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Informal caregivers are a critical component of the US long-term care system, but caregivers often experience poor physical and mental health as a result of strain from the caregiving role. Engagement in community-based educational and volunteer activities contributes to older adult well-being, but previous studies have not assessed whether the effects of these types of engagement are different for older adults who are also caregivers. Using a sample of participants in educational and volunteer activities sponsored by a national nonprofit organization, we find that participants who are caregivers report more benefit from these community-based activities than their noncaregiving counterparts. Connecting caregivers to existing community-based activities may be an efficient strategy for improving caregiver well-being.

Objectives: This review summarizes the current knowledge about volunteering in later life and suggests 5 research questions at the forefront of knowledge development., Results: Rates of volunteering do not decline significantly until the middle of the 7th decade, and older volunteers commit more hours than younger volunteers. Older adults with more human and social capital tend to volunteer, and there is good evidence of a reciprocal relationship between volunteering and well-being. Program and policy developments in the field are outstripping production of knowledge to support evidence-based practices., Discussion: Research on the dynamics of volunteering over the life course as well as the patterns of activities that co-occur with volunteering is needed to guide program development. Research methods and findings from transdisciplinary work on the mechanisms through which psychosocial conditions affect health must be extended to the study of the effects of volunteering on older adults. Finally, we need to engage in more applied social science aimed at improving volunteer management, especially recruitment and retention of older volunteers.

Experience Corps (EC) is a high-commitment US volunteer program that brings older adults into public elementary schools to improve academic achievement of students. It is viewed as a health promotion program for the older volunteers. We evaluated the effects of the EC program on older adults' health, using a quasi-experimental design. We included volunteers from 17 EC sites across the US. They were pre-tested before beginning their volunteer work and post-tested after two years of service. We compared changes over time between the EC participants (n = 167) and a matched comparison group of people from the US Health and Retirement Study (2004, 2006). We developed the comparison group by using the nearest available Mahalanobis metric matching within calipers combined with the boosted propensity scores of those participating in the EC. We corrected for clustering effects via survey regression analyses with robust standard errors and calculated adjusted post-test means of health outcomes, controlling for all covariates and the boosted propensity score of EC participants. We found that compared to the comparison group, the EC group reported fewer depressive symptoms and functional limitations after two years of participation in the program, and there was a statistical trend toward the EC group reporting less decline in self-rated health. Results of this study add to the evidence supporting high-intensity volunteering as a social model of health promotion for older adults., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: To compare outcomes of mortality, institutionalization, physical and mental quality of life, overall life satisfaction, and satisfaction with living arrangements, for depressed and nondepressed clients after 1 year of community long-term care (CLTC) services., Design: Prospective cohort study with repeated assessments at 6 and 12 months., Setting: A publicly funded CLTC agency that coordinates in-home care such as meal delivery, personal care, and nursing care to functionally disabled and low-income adults throughout a Midwestern State., Participants: Adults aged 60 years and older, starting CLTC services with minimal or no cognitive impairment (N = 551)., Measurements: Outcomes included the Medical Outcome Study's Short-Form for physical and mental quality of life and single items for life satisfaction and satisfaction with living arrangements. Diagnostic Interview Schedule and the Center for Epidemiologic Studies Depression Scale determined clients' depression status., Results: Depressed clients (N = 266) had significantly worse scores for all outcomes than nondepressed clients (N = 285), but mortality and institutionalization were not significantly related to depression. Depression was significantly associated with more positive change in mental health (mean change: depressed group = 4.60, standard deviation [SD] = 14.0; nondepressed group = -1.50, SD =11.2) and overall life satisfaction (mean change: depressed group = 0.10, SD = 1.1; nondepressed group = -0.10, SD = 0.8)., Conclusion: After 1 year of CLTC services, depressed clients experienced more improvement in quality of life and life satisfaction, but their outcomes remained significantly lower than nondepressed clients. Depression was consistently and negatively associated with quality of life and satisfaction outcomes.

The Aging Semantic Differential (ASD) by Rosencranz and McNevin (1969) is the most widely used instrument in gerontological and geriatric education to assess the stereotypic attitudes young people have toward older adults. Polizzi (2003) updated the ASD with current adjectives and reduced the instrument to a single latent factor, attitude. We examine the validity of this major instrument and describe the strengths and shortcomings. The instrument was administered to 199 medical students that participated in a national pilot project, Vital Visionaries, funded by National Institute on Aging. Confirmatory factory analysis using structural equation modeling (SEM) was used. Qualitative data captured stereotypic attitudes young people have toward older adults. SEM indexes suggest that a one-factor structure has poor fit. Qualitative analyses suggest medical students hold multiple dimensions of stereotypic attitudes toward older adults. We suggest that the latent factor, attitude, can be assessed with fewer observed items, thereby creating room for the additional latent factors. The resulting instrument could be just as short, but offer a more comprehensive assessment of young people's stereotypic attitudes toward older adults.

Given the growth in the number of older adults and the ageist attitudes many in the health care profession hold, interventions aimed at improving health professionals' attitudes toward older adults are imperative. Vital Visionaries is an intergenerational art program designed to improve medical students' attitudes toward older adults. Participants met for four 2-hour sessions at local art museums to create and discuss art. Three hundred and twenty-eight individuals (112 treatment group, 96 comparison, 120 older adults) in eight cities participated in the program and evaluation. Participants completed pre-and postsurveys that captured their attitude toward older adults, perception of commonality with older adults, and career plans. Findings suggest that medical students' attitudes toward old adults were positive at pretest. However, Vital Visionary students became more positive in their attitudes toward older adults at posttest (p < .001), with a moderate effect size, G = .60, and they felt they had more in common with older adults at posttest (p < .001), with a moderate effect size, G = .64. The program did not influence their career plans (p = .35). Findings from this demonstration project suggest that socializing medical students with healthy older adults through art programs can foster positive attitudes and enhance their sense of commonality with older adults.

Although significant numbers of social service clients experience mental health problems, virtually no research has examined the responsiveness of social service agencies to mental disorder. This article examines the extent to which client depression is reflected in records of a public social service agency, community long-term care (CLTC). Researchers assessed new, consenting CLTC clients for depression using standardized research criteria in a telephone interview. Agency case records were abstracted to determine the extent to which client depression was noted. Sensitivity and specificity of depression notation were 25.21 percent and 92.80 percent, respectively, indicating that agency records reflected depression for about one in four clients meeting depression criteria. Factors associated with accurate depression notation included cognitive impairments, low social support, psychotropic medications, and mental health treatment. The depression notation rates found are comparable to those in medical settings. Structured screening and assessment might enhance detection of mental disorder for social service clients.

Objective: Depression often co-occurs with other conditions that may pose competing demands to depression care, particularly in later life. This study examined older adults' perceptions of depression among co-occurring social, medical, and functional problems and compared the priority of depression with that of other problems., Methods: The study's purposeful sample comprised 49 adults age 60 or older with a history of depression and in publicly funded community long-term care. Four-part, mixed-methods interviews sought to capture participants' perceptions of life problems as well as the priority they placed on depression. Methods included standardized depression screening, semistructured qualitative interviews, listing of problems, and qualitative and quantitative analysis of problem rankings., Results: Most participants identified health, functional, and psychosocial problems co-occurring with depressive symptoms. Depression was ranked low among the co-occurring conditions; 6% ranked depression as the most important of their problems, whereas 45% ranked it last. Relative rank scores for problems were remarkably similar, with the notable exception of depression, which was ranked lowest of all problems. Participants did not see depression as a high priority compared with co-occurring problems, particularly psychosocial ones., Conclusions: Effective and durable improvements to mental health care must be shaped by an understanding of client perceptions and priorities. Motivational interviewing, health education, and assessment of treatment priorities may be necessary in helping older adults value and accept depression care. Nonspecialty settings of care may effectively link depression treatment to other services, thereby increasing receptivity to mental health services.

Objectives: In light of large variation in the quality of medical care, this study assesses the extent to which medical care for depressed elders is consistent with systematic quality standards., Method: Using the Donabedian model, we assess factors related to two quality measures: medical service fit and medical provider contact. We assessed 110 depressed older adults with comorbid conditions through practical guidelines of medical services., Results: We found large variation in the quality of medical care and differences between two quality measures. Structure (Medigap insurance and clinical factors) and process factors (medical professional visits, ER visits, and adequacy of informal care) influenced the quality of medical care., Conclusion: Emphasizing accuracy in quality measures, quality disparities by medical conditions call attention to the risky population with certain conditions targeted for closer follow-up. Appropriate medical care processes can enhance the quality.

This study examines how older adults access organizational volunteer roles and what socio-structural factors are associated with the access. Using the data from the Current Population Survey (U.S. Department of Commerce, Bureau of the Census, 2002), bivariate analyses show that there are variations in access to volunteer roles across types of organizations. Results from multinomial logistic regressions indicate that education, income, age, and race are associated with the ways that older adults access volunteer roles. Voluntary organizations are advised to approach older adults directly, use current volunteers to recruit potential ones, publicize their organizational goals, and disseminate relevant information in efforts to improve access of older adults to volunteer roles.

Objective: This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients., Methods: Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care., Results: Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression., Conclusions: Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers.

Using the 11-item Treatment Evaluation Inventory (TEI), a community sample of 79 homebound and 127 ambulatory older adults rated their acceptance of four depression treatments for two hypothetical cases with mild-to-moderate or severe levels of depressive symptoms. The four treatments were clinic-based cognitive therapy (CT), in-home cognitive bibliotherapy (CB), antidepressant medication (AM), and regimented physical exercise (PE). Older adults had significantly less favorable attitudes toward AM than CT as a treatment for mild-to-moderate symptoms, and they were less accepting of CB than CT for severe symptoms. Concerns about becoming dependent on medication and about its side effects as well as the understanding of loneliness and isolation as causes of depression appear to have affected their scores. African American and Hispanic older adults showed attitudes that were as favorable as those of their non-Hispanic white peers toward all four types of depression treatments. Homebound older adults had less favorable attitudes toward CB than did their ambulatory peers.

Objectives: Elders with depression are disproportionately hospitalized, and they depend on postacute care for recovery. The authors hypothesized that higher quality of postacute care would be associated with better depression outcomes for older adults six months after discharge for inpatient psychiatric care. The study also explored the time frame in which effects of quality of care on depression outcomes were manifested., Methods: The sample consisted of 148 elders (ages 60-95 years) who were hospitalized for major depression and discharged to their homes. Quality of care was measured by the extent to which services met patients' needs. Specifically, quality of care was assessed by whether four domains of needs (psychiatric, medical, functional, and psychosocial) were met six weeks and six months postdischarge. Depression outcomes at six months were measured by the Geriatric Depression Scale., Results: In bivariate analyses at six weeks, no quality-of-care variables were associated with depression outcomes, but in bivariate analyses at six months, quality of functional and psychosocial care was related to depression outcomes. Multivariate analyses revealed that those whose psychosocial needs were unmet at six months showed worse depression outcomes., Conclusions: Findings provided partial support for the association between quality of care and depression outcomes, in that quality of psychosocial care was associated with better outcomes. Also, the findings suggest that the relationship between quality of psychosocial care and depression outcomes may be evident after six months of postacute care.

Objective: The authors examined physical illness among elderly patients hospitalized for treatment of major depression, the impact of comorbidity on functional status, and the burden of comorbidity on post-discharge service needs., Methods: Data for this cross-sectional study were derived from patient interviews and abstracted from hospital charts. The sample comprised 195 older adults hospitalized for treatment of depression on the geropsychiatric unit of a large urban teaching hospital and discharged to home. Medical comorbidity was measured with the Cumulative Illness Rating Scale for Geriatrics. A psychiatrist confirmed DSM-IV for Axis I diagnosis of depression, and the Geriatric Depression Scale measured depression severity. Unit nurses administered the Mini-Mental State Exam. They assessed functional dependency via the OARS Multidimensional Functional Assessment Questionnaire. Service needs post-discharge were measured from physician discharge orders and patient scores on standardized tests., Results: Almost three-fourths of depressed elderly patients had at least one comorbid condition requiring first-line treatment; nearly half had two, and one-fourth had three or more. Comorbid physical illness and cognitive impairment was significantly and negatively associated with elderly patients' functional impairment at discharge. Depressed patients with higher medical comorbidity had significantly more needs for services after they left acute care., Conclusion: Medical comorbidity needs to be assessed and considered in planning for post-acute care for depressed elderly patients discharged home.