Promoting Health Intervention Strategies from Social and Behavioral Research (2000) / Chapter Skim
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Paper Contribution G: The Behavioral and Social Dynamics of Aging Well
Paper Contribution G: The Behavioral and Social Dynamics of Aging Well
Pages 322-336
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From page 322... ...
Public health interest is also sustained by evidence that older adults have high rates of chronic conditions accompanied by functional disability, consume health and social services at a high rate, and illustrate so consistently the negative consequences for heals of lower socioeconomic status (SES)
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From page 323... ...
Epidemiologists have documented both the significance and the persistent age gradient of morbidity and comorbidity and, with behavioral and social scientists, have also documented notable variation in life expectancy and risk of functional disability associated with socioeconomic status, ethnicity, and gender. The documented diversity of older populations has been a significant factor in the growing awareness of gerontologists that chronological age per se is a relatively weak explanatory variable in assessing the prospects of continuing to age well in later life, which is the experience of a substantial majority of older adults (Campbell et al., 1976, Maddox and Glass, 1999~.
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From page 324... ...
A concluding section illustrates how the convergence of theory and research on the social structuring of living and work environments, and on the reconceptualization of dependency in later life as a modifiable interpersonal strategy, suggests a distinctive psychosocial intervention for frail, nursing home-eligible older adults living in the community. The intervention is a distinctive new type of housing with services known as "assisted living." HEALTH AND WELL-BEING IN LATER LIFE: KNOWING THE TERRITORY OF AGING The basic evidence for characterizing the health and well-being of older populations is now well established (Berkman, 1988, Manton, 1988, Manton et al., 1997, Maddox and Glass, 1999~: · The distinctive age gradients of morbidity, disability, and mortality vary significantly by gender, ethnicity, and socioeconomic status, although the gradients are attenuated in very late life as a result of selective survival.
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From page 325... ...
, for many years the data manager of the Health Care Financing Administration's longitudinal National Long Term Care Survey (NLTCS) , observes that functional status complements medical diagnoses in a useful way: functional assessment suggests the range of services likely to be required in care management while diagnosis suggests the possible length of time services may be required.
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From page 326... ...
In sum, the demography and epidemiology of later life have reinforced some of the basic maxims of contemporary gerontology: Older populations are and remain substantially diverse, the gradients of chronic conditions and related functional disability vary significantly by gender, ethnicity, and socioeconomic status, and the mutability of functional status and well-being in later life is well established. In my 40 years in gerontology, probably the most significant event has been increasing evidence-based interest in psychosocial interventions.
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From page 327... ...
(1998~. The substance of the interventions summarized ranges broadly over topics that include uses of pharmacologic agents in combination with psychosocial therapy in control of depression, physical activity regimes to improve physical health and psychological functioning, improvement of memory, home modification to improve ambulation, incontinence control, improving motivation in nursing homes, and a comparative review of what one learns from societal policy initiatives about the modifiability of aging processes.
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From page 328... ...
· Design Issues Overall the studies reviewed are given low marks regarding their weak conceptualization of causation, inadequate measurement of key variables, and poor sample maintenance and motivation. · Findings and Conclusions Consistent evidence of a direct causal link between physical activity and beneficial outcomes across the various intervention studies reviewed was "surprisingly weak and equivocal." The evidence was particularly unclear that physical activity per se, as distinct from social activity, generally was the primary causal factor in outcomes (see, e.g., Glass et al., 1999~.
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From page 329... ...
This anticipatory anxiety appeared to be reduced by participation in a structured group-supported exercise regime that participants described as offering an "element of hope" and a feeling of being better in control of their lives even in the absence of pain reduction. This finding is reminiscent of many intervention studies indicating that structured social support groups are a key variable in achieving beneficial effects from activity and that a sense of selfefficacy is a critical component of this effectiveness.
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From page 330... ...
Varied, challenging environments, Kohn found, promote satisfaction, a sense of efficacy, and the willingness and ability to respond to subsequent environmental change. And Bandura's complementary concept of self-efficacy and its key role in a theory of social learning appear with notable frequency in literature searches for reports of beneficial psychosocial interventions across the life course.
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From page 331... ...
are on strong theoretical ground in describing the process of successful aging as "selective optimization with compensation." That is, realistically, while later life is a season of increased risk of chronic conditions and functional disability, functional competence is not lost at the same rate in all areas of functioning, as the risks of disability increase, successful agers are observed to strive to do a smaller number of things but to do them well and seek environments in which compensatory help can be found in areas of decline. Assisted living housing has emerged as a naturally occurring strategic site in which housing becomes the reasonable counterpart of a work site whose
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From page 332... ...
Some portion of persons currently served in nursing homes, say at least 10%, might be accommodated more appropriately and economically in assisted living facilities. The size of the community-dwelling population that is assessed as having functional disability at a level qualifying individuals as "nursing home equivalent" is at least as large, possible larger, than the 5% already in nursing homes.
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From page 333... ...
When a philosophy of housing is implemented to maximize autonomy, self-efficacy, social support, and participation in decisions about community, does assisted living housing achieve promised outcomes of quality residential care with economy?
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From page 334... ...
These are all evidence of positive outcomes for frail older adults that theory would predict. In their final chapter, Moos and Lemke themselves point to the next task: Now that we have identified the favorable outcomes deliverable in assisted living housing dedicated to enhancing a pro-choice and pro-involvement social climate, we should demonstrate how to promote such a social climate in assisted living facilities more widely.
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From page 335... ...
(1993~. Educational status and active life expectancy in older blacks and whites.
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From page 336... ...
(1989~. Functional status and well-being of patients with chronic conditions.
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