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Communicating with older adults about sexual issues: How are these issues handled by physicians with and without training in human sexuality?
- Authors:
- LEVKOVICH Inbar, GEWIRTZ-MEYDAN Ateret, AYALON Liat
- Journal article citation:
- Health and Social Care in the Community, 29(5), 2021, pp.1317-1326.
- Publisher:
- Wiley
Although sexuality is an important part of health and emotional well-being throughout the entire life cycle, including during old age, little is known about how physicians discuss or approach the topic of sexuality during later life. The present study examined the perspectives of two groups of physicians toward discussing sexuality with older patients: 17 physicians who did not have any training in human sexuality and 21 physicians who were certified as sex therapists. The interviews underwent thematic content analysis to identify and code major themes and patterns. Qualitative analysis of the interviews yielded three main themes: (a) discourse between physicians and older adults regarding sexuality, (b) diagnosing sexual dysfunction among older adults, and (c) treating sexual dysfunction among older adults. Physicians who were not trained in sex therapy did not regularly ask their older patients about sexual functioning and/or problems with sex, tended to diagnose sexual problems from a medical perspective, and offered medication as the main treatment for sexual problems. Physicians trained as sex therapists felt more comfortable discussing sex-related issues with their older patients and diagnosed sexual problems from a medical, social, dyadic and psychological perspective. Although they offered their older patients a greater variety of medication-oriented interventions than those without training in sexuality, they did not rush into such interventions and instead emphasised the importance of the psychological and relational aspects of sex. The present study highlights the importance of human sexuality training for physicians and points out the effects of such training on the discourse, diagnosis and treatment of sexual concerns in later life. (Edited publisher abstract)
A systematic review of research on social networks of older adults
- Authors:
- AYALON Liat, LEVKOVICH Inbar
- Journal article citation:
- Gerontologist, 59(3), 2019, pp.e164-e176.
- Publisher:
- Oxford University Press
Background and Objectives: There has been a substantial interest in life course/life span changes in older adults’ social networks and in the relationship between social networks and health and wellbeing. The study embarked on a systematic review to examine the existing knowledgebase on social network in the field of gerontology. Our focus was on studies in which both ego (respondents) and his or her alters (network members) are queried about their social ties. Research Design and Methods: This study searched for studies published in English before September, 2017, relied on quantitative methods to obtain data from both ego (60 years of age and older) and alters and provided a quantitative account of the social network properties. We searched the following data sets: APA Psychnet, Pubmed, Sociological abstracts, and Ageline. This was followed by a snowball search of relevant articles using Google Scholar. Titles and abstracts were reviewed and selected articles were extracted independently by two reviewers. Results: A total of 5,519 records were retrieved. Of these, 3,994 records remained after the removal of duplicates. Ten records reporting on five original samples were kept for the systematic review. One study described a social network of community dwelling older adults and the remaining studies described social networks of institutional older adults. Discussion and Implications: The present study points to a lacuna in current understanding of social networks in the field of gerontology. It provides a useful review and possible tools for the design of future studies to address current shortcomings in the field. (Edited publisher abstract)
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:
- Oxford University Press
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)
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
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.
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
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.
‘We have become prisoners of our own age’: from a continuing care retirement community to a total institution in the midst of the COVID-19 outbreak
- Authors:
- AYALON Liat, AVIDOR Sharon
- Journal article citation:
- Age and Ageing, 50(3), 2021, pp.664-667.
- Publisher:
- Oxford University Press
Background and objectives: during the coronavirus disease 2019 pandemic in Israel, people residing in continuing care retirement communities (CCRC) found themselves under strict instructions to self-isolate, imposed by the CCRC managements before, during and after the nationwide lockdown. The present study explored the personal experiences of CCRC residents during the lockdown. Research design and methods: in-depth interviews were conducted with 24 CCRC residents from 13 different CCRCs. Authors performed a thematic analysis of interview transcripts, using constant comparisons and contrasts. Results: three major themes were identified: (i) ‘Us vs. them: Others are worse off’. Older residents engaged in constant attempts to compare their situation to that of others. The overall message behind these downward comparisons was that the situation is not so bad, as others are in a worse predicament; (ii) ‘Us vs. them: Power imbalance’. This comparison emphasised the unbalanced power-relations between older adults and the staff and management in the setting and (iii) ‘We have become prisoners of our own age’. Interviewees described strong emotions of despair, depression and anger, which were intensified when the rest of society returned back to a new routine, whilst they were still under lockdown. Discussion and implications: the measures imposed on residents by managements of CCRCs during the lockdown, and the emotional responses of distress among some of the residents, revealed that CCRCs have components of total institutions, not normally evident. This underscores the hidden emotional costs of the lockdown among those whose autonomy was compromised. (Edited publisher abstract)
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:
- Oxford University Press
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)
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)
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)