. The participants completed a survey with included measures of well-being, resilient coping, and coping strategies. Analyses indicate that the best predictive model is that with a single predictor of well-being: resilient coping. Resilient coping is able to predict a significant and large part of the variance in well-being, without the need for including coping strategies.

Journal article

Formal modeling techniques for ambient assisted living

Authors:
PARENTE Guido, et al
Journal article citation:
Ageing International, 36(2), June 2011, pp.192-216.
Publisher:
Springer
Place of publication:
New York

In the development of systems of ambient assisted living (AAL), formalized models and analysis techniques can provide a ground that makes development amenable to a systematic approach. The following formal modeling tools and techniques are reviewed in relation to AAL: fault trees, evidential reasoning, evidential ontology networks, temporal logic, hidden Markov models and partially observable Markov models. A number of scenarios are then presented to provide insight on how each technique can match the needs of different types of problem in the application domain.

Journal article

Conceptual model and map of psychological abuse of older adults

Authors:
CONRAD Kendon J., et al
Journal article citation:
Journal of Elder Abuse and Neglect, 23(2), April 2011, pp.147-168.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA

Psychological abuse of older adults is a hidden and pervasive problem that includes verbal insults and threats, treating the older person like an infant, and isolating them from friends and family. Psychological abuse of older adults is currently not well conceptualised or well measured. The goal of this project was to conceptualise psychological abuse using 3-dimensional concept maps, and to use the concepts generated in this process to develop a theory that could guide measure development for screening and outcome assessment. Panels of local and national experts in the field of elder abuse and neglect and aging were brought together to generate 56 descriptive statements defining psychological abuse. These statements were sorted and rated using Concept Systems software whereby the concepts were depicted as a map. The concept map was comprised of 5 distinct clusters: isolation; insensitivity and disrespect; shaming and blaming; threats and intimidation; and trusted other risk factors. The concept maps guided development of theoretical hierarchies of psychological abuse that should help improve understanding of this type of elder abuse.

Journal article

Understanding service context: development of a service pro forma to describe and measure elderly peoples' community and intermediate care services

Author:
NANCARROW Susan A.
Journal article citation:
Health and Social Care in the Community, 17(5), September 2009, pp.434-446.
Publisher:
Wiley-Blackwell

The purpose of this paper was to develop a pro forma which classifies the components of service delivery and organization which may impact on the outcomes of elderly peoples' community and intermediate care services. The resulting analytic template provides a basis for comparison between services and may help guide service commissioning and development. A qualitative approach was used in which key evaluations and reports were selected on the basis that they described elderly peoples' community and intermediate care services. These were analysed systematically using a qualitative (template) approach to draw out the key themes used to describe services. Themes were then structured hierarchically into an analytic template. Seventeen key documents were analysed. The initial coding framework classified 334 themes describing intermediate care services. These items were then clustered into 78 categories, which were reduced to 17 subcategories, then six overall groupings to describe the services, namely; (1) context; (2) reason for the service; (3) service-users; (4) access to the service; (5) service structure; and (6) the organization of care. The resulting analytic template has been developed into a 'service pro forma' which can be used as a basis to describe and compare a range of services. It is proposed that all service evaluations should describe, in detail, their context in a comparable way, so that other services can learn from and/or apply the findings from these studies.

Journal article

Assessing the effectiveness of interventions to promote advance directives among older adults: a systematic review and multi-level analysis

Authors:
BRAVO Gina, DUBOIS Marie-France, WAGNEUR Bernard
Journal article citation:
Social Science and Medicine, 67(7), October 2008, pp.1122-1132.
Publisher:
Elsevier

Many studies have investigated the effectiveness of interventions in promoting advance directives (ADs) but there is uncertainty as to what works best, and in whom. We conducted a systematic review of the evidence in this regard, using both classical meta-analysis approaches and multi-level analyses. Eleven databases were searched for relevant reports published through March 2007. All prospective studies were eligible, whether involving a single group or several and, in the latter case, regardless of the allocation mechanism. Outcomes included formal and informal ADs assessed by chart review or self-report. Heterogeneous sets of outcomes were pooled under a random-effects model. The search yielded 55 studies, half of which targeted outpatients. Most groups of subjects were educated in a single session led by one healthcare professional. Outcomes were measured within six months of the intervention in 73% of cases. The largest set of single-arm studies yielded an overall AD completion rate of 45.6%. Across randomized trials, the largest pooled odds ratio was 4.0, decreasing to 2.6 when all comparative studies were included. Multi-variable analyses identified the provision of oral information over multiple sessions as the most successful intervention. This was true regardless of the target population. These findings support the effectiveness of educational interventions in increasing the formulation of ADs and provide practical advice on how best to achieve this goal.

Journal article

Historical evolution of assisted living in the United States, 1979 to the present

Author:
WILSON Keren Brown
Journal article citation:
Gerontologist, 47(3), December 2007, pp.8-22.
Publisher:
Gerontological Society of America

This article provides a historical overview of the emergence of assisted living in the United States over a 25-year period to identify goals and key concepts that underpinned the emerging form of care. The method is historical analysis based on records and my own personal experiences in conceptualizing and implementing assisted living in Oregon and nationwide. The author identified four time periods: (a) 1979 to 1985, when a paradigm shift occurred on both the East and West coasts, motivated by distaste for nursing facilities and idealistic values regarding residential environments, service capacity, and consumer-centered care philosophy; (b) 1986 to 1993, when providers, consumers, and state governments became interested and four identifiable types of assisted living (hybrid, hospitality, housing, and health care) appeared, each of which informed the evolution of assisted living; (c) 1994 to 2000, a period of expansion, Wall Street money, dilution of the ideals, and emerging quality concerns; a crisis of confidence and a crossroads for assisted living; (d) 2000 to the present, a time of regrouping, slow-down in growth, and reexamination of earlier efforts to define and set standards for assisted living. Implications: Well-conceptualized and designed research may provide a mechanism to suggest practice, regulatory, and payment models. The author recommends that researchers conduct studies from the values premises underlying the assisted living approach.

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