An Investigation of Quality of Life of the Elderly in South Africa, with Specific Reference to Mpumalanga Province

This paper is based on a research study that investigated the quality of life of elderly persons (aged 60 years and over) in South Africa in the wake of population aging, HIV/AIDS, the process of modernization which ushered in new challenges and the legacy of apartheid. A combination of all these factors among others has played a major role in lowering the quality of life of senior citizens in South Africa. For effective measurement purposes, a conceptual framework of broad categories of quality of life indicators for this proportion of the population are identified as: household structure, social inclusion, care of older persons and care burden on the elderly. Under these broad categories we investigate such specific indicators as: general health; satisfaction with basic needs of food, clothing and housing; emotional well-being; and their environmental harmony regarding access to amenities of transport, sanitation, safe water and security. The influence of socio-demographic factors on the above indicators is also examined. The long term goal of the study is to provide guidance for more creative policies including strategies of poverty reduction, housing older people in a dignified way and providing a wide range of options that facilitate healthy aging, in so doing, catering for the best interests and needs of senior citizens in South Africa. A representative sample of size 900 randomly selected elderly persons in Mpumalanga Province, South Africa is used. Structured interviews and direct observation are used to collect data, and bivariate statistical analyses performed.     

Issues in Publicly Subsidized Long Term Care Systems and Implications for the Religous Sector

Given the increasing numbers of elderly in need of long term care services and the harsh reality of finite resources, new models are required which define those elderly persons who should remain eligible for publicly subsidized long term care. If, in fact, a method is established for serving only a limited number of older persons, i.e., the truly vulnerable elderly, by way of the public system of long term care, a large constituency of older Americans will be left to exist on the margins. The church as an informal care system may appropriately assume the role of ensuring that the available public funds are used wisely and that service gaps inevitably left bewteen the increasing number of older persons and shrinking public support are bridged. In addition, the church must assist in improving all long term services by contributing to public policy formation.     

How Can Ethics Support Innovative Health Care for an Aging Population?

The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development and provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative.     

The Urban Church: A Healing Community for the Older Person

ABSTRACT

Significant relationships between social networks and the well-being of older persons living in cities have been reported. This paper focuses on an attempt to strengthen the social networks of at-risk older persons through linking them with church-based volunteers who provide a wide range of support services. It is argued that the success of these linkages are explained by the costs and rewards involved in the relationship, or exchange, the volunteer's perception of the distribution of resources, and the social distance separating the two. Implications for social policy and church-based ministry with older persons are discussed.     

Pastoral Theological Implications of the Aging Process

Pastoral care of the aged must deliberately attend to spiritual-theological issues involved in the aging process. As clinical, empirical, and practical pastoral experiences demonstrate, these spiritual-theological problems are as varied as the range of overall problems faced by the elderly. In an attempt to focus on major issues, however, it may be helpful to examine the three epochs of aging i.e., young~ldm, iddle-old, and old-old, in order to determine the spiritual and theological issues which are particularly relevant to each epoch. This paper proposes that each of the three developmental epochs has a main spiritual-theological concem which can be expressed in a question: young-old: "What shall I do with my life?"; middleaid: "What about my dying?"; old-old: "Why must I suffer so?" Pastoral ministry is called to further examine the validity of these assertions and draw practical applications in response to these spiritual-theological issues which face older persons.     

Inanspruchnahme psychosozialer Versorgungsstrukturen

In spite of the high proportion of persons with a migration background in Germany, professional mental health care utilization by this population group still seems to be insufficient. This could be due to social as well as structural and individual barriers which impede the professional mental health care-seeking process. The heuristic Mental Health Action Process Approach (M-HAPA) model was developed in order to be able to empirically investigate the specific mechanism of action as well as the specific time of influence of these factors. An empirically supported model should possibly be able to justify targeted interventions. The M-HAPA model describes mental health care utilization behavior, combines the basic ideas of already existing models describing health behavior and health care utilization behavior as well as factors which are specifically relevant for the health care utilization behavior of persons with a migration background. This combination may serve as a basis for future research in the field of mental health care utilization behavior of persons with a migration background.     

Disabilities and aging

Both older persons and those who havedisabilities can encounter discrimination whenthey seek medical care. Just as ageism andstereotypes about older persons mayinappropriately limit medical care for theelderly, limits may be placed on medical carefor those who are disabled simply because ofthe presence of a disability. At the sametime death is the natural end of the lifespanfor all individuals and there are situationswhen aggressive medical care is not indicated. It is not right to always insist on ``doingeverything' for a person even if that personmay be at risk otherwise for discrimination. Using the example of the elderly, this paperexamines the risks of discrimination and thedangers of overtreatment in caring for olderpersons and suggests parallels in theappropriate care of those who havedisabilities. This revised version was published online in June 2006 with corrections to the Cover Date.     

Sex stereotypes and health care: The case of treatment for kidney failure

Differential health care is a potential source of differences in women's and men's health status. This paper discusses sex, race, and age differences in treatment for kidney failure. Women, blacks, and older persons are less likely to receive a kidney transplant (the optimal treatment for kidney failure) than are men, whites, and younger persons. Differences between women's and men's transplant rates have been increasing since 1978. Neither legitimate medical factors nor differential ability to pay explain these sex differences in treatment. Physicians appear to favor males when they select transplant candidates. One reason for this may be that physicians consider it more important to facilitate males' return to employment. Sex stereotypes may be an important influence on the allocation of scarce medical treatments, contributing to sex differences in health status.This paper was originally prepared for the annual meeting of the American Sociological Association in Atlanta, Georgia, August 1988. The research was supported in part by End Stage Renal Disease Network 20.     

Cognitive stimulation for healthy older adults through computer-based programs: a review of the literature / Estimulación cognitiva para personas mayores sanas mediante programas computarizados: una revisión de la literatura

Abstract

Cognitive stimulation programs are widely used as a preventive tool for cognitive decline in older adults, as they can favour positive ageing by maintaining older persons’ autonomy and preserving their cognitive functions. Because of this, and due to its potentially easy application on a large scale and at a low cost, the incorporation of technologies for the cognitive stimulation of older adults has become an area of growing interest. This review outlines the advantages and disadvantages of computer-based cognitive stimulation programs aimed at healthy older adults, focusing on aspects that influence their effectiveness and future direction. Twenty-five articles were considered, including original studies, literature reviews and meta-analyses, published between 2013 and 2017. It was concluded that there is a need to generate more randomized studies with active control groups to assess the effectiveness of cognitive stimulation through computer-based programs, as well as develop designs to establish strategies that increase older adults’ adherence and ensure their motivation to carry out these activities.     

New Migrants in Residential Aged Care: Managing Diversity in Not-for-Profit Organisations

This paper draws on qualitative interviews with migrant Indo-Asian and African personal care workers and registered and enrolled nurses employed by two not-for-profit residential aged care organisations in Australia: AnglicareSA and Resthaven Inc. The paper examines the way these culturally and linguistically diverse staff talk about the safe organisational environment provided by their employers, while in the wider Australian environment, low levels of hostility towards migrants and refugees are a constant cultural force. We demonstrate the impact of these organisations’ foundational ethics and values that influence how human resource diversity management strategies impact on the quality care provided to residents. We argue that this ethic and these human resource strategies act as conduits for culturally and linguistically diverse (CALD) staff to integrate into the workforce and as a mechanism in assisting new migrants to transition into the wider Australian society, while at the same time enriching the care of the older persons.     

Old Age:

According to the research of gerontologists, old age is not as bad as many negative stereotypes portray. However, the crises of loss, physical decline, and social oppression are spiritually difficult for many older persons. This article suggests that we develop images of the latter part of life that are honest with both the possibilities and the dangers. The ministry of the church involves much more than "taking care of" fragile older persons. We must also challenge ourselves to be open to the crises through which God transforms our individual and corporate lives at all ages.     

End-of-life care in nursing homes: the interface of policy,research, and practice

Much attention has begun to focus on the quality of care for persons near the end of life. Palliative care, especially through hospice, has generated much discussion as possibly the most holistic care available. Consideration of how chronically ill older adults receive such care as a result of public policy can benefit from adopting a multidimensional perspective. This paper adopts Bronfenbrenner's ecological model to understand current end-of-life care for nursing home residents, followed by consideration of how each of these dimensions or levels of influence can be used to foster both research agendas and policy reforms to improve end-of-life care of nursing home residents. Specifically, the benefits of considering the influence of such policy initiatives as the Medicare hospice benefit and the Patient Self-Determination Act (PSDA) on end-of-life care in nursing homes and the means through which policy can be informed by clinical research is emphasized.     

Religion,sexuality, and (in)equality in the lives of older lesbian,gay, and bisexual people in the United Kingdom

This article explores how older lesbian, gay, and bisexual (LGB) people in the United Kingdom engage with religion in later life. Drawing on research with older persons who are LGB and with activists, it explores religious spaces as sites of both inclusion and exclusion, historically and in the present day. Particular consideration is given to the equality implications, in the form of parity of participation, including in the context of religious-based social care provision for older people. Future research implications are addressed.     

Health numeracy and cognitive decline in advanced age

ABSTRACT

The study aimed at investigating health numeracy in cognitively well performing healthy participants aged from 50 to 95 years as well as in participants with cognitive impairment, but no dementia (CIND). In cognitively well performing participants (n = 401), demographic variables and cognitive abilities (executive functions, reading comprehension, mental calculation, vocabulary) were associated with health numeracy. Older age, lower education, female gender as well as lower cognitive functions predicted low health numeracy. The effect of older age was partly mediated by executive functions and calculation abilities. Participants with CIND (n = 51) performed significantly lower than healthy controls in health numeracy. The findings suggest that cognitively well performing old individuals have difficulties in understanding health-related numerical information. The risk of misunderstanding health-related numerical information is increased in persons with CIND. As these population groups are frequently involved in health care decisions, particular attention has to be paid to providing numerical information in comprehensible form.     

A Conceptual Framework for Assessing the Spiritual Functioning and Fulfillment of Older Adults in Long-Term Care Settings

ABSTRACT

The 1971 White House Conference on Aging asserted that all persons are spiritual, and that the spiritual well-being of older adults is a significant area of concern for both researchers and practitioners. Many attempts have been made to define and describe spirituality, using instruments designed to measure religious functioning and behavior. While these have been helpful to researchers, they have been of little practical use.

This paper presents a conceptual framework for the operationalization of the variable, “spirituality.” Using this framework, the authors chose three qualitative research questions related to spiritual values which were asked of both older adults and service providers. The results were factor analyzed and an instrument was developed which enables the practitioner to assess the type of spiritual functioning and fulfillment desired by older adults in long-term care settings.     

Holocaust survivors in long-term care

ABSTRACT

Little research exists on the experience of older trauma survivors in long-term care settings. This study examined the experience of Holocaust survivors in community-based and facility-based long-term care. We wished to know if Holocaust survivors had a systematically different experience in such settings compared to persons without a trauma experience in their backgrounds. Through interviews with survivors, American-born Jews in the same settings, family members, and professional staff, we learned that there were differences in certain aspects of mental health and emotional well-being and that these differences are associated with the relative lack of a network of family members as compared to American-born Jews.     

The Development and Manifestation of Altruistic Caring: A Qualitative Inquiry

Qualitative, phenomenological research provides rich information about the constructive, life span perspectives of the manifestation and development of altruism. Using an interpretive phenomenological approach, this study investigated altruism as described by 34 older persons in a continuing care retirement community. The findings identified 13 overarching, common, emergent themes related to this construct. Implications are provided for helping professionals.     

Extending Autonomy for Health Care Preferences in Late Life

Mechanisms for extending autonomy in financial and health care decisions (e.g., advanced directives) are being utilized more frequently. This study examined the hierarchy of documents completed, the characteristics of people completing these documents, the choice of surrogate decision-maker for health care decisions, and with whom health care decisions were being discussed in a sample of 661 persons 65 years of age and older. Comparison between people with and without documents in place suggested that cognitive impairment, level of education, and age were related to preparation of documents. Women were typically chosen as surrogate decision-makers, except in a sample of unmarried men. Surprisingly, participants reported discussing preferences for health care decisions with someone other than their preferred surrogate. There appears to be a need to promote discussion of health care preferences between care-receivers and preferred surrogates.     

A FACTOR ANALYSIS OF BRAIN DAMAGE TESTS ADMINISTERED TO NORMAL SUBJECTS WITH FACTOR SCORE COMPARISONS ACROSS AGES

This study investigated the factorial composition of brain damage tests selected on the basis of a comprehensive review of the test literature. The tests were administered to 100 normal persons between the ages of 16 and 70. Two analyses were performed. The first analysis concerned the determi- nation of the factorial composition of the brain damage tests selected. The results suggested that although the dimensionality of the brain damage test battery is relatively complex, the majority of the tests discriminate on the basis of a few dimensions, at least for normal persons. The second analysis involved the determination of factor scores for each individual on the twelve factors extracted in the 16-70 age group analysis. An analysis of the factor scores as a function of age indicated a significant difference for only two of the factors. This finding was discussed in terms of the possibility that certain of the tests would be psychometrically more efficient in differential diagnosis of brain damage in the older person.     

Quality of life and affect in older persons: Hope, time frames, and training effects

This is a preliminary report of a project designed to increase hope and quality of life (QOL) in older persons through a series of five training sessions. The training sessions for the experimental groups are based on research on happiness, goal imagery, and time management. Data indicates that the training is effective in increasing expected QOL. Several measures of affect and stress are examined as a function of three time frames of self-reported QOL. Daily uplifts are significantly related to present and future QOL while measures of stress and major life changes are not. Correlations of affective measures with QOL tend to increase from time frames of the past five years through the present to the next five years, indicating the relevance of hope for older persons. Training for increased hope works with older persons. Data obtained in the process is used to address theoretical models of QOL in older persons. This project was supported by a grant from the American Association of Retired Persons Andrus Foundation.