Informal Social Support for HIV Medical Care

Abstract

The purpose of this paper is to explore the relationship of availability of HIV-related information and emotional support necessary to obtaining appropriate medical care. Multivariate models control for use of professional case management, mental health services, and drug treatment services. Study data were obtained from the first two rounds of interviews from the New York City Community Health Advisory and Information Network (CHAIN). Household information support and professional ancillary services were significantly associated with entry into appropriate medical care. Among participants in appropriate care at the baseline, only professional services were significantly associated with continuity of care.     

Successful ageing by whose definition? Views of older,spiritually affiliated women

Objectives: Researchers have pointed to significant omissions in Rowe and Kahn's model of successful ageing and their lack of consultation with older people. This study examined late mid‐life and older women's views of successful ageing. Methods: In‐depth interviews were conducted with 14 women aged 60–89 years. Participants who identified themselves as spiritual and religious, or spiritual only and not religious, were recruited using the ‘snowball technique’. Thematic analyses were conducted within an Interpretive Phenomenological Analysis framework. Results: Participants described multiple dimensions of successful ageing with 15 subthemes grouped into three overarching categories of personal agency, social value and quality of life/quality of death. Conclusions: Participants’ multidimensional views of successful ageing were broader than Rowe and Kahn's model and included the need to have a degree of autonomy over the place and manner of the last phase of life and final days (successful dying).      

Spirituality,religion, social support and health among older Australian adults

Aim: To examine the impact of perceived importance of spirituality or religion (ISR) and religious service attendance (RSA) on health and well‐being in older Australians. Methods: A cross‐sectional survey of 752 community‐dwelling men and women aged 55–85 years from the Hunter Region, New South Wales. Results: Overall, 51% of participants felt spirituality or religion was important in their lives and 24% attended religious services at least 2–3 times a month. In univariate regression analyses, ISR and RSA were associated with increased levels of social support (P < 0.001). However, ISR was also associated with more comorbidities (incidence–rate ratio= 1.2, 95% confidence interval 1.08–1.33). There were no statistically significant associations between ISR or RSA and other measures such as mental and physical health. Conclusion: Spirituality and religious involvement have a beneficial impact on older Australians' perceptions of social support, and may enable individuals to better cope with the presence of multiple comorbidities later in life.     

Social support and health of older people in Middle Eastern countries: A systematic review

The aim of this study is to systematically review quantitative studies exploring the association between social support (SS) and the health of older people in Middle Eastern countries. Sixteen electronic databases and other resources were searched to identify studies that met the inclusion criteria of the review. Abstracts of identified papers were screened for relevancy, following which the authors determined eligibility, applied quality criteria and extracted the data. Twenty‐two studies met the inclusion criteria. Even allowing for the diversity of the studies included, this review offered strong and consistent evidence for a positive relation between SS and mental health, while there was inconsistent evidence of an association between SS and other health outcomes. The limited evidence for the Middle Eastern region confirms findings from other settings on the importance of SS for mental health in later life. Current evidence is inadequate to assess whether SS is associated with physical health.     

Management of heart conditions in older rural and urban Australian women

Background: Cardiovascular disease death rates are higher among Australians from regional and remote areas than those from major cities. Aims: To investigate the causes of excess mortality from heart disease in rural compared to urban Australian women aged over 75 years. Methods: In 2004, 944 older urban and rural participants in the Australian Longitudinal Study on Women's Health aged 77–83 years with self‐reported ischaemic heart disease (IHD), heart failure or atrial fibrillation took part in a nested cross‐sectional substudy. We used clinical guidelines to determine key management issues for these conditions. Using logistic regression we calculated odds ratios (OR) and 95% confidence intervals (CI) to assess the relationship between management and area of residence. Results: These older Australian women often did not receive recommended management for their heart conditions. Only 30% reported having had an echocardiogram. Reported use of statins and beta‐blockers was low among women with IHD (58% and 41% respectively) and only 32% of women reporting heart failure were taking angiotensin‐converting enzyme inhibitors. Women from regional/remote areas had greater odds of reporting never having seen a cardiologist (OR = 3.88, 95% CI 1.72–8.72) and never having had an echocardiogram than women from major cities (OR = 2.86, 95% CI 1.42–5.75). Medication use was similar for rural and urban women. Conclusions: Our results suggest that best‐practice treatments for heart conditions are suboptimally provided to older women. In addition, they suggest differential use of some health services, which might help explain higher cardiovascular mortality among rural compared with urban women.     

Patterns of aged care use among older Australian women: A prospective cohort study using linked data

BackgroundWomen live longer than men and have an increased need for long-term care. The objective of this study was to identify patterns of aged care use among older Australian women and to examine how these patterns were associated with their demographic and health-related characteristics.MethodsThe sample consisted of 8768 women from the 1921–1926 birth cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), who had survived to age 75-80 years. ALSWH survey and linked administrative aged care and death datasets from 2001 to 2011 were utilized. Patterns of aged care use were identified using a repeated measure latent class analysis.ResultsWe identified four patterns of aged care use over time, differentiated by timing of service onset, types of service use and time of death. Approximately 41% of the sample were non-users or using basic home and community care (HACC), while 24% were at high risk of using moderate to high-level HACC/community aged care package (CACP). Only 11% had a greater risk of using residential aged care (RAC) over time. Being widowed, residing in remote/regional areas, having difficulty in managing income, having a chronic condition, reporting poor/fair self-rated health, and lower SF-36 quality of life scores were associated with an increased odds of being a member of the following classes: 1) moderate to high-level HACC/CACP, 2) increasing RAC, and 3) early mortality, compared with the non-user class.ConclusionsDistinct patterns of aged care use were identified. These results will facilitate future capacity planning for aged care systems in Australia.     

The Social Support and Social Network Characteristics of Smokers in Methadone Maintenance Treatment

Background: Previous studies have shown social support and social network variables to be important factors in smoking cessation treatment. Tobacco use is highly prevalent among individuals in methadone maintenance treatment (MMT). However, smoking cessation treatment outcomes in this vulnerable subpopulation have been poor and social support and social network variables may contribute. Methods: The current study examined the social support and social network characteristics of 151 MMT smokers involved in a randomized clinical trial of smoking cessation treatments. Participants were 50% women and 78% Caucasian. A high proportion (57%) of MMT smokers had spouses or partners who smoke and over two-thirds of households (68.5%) included at least one smoker. Results: Our sample was characterized by relatively small social networks, but high levels of general social support and quitting support. The number of cigarettes per day was found to be positively associated with the number of smokers in the social network (r = .239, p < .05) and quitting self-efficacy was negatively associated with partner smoking (r = ?.217, p < .001). Conclusions: Findings are discussed in the context of developing smoking cessation interventions that address the influential role of social support and social networks of smokers in MMT.     

The Relationship Between Type and Quality of Social Support and HIV Medication Adherence

Abstract

In the last 10 years HIV has become a disease that can be effectively managed using antiretroviral medications. However, many factors affect adherence, including demographics, income, housing, mental health issues, and access to health care, as well as types and quality of social support. This paper summarizes results regarding specific sources of social support that are part of a larger, randomized study of medication adherence among people with HIV/AIDS. Results summarize findings from 98 program participants and include information regarding support from partners, family and health care providers, as well as the impact of support from these sources on medication adherence. Among participants in this study, those with higher levels of social support from partners demonstrated higher rates of medication adherence. Those who received more social support from their families, however, reported significantly lower adherence rates. These results suggest that efforts to improve medication adherence need to address the diverse types of social support networks of people diagnosed with HIV/AIDS.     

Functional Social Support within a Medical Supervised Outpatient Treatment Program

Background: This study examined functional social support (FSS) and its impact on treatment outcome in alcohol-dependent outpatients treated with supervised disulfiram. Method: FSS was assessed cross-sectionally in 46 severe alcohol-dependent patients participating in a close-meshed biopsychosocial treatment program. The FSS was measured with the Medical Outcome Study Social Support Survey. Results: We found significantly higher FSS levels in patients with a current partnership. No significant influence was found of the FSS on days until relapse and retention time. However, FSS was positively correlated with cumulative abstinence. In comparison with another patient sample, it can be shown that the patients of the close-meshed biopsychosocial treatment program seemed to perceive more FSS, presumably through the higher frequency of the outpatient treatment contacts. Conclusion: High FSS is associated with a current partnership and with a higher cumulative time of abstinence through close professional supervision. A better understanding of the underlying mechanisms of social relationships in alcohol-dependent patients would probably help to improve treatment outcome in the future.     

Oral health considerations in older women receiving oral bisphosphonate therapy

Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older undergoing oral bisphosphonate treatment who returned a mailed questionnaire pertaining to dental symptoms. The study, as previously reported, was conducted within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. The cohort included 7,909 women with bisphosphonate exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who underwent clinical examination. Overall, the average age was 71 ± 9; 70% were white, and 74% had at least some college education. Nearly two-thirds had received oral bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85% had had a dental examination in the past year, 22% reported denture use, and 6% reported moderate to severe periodontal disease. Oral healthcare patterns varied according to age and race and ethnicity. Five hundred seven (6.4%) women reported a tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or exostoses were found in 28% of examined participants with dental symptoms; these were predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6% of symptomatic participants with palatal tori. In summary, among older women with bisphosphonate exposure, oral health varied according to patient characteristics, and BRONJ occurred more frequently after tooth extraction or on palatal tori. These data support efforts to optimize oral health and to identify risk factors for BRONJ in older individuals receiving bisphosphonate drugs.