“Growing Pains and Challenges”: GrandFamilies House Four-Year Follow-Up Evaluation

During the past decade, there has been increased awareness of issues facing grandparent caregiver families on the part of policymakers and service providers. This awareness has prompted efforts to document the numbers of children being raised by grandparents, to identify challenges faced by grandparents raising grandchildren, and to provide services to meet the needs of these families. National estimates suggest that the numbers of grandparent caregiver families are increasing. Recent estimates suggest that 1.4 million (2%) of all children under 18 live in “skipped generation” families in the United States; similarly, 29,000 (nearly 2%) of all children in Massachusetts live in grandparent care. A large majority of grandparent caregivers are responsible for grandchildren three years or more, suggesting that this is a sustained commitment. Grandparent caregiving is a social phenomenon that cuts across all socioeconomic, racial, and ethnic groups. However, a substantial number of grandparent caregiver families face economic hardship; in Massachusetts, a third of grandparent caregiving families and half the grandchildren in grandparent care families have incomes below 133% the federal poverty index. These nontraditional families face many challenges, including healthcare, income security, education, social support, and housing. Public and private partnerships are beginning to respond to some of these challenges. An initiative to provide affordable, supportive housing for grandparent caregiver families was undertaken in 1998. The current report, based on the first four years of the initiative, builds on an earlier study based on the initial six months. It presents the experiences and views of families and front-line staff, as well as reflections from those responsible for its development. Recommendations are presented for future efforts to address supportive housing for grandparent caregiver families

Chronic Disease Self-Management Programs: Relevance for Persons with Dementia

The context for this study is the work of the Healthy Brain Initiative. The CDC has established a cooperative agreement with the Alzheimer’s Association to develop and implement a multifaceted approach to look at cognitive health as a public health issue. Late in 2010, the Association commissioned a review of the major chronic disease prevention programs from a systems approach to begin to understand the source of findings that Medicare beneficiaries with Alzheimer’s and related disorders are much higher cost than those simply with a single chronic disease and no AD. This led to the conclusion that Chronic Disease Self‐Management Program (CDSMP) is the current “gold standard” initiative in this arena. Thus, the Association in cooperation with Dr. Kate Lorig, the researcher who developed CDSMP, began systematic research to explore the extent to which persons with AD are served in CDSMP workshops. Dr. Lorig is the Director of the Stanford Patient Education Research Center and Professor of Medicine in the Stanford School of Medicine

Providing Low-Cost Assistive Equipment Through Home Care Services: The Massachusetts Assistive Equipment Demonstration

This report describes the Massachusetts Assistive Equipment Demonstration, a collaborative project funded by the Robert Wood Johnson’s Home Care Research Initiative and carried out collaboratively by the Gerontology Institute at the University of Massachusetts Boston and the Executive Office of Elder Affairs (EOEA). The purpose of the demonstration was to systematically encourage the use of low-cost assistive equipment among elderly clients through existing case management resources, thereby extending the effectiveness of the Massachusetts home care program by supplementing formal services with expanded use of assistive equipment

Residential Adjustments of Elders: Perspectives of Elders and their Adult Children

While elders tend to prefer to “age in place,” they often have reason to consider residential alternatives. Declining health and loss of social supports invite elders to consider modifying their homes or moving to other settings that are less demanding and more supportive. Residential adjustments of elders are often a family issue. Among middle-aged adults, worry about the safety of aging parents in their residential environments is widespread. Also common is frustration among adult children about their difficulties in persuading parents to make recommended residential adjustments. We conducted a qualitative study on residential decision-making based on focus groups and qualitative interviews with elders and adult children in the Boston area. Residential concerns and issues raised included safety, mobility barriers, home and property maintenance, affordability, and proximity to formal and informal help. We sought information about a variety of residential adjustments including home modifications, use of assistive equipment, and moves to other settings. We found that most elders want to make decisions about residential adjustments by themselves. Many elders see little need to turn to adult children for advice and do not want to burden children. Adult children typically feel responsible in spite of parental insistence that no help is needed and often find it difficult to give parents advice. Adult children are often disappointed that the advice they provide parents is not well received. Elders and adult children often lack accurate information about residential options. While some families communicate effectively and cooperatively to find creative residential solutions, many do not. Most often residential adjustments are made in response to challenging events (death of a spouse or major health event). Further, adjustments are often short-term. Relatively rarely do older people anticipate their support needs and make forward-looking adjustments that will strengthen their ability to cope with declining functional capacity when it occurs

Promoting Safe Mobility Among Elders by Increasing Awareness of Vehicle Modifications (EXECUTIVE SUMMARY)

This research project looks at one strategy to address the safety of older drivers, vehicular modifications. Specifically, a video demonstrating low-tech, low-cost features that may alleviate some driving challenges was produced to determine whether viewing the video would increase awareness of and motivation to use those features. Prochaska and DiClemente’s Transtheoretical Model of intentional behavioral change provides the theoretical framework for this study. This model posits five stages of change, a continuum over which the individual becomes more receptive to taking action

Kinship Care in Massachusetts

The population of kinship care families in the Commonwealth is diverse in its characteristics, resources, and needs. The often-referenced stereotype of the elderly single grandmother caring for a number of grandchildren holds for only a portion of the kinship care families. Many children are cared for by married couples; many of the grandparents are not elderly; and many of the caregivers are not grandparents, but rather aunts, uncles, grown siblings, or other relatives. Although the duration of the caregiving relationship is unknown for non-grandparental care, most of the grandparent caregivers are involved in long-term caregiving. As such, their needs are ongoing and evolve with the growth of the children in their care and changes in their own life circumstances. Information on the economic resources of these families suggests that kinship care families may experience economic hardship levels equivalent to those of vii single-mother families in the Commonwealth. For the segment experiencing hardship, considerable support may be necessary. Barriers to receiving economic support, housing support, and other services (such as custody rules, poor dissemination of information, or other limitations on receiving services) need to be examined and minimized where possible. A sizable segment of the kinship caregiving population does not present obvious economic need. For these families, continued development of programs such as those offered through the Executive Office of Elder Affairs (such as support groups, information and referral) are likely to be particularly useful. Documenting the prevalence and characteristics of kinship care families and their service use would be facilitated by improved and integrated data systems that used more consistent definitions and reporting strategies across agencies

Life at GrandFamilies House: The First Six Months

Recent reports cite estimates of more than two million children in the United States who are currently living in kinship care arrangements; 10% or approximately 200,000 of these relationships are children in foster care. Much kinship care is done by midlife and older persons who are finding themselves assuming new responsibilities associated with parenting their grandchildren, typically for a period of two years or more. This is a social phenomenon that cuts across all socioeconomic, racial, and ethnic groups. There are many challenges facing these nontraditional families including healthcare, income security, education, social support, and housing. Public and private partnerships are beginning to take shape to respond to some of these challenges. This report describes the first six months of one initiative that was undertaken in Massachusetts to begin to address the need for supportive housing

Choosing among residential options: Results of a vignette experiment

Older people who experience declining health are often faced with difficult decisions about possible residential relocation. The research aim was to determine how five distinct dimensions-functional status, features of current housing, social networks, features of retirement communities, and financial considerations-affect decisions to relocate to a retirement community. A vignette experiment with a factorial design was conducted involving both older people and adult children who were concerned with an aging parent. Use of the Internet for administration of the experiment made it possible to deliver information to research participants through video clips. Research participants were influenced by each of the dimensions; however, functional status of the vignette persons had the greatest impact, and financial considerations the least. Adult children were more likely to recommend moves than were older people. The research is suggestive of the potential for use of vignette experiments for a fuller understanding of relocation decisions

Using the internet to administer more realistic vignette experiments

This article illustrates an innovative method of administering stated choice studies (or vignette experiments) using computers and the Internet. The use of video clips to deliver information to research participants makes vignettes more realistic, helps to engage interest of research participants, and can reduce framing effects. The method also provides research participants with interactive options before making judgments. A study to determine the views of older people regarding residential options is used to illustrate the method. Even older people with limited experience in using computers participated successfully. The study findings showed that research participants responded both to the audiovisual characteristics of vignette persons and to the variables in the vignette structure

HIV-2 Integrase Variation in Integrase Inhibitor-Naïve Adults in Senegal, West Africa

Antiretroviral therapy for HIV-2 infection is hampered by intrinsic resistance to many of the drugs used to treat HIV-1. Limited studies suggest that the integrase inhibitors (INIs) raltegravir and elvitegravir have potent activity against HIV-2 in culture and in infected patients. There is a paucity of data on genotypic variation in HIV-2 integrase that might confer intrinsic or transmitted INI resistance.We PCR amplified and analyzed 122 HIV-2 integrase consensus sequences from 39 HIV-2-infected, INI-naive adults in Senegal, West Africa. We assessed genetic variation and canonical mutations known to confer INI-resistance in HIV-1.No amino acid-altering mutations were detected at sites known to be pivotal for INI resistance in HIV-1 (integrase positions 143, 148 and 155). Polymorphisms at several other HIV-1 INI resistance-associated sites were detected at positions 72, 95, 125, 154, 165, 201, 203, and 263 of the HIV-2 integrase protein.Emerging genotypic and phenotypic data suggest that HIV-2 is susceptible to the new class of HIV integrase inhibitors. We hypothesize that intrinsic HIV-2 integrase variation at "secondary" HIV-1 INI-resistance sites may affect the genetic barrier to HIV-2 INI resistance. Further studies will be needed to assess INI efficacy as part of combination antiretroviral therapy in HIV-2-infected patients