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.     

The elderly and high technology medicine: A case for individualized,autonomous allocation

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of technological services by age.     

Illustrating and evaluating the psychosexual symbolic meaning of the coprophilia through the film of Salò, or The 120 Days of Sodom

Coprophilia is a rarely discussed phenomenon although not uncommon in psychiatric intensive care units, inpatient learning disability services and on wards for older people. It evokes intense emotional reactions in those who witness and who are exposed to it. This paper gives a definition and a current diagnostic overview of this unusual phenomenon. It sums up the medical and psychoanalytic approaches, then makes an effort to illustrate and evaluates the psychosexual symbolic meaning of coprophilia through the film of Salò, or The 120 Days of Sodom.     

Afro-centric religious consultations as treatment for psychotic disorders among day hospital patients in Santiago de Cuba

We investigated the utilisation of Afro-centric religious treatments for psychotic disorders among a sample of Cuban day hospital patients. Most (55%) had used such treatments and this practice was more common among older persons, although unassociated with any particular religious background or racial heritage. Persons who preferred Afro-centric religious practices to medical ones were more likely to be of African descent or to have received an Afro-centric religious ritual bath as treatment. A case is made for destigmatising Afro-centric religious treatments and for exploring treatment approaches that combine both medical and religious practices in order to achieve more holistic care.     

The flu shot study: Using multiattribute utility theory to design a vaccination intervention

Differences between the multiattribute utility (MAU) profiles of participants who had previously gotten flu shots and those who had not done so were used to design an informational brochure urging influenza vaccination. The effectiveness of the MAU brochure was evaluated in a VA ambulatory care clinic with a long-standing influenza vaccination program. The target population for the intervention was high-risk clinic patients who had not gotten a shot the previous year. Participants received either a letter urging them to get a flu shot, or a letter plus the informational brochure. A significantly larger proportion of the patients who received the brochure got shots; 36% versus 23% for the letter only. While a 13 percentage point increase is modest, influenza and related complications (preventable through vaccination) are the fourth-leading killers of older persons. Adding a MAU-based brochure to an ongoing vaccination program is inexpensive and may save additional lives.     

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.     

The senior discount: biases against older career changers

This study examined age discrimination in between‐ vs. within‐career job transitions. We expected that older workers transitioning into a new field would experience greater age discrimination than those who change jobs within the same field, particularly when amount of prior job experience is not made salient, and particularly when decision‐makers were highly prejudiced. Results suggested that younger job applicants received higher suitability ratings than older job applicants, and job applicants making a within‐career transition were rated higher than those making a between‐career transition. As hypothesized, older job applicants making between‐career transitions would receive the lowest ratings of suitability for hire when no information regarding experience was presented, and when decision‐makers were highly prejudiced. Implications for the aging workforce are discussed.     

Involuntary sterilization of persons with mental retardation: an ethical analysis

Legitimate concerns on the part of parents and guardians may lead to requests for sterilization of a mentally retarded person in their care. At the same time, mentally retarded persons must be protected from actions that do not serve their best interests. This paper will review the history of involuntary sterilization in the United States and evaluate the ethical arguments that are relevant to decisions about involuntary sterilization. While other, less permanent forms of contraception might be acceptable, involuntary sterilization ought not be performed on mentally retarded persons who retain the capacity for reproductive decision-making, the ability to raise a child, or the capacity to provide valid consent to marriage. Mentally retarded persons who lack capacity in those three areas should be considered for involuntary sterilization only when the procedure is necessary, sterilization would serve the best interests of the mentally retarded person, less intrusive and temporary methods of contraception or control of menstruation are not acceptable alternatives, and procedural safeguards have been implemented to assure a fair decision-making process.     

Cognitive and behavioral distancing from the poor

The author argues that distancing is the dominant response to poor people on the part of those who are not poor and that distancing, separation, exclusion, and devaluing operationally define discrimination. Such responses, together with stereotypes and prejudice, define classism. The article focuses on classism in the United States. Classism is examined in the context of theoretical propositions about the moral exclusion of stigmatized others and is illustrated by cognitive distancing, institutional distancing (in education, housing, health care, legal assistance, politics, and public policy), and interpersonal distancing. The adoption of the Resolution on Poverty and Socioeconomic Status by the American Psychological Association Council of Representatives in August 2000 is cited as an important step in the direction of eliminating the invisibility of low-income persons in psychological research and theory.     

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.     

Counseling the Disabled Older Person for the World of Work

Although work is meaningful to many older persons, numerous barriers exist that prohibit their active participation in the labor force. Employment counselors must possess a variety of attributes to help break down these barriers. This article discusses skills that the counselor needs when working with older adults and in particular with those who are disabled. Specialized approaches to job placement are discussed, including job modification and job restructuring. To become a successful advocate for the disabled elderly wishing to enter or remain in the labor market, the employment counselor is urged to become familiar with characteristics of older persons and federal laws relating to job development and placement for older and handicapped workers.     

Disability,Performance, and Discrimination in the Service to Humanity

In an age when the church is called upon to be an inclusive community, persons with disabilities in Nigeria are still grappling with exclusion. Disability is associated with multiple challenges. The challenges include degrading treatment, marginalization, and exclusion from recruitment opportunities, as well as discrimination in churches. Some people believe that disability has negative connotations and that persons with disabilities are hopeless, helpless burdens and passive “objects” meant to receive charity as well as physical and spiritual deliverance. Persons with disabilities are stereotypically seen as incapable of being productive. It is assumed that because people live with disabilities, they are not meant to occupy leadership positions or fully partake in church activities. The expectation that persons with disabilities be wholly embraced into the Christian fold is yet to be met. This article shares information on the context in which some of the challenges facing persons with disabilities are rooted. It examines the involvement and experiences of persons with disabilities in the activities of the church, church institutions, and church‐affiliated organizations in Nigeria while acknowledging the church’s mandate of inclusion. It finds that stereotyping and discrimination are challenges for persons with disabilities – individuals who are also made in the image of God. In the future, more research needs to be carried out on issues around the isolation of persons with disabilities in the body of Christ. The findings would help interested groups recognize the predicaments of persons with disabilities and find realistic strategies for a progressive inclusive church community – in this way assisting the efforts of the World Council of Churches’ programme on disability.     

Unable to be a Human Being in Front of Other People: A Qualitative Study of Self-Isolation Among People Living with HIV/AIDS in China

In China, acute stigma accompanying an HIV diagnosis can lead to self-isolation. In a cultural setting where family relationships are highly valued and contribute critically to well-being, such self-isolation can thwart HIV self-management and engagement in medical care, and so heighten risk for health disparities. To understand this phenomenon, we conducted individual in-depth interviews with 34 persons living with HIV/AIDS (PLwHA) in Shanghai and Beijing. Inductive content analysis revealed a range of forms of self-isolation motivation, beliefs, and behaviors influenced by: 1) internalized stigma and desire to avoid discrimination; 2) HIV-related factors such as HIV knowledge and disease progression; and 3) familial factors such as a sense of responsibility and family members’ reactions. Based on a proposed framework centering on dialectical family influences (whereby PLwHA are pushed away from, yet pulled toward the family fold), implications for provision of multidisciplinary care in medical settings are considered, including culturally appropriate strategies to decrease health disparities.     

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.     

Virtual augmented exercise gaming for older adults.

This paper details the design, development, and testing of virtual augmented exercise (VAE) gaming for older adults. Three versions of an underwater VAE environment were tested with a sample of 22 healthy adults aged 50 or over. Participants strongly preferred VAE to traditional physical exercise, and adherence rate was 100%. The findings suggest that VAE with puzzles changes or negates the expected negative associations among exercise outcomes. Fitness level was not associated with performance in the game, irrespective of VAE type, indicating that persons who are less physically fit can expect to perform similarly to those who are more physically fit. In conclusion, the research found some evidence for the benefits of VAE with cognitive exercise (solving simple puzzles and hitting targets based on the answer). This type of exercise appears to be a promising method of exercise for older adults.     

The effect of social comparison information on the life satisfaction of frail older persons

In this study, the authors examined the effects of social comparison on the life satisfaction of 455 community-dwelling older persons. These older persons were confronted with a fictitious interview with either an upward or a downward target. After downward comparison, older persons felt more satisfied with their lives than after upward comparison, especially those who had higher levels of frailty. These effects were only found with lower levels of identification. Apparently, downward comparison only serves its self-enhancing function on life satisfaction among frail older persons when they perceive the comparison target as different from themselves.     

Is health-care delivery by partially trained professionals ever morally justified?

...teaching institutions should establish policies for all aspects of care provided by residents-in-training (not just for the acquisition of informed consent to treatment) and establish mechanisms to monitor how these policies are implemented and their effect on the quality of patient care and patient satisfaction with care. Clear policy on which treatments are provided by junior residents and which treatments and aspects of care are provided by senior residents is necessary for patients and their families to have control over what happens to them in the health-care institution....Teaching institutions should regularly assess whether residents are being asked to take on more responsibilities in patient care than they are prepared to do. The reasons to do this are not solely related to protecting the patient from harm. Protecting the residents-in-training from overwhelming guilt, fear, and providing them with a more humane approach to medical education should be a minimal expectation for the training of those who will be expected to provide humane care to others....     

Grasp force control in older adults

Diminished tactile sensibility and impaired hand dexterity have been reported for elderly individuals. Reports that younger adults with severely impaired tactile sensibility use excessive grasp force during routine grasp and manipulation tasks raise the possibility that elderly persons likewise produce large grasp forces that may contribute to impaired dexterity. Impaired pseudomotor functioning also occurs in elderly subjects and may yield a slipperier skin surface that enhances the possibility for excessive grasp force. The present study measured grasp force in 10 elderly and 9 young adult individuals, during grasp and vertical lift of a small object, using a precision (pinch) grip of the thumb and index finger. The slipperiness of the object's gripped surfaces was unexpectedly varied. Skin slipperiness was estimated by also measuring the grasp force at which the object slipped from grasp. The older subjects employed grasp forces that were, on average, twice as large as those of the young subjects, with some producing forces many times greater than the young subjects' average grip force. Grip forces also were significantly more variable across trials in older subjects. This increased variability was not caused simply by the elderly subjects' increased grip force. A portion of the increased force was due to increased skin slipperiness. The grip force that the elderly subjects produced in excess of the slip force (the "margin of safety" against object slippage) was larger than would have been predicted from their skin slipperiness, however. It is suggested that, in part, the excessive grasp forces represent a strategic response to tactile sensibility impairment. Twopoint discrimination limina in the older subjects averaged about four times greater than in the younger subjects. Increased grasp forces in elderly persons may result from other factors, such as increased variability in grip force production. The contributions of excessive grasp forces to impaired dexterity in older persons still need to be addressed experimentally.     

Perceived functional health of disabled elderly persons in a follow-up program for primary care.

180 disabled elderly persons were followed in a home care program after acute care rehabilitation in order to correlate subjective and objective ratings of medical, physical, and social functioning. To assess the benefits of case management services, 95 test patients receiving such care at home were compared with 85 controls who did not receive services. Both groups reported gains in functional health and their reports were verified with objective measures. There was no difference, however, between the groups in outcome. Our findings indicated that self-assessments correlate highly with measures of functional health. Procedures for self-ratings should be developed as important complements to objective functional health measures.