Health and Ageing in Slovenia: Literature Review

The study aims to establish whether professional and scientific literature in Slovenia provides grounds for the integrated approach in care for the elderly. Literature review is used as the method of data collection and analysis. Relevant publications were searched for through the national electronic interdisciplinary bibliographic database. Data was collected twice, for the period from 1994 to 2003 and from 2004 to 2006, to establish the publishing trend. A chart is drawn, based on a distinction among three levels: disciplinary, multi-interdisciplinary and the level of integration. It outlines the conceptualization of elderly people’s health as shaped through selected literature, and another one exposes its changes in time. Results show the prevalent presence of the functionalist theoretical perspective on ageing and the bio-medical model of care for the elderly. The voice of the elderly is poorly acknowledged. Data testify to the lack of literature that would support the implementation of the integrated approach to the health of the elderly.

ElderLynk: A Community Outreach Model for the Integrated Treatment of Mental Health Problems in the Rural Elderly

In 2000, a rural consortium of health care education and service providers established a geriatric mental health outreach program (ElderLynk) for the underserved elderly (aged 65 and older) in ten rural counties in northeast Missouri. ElderLynk evaluated the efficacy of an integrated community-based treatment model through the creation and evaluation of a clinical database. Ten rural counties in northeast Missouri were chosen because they were designated as mental health shortage areas (MHSAs) and because their elderly population approximates the projected level of elderly in the USA in 2020. All patients were managed by a geriatric nurse with treatment planning and oversight provided by a community-based interdisciplinary team which included a psychiatrist, geriatrician, psychologist, and social worker. Using the Geriatric Depression Scale (GDS); the Government Performance and Results Act data (GPRA) to assess life satisfaction, independence/autonomy, psychosocial functioning, and overall health; the Instrumental Activities of Daily Living (IADL); the Mini-Mental Status Examination (MMSE); and patterns of service usage (number of hours of case management and number of counseling sessions), ElderLynk patients improved significantly in overall psychological functioning, level of depression, and reported life satisfaction despite significant declines in mental status, daily function, and overall health.

Health shocks and retirement: the role of welfare state institutions

We investigate the effect of an acute health shock on retirement among elderly male workers in Denmark, 1991–1999, and in particular whether various welfare state programs and institutions impinge on the retirement effect. The results show that an acute health event increases the retirement chances of elderly male workers by 8%, and that this increase in the baseline retirement probability is not affected by eligibility to early exit programs and persists even after accounting for selection due to take-up of disability pension. Neither is it affected by the relatively long duration of sickness benefits in Denmark nor by the promotion of corporate social responsibility initiatives since the mid-1990s. In the late 1990s, however, the retirement rate following a health shock is reduced to 3% with the introduction of the subsidized employment program (fleksjob) but this effect is on the margin of being significant. For the most part, the retirement effect following a health shock seems to be immune to the availability of a multitude of government programs for older workers in Denmark.

Can the Internet Improve the Well-being of the Elderly?

In this paper we report on a project that aimed to evaluate the potential of the Internet to reduce social isolation amongst the elderly, and thereby, improve psychosocial functioning. Twenty residents of a retirement village volunteered to be given access to, and training in, the use of computers and the Internet. After 3 months, they exhibited little change in measures of self-esteem, positive affect, personal well-being, optimism and social connectedness. However, they reported that they found the use of the Internet to be of great benefit. Over the 12 months of the study 12 participants discontinued their involvement for a variety of reasons. After 12 months, the eight participants who remained in the study again reported a range of positive outcomes however, quantitative survey data did not confirm these findings of a generally-positive experience. This discrepancy between the qualitative (interview) data and the quantitative (survey) data suggests that impact of the Internet on the wellbeing of the elderly may be more complex than suggested, and broader than was assessed psychometrically. We make specific recommendations about the introduction of computers to elderly with care both in how participants are selected and how their well being is monitored subsequently.

Expert Strategies: Nurses Providing Care for their Elderly Parents

Few studies have examined how medical professionals, i.e. “caregiving experts,” approach caregiving when called upon to provide it for someone in their own families. Expert strategies are sought in problem-solving research, and may be of similar benefit in the field of caregiving research. Thus, we report data from a focus group with middle-aged, registered nurses about their experiences providing care for an elderly, chronically-ill parent. Questions centered on: (i) key caregiving tasks performed by nurses for elderly parents (ii) obstacles to performing caregiving tasks, (iii) strategies used to overcome obstacles. Participants reported serving primarily as health educators and patient advocates for elderly parents. They advocated in an assertive manner, while simultaneously framing the need for patient assertiveness as an unfair burden placed on patients by the rushed managed care climate. This climate was viewed as placing elderly parents at risk, and interfering with good nursing practices. In serving as health educators for parents, participants linked the need to do so to inadequate health education provided by doctors and/or parents’ passivity in seeking health information. Health education provided to elderly parents centered on diabetes care, the seriousness of which participants believed diabetic parents did not grasp. Participants bemoaned passivity around health perceived in members of their parent’s generation, and encouraged parents to adopt a consumerist approach to medical help seeking. Key caregiver strategies for supporting elderly parents’ health included being impervious to doctor resistance when seeking medical help for parents; encouraging parents to act as healthcare consumers; and ensuring that elderly parents understood their own medical histories. Findings are discussed in terms of caregiving and eldercare program implications.

The Influence of Integration on the Expenditures and Costs of Mental Health and Substance Use Care: Results from the Randomized PRISM-E Study

We compared the healthcare costs associated with an integrated care model to an enhanced referral model for the treatment of depression, anxiety, and at-risk drinking from the randomized Primary Care Research in Substance Abuse and Mental Health for the Elderly study. We examined total healthcare costs and cost components, separately for Veterans Affairs (VA) and non-VA participants. No differences in total health expenditures were detected between study arms. No differences in behavioral health expenditures were detected for non-VA sites, but the VA integrated arm had slightly higher ($38; p < 0.05) behavioral health costs. Differences in other types of services use were detected.

Gender Differences in Contributory Behaviors Among the Oldest-Old Chinese in Shanghai

This study examined gender differences in factors related to contributory behavior among the oldest-old aged 80+ in Shanghai, China. The study population included a randomly selected sample of 349 community dwelling respondents who lived in five districts. Male and female respondents contributed equally to others in informal networks, but in different ways. Objective health status and social ties are related to contributory behavior for both males and females. However, financial status and vision impairment had a different impact on males and females. Healthy aging and strong social networks are two key components for contributory behaviors.

Strength Perspective: An Analysis of Ageing in Place Care Model in Taiwan Based on Traditional Filial Piety

In the 1990s, the government in Taiwan proposed a series of community care related policies, in which the main care model was designed to be ‘the local taking care of the local’. In response to the social problems arising from the ageing of the population and the growing demands for welfare, Executive Yuan of Taiwan formulated the Development Program for the Care Service Industry in 2001. The government designed the elderly care policies based on the notions of community care in promoting the care industry. The community care policies would better serve the elderly and encourage families to purchase affordable services. The government aimed to encourage the non-profit sector and the commercial sector to provide care services. In Taiwan, with the notion of ‘in place’ care, the community care model has become a new trend. This study first analyzes the policies and the practices of community care in Taiwan. Secondly, it discusses how to make use of the ‘strength culture’ among Chinese people to construct a community care model based on the strength perspective of traditional filial piety. Finally, it analyzes the ‘community care centers’ that Taiwan is currently running with the aim of constructing a system of ‘ageing-in-place’ community care based upon the tenets of filial piety.

Designing a Culturally Attuned Bilingual Educational Website for US Latino Dementia Caregivers

Few consumer health websites target low-literate and/or non-English speaking patient populations, despite the fact that these populations are most vulnerable to poor health outcomes. Latinos providing care to a family member with Alzheimer’s disease and related dementias (ADRD) fall within this vulnerable population in that they face numerous language, literacy, and cultural barriers to accessing and using health and social services. As a result, Latino family caregivers tend to suffer greater morbidity due to stress burden than ADRD caregivers in Anglo American, English-speaking families. Moreover, distance and other convenience barriers prevent family caregivers across ethnic groups from utilizing health and support services. The internet represents a promising tool for eliminating barriers to education and service use among family caregivers. In particular, using the internet to reach Latino caregivers, who are most at-risk for stress-related morbidity, could represent a breakthrough means for reducing health disparities in this group. In this paper, we report our efforts to develop a “plain language” bilingual website to educate and support Latino family caregivers. We review our website design process, preliminary evaluation study findings, and future directions for web-based education for under-served Latino family caregivers.

Late-life Widowhood and Meaning in Life

The relationship between elders’ marital status and length of widowhood, as well as other personal and familial resources and the sense of meaning in life, as defined by logotherapy, was tested among 180 Israeli elderly community dwellers aged 64–95. Results show that an event such as late-life widowhood can create a loss of the sense of meaning in life. In addition, a significant difference was found between married and recently widowed elders in relation to meaning in life. Other variables that affected and explained meaning in life were subjective health, education, the quality of social support relationships, and activity level. The results support Frankl’s logotherapy approach, underscoring the importance of helping older people in general, and the widowed elders in particular, to discover and create new life meanings.

Intergenerational Family Relations and Life Satisfaction Among Three Elderly Population Groups in Transition in the Israeli Multi-cultural Society

The study aims to illuminate the links between personal and familial resources and wellbeing of elders 65+ in three population groups in Israel: kibbutz members, new immigrants from the former Soviet Union and Arabs—all of whom are undergoing different types of personal, social and economic transitions. About 70 respondents in each group were interviewed regarding life satisfaction, familial relations based on the paradigm of intergenerational family solidarity and personal resources (socio-demographic and physical functioning). The main conclusions of this study are: the lives of the elderly immigrants are much more disruptive by the transitional migration processes they are undergoing and this affects their well-being which was much lower than the other two groups. Additionally they received more help from the family. Family solidarity, mainly opportunity structures and emotional bonds were especially strong among the Arabs, with the lowest level of conflict. The Arab elderly were also different from the other two groups in the lower level of help they provided to their adult children, probably due to their more limited level of personal resources and the differing social expectations. The majority of respondents acknowledged some degree of filial obligations, although much lower among kibbutz members. Personal resources (physical functioning and financial adequacy) had the strongest effect on life satisfaction in all three groups. The dimensions of family solidarity played a less dominant role. The discussion highlights the distinctive family culture of the three groups, the transition they face, and their differential resources with some policy recommendations.

Emergence of the notion of retirement in rural China:

Since the outset of the reform process in 1978, rural China has been undergoing fundamental changes in the relationships between the state, society and individuals. Social policy, including pension policy for rural residents, is an essential factor in this transformation process which has influenced the life chances of many peasants. This paper deals with the relationship between social policy and individual life courses in the case of Shanghai’s rural pension policy. It integrates the theoretical insights from life course research to emphasise the close relationship between the state welfare and the institutionalisation of the life course. By analysing biographical interviews conducted in rural Shanghai, this article has identified the changing nature of welfare mix in rural old-age security as well as the emergence of the notion of retirement among the peasants in rural Shanghai. The introduction of the innovative rural pension policy has given rise to the rudimentary emergence of a modern life course, in the contour of a temporal partition between work and retirement. However, diverse local subsidies and individual household situations have led to different perceptions and biographical orientations of the peasants with respect to their old-age security and retirement.

Exit and voice: an investigation of care service users in Austria, Belgium, Italy, and Northern Ireland

The past decades have seen an introduction of market elements in the provision of social care services (Finer 1999; Mabbett and Bolderson 1999). Welfare state reforms all over Europe have produced welfare pluralism and claims that the increased choice will enhance user participation, promote older persons’ autonomy, and improve the quality of services. Within the Fifth FP Research Project CARMA (Care for the Aged at Risk of Marginalization) a case study among users of care services in Austria, Belgium, Italy, and Northern Ireland was conducted that focussed on friction and conflict between clients and service providers and investigated the reasons for discharge and denial of admission to a service. The data from this study can be interpreted in terms of Hirschman’s (Exit, voice, and loyalty: responses to decline in firms, organizations, and states. Harvard University Press, Cambridge, 1970) theory on ‘exit’ and ‘voice’ as expressions of consumers’ dissatisfaction with the quality of a product. Data were collected in different systems offering a variety of procedures for exit from one provider and the choice of a competitor. Also different practices of handling voice i.e., complaints have been documented. The paper questions to what extent various possibilities for exit and voice can enhance users’ autonomy and increase the quality of the service supply. It thus contributes empirical findings to a debate that often emphasizes ideological arguments.

Children’s impact on the mental health of their older mothers and fathers: findings from the <Emphasis Type="Italic">Survey of Health,Ageing and Retirement in Europe</Emphasis>

The relation between social support and mental health has been thoroughly researched and structural characteristics of the social network have been widely recognised as being an important component of social support. The aim of this paper is to clarify the association between children and depressive mood states of their older parents. Based on international comparative data from the Survey of Health, Ageing and Retirement in Europe we analysed how the number of children, their proximity and the frequency of contact between older parents and their children are associated with the mental health of older people, using the EURO-D index. Our results indicate a positive association of children and depressive mood since childless men and women report more depressive symptoms. Moreover, few contacts with children were associated with an increased number of depressive symptoms. The family status was related to mental health as well: older men and women living with a spouse or partner had the lowest levels of depression. Interestingly, the presence of a spouse or partner was more relevant for the mental health of older people than the presence of, or contact with, their children.

“Still the same and better off than others?”: social and temporal comparisons in old age

Cognitive adaptation in the elderly and the motivated use of temporal and social comparisons set the conceptual frame for the present study. Three research questions were investigated in a sample of 2.129 persons aged between 50 and 90 years. First, the direction of social and temporal comparisons for three domains (physical fitness, mental fitness, psychological resilience) was studied, and findings did show that especially lateral followed by upward comparisons were most frequent under both perspectives; downward comparisons clearly showed the least frequency. Second, the distribution of comparison directions was investigated across four age groups. These analyses showed that upward comparisons increased and lateral comparisons decreased across age groups; differential results were observed for the domains under consideration. Third, the relation between social and temporal comparisons and self-esteem was studied. Results obtained here indicated a motivated use of specific comparison directions since downward social comparisons and upward temporal comparisons were most frequent in persons with low self-esteem. Taken together, the study underlines the different functions of social and temporal comparisons in adulthood and old age; it indicates a predominant need for consensus and consistency, and it highlights the importance of self-esteem in cognitive adaptation.

Ageing in Place in the United Kingdom

Ageing in Place is a key component of UK policy on older people and housing. Helping older people to ‘age in place’ at home is seen to benefit the quality of life and also provide a cost-effective solution to the problems of an expanding population of very old people. However, the reality is not straightforward and in this paper, some results of qualitative research are presented to illustrate the benefits, problems and challenges that exist in relation to Ageing in Place in the United Kingdom. The research is based on qualitative data collected from 40 people age 80–89 in the north-west of England as part of the ENABLE-AGE Project 2002 to 2004. The research suggests that while Ageing in Place may bring social and psychological benefits, there can also be a significant downside on an everyday level. Home in old age can be a place of negative experiences, such as isolation and loneliness and there are often significant weaknesses in terms of informal support, physical environment of the home and neighbourhood and social network, which undermine the person’s ability to live independently. The paper reviews recent UK initiatives to use “telecare” to address some of these issues.

The relation between attachment and intergenerational support

This study investigated the relation between the internal representation of attachment and the perception of the actual exchange of intergenerational support within 100 dyads of adult daughters and their elderly mothers in Germany. Results showed relations between the daughters’ preoccupation and avoidance with their perception of receiving emotional support from their parents and providing instrumental support to them. No relations were found between the mothers’ attachment and the support they provided to the daughters. These results are discussed with respect to different conditions for emotional and instrumental support of adult daughters and their elderly mothers, and a relationship specific approach to attachment.

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Long-term Botulinum Toxin Treatment for Dysphagia Due to Large Epiphrenic Diverticulum in Elderly Patients: A Report of Two Cases

Symptomatic esophageal epiphrenic diverticula are usually repaired with diverticulectomy and esophagomyotomy with substantial morbidity and mortality rates, especially in elderly patients. We describe the cases of two elderly patients who had dysphagia caused by large epiphrenic diverticula. Due to severe comorbid diseases, both patients were unable to withstand surgical intervention; botulinum toxin solution was injected endoscopically at multiple sites in the region of the lower esophageal sphincter and esophageal wall near the diverticulum. Symptoms improved immediately and the beneficial effect of botulinum toxin remained for 5–6 months. During the long-term follow-up, the patients developed symptomatic relapses treated by subsequent botulinum toxin solution reinjections resulting in longer-lasting symptom relief.

European patterns of intergenerational financial and time transfers

The ageing of the European population is expected to strongly influence both the structure of family relations and the pattern of private transfers between generations. Using data from the Survey of Health, Ageing and Retirement in Europe conducted from the perspective of adults aged 50 and above in ten European countries, we provide an analysis of financial and time transfers, either given or received. Our results show that cash gifts mainly flow to the younger generations, while time transfers are directed both upwards and downwards. When comparing the countries, we find some remarkable similarity in the pattern of transfers, although there are inter-country differences. These differences sometimes follow the expected north-south European gradient, but not always. The results suggest that the social and demographic transformations currently taking place in Europe often have contradictory and paradoxical effects upon the nature of intergenerational exchanges.

Native-born Chinese Women’s Experiences in Medical Encounters in the U.S.

Native-born Chinese women’s experiences with medical help seeking in the U.S. is poorly understood, including how life phase affects it. Focus groups with middle-aged and older immigrant Chinese women explored: a) behaving assertively with doctors, b) strategies for assertiveness, c) characteristics of “ideal” doctors. Assertiveness was described as a reciprocal behavioral process between patient and doctor. Responsibility for initiating the process was seen as resting with doctors. Patient assertiveness goals included obtaining information and referrals. Strategies for achieving goals included not mentioning low-priority medical concerns in order to increase odds of obtaining referrals, and switching doctors when dissatisfied with communication. Older women reported refusing medical treatment due to language barriers. Cultural values, reported to be rooted in Confucianism, were identified by participants as shaping their help seeking. “Ideal” doctors were described as unhurried, and fully responsive to patient symptoms. Older women viewed “direct speaking” by doctors as always desirable around general information, and sometimes desirable around serious diagnoses. Older women perceived cultural differences with American-born Chinese providers. Findings are discussed in relation to continuity of care issues.