Population Of Community-dwelling Older Adults Research Articles

History of cancer and mortality in community-dwelling older adults

Background: The association between a history of cancer and mortality has not been studied in a propensity-matched population of community-dwelling older adults. Methods: Of the 5795 participants in the Cardiovascular Health Study, 827 (14%) had self-reported physician-diagnosed cancer at baseline. Propensity scores for cancer were used to assemble a cohort of 789 and 3118 participants with and without cancer respectively who were balanced on 45 baseline characteristics. Cox regression models were used to determine the association between cancer and all-cause mortality among matched patients, and to identify independent predictors of mortality among unmatched cancer patients. Results: Matched participants had a mean (SD) age of 74 (6) years, 57% were women, 10% were African Americans, and 38% died from all causes during 12 years of follow-up. All-cause mortality occurred in 41% and 37% of matched participants with and without a history of cancer respectively (hazard ratio when cancer was compared with no cancer, 1.16; 95% confidence interval, 1.02–1.31; P = 0.019). Among those with cancer, older age, male gender, smoking, lower than college education, fair-to-poor self-reported health, coronary artery disease, diabetes mellitus, chronic kidney disease, left ventricular hypertrophy, increased heart rate, low hemoglobin and low baseline albumin were associated with increased risk of mortality. Conclusions: Among community-dwelling older adults, a history of cancer was associated with increased mortality and among those with cancer, several socio-demographic variables and morbidities predicted mortality. These findings suggest that addressing traditional risk factors for cardiovascular mortality may help improve outcomes in older adults with a history of cancer.

15.4% of older people with hip fracture have visual impairment, 38.6% auditory impairment and 30.1% combined sensory impairment

Commentary on: Grue EV, Kirkevold M, Ranhoff AH. Prevalence of vision, hearing, and combined vision and hearing impairments in patients with hip fractures. J Clin Nurs 2009;18:3037–49.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] This prospective descriptive correlational study investigated an often overlooked clinical condition in older adults, sensory impairment. The study specifically addressed vision and hearing impairment in hospitalised older adults who had sustained a hip fracture. Sensory impairments affect older adults' ability to interact with and navigate safely in their environment, as demonstrated by the high prevalence of sensory impairment in this sample of hip fracture patients as compared with the general population of community-dwelling older adults. In this study 332 older adults were screened for vision and hearing impairment using the RAI-AC and the KAS-Screen. These self-report measures were completed by a research nurse. Of the 332 patients screened, 279 (83.7%) were found to have some level of sensory impairment. Of those who screened positive for sensory impairment, 186 were further evaluated with vision testing, including visual acuity, peripheral vision, central field vision and binocular stereo depth perception. Ears were checked for cerumen. … [1]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bclinical%2Bnursing%26rft.stitle%253DJ%2BClin%2BNurs%26rft.aulast%253DGrue%26rft.auinit1%253DE.%2BV.%26rft.volume%253D18%26rft.issue%253D21%26rft.spage%253D3037%26rft.epage%253D3049%26rft.atitle%253DPrevalence%2Bof%2Bvision%252C%2Bhearing%252C%2Band%2Bcombined%2Bvision%2Band%2Bhearing%2Bimpairments%2Bin%2Bpatients%2Bwith%2Bhip%2Bfractures.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1365-2702.2009.02856.x%26rft_id%253Dinfo%253Apmid%252F19732248%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/j.1365-2702.2009.02856.x&link_type=DOI [3]: /lookup/external-ref?access_num=19732248&link_type=MED&atom=%2Febnurs%2F13%2F2%2F59.atom [4]: /lookup/external-ref?access_num=000270664100013&link_type=ISI

Is Greater Self-Neglect Severity Associated With Lower Levels of Physical Function?

This study examined the association between severity of self-neglect and physical function in a population of community-dwelling older adults. Participants were older adults (N = 1,094) reported to the Chicago Department on Aging for suspected self-neglect from 1993 to 2005, who also participated in the Chicago Health Aging Project. The primary outcome of physical function was assessed using physical performance tests. Secondary outcomes were assessed using the Katz, Nagi, and Rosow-Breslau scales. Multiple regression models were used to assess these associations. After adjusting for confounders, higher self-neglect severity scores were associated with lower physical performance testing (coefficient = -.062, p = .001). Greater self-neglect severity was also correlated with the reported number of impairments on the Katz, Nagi, and Rosow-Breslau scales (coefficients = .024, .024, and .016, respectively, p = .001). Higher self-neglect severity is associated with lower levels of physical function among older adults.

A Propensity-Matched Study of the Association of Peripheral Arterial Disease With Cardiovascular Outcomes in Community-Dwelling Older Adults

The association between peripheral arterial disease (PAD) and outcomes has not been studied in a propensity-matched population of community-dwelling older adults. A public-use copy of the Cardiovascular Health Study (CHS) data was analyzed to test the hypothesis that baseline PAD is associated with increased all-cause mortality and cardiovascular morbidity. Of the 5,795 CHS participants, 5,630 had data on baseline ankle-brachial index, and 767 had PAD, defined as ankle-brachial index <0.9. Propensity scores for PAD were calculated for each participant using 66 baseline covariates and were used to match 679 pairs of participants with and without PAD. Matched Cox regression models were used to estimate associations of PAD with outcomes during a median follow-up period of 7.5 years. Overall, 55% of matched participants died from all causes during 9,958 patient-years of follow-up. All-cause mortality occurred in 61% (rate 8,710/100,000 patient-years) and 50% (rate 6,503/100,000 patient-years) of participants, respectively, with and without PAD (matched hazard ratio for PAD vs no PAD 1.47, 95% confidence interval (CI) 1.23 to 1.76, p <0.0001). Prematch unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios for PAD-associated all-cause mortality were 2.90 (95% CI 2.61 to 3.21, p <0.0001), 1.53 (95% CI 1.36 to 1.71, p <0.0001), and 1.57 (95% CI 1.39 to 1.78, p <0.0001), respectively. Matched hazard ratios for PAD for incident heart failure and symptomatic PAD were 1.32 (95% CI 1.00 to 1.73, p = 0.052) and 3.92 (95% CI 2.13 to 7.21, p <0.0001), respectively. In conclusion, in a propensity-matched well-balanced population of community-dwelling older adults, baseline PAD was associated with increased all-cause mortality and cardiovascular morbidity.

Minimally Elevated Cardiac Troponin T and Elevated N-Terminal Pro-B-Type Natriuretic Peptide Predict Mortality in Older Adults: Results From the Rancho Bernardo Study

This study investigated the prognostic value of detectable cardiac troponin T (TnT) and elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in a population of community-dwelling older adults. Minimally elevated levels of TnT, a marker of cardiomyocyte injury, have been found in small subsets of the general population, with uncertain implications. A marker of ventricular stretch, NT-proBNP has clinical utility in many venues, but its long-term prognostic value in apparently healthy older adults and in conjunction with TnT is unknown. Participants were 957 older adults from the Rancho Bernardo Study with plasma NT-proBNP and TnT measured at baseline (1997 to 1999) and followed up for mortality through July 2006. Participants with detectable TnT (>/=0.01 ng/ml, n = 39) had an increased risk of all-cause and cardiovascular death (adjusted hazard ratio [HR] by Cox proportional hazards analysis: 2.06; 95% confidence interval [CI]: 1.29 to 3.28, p = 0.003 for all-cause mortality; HR: 2.06, 95% CI: 1.03 to 4.12, p = 0.040 for cardiovascular mortality); elevated NT-proBNP also predicted an increased risk of all-cause and cardiovascular mortality (adjusted HR per unit-log increase in NT-proBNP: 1.85, 95% CI: 1.36 to 2.52, p < 0.001 for all-cause mortality; HR: 2.51, 95% CI: 1.55 to 4.08, p < 0.001 for cardiovascular mortality). Those with both elevated NT-proBNP and detectable TnT had poorer survival (HR for high NT-proBNP and detectable TnT vs. low NT-proBNP and any TnT: 3.20, 95% CI: 1.91 to 5.38, p < 0.001). Exclusion of the 152 participants with heart disease at baseline did not materially change the TnT mortality or NT-proBNP mortality associations. Apparently healthy adults with detectable TnT or elevated NT-proBNP levels are at increased risk of death. Those with both TnT and NT-proBNP elevations are at even higher risk, and the increased risk persists for years.

Abstract 3486: Minimally Elevated Cardiac Troponin T Independently Predicts Death in Apparently Healthy Adults: Results from the Rancho Bernardo Study

Background: Minimally elevated levels of cardiac troponin T (TnT), a marker of cardiac myocyte injury, have been found in small subsets of the general population. The significance of these rare elevations is controversial. The purpose of this study was to determine the prognostic value of detectable TnT levels in a population of community-dwelling older adults. Methods: Prospective community-based study of 375 men and 584 women ages 60 to 97 (mean 77) who had plasma TnT measurements (Elecsys® Troponin T, Roche Diagnostics) at baseline (1997–99) and were followed for mortality through July 2006. Participants were divided into 2 groups based on TnT levels: Undetectable (n = 917) and Detectable (≥ 0.01 ng/ml, n = 39). Results: The 39 (4.1%) participants with detectable TnT levels were older and were more likely to be men (both p &lt; 0.01) than those with undetectable TnT. Most of those with detectable TnT levels did not have known heart disease at baseline (79%, 95% C.I. 64 – 89%). During an average 6.3 year follow-up, 220 deaths occurred; 42% were cardiovascular (CV). In Cox proportional hazards regressions, participants with detectable TnT had increased risk of all-cause death (HR = 4.6, 95% CI 3.0 –7.1, Figure ) and of CV death (HR = 5.6, 95% C.I. 3.0 –10.6). Adjusting for age, sex, lifestyle characteristics, and multiple CV risk factors, as well as exclusion of the 152 participants with known heart disease at baseline, did not materially change the TnT-mortality associations. Conclusions: Apparently healthy adults with detectable TnT, even at levels not currently considered abnormal, are at increased risk of death. The prognostic value of TnT persists for years.

The Australian/Canadian Osteoarthritis Hand Index in a community-dwelling population of older adults: Reliability and validity

To assess the acceptability and measurement properties of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) applied to a community-dwelling population of older adults with hand problems. Data were obtained from 2 related sources: 2,113 responders to a 2-stage cross-sectional postal survey who reported hand problems in the previous 12-months, and 55 participants with hand problems completing a clinical assessment. The AUSCAN subscales were assessed for data quality and scaling properties. Test-retest reliability was assessed in clinical participants reporting no change in their hand condition at 1 month. Construct and criterion validity were evaluated using other data from the survey and clinical assessment. Internal consistency of the subscales was tested using Cronbach's alpha and item-total correlations. AUSCAN subscales had high completion rates in the survey (missing data: 2.3-2.7%). Subscale scores covered the possible range but were skewed towards lower pain, stiffness, and functional problems. Test-retest reliability estimates supported the use of the pain and stiffness subscales (rho > 0.7), with the estimate for stiffness being slightly lower (rho = 0.64). The subscales demonstrated both construct validity (significantly higher subscale scores in participants reporting a recent general practitioner consultation for their hand problems and high correlations with hand function performance measures) and criterion validity (high correlations with generic health measures and disease-specific measures). The AUSCAN is a valid and reliable measure of hand problems in a community-dwelling population of older adults. The AUSCAN performs well both in terms of its internal reliability and its relationship with external constructs.

Depressive symptoms among older adults in urban and rural areas

To determine if there are differences in depressive symptoms between residents of urban areas, small town zones, and predominantly rural regions and to determine factors associated with depressive symptoms among these groups of residents. The study was set in the Canadian province of Manitoba amongst a community-dwelling population of older adults who were cognitively intact. The design of the study was a cross-sectional survey and measures included age, gender, education, living arrangements, number of persons providing companionship, perceived adequacy of income, functional impairment, self-rated health and the Center for Epidemiologic Studies-Depression (CES-D) scale. Urban/rural residence was measured by grouping Census sub-divisions according to 1991 Census population: urban (>19,999); small town (2500 to 19,999); or predominantly rural (<2500). In the total sample (n = 1382), 11.5% exhibited depressive symptoms: 11.6% in urban areas (n = 844); 14.0% in small town zones (n = 250); 9.0% in predominantly rural regions (n = 288) (p > 0.05, chi-square test). No rural-urban differences were seen in multivariate models. In predominantly rural regions, living alone, perceiving one's income as inadequate, and having functional impairment were associated with depressive symptoms. The only significant factor in small town zones was poorer self-rated health whereas in urban areas, poorer self-rated health, functional impairment, and fewer persons providing companionship were significantly related to depressive symptoms. We did not observe rural-urban differences. However, the factors associated with depressive symptoms varied among older adults living in predominantly rural regions, in small towns, and in urban areas.

Isometric performance following total hip arthroplasty and rehabilitation

We compared differences in isometric strength between older adults who have undergone elective unilateral total hip arthroplasty (THA) and completed rehabilitation with a population of community-dwelling older adults who have not had THA. The study was a cross-sectional design, and 22 unilateral THA subjects and 38 community-dwelling older adults participated. THA subjects received on average 13 outpatient or home-based physical therapy sessions before evaluation. THA subjects were evaluated 4 to 5 months postsurgery. We assessed isometric muscle strength by measuring peak hip torque per body weight with a robotic dynamometer during abduction, flexion, and extension. No significant performance differences were observed between operated and nonoperated hips of THA subjects. THA subject operated and nonoperated hips generated significantly less peak torque per body weight during flexion (p = 0.03) compared with community-dwelling older adult hips (THA subject operated hips = 6.96 ft-lb/lb, THA subject nonoperated hips = 8.26 ft-lb/lb, community-dwelling older adult hips = 11.56 ft-lb/lb). No significant differences were observed between THA subjects and community-dwelling older adults during hip extension (p = 0.55) or abduction (p = 0.17). At 4 to 5 months postsurgery, THA subjects were not at the same level of biomechanical performance as community-dwelling older adults. Significant strength deficits were found in THA subject operated versus nonoperated hips during isometric flexion. Additional or modified physical therapy that targets the hip flexors is recommended after THA.

Older Adults’ participation in preventive health maintenance activities and perceived satisfaction with the healthcare provider

Summary Objectives As the number of community-dwelling older adults increases, assisting them to maintain health is an optimal goal of care. Adherence to treatment plans, medical follow-up, and the participation in preventive health maintenance activities (PHMA) are primary approaches to health maintenance. But the impetus for this group to request or assent to PHMA remains unclear. Thus, the purpose of this study was to determine whether satisfaction with healthcare providers influenced community-dwelling older adults’ participation in PHMA. Design A descriptive design was used to investigate whether healthcare satisfaction influenced participation in PHMA in a population of community-dwelling older adults. Sample, Setting, Measures Thirty-nine community-dwelling older adults completed two questionnaires, participation in PHMA and the patient satisfaction in healthcare providers scale. Results The majority of participants were satisfied with their healthcare providers but that finding had little influence on PHMA participation. Conclusions Healthcare provider satisfaction may play a limited part in influencing whether older adults participate in PHMA. The onus remains on the geriatric healthcare provider to educate, encourage, schedule, refer, and follow-up on the completion of PHMA to help safeguard the health of community-dwelling older adults.

Depression and Obstructive Sleep Apnea (OSA)

For over two decades clinical studies have been conducted which suggest the existence of a relationship between depression and Obstructive Sleep Apnea (OSA). Recently, Ohayon underscored the evidence for a link between these two disorders in the general population, showing that 800 out of 100,000 individuals had both, a breathing-related sleep disorder and a major depressive disorder, with up to 20% of the subjects presenting with one of these disorders also having the other. In some populations, depending on age, gender and other demographic and health characteristics, the prevalence of both disorders may be even higher: OSA may affect more than 50% of individuals over the age of 65, and significant depressive symptoms may be present in as many as 26% of a community-dwelling population of older adults.In clinical practice, the presence of depressive symptomatology is often considered in patients with OSA, and may be accounted for and followed-up when considering treatment approaches and response to treatment. On the other hand, sleep problems and specifically OSA are rarely assessed on a regular basis in patients with a depressive disorder. However, OSA might not only be associated with a depressive syndrome, but its presence may also be responsible for failure to respond to appropriate pharmacological treatment. Furthermore, an undiagnosed OSA might be exacerbated by adjunct treatments to antidepressant medications, such as benzodiazepines.Increased awareness of the relationship between depression and OSA might significantly improve diagnostic accuracy as well as treatment outcome for both disorders. In this review, we will summarize important findings in the current literature regarding the association between depression and OSA, and the possible mechanisms by which both disorders interact. Implications for clinical practice will be discussed.

Inter-rater Reliability And Construct Validity Of The Dynamic Gait Index In Older Adults

The Dynamic Gait Index (DGI) is one of the most challenging gait mobility tests available for the older adult population. Research demonstrates that scores on the DGI discriminate community-dwelling elderly who report falls from those who do not report a fall history. Reports indicate that the DGI has good inter-rater reliability within a group of instrument-specific trained physical therapists. No studies have been performed on interrater reliability of the DGI as a single test in the population of community-dwelling older adults or among untrained raters of varying clinical experiences. PURPOSE The purpose of this investigation is to examine the interrater reliability of the DGI as applied to community-dwelling elderly by raters with backgrounds in either physical therapy or Kinesiology. METHODS Fourteen community-dwelling adults (age range: 51–93; mean: 75.4 years) performed the DGI and the reduced Continuous Scale Physical Function Performance Test (CS-PFP10). The DGI tests were videotaped and subsequently analyzed by five raters. Three raters were licensed physical therapists, one rater was a PhD in Kinesiology, and one rater was a first year graduate student with a BS in Kinesiology. A repeated-measures ANOVA was used to derive intraclass correlation coefficients (ICC) for the purpose of assessing inter-rater reliability of the DGI scores. Pearson correlation was used to compare the DGI scores from the five raters to the subscales and total score of the CS-PFP10. RESULTS The estimated inter-rater reliability within the individual eight tasks ranged from r = .69 to .97 and the intraclass r for the total DGI score was .90. The DGI scores also correlated well with the lower body strength, endurance, and balance and coordination subscales, as well as the PFP10 total score (r = .52 −.78, P<0.10 across all testers). In addition, the magnitudes of the associations were marginally stronger in cases when physical therapists provided the DGI rating as compared to the raters without a physical therapy background. CONCLUSIONS The strong ICC of the total DGI score implies that the variation in measurements on the total score is more likely due to the participants' abilities to execute the tasks versus conflicting scoring ability of the testers. While these findings generally provide evidence that the DGI merits attention as an appropriate assessment tool that can be applied in various clinical settings, the stronger degree of association between DGI and the ADL-based CS-PFP10 scores among physical therapists suggests that test-specific training may further improve the inter-rater reliability of this instrument.

Inter-rater Reliability And Construct Validity Of The Dynamic Gait Index In Older Adults

The Dynamic Gait Index (DGI) is one of the most challenging gait mobility tests available for the older adult population. Research demonstrates that scores on the DGI discriminate community-dwelling elderly who report falls from those who do not report a fall history. Reports indicate that the DGI has good inter-rater reliability within a group of instrument-specific trained physical therapists. No studies have been performed on interrater reliability of the DGI as a single test in the population of community-dwelling older adults or among untrained raters of varying clinical experiences. PURPOSE The purpose of this investigation is to examine the interrater reliability of the DGI as applied to community-dwelling elderly by raters with backgrounds in either physical therapy or Kinesiology. METHODS Fourteen community-dwelling adults (age range: 51–93; mean: 75.4 years) performed the DGI and the reduced Continuous Scale Physical Function Performance Test (CS-PFP10). The DGI tests were videotaped and subsequently analyzed by five raters. Three raters were licensed physical therapists, one rater was a PhD in Kinesiology, and one rater was a first year graduate student with a BS in Kinesiology. A repeated-measures ANOVA was used to derive intraclass correlation coefficients (ICC) for the purpose of assessing inter-rater reliability of the DGI scores. Pearson correlation was used to compare the DGI scores from the five raters to the subscales and total score of the CS-PFP10. RESULTS The estimated inter-rater reliability within the individual eight tasks ranged from r = .69 to .97 and the intraclass r for the total DGI score was .90. The DGI scores also correlated well with the lower body strength, endurance, and balance and coordination subscales, as well as the PFP10 total score (r = .52 −.78, P<0.10 across all testers). In addition, the magnitudes of the associations were marginally stronger in cases when physical therapists provided the DGI rating as compared to the raters without a physical therapy background. CONCLUSIONS The strong ICC of the total DGI score implies that the variation in measurements on the total score is more likely due to the participants' abilities to execute the tasks versus conflicting scoring ability of the testers. While these findings generally provide evidence that the DGI merits attention as an appropriate assessment tool that can be applied in various clinical settings, the stronger degree of association between DGI and the ADL-based CS-PFP10 scores among physical therapists suggests that test-specific training may further improve the inter-rater reliability of this instrument.

Removing Environmental Barriers in the Homes of Older Adults with Disabilities Improves Occupational Performance

The current study examines the effectiveness of an occupational therapy home modification intervention program by examining differences in self-reported occupational performance before and after intervention in a population of community-dwelling older adults with disabilities. An occupational therapy intervention was provided in the homes of 16 older adults with functional limitations. The intervention included changing the existing space by the provision of adaptive equipment and making architectural modifications (including major remodeling) to the home. No remediative treatment was provided. The Canadian Occupational Performance Measure was used to measure satisfaction and performance in daily activities in the home before and after home modification intervention. Overall, the mean scores on the satisfaction and performance subscales indicated an improvement in performance and satisfaction with occupational performance. The average number of barriers in each home was 4.7. An average of only 2.5 barriers were solved during the intervention. The removal of environmental barriers from the homes of older adults who have functional limitations can significantly improve their occupational performance and their satisfaction with their ability to perform everyday activities.

Dietary intake of older adults in the Kingston area.

The objectives of this research were to describe the dietary intake and identify risk factors for poor dietary intake in community-dwelling older adults living in the Kingston, Frontenac, and Lennox & Addington Health Unit area. Dietary intake information was collected from a convenience sample of 105 relatively healthy, active older adults (84 women, 21 men) using 24-hour recalls from three non-consecutive days. Risk factors for poor dietary intake were identified through a structured interview. Multiple linear regression was used to generate a model to predict dietary intake, which was measured using a diet score based on Canada's Food Guide to Healthy Eating. Group averages reflected reasonable diet quality, but some subjects had very low nutrient intakes, particularly of zinc and vitamins B6, B12, and C. On average, women had a lower-than-recommended intake from all food groups, while men consumed adequate amounts of all food groups except milk products. Higher scores indicated better overall diet quality, and the following were significant predictors of a high diet score: "almost always" preparing one's own meals, food "almost always" or "sometimes/never" tasting good, eating lunch every day, and taking fewer prescription medications. This model requires validation with a larger and more diverse population of community-dwelling older adults.

Changes in chewing ability with ageing: a 7-year study of older adults.

One of the most important consequences of oral diseases and disorders is a reduction in the ability to chew. This paper reports the results of a study of changes in chewing ability in a population of community-dwelling older adults who were aged 50 years and over when first recruited. Data were collected at baseline, and at 3 and 7-year follow-ups using an index of chewing capacity consisting of six indicator foods, a four-item measure of the psychosocial impact of chewing dysfunction and a single-item rating of satisfaction with chewing ability. The percentage of subjects who reported a problem chewing increased from 24.0% at baseline to 25.2% at 3 years and 33.8% at 7 years. The increase in prevalence over 7 years was 5.3% in dentate subjects aged 64 years and under at baseline and 26.1% in edentulous subjects aged 65 years and over. Overall, there were increases in the proportion reporting some psychosocial impact and the proportion reporting dissatisfaction with their ability to chew. Patterns of change with respect to these variables differed across groups defined by age and dental status. Change scores computed from baseline and the 7-year follow-up indicated considerable within-subject change, with some individuals improving and some deteriorating. However, they confirmed that overall there was a decline in oral functioning in this population and that older edentulous subjects showed the greatest propensity to change. Factors which predict the patterns of change identified by this study need to be explored in order to enhance our understanding of changes in the chewing ability of this population as it ages.

Beyond church attendance: religiosity and mental health among rural older adults.

Data from 2 independent random samples of the population of community-dwelling older adults in eastern North Carolina are used to assess the effects of Christian religious subdimensions, including church attendance and participation, belief that religious faith affects health, and belief that prayer and God combine with medical treatment to cure illness, upon mental health. Self-reported religiosity in this population across dimensions is described and the effects of selected demographic characteristics upon religiosity are assessed. Lastly, the main effects of demographic characteristics, religiosity, and health status upon the mental health of respondents are explored. Findings suggest that Christian religious beliefs and practices are widespread in this mainly rural population and that females and African American elderly people are more likely than others to profess religious beliefs and to participate in church-related activities. Multivariate results suggest that reduced health status, including functional ability, combines with limited participation in church activities to result in poorer self-rated mental health and more symptoms of depression. The implications of the findings for the role of Christian religiosity in health and mental health are discussed.

The Gatekeeper Model

ABSTRACT One of the most important needs of an aging population is to insure that older adults are able to live as independently and safely as possible. The question for social policymakers is how to meet this goal in an era of shrinking resources and growing numbers of older adults. The Gatekeeper Model is highlighted as a method to insure that older adults at risk of problems that impact their ability to live independently can be helped by existing systems of care. The model trains employees of community businesses and corporations who work with the public to serve as community gatekeepers by identifying and referring community-dwelling older adults who may be in need of help. A research project was conducted at Spokane Mental Health, Elder Services Division, where the model was developed. The results indicate that community-based gatekeepers found 40% of clients. Gatekeepers find a distinct population of community-dwelling older adults who are not found by more traditional referral sources. The social policy implications of the Gatekeeper Model are discussed.