Understanding the vulnerability of older adults: extent of and breaches in support systems in Uganda

ABSTRACTOlder adults’ vulnerability and resilience are a result of processes constructed throughout the lifecycle. In Uganda, older people almost always rely exclusively on their social networks for care and economic support when in need. These support systems are mainly family based, and play a role of safety net for their older members. However, localised in-depth studies have pointed out the limitations of family-based support systems, especially in the context of the HIV/AIDS epidemic. This paper uses 83 in-depth interviews conducted in various settings across Uganda with older people and their family members on the subject of their support systems. Over and above the lack of immediate/personal resources characterising most older people, our results highlight the importance of the extent of support systems and resource diversity. Most of the people in our case studies had lost descendants due to the civil war, the HIV/AIDS epidemic, or simply family break-ups, events which often create large breaches and gaps in support systems. Few older people can be resilient in this situation, primarily because there are often not enough resources available in their support networks to cover the needs of all, especially education for the young and health-care access for the old.

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Social capital and health care access among the older adults in Bangladesh

Working with Older People ◽

10.1108/wwop-05-2018-0012 ◽

2019 ◽

Vol 23 (1) ◽

pp. 54-63

Author(s):

Md. Shahidul Islam

Keyword(s):

Older Adults ◽

Health Care ◽

Social Capital ◽

Logistic Regression ◽

Older People ◽

Health Care Access ◽

Economic Hardship ◽

Content Type ◽

Care Access ◽

Access Problem

Purpose The purpose of this paper is to investigate the association between social capital (SC) and health care access problem among the older people in Bangladesh. Design/methodology/approach This study applied a random sampling method to select 310 older adults (all aged 60 years) in Bangladesh. Exploratory factor analysis was employed to extract SC dimensions. Logistic regression was applied to measure the association of SC dimensions and access. Findings The logistic regression result shows that with a one-unit increase in social network, norms of reciprocity, and civic participation, health care access problem will be decreased by OR= 0.732 (95% CI =0.529–1.014); OR=0.641 (95% CI = 0.447–0.919); and OR=0.748 (95% CI = 0.556–1.006) units. Respondents who have economic hardship were 3.211 (OR=3.211, CI = 0.84–5.59) times more likely to say that they had health care access problem compared with who had no economic hardship. Research limitations/implications The study showed that the lower level of SC and presence of economic hardship increased the probability to health care access problem among the older people. Improving SC may be helpful in reducing health care access problem. However, economic hardship reductions are also important to reduce the health care access problem. Improving SC and reducing economic hardship thus should be implemented at the same time. Practical implications The study showed that low SC and economic hardship increased the probability to health care access problem. Improving SC may be helpful in reducing health inequity. However, economic hardship reductions also important to health care access. Therefore, improving SC and reducing economic hardship should be implemented at the same time. Originality/value This study has a great policy importance in regard to reducing health care access problem among the older adult in Bangladesh as SC has a potential to bring about a concomitant improvement in the condition of the health care access.

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Health Among Sexual Minority Older Adults: Individual Differences and Implications for Improving Health

Innovation in Aging ◽

10.1093/geroni/igaa057.3170 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 860-860

Author(s):

Britney Wardecker ◽

Cara Exten

Keyword(s):

Older Adults ◽

Individual Differences ◽

Sexual Minority ◽

Health Care Access ◽

Psychological Health ◽

Negative Mood ◽

Health Problems ◽

Future Research ◽

Care Access ◽

Age Related

Abstract The number of sexual minority (SM) older adults is increasing rapidly, yet this population continues to be underrepresented in research (Fredriksen-Goldsen & Kim, 2017) and experiences significant disparities in health and health care access (Fredriksen-Goldsen, 2016; Wallace et al., 2011). In the current symposium, we analyze data from U.S. national probability samples of middle-aged and older adults (MIDUS, HRS, NESARC-III) to consider how age-related concerns and challenges may be experienced differently by SM individuals compared to their heterosexual counterparts. This symposium includes novel methods and statistical tools, such as daily diary assessments, multilevel modeling, and time-varying effects models. Individual presentations evaluate how: (1) SM women, compared to heterosexual women, may respond differently to menopause through norms and values surrounding womanhood; (2) midlife and older SM individuals use alcohol and cigarettes more frequently across a typical week than their heterosexual counterparts, though their substance use may not be tied to common triggers (e.g., negative mood, stress); (3) despite bisexual older adults reporting more health problems compared to lesbian and gay counterparts, they are less prepared for health concerns and crises (e.g., reporting a lower number of valid wills); and (4) the prevalence of depression and anxiety varies across age, such that older SM adults—especially women—are particularly vulnerable to psychological health problems. These presentations collectively examine complex issues facing older SM adults while emphasizing individual differences (i.e., women’s concerns, bisexual people’s issues). We discuss challenges in researching this growing at-risk population, and we highlight areas of future research and intervention.

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The Role of Immigration in the Health of Lesbian, Gay, Bisexual, and Transgender Older Adults in the United States

The International Journal of Aging and Human Development ◽

10.1177/0091415019842844 ◽

2019 ◽

Vol 89 (1) ◽

pp. 3-21

Author(s):

Jane J. Lee ◽

Hyun-Jun Kim ◽

Karen Fredriksen Goldsen

Keyword(s):

Older Adults ◽

Health Care ◽

Health Behaviors ◽

Health Outcomes ◽

Health Care Access ◽

Well Being ◽

The United States ◽

Foreign Born ◽

Care Access ◽

Bisexual And Transgender

Lesbian, gay, bisexual, and transgender (LGBT) aging research is growing around the globe. Yet, few studies have examined the interconnectedness of different populations and cultures. This study examines whether LGBT foreign-born older adults experience greater health disparities than their U.S.-born counterparts. We conducted a cross-sectional analysis of the National Health, Aging, and Sexuality/Gender Study: Aging with Pride from 2014, which assessed measures of health and well-being among LGBT adults aged 50 years and older ( n = 2,441). We compared sociodemographic characteristics, health-care access, health behaviors, and health outcomes between foreign-born and U.S.-born participants. Foreign-born LGBT older adults reported greater socioeconomic disadvantage and higher levels of experiencing barriers to health-care access than U.S.-born LGBT older adults. Groups did not significantly differ in health behaviors and health outcomes when controlling for sociodemographic factors. Greater understanding of the mechanisms that shape the relationship between migration and health among the LGBT population is warranted.

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Social and Behavioural Determinants of the Difference in Survival among Older Adults in Japan and England

Gerontology ◽

10.1159/000485797 ◽

2018 ◽

Vol 64 (3) ◽

pp. 266-277 ◽

Cited By ~ 4

Author(s):

Jun Aida ◽

Noriko Cable ◽

Paola Zaninotto ◽

Toru Tsuboya ◽

Georgios Tsakos ◽

...

Keyword(s):

Older Adults ◽

Older People ◽

Social Relationships ◽

Evaluation Study ◽

Ageing Population ◽

Care Services ◽

Health And Social Care ◽

Cross Country ◽

The Difference ◽

Family Based

Background: A rapidly ageing population presents major challenges to health and social care services. Cross-country comparative studies on survival among older adults are limited. In addition, Japan, the country with the longest life expectancy, is rarely included in these cross-country comparisons. Objective: We examined the relative contributions of social and behavioural factors on the differences in survival among older people in Japan and England. Methods: We used data from the Japan Gerontological Evaluation Study (JAGES; n = 13,176) and the English Longitudinal Study of Ageing (ELSA; n = 5,551) to analyse all-cause mortality up to 9.4 years from the baseline. Applying Laplace regression models, the 15th survival percentile difference was estimated. Results: During the follow-up, 31.3% of women and 38.6% of men in the ELSA died, whereas 19.3% of women and 31.3% of men in the JAGES died. After adjusting for age and baseline health status, JAGES participants had longer survival than ELSA participants by 318.8 days for women and by 131.6 days for men. Family-based social relationships contributed to 105.4 days longer survival in JAGES than ELSA men. Fewer friendship-based social relationships shortened the JAGES men’s survival by 45.4 days compared to ELSA men. Currently not being a smoker contributed to longer survival for JAGES women (197.7 days) and ELSA men (46.6 days), and having lower BMI reduced the survival of JAGES participants by 129.0 days for women and by 212.2 days for men. Conclusion: Compared to participants in England, Japanese older people lived longer mainly because of non-smoking for women and family-based social relationships for men. In contrast, a lower rate of underweight, men’s better friendship-based social relationships, and a lower smoking rate contributed to survival among participants in England.

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IMPACT OF PREDISPOSING, ENABLING, AND NEED FACTORS IN HEALTH CARE ACCESS AMONG OLDER ADULTS WITH DISABILITIES

The Gerontologist ◽

10.1093/geront/gnv347.02 ◽

2015 ◽

Vol 55 (Suppl_2) ◽

pp. 670-670

Keyword(s):

Older Adults ◽

Health Care ◽

Health Care Access ◽

Adults With Disabilities ◽

Care Access

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Challenges Faced and Support Received: Older Adults’ Perceptions of Hurricane Sandy

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.133 ◽

2016 ◽

Vol 11 (1) ◽

pp. 39-47 ◽

Cited By ~ 2

Author(s):

Allison R. Heid ◽

Seran Schug ◽

Francine P. Cartwright ◽

Rachel Pruchno

Keyword(s):

Public Health ◽

Older Adults ◽

New Jersey ◽

Older People ◽

Hurricane Sandy ◽

Community Networks ◽

Structured Interviews ◽

Ongoing Research ◽

The People

AbstractObjectiveIndividuals exposed to natural disasters are at risk for negative physical and psychological outcomes. Older adults may be particularly vulnerable; however, social support can act as a resource to help individuals respond to severe stressors. This study explored the challenges older people faced before, during, and after Hurricane Sandy in October 2012 and the people they turned to for support.MethodsSemi-structured interviews were conducted with 20 older adults in New Jersey drawn from the ORANJ BOWL (Ongoing Research on Aging in New Jersey – Bettering Opportunities for Wellness in Life) research panel, who experienced high levels of primary home damage during Hurricane Sandy. Content analysis of interview transcripts classified older adults’ perceptions on how they “made it” through—the challenges they faced and the support they received.ResultsThe findings suggested that older adults experienced emotional, instrumental, social, and financial challenges before, during, and after the storm. However, by relying on family and friends, as well as neighbors and community networks, older people were able to respond to stressors.ConclusionsOur findings carry implications for ensuring that older adults are connected to social networks before, during, and after disasters. The role of neighbors is particularly important when disasters strike. (Disaster Med Public Health Preparedness. 2017;11:39–47)

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The Impact Of A Whole Health Model Of Care On Patient Outcomes

Innovation in Aging ◽

10.1093/geroni/igab046.3043 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 838-838

Author(s):

Anna Faul ◽

Pamela Yankeelov ◽

Joseph D'Ambrosio ◽

Sam Cotton ◽

Barbara Gordon ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Social Determinants ◽

Health Care Access ◽

Determinants Of Health ◽

Education Attainment ◽

Psychological Determinants ◽

Care Access ◽

The Impact ◽

Over Time

Abstract The FlourishCare Model (FCM) transforms primary care sites by addressing all determinants of health and focusing on helping patients to flourish. The FlourishCare Index (FCI) is a clinical measure to assess the effectiveness of the FCM to address all determinants of health. We will present data on the effectiveness of the FCM serving 159 older adults with MCCs. The sample was mostly female (77%), White (64%), retired (54%), married (30%) or widowed (20%) and living in urban areas (64%). The mean age was 69 (SD=15), with 13 years education (SD=3). Patients changed significantly over time on total FCI scores (57%-72%;□=3.80,SE=0.63). Results show significant growth over time for individual health behaviors (58%-67%;□=2.14,SE=0.84), health care access (71%-89%;□=4.43,SE=1.00) and social determinants (62%-85%;□=5.54,SE=1.02) with psychological determinants (54%-61%;□=1.74,SE=0.95) and environmental determinants (70%-81%;□=2.81,SE=1.62) showing a trend to significance. Interaction effects with time show that the FCM supported patients with lower education attainment to improve at a higher rate than those with higher education attainment, for the total FCI score (□=-0.59,SE=0.24) and health care access (□=-0.94,SE=0.38). Receiving mental health counseling resulted in more improvement in psychological determinants than those who did not receive counseling (□=3.43,SE=2.04). The FCM was able to support rural patients at a higher rate than urban patients to gain access to health care (□=4.13,SE=2.02). The FCM supported Hispanic patients the most in improving social determinants of health (□=8.40,SE=3.93). This study showed the importance of a systems approach to care using measures that focus on what matters most to older adults who value quality-of-life outcomes.

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Perceived Barriers to Health Care Access Among Rural Older Adults: A Qualitative Study

The Journal of Rural Health ◽

10.1111/j.1748-0361.2005.tb00084.x ◽

2005 ◽

Vol 21 (3) ◽

pp. 206-213 ◽

Cited By ~ 171

Author(s):

R. Turner Goins ◽

Kimberly A. Williams ◽

Mary W. Carter ◽

S. Melinda Spencer ◽

Tatiana Solovieva

Keyword(s):

Older Adults ◽

Health Care ◽

Qualitative Study ◽

Health Care Access ◽

Perceived Barriers ◽

Barriers To Health Care ◽

Care Access ◽

Barriers To Health ◽

Rural Older Adults

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Seven ‘deadly’ assumptions: unravelling the implications of HIV/AIDS among grandmothers in South Africa and beyond

Ageing and Society ◽

10.1017/s0144686x08007265 ◽

2008 ◽

Vol 28 (7) ◽

pp. 935-958 ◽

Cited By ~ 42

Author(s):

MAY CHAZAN

Keyword(s):

South Africa ◽

Older Women ◽

Southern Africa ◽

Safety Net ◽

Decision Makers ◽

Negative Consequences ◽

The Past ◽

Aids Epidemic ◽

Funding Agencies ◽

Hiv Aids

ABSTRACTOver the past few years, the pivotal roles older women play in responding to the unprecedented HIV/AIDS epidemic in southern Africa has received increasing recognition by academics, governments, funding agencies, non-governmental organisations, and citizens around the world. Yet, discourses surrounding AIDS and ‘grandmotherhood’ are laden with a number of ungrounded assumptions that have important implications for researchers, advocates and decision-makers. Drawing on ethnographic and survey data predominantly from South Africa, this paper challenges seven such assumptions. The paper illustrates how certain prevailing ‘wisdoms’ about grandmothers and AIDS in southern Africa are not entirely accurate and may mask many women's struggles and vulnerabilities, perpetuate stereotypes and misguide well-meaning policies. It also suggests that the societal impacts of AIDS in the region are, at present, not as dramatic as often portrayed, largely because the strength and resilience of many older women have cushioned some of the negative consequences. The paper thus calls for more nuanced and forward-looking analyses and interventions – ones that recognise grandmothers as central to the society's thin safety net and that grapple with older women's complex and diverse vulnerabilities.

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