Older Persons In Israel Research Articles

Bound in an Imbalanced Relationship: Family Caregivers and Migrant Live-In Care-Workers of Frail Older Persons in Israel.

Migrant care-workers (MCWs) are often the main caregivers for frail older persons. We examined the complex relationship between MCWs and primary family caregivers (PFCs) in Israel to better understand how MCWs and PFCs perceive the formal and informal nature of their relationship. Given the high prevalence of two-income families who are unavailable for caregiving, the relationships among MCWs, PFCs, and care-recipients warrants examination, particularly when PFCs serve as managers of care and the care-recipient has dementia. The sample of 116 MCWs and 117 PFCs included 92 MCW-PFC pairs who were part of a larger study on home care for frail older persons. A mixed-methods approach was used involving quantitative (correlations/paired t-tests) and qualitative (grounded theory framework) analyses conducted on data obtained from structured interviews. A significant correlation was found between ratings of the quality of the relationship by MCWs and PFCs, although PFCs rated it significantly more positively than MCWs. MCWs' ratings of their relationship with the PFCs were significantly correlated with their ratings of the quality of their relationship with the care-recipient. Four main thematic categories emerged from the qualitative analysis: (1) communication, (2) dependence, (3) relationship quality, and (4) triad: MCW-PFC-care-recipient. For each theme, we present perspectives of MCWs and PFCs, reflecting either "closeness" or "distance" in their relationship. The findings highlight the complexity of such relationships, with the potential for a meaningful positive bond or mistrust or abuse. The study provides a basis for testing methods for ameliorating the negative experiences described by some participants.

Age, ageing, ageism and \u201cage-itation\u201d in the Age of COVID-19: rights and obligations relating to older persons in Israel as observed through the lens of medical ethics

COVID-19, the illness caused by the SARS-CoV-2 virus, has reached pandemic proportions. Although the virus can cause disease in anyone, it is particularly dangerous for those with various “co-morbidities” such as heart disease, hypertension, diabetes, obesity and others. Furthermore, advancing age (from about 60 on), even in those older persons without any accompanying illnesses, is a strong and independent risk factor for pneumonia, need for an ICU bed and death from the virus. It is therefore essential to find ways to protect all at-risk persons (old or young) from the virus but at the same time not harming, more than absolutely necessary their essential freedoms as well as taking into account their social/psychological needs. Compared with other OECD countries, Israel’s population is still relatively young, with only 11.5% being over 65+ with a smaller proportion of older persons in long-term institutions than that found in most other comparable jurisdictions. These factors might explain a part of the country’s (so far) relatively low rates of serious disease and mortality compared to those seen in other developed countries. However there are still over a million older citizens at risk and the numbers of infected, hospitalized and seriously ill persons are rising once again. This is no time for complacency.An analysis of the effect of age on the disease as seen through the principles of medical ethics is followed by a proposal as to how best to balance these sometimes conflicting goals. This paper relates mainly to older persons in the community since the Ministry of Health early on in the pandemic initiated an effective program (Magen Avot) meant to protect those older persons in long-term care institutions. Recommendations include the Ministry of Health publishing clear guidelines as to risk factors and offering sensible advice on how to practice physical (not “social”) distancing without exacerbating an older person’s sense of social isolation. In order to reduce the incidence of influenza (which can clinically be confused with COVID-19) and the potentially disastrous consequences of a “double pandemic” this coming winter, a robust flu vaccination program needs immediate implementation. Persons at all ages (but especially those 60+) should be encouraged and assisted to sign advance directives, especially those who do not wish to undergo invasive therapy. An individual older person’s wish to “make way” for younger people should be respected as an expression of his/her autonomy. As we enter the second wave, triage mechanisms and protocols need to be circulated in readiness for and well before a situation in which an acute imbalance develops between the availability for acute resources and the population’s need for them. The Ministry of Health, in cooperation with other relevant ministries and NGOs, should take the lead in developing plans, ensuring that they are carried out in an orderly, timely and transparent manner. The blanket is indeed not large enough but we must place it as judiciously as possible in order as much as possible to protect, cover and keep warm the body politic.

Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel.

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009-2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.

Predictors of Migrant Live-in Care Workers' Burden/Burnout and Job Satisfaction When Caring for Frail Older Persons in Israel.

To clarify how work characteristics affect migrant live-in care workers' burden/burnout as well as their job satisfaction. Data from 116 migrant live-in care workers were collected in 2013-2014 in Tel Aviv and Jerusalem through structured interviews about their job satisfaction and their degree of burden/burnout. Due to the conceptual and empirical similarity (zero-order correlation and joint internal reliability), of burden and burnout, the 2 were combined into one variable. These outcome measures were examined in connection with the older person's level of disability, care workers' relationship with the older person, and their employment conditions. According to the regression models, work characteristics (care recipients' functional status and care workers' relationship with the care recipient) had a direct impact on burden/burnout. Employment-related variables (employment conditions and satisfaction with those conditions) had an indirect effect. A combination of work characteristics (relationship with the older person) together with the care worker's response to employment conditions (satisfaction with employment conditions) had a direct influence on the care workers' job satisfaction. Problematic employment conditions had an indirect effect. The results suggest that fostering better relationships and improving employment conditions could help reduce care workers' burden/burnout as well as improve their degree of satisfaction.

Predictors of Smoking Cessation in Old–Old Age

There is a dearth of knowledge on smoking cessation in older adults. This study examined predictors of smoking cessation in persons over age 75. This study is a secondary analysis of a prospective longitudinal study. A sample of 619 older persons aged 75-94 was drawn from a representative cohort of older persons in Israel and was examined longitudinally. By means of interviews, we assessed smoking, health, Activities of Daily Living (ADL), Instrumental ADL, cognitive dysfunction, and well-being. Continuing smokers tended to be lonelier. Participants who quit smoking took more medications and had greater cognitive dysfunction compared to those who continued smoking. Greater cognitive dysfunction and high medication use or the physical causes for high medication use may precipitate smoking cessation in persons aged 75-94, potentially through a greater influence of caregivers on one's lifestyle. Cognitive dysfunction and high medication use predicted smoking cessation. Smoking cessation for long time smokers may be influenced by greater ill health. Influence of caregivers may augment smoking cessation. Given these findings, for persistent smokers into old age, smoking cessation may occur at the time of physical and functional decline during the end of life period.

The Contribution of a “Supportive Community” Program for Older Persons in Israel to Their Offspring Who Are Primary Caregivers

The “supportive community” programs in Israel provide a basket of services for older persons living in their own homes. This study examined the differences between caregiver burden and quality of life of 55 offspring who were the primary caregivers of their older parents who were members of a supportive community, compared to 64 offspring whose parents were nonmembers. The findings showed that the role stress factor of caregiving burden was lower, and the psychological health domain of quality of life was higher among offspring whose parents were members of supportive communities. Some of the predictor variables of burden were income status of caregiver, sharing with others in caregiving, and membership of the parent in a supportive community. The primary predictor variable of the quality of life was caregiving burden. The practical conclusion of this study is to further develop and market supportive community programs in various communities.

The Old, Old-Old, and the Oldest Old: Continuation or Distinct Categories? An Examination of the Relationship between Age and Changes in Health, Function, and Wellbeing

This study aims to examine whether old age, old-old age, and oldest-old age comprise distinct categories via comparing persons aged 75-84, 85-94, and 95+ on demographics, health, function, and wellbeing. The sample was drawn from a representative longitudinal cohort of older persons in Israel. Matched cohort comparisons found a significant decline in Activities of Daily Living (ADL), instrumental ADL, cognitive function, percent of participants who go outside their home, and physical activity, with an increase in physical and mobility difficulties, and no difference in depressed affect or loneliness. Longitudinal results showed increased widowhood, institutionalization, comorbidity, physical and mobility difficulties, loneliness, and depressed affect, as well as decreased subjective health and physical activity over time. In the absence of changes in social support as manifested by marital status and community living, there was no decline in wellbeing. Current evidence of various gradual quantitative differences suggest that in most respects old age may be better conceptualized as a single phase marked by a continual quality.

Psychometric Properties of the Hebrew Version of the de Jong Gierveld Loneliness Scale

The purpose of this study was to evaluate the reliability and validity of the Hebrew version of the De Jong Gierveld Loneliness Scale. Cross-sectional research methodology was used to measure loneliness felt by older adults. Data of this study were drawn from tree samples that included altogether 2,100 older persons in Israel. The De Jong Gierveld Loneliness scale demonstrated good psychometric properties similar to those of the English version. Internal consistency of Cronbach's alpha was high (α = .86), and the measure showed good convergent and exploratory validity. This was due to significant correlations with frequency of feeling loneliness, quality of life, satisfaction with life, value of life, and perceived health, functional, and economic status. Factor analysis showed three loading factors instead of the two in the original version. The scale can be a useful for comparative research as well as a screening instrument for professionals working with older adults to assess the degree of loneliness felt by them. The scale also provides indications of the need for professional intervention when loneliness is great and negatively affects the older person's quality of life.

Homebound older persons: Prevalence, characteristics, and longitudinal predictors

The current study examines the prevalence and correlates of homebound status aiming to elucidate the predictors and implications of being homebound. Analyzed sample was drawn from two representative cohorts of older persons in Israel, including 1191 participants (mean age = 83.10 ± 5.3 years) of the first wave of the Cross-Sectional and Longitudinal Aging Study (CALAS) and 418 participants (mean age = 83.13 ± 5.2 years) of the Israeli Multidisciplinary Aging Study (IMAS). Cross-sectional and longitudinal analyses were conducted. Homebound prevalence rates of 17.7–19.5% were found. Homebound participants tended to be older, female, have obese or underweight body mass index (BMI), poorer health, lower functional status, less income, higher depressed affect, were significantly lonelier (in CALAS), and more likely to have stairs and no elevators, than their counterparts. Predictors of becoming homebound include low functional IADL status, having stairs and no elevator (in both cohorts), old age, female gender, and being obese or underweight (in CALAS). The study shows that homebound status is a prevalent problem in old-old Israelis. Economic and socio-demographic resources, environment, and function play a role in determining the older person's homebound status. Implications for preventing homebound status and mitigating its impact with regards to the Israeli context are discussed.

The Effect of Homebound Status on Older Persons

To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization. Cross-sectional and longitudinal analysis using existing data sets of a national survey. A national survey. The analyzed sample was drawn from a representative cohort of 1,191 older persons in Israel (mean age 83.1±5.3) in the first wave of the Cross-Sectional and Longitudinal Aging Study and 621 participants in the second wave of the study. Homebound status, health, function, environment, mental health, distal events, mortality, activities daily living (ADLs), instrumental activities of daily living (IADLs), Orientation-Memory-Concentration Test, and Center for Epidemiologic Studies Depression Scale. Mortality data were recorded from the Israeli National Population Registry. Homebound participants had a significantly higher risk of mortality than their non-homebound counterparts, even after controlling for background variables, health, and function (risk ratio=1.33, 95% confidence interval=1.08-1.63). In cross-sectional analysis, homebound status was related to depressed affect even after controlling for demographics, health, and function. In longitudinal analysis, homebound status predicted future depressed affect and ADL and IADL difficulties when controlling for demographics and health, but only IADL prediction was statistically significant when baseline levels of the outcome variable were entered into the regression. The results highlight the detrimental effects of homebound status, underscoring the importance of preventing this state, of interventions to assist those who are homebound, and of future research to examine the efficacy and coverage of services to this population.

Differences Between Users and Nonusers of Day Care Centers Among Frail Older Persons in Israel

Day care centers are one of the core community-based services for frail older persons. The purpose of the study is to examine differences in characteristics of users and nonusers of day care centers among frail older people and factors that explain service utilization. Personal interviews are conducted with 333 respondents, of whom 81 were users. Based on the behavioral model of Andersen, the results show that both groups significantly differed in most predisposing (age, marital status), enabling (having a homecare worker), and need (IADL [instrumental activities of daily living]) factors. The findings lend support to Andersen’s behavioral model and suggest that further research is needed to assess underutilization of day care centers. Implications for research, policy, and practice are discussed.

Client Satisfaction with Live-In and Live-Out Home Care Workers in Israel

In an era of globalization where the migration of long-term care workers is common, foreign live-in home care workers can compensate for the unavailability of family members and, perhaps, even substitute for institutional care in the provision of long-term care services to disabled older persons. This study examines differences in home care satisfaction between disabled older persons in Israel with “live-in” home care workers and those with “live-out” workers, and explores some differences in socio-demographic and personal characteristics between these two groups. Face-to-face interviews were held with a random sample of 93 older persons in Beer-Sheva. Older persons with live-in home care workers were more satisfied with their home care service than those with live-out workers. Those with live-in workers were more severely disabled, tended not to have any children living in close proximity, although an adult child was available as an informal caregiver. Communication difficulties between the elderly persons and their home care workers were found not to affect negatively the satisfaction with the service.

Dietary intake and eating patterns of elderly people in Israel: who is at nutritional risk?

To determine dietary intake and eating patterns of older persons in Israel and to identify factors associated with low intake. A cross-sectional study. Community-dwelling participants living in the Beer-Sheva area were interviewed at home, using a 24 h food questionnaire with additional questions regarding health and eating habits. Dietary intake was compared between people aged 65-74 and 75 y and older. A total of 377 people over the age of 65 224 aged 65-74 and 153>75, were randomly selected from the Negev population. Dietary intake of energy, fat, carbohydrates, vitamins E, C and B(1) were significantly lower for people aged 75 and older compared with people aged 65-74. Low energy intake was associated with lower subjective health status for men (P<0.01), poor appetite (P<0.01) and more gastrointestinal problems (P<0.05) for women and lower snack consumption (P<0.01) for both genders. In a multivariate model, low energy intake was associated with low appetite and higher use of medication for both sexes and with frequency of eating alone and not consuming snacks for men. Dietary intake is lower among individuals older than 75 than in 65-74 y old. Risk factors for low intake include poor appetite and health status, gastrointestinal problems, and eating alone. Snacking enhanced dietary intake and should be encouraged in this group.