Objectives The National Social Life, Health and Aging Project is the first population-based, nationally representative study to ask older adults about their recent experience of mistreatment. This article provides estimates of mistreatment by family members and examines the association of mistreatment with demographic and health characteristics. Methods We selected community-residing participants aged 57 to 85 using a multistage area probability design. Of those eligible, 3,005 participated in the study, for a weighted response rate of 75.5%. We asked respondents if in the past year they had experienced mistreatment in the following domains: verbal, financial, and physical. We asked those who reported mistreatment about their relationship to the person responsible. Results In all, 9% of older adults reported verbal mistreatment, 3.5% financial mistreatment, and 0.2% physical mistreatment by a family member. Odds of verbal mistreatment were higher for women and those with physical vulnerabilities and were lower for Latinos than for Whites. Odds of financial mistreatment were higher for African Americans and lower for Latinos than for Whites and were lower for those with a spouse or romantic partner than for those without partners. Discussion Few older adults report mistreatment by family members, with older adults quite insulated from physical mistreatment.

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BACKGROUND: Low literacy influences cervical cancer screening knowledge, and is a possible contributor to racial disparities in cervical cancer. OBJECTIVE: To examine the hypothesis that literacy predicts patient adherence to follow‐up recommendations after an abnormal Pap smear. DESIGN: A prospective, continuity clinic‐based study. PARTICIPANTS: From a sample of 538 women undergoing literacy testing at the time of Pap smear screening, we studied 68 women with abnormal Pap smear diagnoses. MEASUREMENTS: Literacy was assessed using the Rapid Evaluation of Adult Literacy in Medicine (REALM). We also measured other proxies for literacy, including educational attainment and physician estimates of patients' literacy level. Outcome measures included on‐time and 1‐year follow‐up and duration of time to follow‐up after an abnormal Pap smear. RESULTS: Only one‐third of the cohort adhered to follow‐up recommendations. At 1 year, 25% of the women had not returned at all. Patients with inadequate literacy (as assessed by the REALM) were less likely to follow up within 1 year, although this result was not statistically significant (adjusted odds ratio [OR]=3.8, 95% confidence interval [CI]: 0.8 to 17.4). Patients subjectively assessed by their physician to have low literacy skills were significantly less likely to follow up within 1 year (adjusted OR=14, 95% CI: 3 to 65). Less than high school education (hazard ratio (HR)= 2.3; 95% CI: 1.2, 4.6) and low physician‐estimated literacy level (HR=3.4, 95% CI: 1.4, 8.2), but not objective literacy level, were significant predictors of duration of time to follow‐up, adjusting for recommended days to follow‐up and other factors. CONCLUSIONS: Among women with an abnormal Pap smear, those perceived by their physician to have low literacy were significantly more likely to fail to present for follow‐up.

Older women in this sample were sexually active, engaged in potentially risky sexual behavior, and believed that physicians should address issues of sexuality. Older African American women were significantly more likely than white women to report HIV-related changes in their behavior and to discuss sex with a physician. This community-based study corroborates clinical research and suggests both a gap and a disparity in older women's dialogue with physicians. It also indicates the need for more broadly generalizable data on issues pertinent to older women's sexual health.

Innovative community based social and behavioral interventions for individuals suffering from Alzheimer's disease and their family caregivers have increased substantially in creativity and recognition over the years. However, the commitment to the scientific design and evaluations of these programs has not followed suit. The goal of this paper is to explicate the benefits of a systematic approach to the design and evaluation of intervention programs with the challenges of the Alzheimer's dyad in mind. Because of the unique nature of the disease, Alzheimer's programs must flexibly apply existing intervention and evaluation techniques to program designs which accommodate the degenerative course of the disease and the unique strain experienced by family caregivers. Using existing literature as a vehicle to illustrate how successful and unsuccessful programs have addressed these goals, the paper stresses the need for design and evaluations which apply creative and robust treatments, but do not compromise scientific rigor.