Research: Perceptions of personal safety among older Australians

Introduction: There is public perception, partly attributable to the media, that older people are disproportionately the victims of crime and are greatly concerned for their personal safety. Objectives: To identify at a population level older people's perceptions of their personal safety in their home and separately in their neighbourhood, and the predictors of feeling safe in each setting. Methods: Logistic regression analysis of responses from randomly selected older Australians (65+ years) living independently in the community (n= 8881) to a cross‐sectional telephone general health survey. Results: The vast majority of respondents, although higher in men, reported feeling safe in their home (96%) and neighbourhood (92%) ‘all’ or ‘most’ of the time. Feeling safe did not decline with age. Significant predictors of feeling safe ‘all’ the time were identified and some gender differences were noted. Conclusions: The perception that older people are greatly concerned with their personal safety is not supported by these findings.     

Discrepancies between personal income and neighbourhood status: effects on physical and mental health

During their life course, older persons income level may become discrepant with the socio-economic status of their neighbourhood. This study examines whether and how such discrepancies affect older persons physical and mental health. Using baseline data from the Longitudinal Aging Study Amsterdam, 2,540 non-institutionalised persons aged 55–85 years were classified based on self-reported income and neighbourhood status. Two categories defined discrepancies: discrepant-low (DL, low income in high-status neighbourhood), and discrepant-high (DH, high income in low-status neighbourhood). Both categories were compared with the same reference category: matched-high (MH, high personal and high neighbourhood income status). A range of health indicators were examined, as well as mediating effects of neighbourhood and individual characteristics. Among the 504 persons who reported a high income, 16% lived in a low-status neighbourhood (DH). Conversely, among the 757 persons living in a high-status neighbourhood, 24% had a low income (DL). The DL category mainly lived in rural areas, and the DH category predominantly in large cities. The data show discrepant income effects (DL vs. MH) on physical and cognitive ability, self-rated health, and loneliness, and discrepant neighbourhood effects (DH vs. MH) on physical and cognitive ability, depressive symptoms, and loneliness. Personal income effects were partly mediated by other personal characteristics, and neighbourhood effects were fully mediated by socio-economic neighbourhood characteristics as well as by older persons perceptions of their neighbourhood and their income. It is concluded that discrepancies between personal income and neighbourhood status, accrued throughout the life course, are associated with poor health.     

Will housing tenure drive unequal outcomes for Consumer‐Directed Care recipients?

Initiatives to promote consumer choice are increasingly a feature of Australian welfare policies and programs. Consumer Directed Care (CDC) for older people and the National Disability Insurance Scheme for people younger than 65 years with a disability are two examples of this move towards consumer choice in policy and program development. The ability for service users to benefit from these programs is premised on the fact that their housing is stable and suitable. Yet, there is evidence that this is not the case, and many older people and people with disabilities experience significant housing challenges and stress. This article focuses on CDC and its implications for one particular group under housing stress – low‐income older renters. Might they be at risk of limited access to home care services, and what are the broader local neighbourhood implications of this policy?     

Co-Learning With Home Care Aides and Their Clients: Collaboratively Increasing Individual and Organizational Capacities

Changes in health care provide unprecedented opportunities for collaboration across research, education, and practice for the common goal of enhancing the well-being of older adults and their caregivers. This article describes how a pilot project, Promoting Seniors’ Health with Home Care Aides, has synergistic education, research, and practice effects that enhance individual and organizational capacities. This pilot is an innovative partnership with home care aides to deliver a safe physical activity program appropriate for frail seniors in a real-life public home care program. The intervention and research occur in older adults’ homes and thus provide rare opportunities for the research team and partners to learn from each other about dynamics of home care in older adults’ life contexts. Co-learning is essential for continuous quality improvement in education, research and practice. The authors propose to establish “teaching home care” to ensure ongoing co-learning in gerontology and geriatrics.     

When it is more than a job: close relationships between home health aides and older clients

OBJECTIVES. A qualitative study was conducted to investigate the types of relationships that were formed between older clients and their home health aides and to identify structural characteristics and interactive processes that facilitated various types of relationships. METHODS. Using semistructured interviews, members of 16 families and their home health aides described the relationships that developed between clients and aides and the conditions and contexts that facilitated or inhibited close relationship development. Data were coded and analyzed using a multistage process. RESULTS. Most relationships between aides and older clients were described as friendship or like one of the family, with friendship occurring most often. Several structural conditions and numerous interactive friendship processes were identified. The cognitive process of boundary setting discriminated between friendships and family-like relationships. DISCUSSION. Results show support for socioemotional selectivity theory and highlight the benefits of close relationships for older homebound adults and their home health aides.     

Promote social participation among older persons by identifying physical challenges – An important aspect of preventive home visits

IntroductionSocial participation can have a positive impact on health; however, physical challenges can be hindrances. During a preventive home visit a health professional (visitor) assesses different aspects of physical, mental and social health. However, there might be a challenge for the visitor to discover the interrelationship between physical factors that hinder social participation. Therefore, the aim of this study was, in the context of preventive home visits, to identify physical factors which can hinder older persons from taking part in social contexts.MethodsCross-sectional register data from preventive home visits to older persons (n = 1245, ≥77 years old, without home care) was used. Data was collected during a period of 17 months, in seven Swedish municipalities. Logistic regression was used to analyze the association between physical factors and the item physical problems hindering social participation.ResultsThe mean age was 78.8 (standard deviation 1.8 years), and 55% were women. The physical factors significantly associated with physical problems hindering taking part in social contexts were: having urinary incontinence (women only), having pain, impaired endurance and using a mobility device.ConclusionsThis study provides insights into how to make the best use of the questions asked during preventive home visits, in order to enable older persons to take part in social contexts. The results recognize the importance of taking into account physical challenges to be able to support social participation. Furthermore, considering physical challenges for social participation on both an individual and a societal level might reduce inequalities among older persons.     

Cultural perspectives on aging and well-being: a comparison of Japan and the United States

This study investigated age differences in multiple aspects of psychological well-being among midlife and older adults in Japan (N = 482) and the United States (N = 3,032) to test the hypothesis that older Japanese adults would rate aspects of their well-being (personal growth, purpose in life, positive relations with others) more highly that older U.S. adults. Partial support was found: older adults in Japan showed higher scores on personal growth compared to midlife adults, whereas the opposite age pattern was found in the United States. However, purpose in life showed lower scores for older adults in both cultural contexts. Interpersonal well-being, as hypothesized, was rated significantly higher, relative to the overall well-being, among Japanese compared to U.S. respondents, but only among younger adults. Women in both cultures showed higher interpersonal well-being, but also greater negative affect compared with men. Suggestions for future inquiries to advance understanding of aging and well-being in distinct cultural contexts are detailed.     

Objective and subjective measures of the neighbourhood environment: Associations with frailty levels

ObjectivesThe aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults.MethodsA cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents’ perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty.ResultsFrail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables.DiscussionNeighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.     

Everyday Challenges in Context: The Influence of Contextual Factors on Everyday Problem Solving Among Young,Middle-Aged,and Older Adults

The authors examined the experimental effects of social context on everyday problem–solving performance by older, middle-aged, and younger adults. Participants were presented with six everyday problems constructed by framing two behavioral challenges in social contexts representative of the lives of older, middle-aged, and younger adults. As predicted, participants performed best when problems were situated in contexts representative of their own age group. Older adults also outperformed the other age groups on problems set in older adult contexts, suggesting that when problems are set in ecologically relevant contexts, one may not observe previously reported age-related declines in performance.     

Neighbourhood deprivation and overweight: the GLOBE study

BACKGROUND: Increasing morbidity and mortality rates of coronary heart disease (CHD) by increasing levels of neighbourhood deprivation may be explained by a positive association between neighbourhood deprivation and risk factors of CHD. In this study we investigated the association between neighbourhood deprivation and overweight. Further, we examined whether this association was modified by educational level, age and sex of the neighbourhood residents. METHODS: Data were used from 8897 subjects who participated in the baseline measurement of the Dutch GLOBE Study in 1991 and lived in 86 neighbourhoods of the fifth largest city in The Netherlands (Eindhoven). Neighbourhood deprivation was based on aggregated self-reported information about educational and occupational level and employment status. Self-reported body height and body weight were used to define overweight body mass index ((BMI) >or=25). RESULTS: Adjusted for educational level, age and sex of neighbourhood residents, odds ratios of overweight increased significantly by increasing neighbourhood deprivation (odds ratio=1.20, 95% CI 1.02, 1.41 in the highest vs lowest quartile of neighbourhood deprivation). Stratified analyses showed a stronger association between neighbourhood deprivation and overweight in females compared to males, and in older (>or=49 y of age) compared to younger participants. The pattern of increasing odds ratios of overweight by neighbourhood deprivation was generally similar in all educational groups, the highest educational group being the exception with no association between neighbourhood deprivation and overweight. CONCLUSIONS: Increased prevalence rates of overweight in more compared to less deprived neighbourhoods are likely to contribute to the positive association between neighbourhood deprivation and CHD. Our results justify the development of a community-based strategy of primary prevention of overweight in deprived neighbourhoods, which may have a larger impact in females and older residents in particular. Prior to implementation, however, longitudinal research needs to further examine responsible mechanisms for the development of neighbourhood inequalities in overweight.     

Asymptomatic bacteriuria and urinary tract infection in older adults

Asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are common in older community dwellers (ages 65 and older) and nursing home residents. The challenge involved in distinguishing ASB from UTI in this population results from other comorbid illnesses that may present with symptoms similar to UTI and from elderly adults who have cognitive impairment not being able to report their symptoms. This article reviews the most updated information on diagnosis, microbiology, management, and prevention of ASB and UTI as they pertain to older community dwellers and nursing home residents.     

Environmental facilitators for outdoor walking and development of walking difficulty in community-dwelling older adults

Older adults who report environmental barriers in their neighborhood have a higher risk for walking difficulty. However, environmental facilitators that protect against walking difficulty are not well known. The objective of this study was to identify the effect of environmental facilitators for outdoor walking on development of walking difficulty in community-dwelling older people. This was a prospective study with a 3.5-year follow-up time on 261 community-dwelling people aged 75–81 years, who at baseline were able to walk 0.5 km without difficulty. Environmental facilitators for outdoor walking were self-reported with standardized questionnaires, including having features in one’s home which make it easy to access the outdoors, having a park or other green area within a walking distance from home, having outdoor recreational facilities within a walking distance from home, having features in the nearby environment, which are attractive for outdoor activities, and perceiving the surrounding environment or facilities nearby as motivating factors for physical activity. Self-reported difficulty in walking 0.5 km was assessed every 6 months. Of the participants, 46 % developed walking difficulty during the follow-up. Having a park or other green area within a walking distance from home was the most frequently reported facilitator. Environmental facilitators decreased the risk for development of walking difficulty, hazard ratio per item 0.86, (95 % confidence interval 0.73–1.02). The results indicate that the mobility of older community-dwelling people may be promoted with outdoor recreational facilities that are easy to access and located within a walking distance from home.     

Perceptions of local neighbourhood environments and their relationship to childhood overweight and obesity

OBJECTIVES: To examine associations between parent and child perceptions of the local neighbourhood and overweight/obesity among children aged 5-6 and 10-12 y. DESIGN: Cross-sectional survey. SUBJECTS: In total, 291 families of 5-6-y-old and 919 families of 10-12-y-old children. MEASURES: Parent's perceptions of local neighbourhood and perceived child access to eight local destinations within walking distance of home; 10-12-y-old children's perception of local neighbourhood; socio-demographic characteristics (survey). Children's height and weight (measured). RESULTS: No perceptions of the local neighbourhood were associated with weight status among 5-6-y-old children. Among 10-12-y-old children, those whose parents agreed that there was heavy traffic in their local streets were more likely to be overweight or obese (OR=1.4, 95% CI=1.0-1.8), and those whose parents agreed that road safety was a concern were more likely to be obese (OR=3.9, 95% CI=1.0-15.2), compared to those whose parents disagreed with these statements. CONCLUSIONS: This study suggests that parental perceptions of heavy traffic on local streets and concern about road safety may be indirect influences on overweight and obesity among 10-12-y-old children. Future work should also consider perceptions of the neighbourhood related to food choice.     

Similarities and differences in attitudes toward long-term care between Japanese Americans and Caucasian Americans

The purpose of this study was to compare attitudes toward the use of long-term care between older Japanese Americans (n = 1,244) and older Caucasian Americans (n = 1,354). When presented with a hypothetical situation in which they have dementia, 39% of older Japanese Americans and 42% of older Caucasians intended to be cared for at home, whereas 53% versus 38%, respectively, intended to use nursing home care (P <.001). If the hypothetical situation was hip fracture, 81% of older Japanese Americans and 72% of older Caucasians intended to be cared for at home, with 13% of both groups intending to use nursing home care (P = NS). The subjects' perceptions of what their families, friends, ministers, and communities would want them to choose differed, with more uncertainty among Caucasians (P <.001). For provision of home care, Japanese Americans were more likely to rely on loved ones than Caucasians, who were more likely to rely on paid providers. Multivariate logistic regression showed ethnicity to be independently related to intention to use nursing home care in the dementia scenario, controlling for demographic variables. Being married lowered the odds of intending to use nursing homes in any situation. We conclude that Caucasian Americans intend to use paid home health care at higher rates than Japanese Americans if they become disabled by dementia. Japanese Americans demonstrated more certainty about the influences of others on their opinions, suggesting a more stable cultural norm in this population, and intended to use more nursing home care in the event of permanent debility (dementia).     

Home environment risk factors for falls in older people and the efficacy of home modifications

Most homes contain potential hazards, and many older people attribute their falls to trips or slips inside the home or immediate home surroundings. However, the existence of home hazards alone is insufficient to cause falls, and the interaction between an older person's physical abilities and their exposure to environmental stressors appears to be more important. Taking risks or impulsivity may further elevate falls risk. Some studies have found that environmental hazards contribute to falls to a greater extent in older vigorous people than in older frail people. This appears to be due to increased exposure to falls hazards with an increase in the proportion of such falls occurring outside the home. There may also be a non-linear pattern between mobility and falls associated with hazards. Household environmental hazards may pose the greatest risk for older people with fair balance, whereas those with poor balance are less exposed to hazards and those with good mobility are more able to withstand them. Reducing hazards in the home appears not to be an effective falls-prevention strategy in the general older population and those at low risk of falls. Home hazard reduction is effective if targeted at older people with a history of falls and mobility limitations. The effectiveness may depend on the provision of concomitant training for improving transfer abilities and other strategies for effecting behaviour change.     

Built environment and mobility of older adults: important policy and practice efforts

As people age, they prefer to "age in place." The concept of aging in place refers to the ability to live in one's own home, wherever that might be, for as long as one can feel confident and comfortable. Where people live and whether these environments can support them are critical questions for public health and public policy, especially since the baby boomers began to turn 65 on January 1, 2011. Equally important for public policy, those aged 85 and older are the fastest growing population group in the United States. The Health and Aging Policy Fellows Program, with the Centers for Disease Control and Prevention Healthy Aging Program, has supported a project to determine how design features of the built environment can support the mobility of older adults. Mobility refers to physical activity, usually walking, but also encompasses the ability to stay connected to nearby community resources and services. The project's purpose is to investigate features that support mobility in built environments. This policy brief introduces the realist synthesis method used in the project and selected national initiatives and activities to place this work in a broader context. Given the importance of mobility concerns to older adults, it must be determined without delay which design features support mobility and how local areas can better prepare to support the health of their aging populations.     

Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns

Background

Rapidly aging populations with an increased desire to remain at home and changes in health policy that promote the transfer of health care from formal places, as hospitals and institutions, to the more informal setting of one's home support the need for further research that is designed specifically to understand the experience of home among older adults. Yet, little is known among health care providers about the older adult's experience of home. The aim of this study was to understand the experience of home as experienced by older adults living in a rural community in Sweden.

Methods

Hermeneutical interpretation, as developed by von Post and Eriksson and based on Gadamer's philosophical hermeneutics, was used to interpret interviews with six older adults. The interpretation included a self examination of the researcher's experiences and prejudices and proceeded through several readings which integrated the text with the reader, allowed new questions to emerge, fused the horizons, summarized main and sub-themes and allowed a new understanding to emerge.

Results

Two main and six sub-themes emerged. Home was experienced as the place the older adult could not imagine living without but also as the place one might be forced to leave. The older adult's thoughts vacillated between the well known present and all its comforts and the unknown future with all its questions and fears, including the underlying threat of loosing one's home.

Conclusions

Home has become so integral to life itself and such an intimate part of the older adult's being that when older adults lose their home, they also loose the place closest to their heart, the place where they are at home and can maintain their identity, integrity and way of living. Additional effort needs to be made to understand the older adult's experience of home within home health care in order to minimize intrusion and maximize care. There is a need to more fully explore the older adult's experience with health care providers in the home and its impact on the older adult's sense of "being at home" and their health and overall well-being.     

Age, consumer direction, and outcomes of supportive services at home

PURPOSE: Supportive services at home are essential for older people with severe chronic impairments. Newer "consumer-directed" models of organizing home-based services rely heavily on service recipients rather than home care agencies to arrange and direct care at home. This study examined differences in service experience and outcomes between recipients over and under age 65 who direct their own services in one large Medicaid program. DESIGN AND METHODS: A random sample of 1,095 recipients of In-Home Supportive Services in California was selected and interviewed by telephone. Interviews were conducted in English, Spanish, and three Asian languages; those with severe cognitive impairment were excluded from the study. RESULTS: Findings indicate that although younger recipients embrace self-direction more enthusiastically than older ones, age differences are small on a majority of service outcomes. On average, older users embrace this model and manage within it much like younger users. Some differences emerge between the young-old (65-74) and old-old (75+), but these are neither consistent nor determinative. IMPLICATIONS: Old age is far from an inevitable barrier to self-direction. As with other age groups, there are opportunities and obstacles to be addressed as this newer approach to home care is disseminated.     

Comprehension of Speeded Discourse by Younger and Older Listeners

Researchers have argued that older adults are more adversely affected by speeding speech than are younger adults. However, the age effects usually occur when (1) the speech materials are artificially speeded to rates well above those that occur in natural speech; (2) the speeding method introduces distortions that tax the older adult's auditory processes; and (3) the speech materials are simple sentences or very short passages. This study evaluated whether older adults are disadvantaged when listening to extended discourse (10- to 15-min lectures) speeded to a rate near to the limit of normally encountered fast speech (240 words/min) with a minimum of acoustic distortion. Perceptual difficulty was further manipulated by presenting stimuli in either quiet or with a 12-talker background babble. Younger and older adults had more difficulty recalling the details of the discourse and integrating their contexts when stimuli were presented at faster rates and in higher levels of background noise. Although each of these manipulations were found to cause large differences in performance, the age groups were generally found to perform analogously in most conditions. Potentially the availability of semantically rich materials, and the extended durations of the passages, allowed the older adults an opportunity to adjust to the faster speech rates and maintain performance levels similar to younger adults.     

No place like home: older adults and their housing

OBJECTIVES: The home is both older Americans' largest asset and their largest consumption good. This article employs new data on the consumption and assets of older Americans to investigate what role the home plays in the economic lives of older adults. METHODS: We used 20 years of data from the Consumer Expenditure Survey to examine the asset and consumption trends of four cohorts of older Americans. We compared the data with other survey results. RESULTS: Older Americans' homeownership rates were stable until age 80. The homes were increasingly mortgage free; home equity increased with age, and relatively few older adults took out home equity loans or reverse annuity mortgages. Housing consumption flows increased with age; nonhousing consumption flows declined after age 60 at a rate of approximately 1.4% per year. DISCUSSION: The results suggest that the consumption of cohorts of older Americans does not decrease dramatically over a 20-year period and that they are also not converting their housing assets into other types of income or consumption, at least up to age 80. A number of reasons, including the bequest motive and the life cycle hypothesis, might explain this behavior.