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Objectives Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia. Methods Using data from 303 participants (29.4% Black) with probable dementia in the 2011 National Health and Aging Trends Study, competing risk hazards models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over 8 years (through 2019). Covariate selection was guided by the Andersen model of health care utilization. Results Paid care was associated with lower risk of transitioning out of the community (subhazard ratios [SHR] = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.65, 95% CI [0.44, 0.95]). There was no racial difference in the use of paid care despite evidence of greater care needs in Blacks. Furthermore, Black participants were less likely to transition out of the community than Whites. Discussion Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.

Introduction The number of people with dementia has been increasing. Evidence shows that over 16 million family caregivers provide unpaid care for people with dementia. However, family caregivers experience several challenges throughout their caregiving role, including that of social isolation. Although social isolation in people with dementia has been well documented, social isolation in their family caregivers has not received as much scholarly attention. This scoping review sought to address this dearth of research through the following research question: “What are themes, concepts, or constructs that describe social isolation of family caregivers for people living with dementia?”. Method An electronic search was conducted in PubMed, PsycInfo, and Scopus, using the following Boolean search phrase: dementia AND “social isolation” AND (caregiver OR carers). Content analysis was conducted to identify relevant themes. Findings The initial search yielded 301 studies. Through screening processes, 13 studies were eligible for review. Based on a synthesis of evidence, five themes emerged from the data: disease progression, psychological state, social networks, social supports, and technology. Discussion This review demonstrates that caregiving is related to social isolation in family caregivers of people living with dementia. The experience of social isolation was related to the progression of dementia, psychological states, and lack of supports. In contrast, social supports, social networks, and using technology may reduce social isolation. Identifying themes provides policy and practice implications, such as using information and communication technology to create and redefine social networks.

Family caregiving has been linked to an increased risk of poor mental health, poor physical health, and higher rates of perceived social isolation among caregivers. Despite the connection between caregiving and negative outcomes, or perhaps because of this connection, caregivers seek out and enjoy other life roles and activities including formal volunteerism. To explore the connection between informal caregiving and volunteering and establish the representative prevalence of formal volunteering among caregivers, descriptive and multivariate logistic regression analyses were carried out with data from 1,745 caregivers in the National Study of Caregiving (NSOC) (2017). Utilizing social capital theory four models were constructed with salient demographic characteristics associated with volunteering (model 1), caregiving context (model 2), caregiver physical and mental health (model 3), along with participation in informal and formal social networks (model 4). About a quarter of the sample participated in volunteering (26%). The average age was 60.5 years (SD = 14.3) and more than half consisted of female caregivers (67.11%). Non-Hispanic Whites (62.9%) were the majority of the sample, followed by non-Hispanic Blacks (28%), Hispanic (6.5%), and caregivers in other racial/ethic groups (2.6%). Gender, educational achievement, caregiving for a spouse, coresiding with care recipient, caregiving for multiple care recipients, quality of relationship with care recipient, caregiver psychological well-being, having emotional/physical support, attending religious services, and group activity participation were all significant indicators for caregiver volunteerism. Findings support the importance of both human and social capital in volunteering among caregivers.

This systematic review examined the factors associated with social work students' attitudes toward older adults or working with older adults from the literature published in the last decade. Twelve peer-reviewed empirical studies published between 2011 and 2020 were included for review. Results suggest that both direct and indirect exposures to older adults positively changed social work students' attitudes. While infusing exposure to older adults into courses appeared effective in modifying students' attitudes, inconsistent measurement and lack of information across studies made it impossible to compare the effectiveness of interventions across studies. Implications for gerontological social work education are discussed.

The tendency of caregiving alone is increasing, and these solo caregivers often perceive caregiving responsibilities as a burden. Still, literature on positive aspects of caregiving shows that not all caregivers experience severe distress. Little is known on which factors make a difference in experiencing caregiving distress among solo caregivers. We focused on the empirical findings on the negative impact of social isolation on caregiver’s mental health, examining if and how the intersection of solo caregiving and social isolation is related to severe caregiving stress among caregivers of older adults in Korea. We analyzed 501 family caregivers of older adults in Korea using survey data from the Care Work and the Economy research project (2018). We conducted ordinal logistic regression analysis. The findings show that solo caregivers with a lack of social time fall under the most at-risk group of caregivers in terms of experiencing severe stress (OR=3.72, SE=0.93) whereas solo caregivers with enough social time did not show significantly higher stress compared to the reference group (OR=1.50, SE=0.43). Being socially isolated caregivers still had high levels of stress despite the division of care (OR=2.16, SE=0.55), implying the need to provide caregivers more time for social interaction with others. The current public long-term care insurance in Korea provides limited hours of in-home care aide services to enable aging in place of older adults. To reduce the social isolation of caregivers, it is necessary to extend the service hours and provide support, such as creating online caregiver networks.

Objectives: Paid care provided in the home or through community organizations includes important support services for older adults with dementia such as cleaning and personal care assistance. These services could delay the transition to long-term care, but access may differ across sociodemographic groups. This study examined the relationship between paid care and transitioning out of the community among diverse older adults with dementia. Methods: Using data from 303 participants (29.4% Black) with probable dementia in the National Health and Aging Trends Study (2011-2019), subdistribution hazard models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over the next eight years. Covariate selection was guided by the Andersen model of healthcare utilization. Results: Paid care was associated with lower risk of transitioning out of the community (SHR = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.63, 95% CI [0.42, 0.94]) and was only evident among Whites. There were no racial differences in the use of paid care, but Black participants were less likely to transition out of the community than Whites despite evidencing greater care needs. Discussion: Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.

RÉSUMÉLes personnes âgées dont la capacité de prise de décision est réduite et qui n’ont pas de soutien familial ou d’amis pour les aider à compenser ces déficits sont dites « solitaires » et nécessitent un tuteur public. Le but de cette étude était de recenser les publications avec comités de pairs et la littérature grise afin d’examiner la portée des travaux de recherches réalisés jusqu’à ce jour concernant les personnes âgées solitaires au Canada et aux États-Unis. Nous n’avons recensé que peu d’études sur ce sujet. Aucune étude ou rapport canadien n’a été trouvé. Les personnes âgées solitaires étaient plus avancées en âge, sans enfants ou avec peu d’enfants, et leurs troubles cognitifs étaient plus sévères, comparativement aux personnes âgées non solitaires. Ces résultats démontrent une rareté des études sur les personnes âgées solitaires. Il est urgent que davantage de recherches soient réalisées avec des collectes de données standardisées concernant la tutelle chez les personnes âgées solitaires afin de faciliter la réalisation d’études sur la prévalence de la tutelle publique au Canada.

Engagement in productive roles has been associated with better health in later life. According to identity accumulation theory, more social roles help individuals be more socially integrated, leading to enhanced psychological well-being by diminishing the risk of focusing their energy into a single role. However, less is known about the mechanisms behind the relationship between productive roles and mental health of older caregivers. The aims of this study are to examine: (1) the association between productive social roles and psychological well-being for caregivers and non-caregivers, and (2) the mediating effect of social isolation on this relationship. The study analyzed 3,951 community-dwelling Medicare beneficiaries ages 65 or above from Rounds 1 to 3 of the National Health and Aging Trends Study (210 caregivers, 3,741 non-caregivers). Multiple-group analysis for structural equation modeling was conducted to compare caregivers to non-caregivers. For both caregivers and non-caregivers, having a volunteer role increased well-being, while paid employment was not significantly associated with well-being. Social isolation mediated neither employee nor volunteer role with well-being for both caregivers and non-caregivers. Assuming that volunteering for others without monetary compensation brings meaning in life, this finding supports the provision of services (e.g., respite care) that could supplement caregiving time, allowing caregivers to have more freedom to use the time in such community-engaging roles. Even though self-rated health was controlled, there is a chance that healthier individuals engage in productive roles. Thus, reciprocal relationships between productive roles and health should be considered in future investigations.

This chapter will focus on the Grand Challenge of extreme economic inequality and the ways in which it manifests in older age groups. Extreme economic inequality refers to considerable imbalances between the highest economic strata and the lowest in the distribution of both wealth and income in a nation. The chapter begins with a description of the contributing factors to extreme economic inequality in the United States, including political, social, and economic factors. The relationship between extreme economic inequality over the lifespan and income security in retirement is discussed. Strategies for mitigating the effects of long-term poverty are presented. Finally, the chapter highlights international models that could be applied to the United States and makes recommendations for policy changes that could be spearheaded by social workers to reduce extreme economic inequality and enhance income security in retirement.

Social isolation is a critical public health issue that socially isolated individuals are at increased risk for mortality and deteriorated health. Those who acquire hearing loss in later life experience difficulties with communication, potentially leading to social isolation. However, less is known about the social consequences of age-related hearing loss, and few studies have assessed the influence of environmental factors on hearing loss and social isolation. The aims of this study are to examine: (1) the association between hearing loss and social isolation of older adults over time, and (2) the moderating effects of perceived neighborhood social cohesion and disorder on this relationship. We analyzed 2,080 community-dwelling Medicare beneficiaries aged 65 or above from Round 1 to 3 of National Health and Aging Trends Study. We conducted random coefficient models, entering hearing loss as a random coefficient. Older adults with hearing loss were less socially isolated than those without hearing loss. However, the effect of hearing loss on social isolation varied depending on perceived neighborhood social cohesion. Older adults with hearing loss who reported high neighborhood cohesion had significantly lower social isolation compared to those without hearing loss, while those with hearing loss who perceived low social cohesion had significantly higher social isolation. Our findings suggest neighborhood social cohesion can serve as a potential protective factor for older adults with hearing loss. This poster will propose neighborhood-level interventions that could supplement other services for those with hearing loss, such as assistive devices that are rarely covered by health insurance.