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Objectives Most older adults with dementia are assisted by multiple caregivers, but the relationship of care network structure with health care access and quality is underexamined. We sought to test the associations of care network characteristics with the physician visit experience for older adults with dementia across diverse racial/ethnic groups. Methods We used data on Medicare beneficiaries (aged 65+) with dementia from the National Health and Aging Trends Study (2015–2019) to fit logistic regression models to test associations between physician visit outcomes and (a) size of the potential care network and (b) proportion of potential care network members (PCNMs) currently helping with daily functioning tasks. We also tested for modifications by race/ethnicity. Results Hispanic respondents had the largest potential care networks (M = 6.89, standard deviation [SD] = 3.58) and the smallest proportion of PCNMs providing help with daily functioning (M = 29.89%, SD = 22.29). In models adjusted for demographics and dementia classification, both network size and proportional involvement of PCNMs were positively associated with the presence of a PCNM and assistance during the visit. Associations remained significant at 4-year follow-up for the presence of PCNM at the visit and were robust to further adjustments for insurance type, income, and health factors. Associations were not modified by race/ethnicity. Discussion Larger networks and a higher proportion of PCNMs providing assistance predicted caregiver presence and assistance at the physician visit but not access to care. Findings suggest that strengthening care networks early in the disease may support improved health care outcomes for persons with dementia across diverse populations.

The Brief Sense of Community Scale (BSCS) is a well-validated measure of psychological sense of community (PSOC), but it has yet to be tested with Spanish-speaking older adults. The current study uses data from face-to-face interviews with a non-probability sample of 154 community-dwelling older adults in Puerto Rico. We used confirmatory factor analysis (CFA) to test three competing factor structures. We also tested internal consistency reliability and convergent validity. CFA results show the second-order four-factor model was the best fit (χ2 (16) = 20.78, p = 0.187; CFI = 0.997, TLI = 0.995, SRMR = 0.026, RMSEA = 0.044, 90% CI [

Low-income senior housing provided through the Section 202 Supportive Housing for the Elderly program is a critical site for aging in place, and many of these properties have hired service coordinators to monitor residents' quality of life, provide access to services, and promote their ability to age in place. To address gaps in the limited literature on Section 202 buildings, this study examined the association between service coordination and low-income senior housing residents' preference to age in place with particular attention to the most economically vulnerable. We analyzed data from 255 older adults living in eight Section 202 buildings in Southeastern Michigan using logistic regression. Self-perceived economic vulnerability moderated the relationship between service coordination and preference to age in place. Among those who had not received service coordination, the high economic vulnerability group was more likely to prefer to age in place compared to more economically secure residents. Among those who received assistance from a service coordinator, economically vulnerable residents were less likely to express a preference to age in place compared to other residents. Findings indicate a complex relationship between service coordination, economic resources, and preference to age in place in senior housing, and suggest areas for future research.

As age-friendly community (AFC) initiatives grow, it will be essential to determine whether older adults who live in an AFC have better health than those who live in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: an AFC group (livability score of 51+; n = 2364) and a non-AFC (score ≤ 50, n = 663). The outcome variable was self-rated health (M = 3.5; SD = 1.1; range: 1–5). We used an inverse probability weighting approach to evaluate whether older adults who live in an AFC reported better self-rated health than those who live in a non-AFC. Findings showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b = 0.08, p = 0.027). Compared to non-Hispanic Whites, Black and Hispanic older adults reported worse self-rated health. Inasmuch as living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to develop and sustain high-quality, accessible built and social environments.

Background and Objectives Cities and counties worldwide have adopted the concept of “age-friendly communities.” These communities aspire to promote older adults’ well-being by providing a safe, affordable built environment and a social environment that encourages their participation. A major limitation in this field is the lack of valid and reliable measures that capture the complex dimensionality and dynamic nature of the aging–environment interface. Research Design and Methods This study uses data from the AARP 2016 Age-Friendly Community Surveys (N = 3,652 adults aged 65 and older). The survey includes 62 indicators of age-friendliness, for example, outdoor spaces, transportation, housing, social participation, and community and health services. We randomly split the sample into 2 equal subsamples for confirmatory factor analysis (CFA) and structural equation modeling (SEM). Results CFA results indicated that both the 5-factor model and the second-order factor model adequately fit the data. In the SEM 5-factor model, outdoor space (β = 0.134; p = .017), social participation (β = 0.307; p < .001), and community and health services (β = −0.149; p = .008) were associated with self-rated health, the outcome of interest. The path coefficients of housing and transportation were not significant. In the second-order factor model, people who lived in more age-friendly communities reported better self-rated health (β = 0.295; p < .001). Discussion and Implications Our findings show that the Age-Friendly Community Survey measures demonstrate reliability and concurrent validity. To promote older adults’ well-being, practitioners, policymakers, and researchers should focus on improving their built and social environments. They can use these measures for short- and long-term planning, monitoring, and evaluating age-friendly community initiatives.

Older African Americans may underutilize mental health services, although they experience mental health problems at rates comparable with those of whites. Untreated mental disorders contribute to increased risk of morbidity and mortality and decreased quality of life, and therefore, understanding the factors that influence racial disparities in service use is critical. This study examined whether county characteristics were associated with mental health service use by older African Americans after the analyses adjusted for individual characteristics.This study combined individual-level data from the 2008-2012 Medical Expenditure Panel Survey with county-level data for 2008-2012 from the 2013-2014 Area Health Resources Files and county-level data from the 2008-2012 Chronic Conditions Report of the Chronic Conditions Data Warehouse for 1,567 community-dwelling African Americans ages 60 and older. Multilevel logistic regressions were used to examine the role of county characteristics on mental health services use with adjustment for individual-level risk factors.At the county level, individuals living in a county with a higher proportion of African Americans were less likely to use mental health services. At the individual level, higher income and mental health status were associated with mental health service utilization.Among older African Americans, the racial composition of one's county of residence played a role in mental health service use, indicating the need for future research focusing on the relationship between an area's racial composition and mental health service use. Programs may be able to ameliorate racial disparities in mental health care by targeting areas with a higher percentage of African Americans.

The human rights perspective is emphasized through the social work code of ethics and practice principles. However, the efforts to improve the human rights perspective of social workers were insufficient in gerontological social work education in South Korea. Thus, the study aimed to prove the effects of a human rights-based approach intervention for gerontological social workers, which consisted of nine online sessions using Zoom. PI developed the program based on McPherson’s integrated framework for Human Rights Practice in Social Work. A quasi-experimental design was used. The experimental group consisted of 36 social workers, and the control group was 31 social workers at senior centers. The pre-post tests for the experimental group and posttest for the control group were conducted. The socio-demographic characteristics of the two groups were equivalent. The key measure was the Human Rights Lens in Social Work (HRLSW) scale consisting of two sub-dimensions: social problems as rights violations and clients as experiencing rights violations.The effect sizes of the online program’s effects on the social worker’s rights-based perspective were large over .90. In addition, the degrees two dimensions of the HRLSW at the posttest were significantly higher than those of the control group (social problems as rights violations: d = 1.04, p < .001; clients as experiencing rights violations: d=0.98, p

The WHO developed the concept of age-friendly environments that contribute to older adults' better health and well-being. However, research on the effects of age-friendly communities (AFCs) on their health is limited. As AFC initiatives grow, it will be essential to examine whether older adults who live in an AFC have better health than those in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3,027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: the AFC group (livability score of 51+; n=2,364) and the non-AFC group (score≤50, n=663). The outcome variable was self-rated health (M=3.47; SD=1.09; range: 1-5). Findings employing an inverse probability weighting approach showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b=0.08, p=.027). Compared to non-Hispanic whites, Black and Hispanic older adults reported worse self-rated health. Oldest old individuals had better health status than young-old adults. Consistent with previous literature, higher education, and frequent social interaction were associated with better self-rated health. The study adds to the growing literature on the role of age-friendly environments in older adults’ health and suggests directions for future research. Since living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to build high-quality, accessible built and social environments.

This article investigates distinct patterns of adverse childhood experiences (ACEs) in a representative sample of US older adults, and how the ACEs patterns relate to major depression and substance use disorder (SUD).Data came from the National Epidemiologic Survey on Alcohol and Related Conditions III. The study sample consisted of older adults aged 55 or older (Results of the LCA identified four classes of ACEs: High Adversity (6%), Low Adversity (69%), Child Abuse (16%), and Parental Substance Use (8%). The three classes of High Adversity, Child Abuse, and Parental Substance Use showed significantly higher rates of SUD than the Low Adversity class. The High Adversity and Child Abuse classes were more likely to have major depression compared to the Low Adversity class. In addition, major depression mediated the association between ACEs and SUD for those two classes.The findings provide evidence for a long-term impact of ACEs on mental health and SUD later in life and emphasize trauma-informed care principles in interventions for older adults with SUD.

Older adults living in racially segregated neighborhoods often lack access to mental health care. This study assessed the role of racial segregation in mental health service use and examined whether the relationship between segregation and mental health service use differs by race/ethnicity. We linked residential segregation data from the National Neighborhood Change Database to the 2015 Medical Expenditure Panel Survey. The sample included 4,023 adults aged 65 and older. We measured mental health service use as visit(s) to a mental health professional and/or use of prescribed medication for mental health (1=yes, 0=no) during the past year. Residential segregation was assessed using a combined measure of isolation (level of interaction with the same racial and ethnic group members) and dissimilarity (evenness of distribution of racial groups). Indices ranged from 0 (integrated) to 1 (segregated). We adjusted for age, sex, race/ethnicity, marital status, education, income, attitude toward health care, health insurance, and mental health status. Multiple logistic regression analyses showed that older adults living in more segregated counties were less likely to use a mental health service than those living in more integrated counties (OR=0.77, p=.04). The relationship did not differ by race/ethnicity. As expected, Blacks and Hispanics underused mental health services compared to Whites. The findings highlight that racial segregation limits access to mental health care. Practitioners and policy-makers should identify mental health needs and service use patterns to target services effectively and efficiently. Future research should explore the intersection of income and mental health care resources in segregated neighborhoods.

Older adults are closely connected to their neighborhoods and they spend more time there than younger adults. Because their mobility is often impeded by diminished health and functioning, access to neighborhood health and social services is essential for their well-being. This article examines whether geographic proximity to these types of neighborhood resources is associated with depression among older adults in South Korea.Data are fromThe LPA identified three distinct subgroups of geographic proximity to neighborhood resources:Our findings suggest that access to essential services in one's neighborhood is associated with lower levels of depression, which supports existing evidence that age-friendly community initiatives are important to older adults' psychological well-being.

Given the ethnic/racial disparities in end-of-life care, this study aimed to describe and identify factors affecting engagement in three types of advance care planning including informal talk, living will, and durable power of attorney for health care among ethnic/racial minority older adults. Living will refers to any written instruction about medical treatments at the end-of-life while durable power of attorney for health care allows someone to make a health care decision when an individual is incapable of making a reasoned decision.We used a subset of racial/ethnic minority groups drawn from the second wave of the National Health Aging and Trends Survey (The descriptive result showed that informal talk (60%) happened most followed by durable power of attorney for health care (30%) and living will (26.5%) completion. Multivariate logistic regression analyses found that higher education and lower preference toward life-sustaining treatment were associated with engagement in all three types of advance care planning. Having multimorbidity and U.S. born were associated with having informal talk. Non-Hispanic others were more likely to have informal talk and complete durable power of attoreny for health care to compared to Blacks. Furthermore, married older adults were more likely to complete living wills compared to those separated/divorced or never married.Our findings about different factors affecting engagement in advance care planning indicate that we may need targeted approaches to promote each type of advance care planning for ethnic/racial minority older adults.

In South Korea, the number of older adults living alone is rapidly increasing with the growth of the ageing population. Although there is some evidence of a link between financial strain and depression in this population, there is limited empirical evidence on the relationship between food insecurity and depression in older adults living alone despite the fact that they have a high prevalence of food insecurity and tend to seek food assistance. This study aims to investigate whether food insecurity explains depressive symptoms in Korean older adults living alone. We employed data from the Korea Welfare Panel Study collected from a large-scale national sample in South Korea. Our sample consisted of 815 older adults aged 65 or older who lived alone. Conducting ordinary least square regression analyses, we tested the main effect of food insecurity on depression and the interaction effect of food insecurity and low income. We found that the relationship between food insecurity and depressive symptoms differed by low-income status (b = 6.27, p = 0.047). The association was significant only in the low-income group (b = 1.37, p = 0.04). These findings suggest that protecting access to food may be a promising strategy to lessen depressive symptoms associated with financial strain among older adults living alone.

Background and objectives Although older Hispanics experience high rates of depression, they tend to underuse mental health services. The study examined the association between county characteristics and mental health service use among older Hispanics, controlling for individual characteristics. Research design and methods The study used the 2008-2012 Medical Expenditure Panel Study and linked county-level data from the 2013-2014 Area Health Resources Files and the 2008-2012 Chronic Conditions Data Warehouse, using the Federal Information Processing Standard county code. The sample includes 1,143 community-dwelling Hispanics ages 60 years or older (Level 1) and 156 counties (Level 2) where the sample resides. The single dichotomous measure of mental health service utilization was based on whether or not the respondent met one or more of three conditions: (1) the respondent received care from a mental health professional, (2) received a service including mental health counseling or psychotherapy, or (3) received a service that was related to the International Classification of Diseases. Multilevel logistic regression analysis was used to examine the role of county context. Results The proportion of older adults and the existence of community mental health centers at the county-level were associated with mental health services use among this population. At the individual-level, education and mental health status were also associated with using mental health services. Discussion and implications The county context plays an important role in understanding mental health services use among older Hispanics, indicating the need for intervention strategies at the county level.

Older adults prefer to live in their current home or community and ‘Aging in place’ has been shown to reduce the cost of caring for older adults and help their successful aging. Although age-friendly communities (AFC) initiatives have been helpful to aging in place, little has been known about the relationship between the types of AFC and aging in place. Using the 2017 AARP Age-Friendly Community Survey, we included 1,079 adults aged 65 or older. We measured aging in place as ‘move to a different community’, ‘move into a different residence within your current community’, and ‘stay in your current residence’, and included eight AFC constructs. We identified the type of AFC using Latent Profile Analysis: low-friendly, mid-friendly, and high-friendly. We also ran multinomial logistic regression to examine whether the types of AFC were associated with aging in place. Of the total participants, 26.0% lived in the low-friendly community, 23.7% in the mid-friendly community, and 50.3% in the high-friendly community. Older adults living in the high-friendly community were more likely to stay in the current residence (64.7%) than those in the low-friendly (47.1%) (χ2=28.680, p

Many older adults prefer to live within their community because they have built strong relationships with their neighbors and neighborhood. Although housing-related factors promote aging in place, findings on the relationships of late-life challenges to aging in place (e.g., cost of living, autonomy) and relocation are mixed. Less is known about the types of challenges to aging in place and about the relationship between the types of challenges and relocation. Using data from the AARP 2015 Age-Friendly Community Surveys (N=3,190 adults aged 65 and older), this study examined the intersection of challenges to aging in place (e.g., home size, cost, safety, independence, family, transportation) and relocation (i.e., move to a different home outside of their community). Using latent class analysis (LCA), we identified five subgroups of late-life challenges to aging in place: multifaceted challenges, cost of living, independence, social connection, no concern. Findings from LCA with a distal outcome showed that older adults with multifaceted challenges (b=0.77, p

Background and Purpose: Although nursing home culture change models (e.g., Green House, The Pioneer Network) in the U.S. have been proven to improve the quality of life of the residents by providing person-centered care and home-like environment, limited efforts have been made to implement a model in Korea. The purpose of this study was to examine whether the adapted culture change model would improve the quality of life of the residents and strengthen the person-centered climate. Methods: Employing a quasi-experimental design, the PI developed and implemented a 12-session culture change enhancement program to 32 staff in four nursing homes. Data were collected from 109 nursing home residents before and after the intervention, and key measures included the quality of life scale and the person-centered climate. The paired t-test analyses were performed with SPSS 26.0. Results: Paired samples t-tests showed that the culture change intervention significantly improved the quality of life of the residents. There were significant differences in the scores for privacy at pretest (M=2.63) and posttest (M=3.21); autonomy at pretest (M= 3.20) and posttest (M= 3.43); relationships at pretest (M= 2.88) and posttest (M= 3.36); individuality at pretest (M=3.26) and posttest (M=3.61). An average score for person-centered climate (M=6.25) were significantly higher than that of pretest (M=5.96) (p

Transportation is critical to older adults’ ability to participate in social activities in their community. We examined the association between modes of transportation and restrictions in social activity (i.e.visiting with others, religious attendance, clubs and organised activities, and going out for enjoyment), with particular attention to the moderating effects of economic vulnerability. We used logistic regression to analyse data from 7,197 community-dwelling older adults from the 2011 wave of the National Health and Aging Trends Study, a representative sample of adults aged 65 and over in the United States of America. Economic vulnerability moderated the association between transportation mode and social activity restrictions. Findings suggest that even when economically vulnerable older adults have access to driving, walking or public transit, they may be at a higher risk for social exclusion than their counterparts with more financial resources.

Background: Family members are involved in the decision-making process of advance care planning (ACP). However, there is limited evidence about how family caregiving situations affect engagement in...

Social isolation among older adults has brought about poor outcomes of their health and well-being. Information and Communication technology (ICT) is known to alleviate social isolation of older adults. However, it is unknown how ICT access and use are associated with social isolation by race. This study examined the association of ICT and social isolation from the National Health and Aging Trends Study (NHATS), estimating moderating effects of race and ethnicity. The sample for this study was community dwelling Medicare beneficiaries aged 65+ (n=5,567). An index for ICT was formed from five domains: social network websites, email and texting, working cellphone, tablet devices and online computer use (range 1-5, mean=3.96, SD=0.927), and social isolation was derived from responses to five areas: living arrangement, attending religious activities, numbers of important people to talk with, attending other activities such as club participation and volunteer work (range=0-2, mean=1.74, SD=0.927). Race and ethnicity included White (69.6%), African-American (20.7%), Hispanic (5.5%) and Asian/Pacific Islander (2.5%). Multiple linear regression was used using a moderating effect of race/ethnicity, including relevant covariates. Findings revealed increased ICT use was associated with lower social isolation (b=0.05, p

Psychological sense of community is a concept used to describe how individuals feel about their community. The Brief Sense of Community Scale (BSCS) is an 8-item scale that includes these four domains: membership, needs fulfillment, emotional connection, and influence. It has been used in various contexts and was validated with young adults in Puerto Rico. The purpose of this study was to validate the BSCS for use with Spanish-speaking older adults in Puerto Rico. We conducted face-to-face interviews with a non-probability sample of 154 community- dwelling adults aged 60+ in Puerto Rico. BSCS is comprised of a 5-point likert-type scale with score values ranging from 0 (strongly agree) to 4 (strongly disagree) (total score range 0-32, mean= 24.75, SD= 6.04), and it showed good reliability in our sample (a=.85) and acceptable subscale reliability (membership, a=.85; needs fulfillment, a=.85; influence, a=.66; and emotional connection, a=.69). Five competing factor structures were tested based on prior research using confirmatory factor analysis (CFA). The CFA indicated that a four factor structure from the original scale was the best fit (χ² (16) =25.9; p=.06; RMSEA=.06; CFI=.98; TLI=.97; SRMR=.04). The BSCS showed significant correlations in the expected direction with quality of life (r=.41), social isolation (r=.34), loneliness (r=.27) and self-rated health (r=.17). We conclude that the BSCS is a valid and reliable scale for measuring psychological sense of community with community-dwelling Spanish-speaking older adults in Puerto Rico. Future research should confirm and extend our findings with other Spanish-speaking older adult populations.

Previous literature suggests that social factors (e.g., social cohesion, social support) are protective predictors of mental health problems. However, there might be a reciprocal relationship between social factors and mental health and the relationship changes over time. Therefore, this study examined the longitudinal relationship between community social cohesion and mental health using a latent growth curve model with 8 waves of the National Health and Aging Trends Study (NHATS; 2011-2018), a nationally representative panel study of Medicare beneficiaries in the United States. Social cohesion measured the perceived level of mutual trust by three items (score range: 0-6) and mental health was measured by PHQ-4 (score range: 0-12). The final model including covariates (age, gender, functional disabilities) fit the data well: χ2=1036.383, p

Cities and counties worldwide have adopted the concept of “age-friendly communities” to promote the well-being of older adults. An age-friendly community is a place that provides a safe and affordable built environment and a social environment that encourages older adults’ participation. A major limitation in this field is the lack of valid and reliable measures of age-friendly communities. This study used data from the AARP 2016 Age-Friendly Community Surveys (N=3,652 adults ages 65 and older). This study included 57 indicators of age-friendliness (e.g., housing, transportation, public space, civic engagement, volunteering, community, and health services); socio-demographic characteristics; and health-related characteristics. We randomly split the sample into two subsamples for confirmatory factor analysis (CFA) (n=1,682) and structural equation modeling (SEM) (n=1,682). The CFA resulted in a three-factor structure to measure age-friendly communities: built environment, transportation, and social environment. Model fit indices were acceptable (χ²(44)=14204.09; p

Background and Purpose: Addressing issues of quality of life of nursing home residents based on the human rights-based approach has been a top priority in the long-term care system in Korea but no study has yet examined the relationship between self-determination of nursing home residents and their quality of life. This study aimed to examine whether greater levels of self-determination in the provision of daily care were associated with higher levels of quality of life of the residents. Methods: We collected data from 332 residents (+65) at 20 nursing homes in a metropolitan city. We measured residents’ right to self-determination using the autonomy scale of the Client-centered Care Questionnaire. We also included quality of life, socio-economic characteristics, ADLs, depressive symptoms, and social networks. We ran multiple regression analysis using SPSS 26.0. Results: The findings of this study revealed that greater levels of residents’ right to self-determination were associated with higher levels of quality of life (β =-.425, p

This study evaluated the psychometric properties of a Korean version of the Caregiver Self-Efficacy Scale (CSE-K). The sample included 145 Korean American caregivers. Confirmatory factor analyses (CFA) were conducted to examine the factor structure of the CSE-K. We tested convergent validity of the CSE-K by examining its relationships with caregiver depression and burden. Internal consistency reliability of the CSE-K was also tested. The initial model of CFA based upon the structure of the original CSE revealed the poor model fit; however, the revised model produced the excellent model fit. Convergent validity was established, and excellent internal consistency reliability was found in the CSE-K. The results of this study show that the CSE-K is a reliable and valid measurement to assess caregiver self-efficacy for Korean American caregivers.

A growing number of cities and towns are implementing “friendly” initiatives to change the community’s social and physical infrastructure to address the needs of a particular vulnerable segment of their population. Three prominent examples are aging-friendly, child-friendly, and immigrant-friendly initiatives. Although the limited but growing literature describes these initiatives as promising strategies to improve the quality of life of the targeted population, to date there has been little written about the underlying goals, values, and assumptions of these efforts. Using the value-critical approach, this article aims to better understand these aspects of population-friendly initiatives by examining the scholarly and grey literature. Social workers engaged in community and policy practice can play a key role in these efforts and call attention to the ways they may alleviate or exacerbate inequities. Future research is needed to assess the effects of these initiatives on their targeted population...

This study aims to investigate older adults’ perceptions of the age-friendliness of Busan. A total of 1000 older adults were recruited sampled using stratified random methods. The respondents in the study showed relatively low levels of age-friendliness in civic participation and employment, social participation, communication and information, respect and social inclusion, and housing. However, the levels of age-friendliness for community support and health, outdoor spaces and buildings, and transportation were comparatively high. Based on the findings of this study, several implications for urban policy are discussed.

Given the increasing number ethnic minority older adults in the U.S., there is a growing attention toward their engagement in advance care planning (ACP) because of its positive effects on the quality of end-life care. The purpose of the study was to describe and identify factors affecting engagement in three different types of ACP such as informal talk, living will (LW), and durable power of attorney for health care (DPAH) among ethnic minority older adults. Data was drawn from the second wave of the National Health Aging and Trends Survey. A total of 543 older adults who identified themselves as an ethnic/racial minority and completed the questions about ACP were included in our study. The descriptive results showed the highest level of engagement in informal talk (60%) compared to LW (26.5%) and DPAH (30%). Informal talks happened mostly with adult children (57.7%) and they were frequently designated as surrogate decision makers (70.7%). Multivariate logistic regression analyses revealed that a higher level of education and greater preference toward life-sustaining treatment were associated with all three types of ACP engagement. Ethnicity (Non-Hispanic others compared to blacks), multimorbidity, and being born in the U.S. were associated with informal talk. Marital status (Married compared to never married) was related to LW completion whereas interview language (English) was associated with DPAH completion. These findings indicate that informal talk, LW, and DPAH may have different facilitators and barriers, suggesting the necessity of developing targeted strategies to promote each type of ACP for ethnic minority older adults.

Advance care planning (ACP) has positive effects on the quality of end-of-life of older adults. Given the influence of environmental factors on health and behavioral health behaviors among older adults, geographic variations may exist in engagement in ACP. This study examined whether 1) there was a regional variation in engagement in ACP and 2) there was a racial/ethnic difference in ACP across regions (Northeast, Midwest, South, and West). Drawn from the 2012 National Health and Aging Trends Study, 2,015 Medicare beneficiaries in the U.S. were included in analyses. Results from logistic regression analysis showed that older adults living in the West (OR=1.66, p=0.003) and the Midwest (OR=1.39, p=0.032) were more likely to be engaged in ACP compared to those living in the South. African Americans (OR=0.31, p

Purpose: We tested the reliability and validity of the Self-Efficacy Questionnaire for Children (SEQ-C) in a sample of children living in orphanages in South Korea. Methods: Our study sample consisted of 334 children aged 13–18 obtained using a convenience sampling method. We conducted a confirmatory factor analysis to identify the factor structure of the 24 self-efficacy items and used a Pearson correlation to explore the scale’s validity. Results: The findings show the SEQ-C is a reliable scale with a three-factor model measuring social, academic, and emotional self-efficacy. Construct validity was also supported by finding a significant negative correlation between self-efficacy and depression. Conclusions: Our study informs social workers and researchers that the SEQ-C measure is a useful tool for practical evaluation and intervention that can be used for children with disadvantaged socioeconomic backgrounds in South Korea.

This article presents and discusses the results of a national survey of social work PhD students, faculty, and administrators (n = 416), conducted by the Group for the Advancement of Doctoral Education in Social Work (GADE), in December 2012. The survey was undertaken to inform the updating of GADE’s 2003 Guidelines for Quality in Social Work Doctoral Programs, which is intended to facilitate the development, evaluation, and improvement of social work PhD programs. Results indicate areas of agreement and divergence among key stakeholder groups regarding the perceived importance of various indicators of quality as well as their expectations concerning student outcomes. Implications for PhD program assessment and development are discussed.

Well-being has been conceptualized as a two-dimensional construct that includes both hedonic and eudaimonic components. To date, existing measures of well-being may not adequately capture both of these components for older adults, and limited literature has explored whether the two constructs can be integrated into one factor to measure well-being in this population.This study examined the factor structure of the 11 well-being items from the National Health and Aging Trends Study (NHATS), a nationally representative panel study of Medicare recipients in the US. Using data from the 2011 wave, we divided the community-dwelling sample into two random subsamples, testing our theory in sample 1 (n = 3305) and examining the replicability of the solution in sample 2 (n = 3297).We conducted confirmatory factor analyses using a correlated uniqueness approach to account for the frequency and negatively worded method effects. The findings from sample 1 indicated that the single factor structure was a superior fit to the data, and the solution was confirmed by sample 2 [χ(2)(33) = 85.002, p.001, RMSEA = 0.022 (90% CI = 0.016-0.028), CFI = 0.993, TLI = 0.989, WRMR = 0.831].Findings suggest that although the hedonic and eudaimonic components of well-being may be conceptually distinct, they are highly correlated in the NHATS well-being measures and should be measured as a single construct. Implications for future research using the NHATS and research using other data sources and focusing on other populations are discussed.

Background and objectives In the United States, the older adult population and the proportion of neighborhoods experiencing gentrification are both growing. However, there is limited scholarship on the effects of gentrification on older adults, with most work focusing on those who leave rather than stay. This study examines the effects of remaining in a gentrifying neighborhood on older adults' self-rated health and mental health, with particular attention to outcomes for those who are economically vulnerable. Research design and methods Data are from 6,810 community-dwelling respondents in metropolitan areas from the first wave of the National Health & Aging Trends Study combined with the 1970-2010 National Neighborhood Change Database. We estimate the effects of gentrification on self-rated health and mental health separately using a quasi-experimental approach and comparing two methods: matching design and linear regression. Results Economically vulnerable older adults in gentrifying neighborhoods reported higher self-rated health than economically vulnerable older adults in low-income neighborhoods. Both economically vulnerable and higher-income older adults in gentrifying neighborhoods had more depression and anxiety symptoms than those living in more affluent areas. Higher-income older adults in gentrifying neighborhoods had poorer mental health than their counterparts in low-income neighborhoods. Discussion and implications Findings call attention to the complexity of gentrification, and the need for more research examining how the intersection of neighborhood and individual characteristics influences older adults' health. Results reinforce the need for neighborhood-level interventions as well as relocation support to promote health in later life and caution against an overemphasis on aging in place.

This study aimed to explore the prevalence of and risk factors for self-neglect among older adults who live alone. Data were obtained through face-to-face interview responses of 1,023 older adults living alone in a metropolitan area in South Korea, selected via stratified random sampling, which considered the population variables gender, age group, and district. Descriptive statistics were used to characterize the prevalence of self-neglect, and hierarchical multiple regression analysis was conducted to identify significant risk factors of self-neglect. At least 22.8% of the participants could be considered to have one form of elder self-neglect. Consistent with previous research, self-neglect was more prevalent in the older people living alone who had higher levels of depressive symptoms or a lack of family social support. Unexpectedly, self-neglect was more prevalent among respondents with higher levels of education and cognitive abilities, lower levels of medical comorbidities, and more children. Additionally, social networks of friends and use of social services (formal social support) did not affect the frequency of self-neglect. The findings have implications for gerontological practice and policy, especially for older people living alone in South Korea.

Neighborhood age composition is an understudied area. Furthermore, existing empirical and conceptual work is conflicting, with some scholarship-indicating neighborhoods with older adults are beneficial and other scholarship suggesting it can be detrimental. Combining data from 7,197 older adults from the first wave (2011) of the National Health & Aging Trends Study and census tract data from the National Neighborhood Change Database, the purposes of our study were to: 1) identify the characteristics of neighborhoods experiencing different types of changes in age composition, and 2) examine the association between neighborhood age composition and self-rated health. Findings indicate that neighborhoods experiencing Concentration (where the number of older adults are declining but their percentage of the total population are increasing), the majority of which are in urban areas, have less aggregate economic resources, more indicators of neighborhood disorder, and less access to services and supports. Regression models also suggest older adults living in Concentration neighborhoods reported lower self-rated health compared to those living in the other three neighborhood types. Findings point to the importance of considering neighborhood age composition when targeting interventions and resources, and the potential consequences of being stuck in place in a neighborhood that does not meet elders' needs.

Modifying neighborhood environments to target well-established risk factors for cardiovascular disease may reduce health disparities by complementing clinical services. Prior research, however, includes limited measures of neighborhoods and does not adequately account for individual-level processes known to mediate health outcomes. We combine baseline data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) dataset with neighborhood-level data to yield a diverse sample of Black and white middle-aged and older residents of Baltimore City (N=2707). We use structural equation modeling to examine associations between neighborhood environments and obesity (BMI>=30), focusing on individual-level mediators. Initial direct associations between neighborhoods and obesity (e.g., presence of businesses, β=-0.062) are mediated by healthcare access and health behaviors. Additional indirect pathways exist through health behaviors (e.g., neighborhood disorder, access to parks). These findings highlight the importance of considering indirect pathways to cardiovascular health promotion among aging adults in different neighborhood contexts.

This study examined the use of preventive health services among Korean American adults. Data were drawn from a cross-sectional survey of 212 Korean Americans in the Chicago, Illinois, metropolitan area. Guided by the Andersen's behavioral model, the authors examined whether predisposing (age, gender, marital status, household size, education), enabling (income, health insurance, English proficiency, citizenship, social network), and need (health status) factors are predictive of Korean Americans' preventive health services utilization. A binomial logistic regression showed that younger age, male, noncitizen, low income, no insurance, a larger family network, and better perceived health were associated with decreased odds of using preventive health services.

This study examines the relationship between the family caregiving environment and older adults’ engagement in advance care planning (ACP) which includes (1) informal talking about end of life care with someone and (2) formal engagement in ACP (i.e., having a durable power of attorney or having advance directive). Despite potential influences of family caregivers on engagement in ACP, limited studies have examined whether the family caregiving environment affects the care recipients’ decision and choices in ACP. We combined two data sets: the 2012 National Health and Aging Trends Study (NHATS) and the 2011 National Study on Caregivers (NSOC; supplemental survey with caregivers of participants of the NHATS). A total of 328 cases who completed ACP questionnaires from the NHATS and whose caregiver completed the NSOC were included in our study. Logistical regression analyses showed that care recipients who were White and with a high school diploma were more likely to informally talk about ACP. Also, higher levels of disagreement between family members to care for older adults were associated with lower levels of formal engagement in ACP (OR=0.5); higher levels of caregiver burden with higher levels of formal engagement (OR=1.1). Age 85 or older, being White, high school diploma, fallen down last year were also related to higher levels of formal engagement in ACP. Results of this study indicate that the caregiving environment may differently affect care recipients’ decisions regarding informal and formal engagement in ACP, suggesting different intervention strategies by types of ACP.

Although some evidence suggests that community characteristics may play an important role in the development of depressive symptoms among older adults, current literature has not attended to the role of community characteristics in depression in South Korea. This study begins to address this gap in the literature by examining the relationship of community characteristics and depressive symptoms, controlling for individual characteristics. Using a cross-sectional design and probability sampling, we surveyed 949 older adults living alone in 70 communities in the Busan metropolitan area in South Korea in 2012. A multilevel logistic regression analysis was conducted to test the hypothesis that community characteristics are predictive of depressive symptoms. We find that both the proportion of older adults and the number of senior citizen facilities in a community are associated with depressive symptoms, whereas community poverty is not related to depressive symptoms. Men with lower income, with lower levels of functional abilities, and without stronger family and friend social networks have a higher risk of depressive symptoms. Implications for research, practice, and policy are discussed.

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.