Anticipating relocation: concerns about moving among NORC residents

Changes in Community-Dwelling Elderly's Activity and Participation Affecting Depression during COVID-19 Pandemic: A Cross-Sectional Study

We determined the changes in the activity or participation of the community-dwelling elderly in Japan during the COVID-19 pandemic and identified the activities leading to depression. This will allow us to evaluate rehabilitation interventions that can be used to minimize or eliminate the negative impact of COVID-19 on today's community-dwelling elderly. Herein, demographics, activity or participation (Activity Card Sort-Japan version: ACS-JPN), the number of social networks (Lubben Social Network Scale: LSNS), and depression (Geriatric Depression Scale: GDS) were examined in 74 community-dwelling elderly in Japan from August to October 2020. A statistical analysis was conducted to determine the effect of demographics on GDS, LSNS, and ACS-JPN, to compare the activity retention rates of the four domains using ACS-JPN, and to extract the activities that might affect depression using a generalized linear model. The results show that the retention of leisure activity with a high physical demand (H-leisure) and sociocultural activities was significantly lower than instrumental activities of daily living and leisure activity with a low physical demand (L-leisure). L-leisure and the number of social networks were possible risk factors for depression during the pandemic. This study highlighted the importance of maintaining the number of L-leisure and social networks at home to prevent depression in community-dwelling elderly when they could not perform outdoor activities and direct interpersonal interaction.

An Overview of Naturally Occurring Retirement Communities (NORCs) for Ageing in Place

As an alternative to ageing at home in the community, naturally occurring retirement communities (NORCs) have great potential to facilitate ageing in place; however, they have not attracted much research attention. This study conducts an overview of NORCs, aiming to examine the previous research in a comprehensive manner in order to explore how NORCs impact ageing in place, with the goal of guiding future research. The research presented here employs the content analysis method to review prior NORC-related studies and categorise research themes and findings following top-down coding principles. A total of 49 articles were selected from the Scopus and Web of Science databases, and the results show that the “social environment”, which was the most discussed topic (n = 24), provides the necessary mental support and physical motivation for older adults to live actively in NORCs, and that NORCs play a positive role in preserving public resources and promoting individual health. The limitations of this study include the fact that there is little public information on NORC programs and the subjective classification of themes, among others. This study acts as a foundation for future research on NORCs, which serve as a perfect model for healthy ageing in place.

Promising Aging in Community Models in the U.S.: Village, Naturally Occurring Retirement Community (NORC), Cohousing, and University-Based Retirement Community (UBRC)

Aging in Community (AIC) is the preferred way to age. This systematic review identified promising AIC models in the U.S. and analyzed model characteristics and push-pull factors from older adults’ perspectives. Push factors are those driving older adults to leave, while pull factors attract them to stay in a community. We conducted a two-phase search strategy using eight databases. Phase I identified promising AIC models and Phase II expanded each specific model identified. Fifty-two of 244 screened articles met the criteria and were analyzed. We identified four promising AIC models with the potential to achieve person-environment (P-E) fit, including village, naturally occurring retirement community (NORC), cohousing, and university-based retirement community (UBRC). Each has a unique way of helping older adults with their aging needs. Similar and unique push-pull factors of each AIC model were discussed. Analyses showed that pull factors were mostly program factors while push factors were often individual circumstances. Continued research is needed to address the challenges of recruiting minority older adults and those of lower socio-economic status, meeting older adults’ diverse and dynamic needs, and conducting comparative studies to share lessons learned across the globe.

Self-Perception of Physical Function Contributes to Participation in Cognitively- and Physically-Demanding Activities After Stroke

Background: Persons with and without aphasia experience decreased participation in meaningful activities post-stroke that result in reduced autonomy and poorer quality of life. Physical, cognitive, and/or communication deficits are prevalent post-stroke and many activities given up are purported to require high levels of communicative, cognitive, or physical skill. However, the relationship between deficits after stroke and participation in life activities that appear to require high skill levels in these three areas has not been investigated fully.

Objectives: The objectives of this study are to: (1) determine differences in reported participation in communicatively-, cognitively-, or physically-demanding activities in persons after stroke with and without aphasia living in the community, and to (2) investigate whether performance on commonly used self-perception assessments of these three areas predicts reported participation in activities requiring higher levels of skill in these domains.

Methods: In a cross-sectional design, 82 individuals at least 6 months post-stroke with (N = 34) and without aphasia (N = 48) were administered a battery of neuropsychological and participation-based assessments. Supported communication techniques maximized inclusion of individuals with aphasia. A series of regression analyses investigated the relationship between self-perceived communicative, cognitive, and physical functioning and reported participation in activities post-stroke that required high amounts of skilled function in these areas.

Results: People with and without aphasia did not differ in terms of the percentage retained in communicatively-, cognitively-, or physically-demanding activities. All individuals retained higher levels of participation in communicatively- and cognitively-demanding activities (at least 60% retained), compared to participation inphysically-demanding activities (about 50% retained). The strongest predictor for retaining participation in two of the three domains of activities was self-perception of physical function, though much of the variance remained unexplained. Self-perception of communication was not related to participation retention in any of the three domains.

Significance of Impact: Rehabilitation professionals should be aware of the impact that a variety of communicative, cognitive, and physical factors may have on participation post-stroke. Self-perceptions of impairments in communication and cognition may not directly predict participation in activities requiring high levels of communicative and/or cognitive skill, at least for those with mild impairment, even though activities requiring those skills are given up or done less after stroke.

Influence of Environmental Factors on Social Participation Post-Stroke

Objectives

For rehabilitation professionals to adequately address meaningful participation in social activities with their patients after a stroke, there must be a better understanding of neurobehavior, that is, how neurological impairment and its sequelae and environmental factors support or limit social participation. The current study examines how stroke severity (NIH Stroke Scale), its impact on perceived mobility (Stroke Impact Scale mobility domain), and the environment (MOS Social Support–Positive Social Interactions scale and Measure of Stroke Environment receptivity and built environment domains) influence social participation (Activity Card Sort: ACS).

Methods

A correlational, cross-sectional design examined the relationships among neurological impairment, perceived limitations in activity, environmental factors, and social participation. Participants included 48 individuals who were at least 6 months post-stroke both with aphasia (N = 22) and without aphasia (N = 26) living in the community for whom all measures were available for analysis.

Results

No differences in social participation were found between those with and without aphasia, though both groups reported a large (25-30%) decline in participating in their prestroke social activities. For the ACS Social Domain activities and ACS Partner to Do With activities (percent retained), 37% and 35% of the variance, respectively, was accounted for by the predictor variables, with only MOS Social Support making an independent contribution to social participation. In this sample, neurological impairment was not a significant correlate of social participation. Additionally, perceived mobility and the built environment were not found to independently predict participation in social activities.

Conclusions

Perceived social support was found to predict social participation in individuals living in the community 6 months or greater post-stroke. Focusing on social support during post-stroke rehabilitation may provide an avenue for increased social participation and more successful community reintegration.

Should I Stay or Go: Rural Ageing, a Time for Reflection

(1) Background: Studies have shown that older people prefer to continue living in their own home and community as they age; however this is dependent upon available services and social support. In Australia about two thirds of people will age at home. The Australian Government provides home care packages to support ageing in place yet in rural areas not all services are available. The lack of employment opportunities in rural areas often results in family residing at a distance reducing available social support. This study aims to evaluate informal social support and its influence on ageing in place amongst older people in three Australian rural communities in Australia. (2) Methods: A multiple embedded case study was undertaken in three diverse rural communities. Eleven older rural residents ageing in place aged 65+ were interviewed about their ageing experience and plans for their future in the light of available social support along with 15 members of their social networks. Social networks were then visually depicted with the use of ecomaps and network members were interviewed. (3) Results show that kin and non-kin social networks support ageing in place however ageing is a time of change and reflection. (4) Conclusions: There is a need for more discussion within these networks when it comes to future planning.

Activity-Based Goals Generated by Older Adults With Mild Cognitive Impairment

Client-centered care is one promising rehabilitation model that may support the unique needs of older adults with mild cognitive impairment (MCI). This secondary analysis examined (a) whether older adults with MCI generated activity-based goals using a client-centered model and (b) the types of goals generated. Thirteen older adults with MCI addressed 55 goals. Using client-centered care, the participants generated goals despite subtle limitations in activities and participation. Participants generated the greatest number of goals related to instrumental activities of daily living. This study demonstrated that older adults with MCI generated goals through a client-centered model. This is important because older adults with MCI are at risk for disability, and they may benefit from early rehabilitation care models that minimize activity limitations and participation restrictions despite underlying cognitive impairments.

Assessing future care preparation in late life: Two short measures

The purpose of this article is to introduce 2 short forms of the previously published measure of preparation for future care (PFC). Community-dwelling older adults ages 65-94 who had completed the 29-item Preparation for Future Care Needs scale were randomly divided into scale development (n = 697) and scale validation (n = 690) samples. Fifteen items were selected using exploratory and confirmatory factor analyses on the scale development and scale validation samples, respectively. Consistent with PFC theory, the 5 subscales of the original long-form measure (Awareness, Gathering Information, Decision Making, Concrete Planning, Avoidance of Care Planning) were maintained. A 5-item scale with acceptable score reliability and validity was also developed. Compared to the long form, these short forms are more easily incorporated into epidemiologic studies and can be used in medical, psychology, and social work practice to initiate discussions about long-term care planning. (PsycINFO Database Record

The creation of age-friendly environments is especially important to frail older people

The preference of older people when it comes to ageing in place may be modified by levels of frailty. The aim of this research is to characterise the relationship between frailty and ageing in place, and to identify differences in neighbourhood characteristics supporting ageing in place missed by frail and non-frail older people. A concurrent nested mixed-methods approach was used. For quantitative evaluation, a sample of 945 independently living older adults residing in four districts of Rotterdam were asked to complete a questionnaire in 2013 (response rate = 62%; N = 558). In addition, 32 interviews were conducted with frail and non-frail older people. Results showed that gender, age and especially frailty were related to missed neighbourhood characteristics. People displayed awareness of their increasing frailty and often acknowledged that it increased the need for neighbourhood characteristics enabling them to age in place. We can conclude that dependence on neighbourhoods varies with frailty status. This relationship is dynamic; with frailty, older people become more dependent on their neighbourhood. However, expectations regarding neighbourhood characteristics seem to dissipate with advanced age and increasing frailty.

Management of Relocation in Cognitively Intact Older Adults

Relocation, a major life transition that can affect health positively and negatively, is moving from one permanent home to another. Many older adults will relocate at some time during their life. Relocation is also a complex process that requires careful consideration and planning before the move (i.e., pre-location) and adjustment to the new home after the move (i.e., post-relocation). The current article is a summary of content based on a comprehensive evidence-based practice guideline focused on management of relocation in cognitively intact older adults. The guideline was designed to be used across diverse settings by nurses and other providers. Pre-relocation guidelines include assessment for the need for relocation, interventions prior to moving, and outcomes for evaluation of the pre-relocation process. For post-relocation, content focuses on assessment of risks for not adjusting after the move as well as intervention guidelines to promote adjustment and outcomes for evaluation. Implications include advocacy for older adults by using the guideline, disseminating it, and conducting future research. [Journal of Gerontological Nursing, 42(11), 14-23.].

Making the Move: A Mixed Research Integrative Review

The purpose of this mixed research integrative review is to determine factors that influence relocation transitions for older adults who are considering a move from independent living to supervised housing, such as assisted living, using the Theory of Planned Behavior as a conceptual guide. PubMED, CINAHL, and PsychInfo databases were queried using key words: relocation, transition, older adults, and, elderly and time limited from 1992 to 2014. Sixteen articles were retained for review. The majority of articles, qualitative in design, reveal that older adults who comprehend the need to move and participate in the decision-making process of a relocation adjust to new living environments with fewer negative outcomes than older adults who experience a forced relocation. The few quantitative articles examined the elements of impending relocation using a variety of instruments but support the necessity for older adults to recognize the possibility of a future move and contribute to the relocation process. Additionally, the influence of family, friends, and health care providers provides the older adult with support and guidance throughout the process.

Characterizing Older Adults' Involvement in Naturally Occurring Retirement Community (NORC) Supportive Service Programs

Naturally Occurring Retirement Community (NORC) Supportive Service Programs constitute one of the longest-standing models for age-friendly community initiatives. As a support-focused model, NORC programs typically offer a range of benefits--including direct services, group activities, and broader community development activities--that are intended to engage older adults with diverse needs, preferences, and interests. Moreover, NORC programs are designed to be used according to the needs of the particular participant engaging with them at a particular point in time. This range and flexibility of benefits indicate the importance of more systematically characterizing the ways in which older adults are involved with NORC programs. For this purpose, we used data from in-depth interviews with 35 residents across 6 NORC programs in New York City. Qualitative analysis revealed 6 ordered categories of involvement: (a) consciously no involvement; (b) involved, but not consciously; (c) relationship with staff only; (d) selectively involved with a strong sense of security; (e) NORC program leaders; and (f) dependence on the NORC program. Overall, results indicate how older adults' involvement in NORC programs can be characterized beyond their utilization of specific types of services and by their relationship with the program as a whole. Findings suggest the importance for outcomes research on NORC programs and related models to consider subgroup differences by involvement. Results also provide directions for theory development on engagement in voluntary programs, as well as for practice to enhance older adults' involvement in supportive service programs.

Neighborhood Support and Aging-in-Place Preference Among Low-Income Elderly Chinese City-Dwellers

OBJECTIVES

Preferences for aging-in-place are unclear among low-income elderly Chinese city-dwellers, who are more likely to be geographically bound, to have little care support, but possess strong filial values and family cohesiveness. This study investigated the preferences for aging-in-place and its contributing neighborhood factors among low-income Chinese elderly in a metropolitan city.

METHOD

We conducted interviews with 400 older people residing in public housing estates in Hong Kong.

RESULTS

The majority of low-income elderly persons (80.4%) prefer to age in place even if their health and functioning has deteriorated beyond independent living. Logistic regression showed that (a) having very low income (<HK$2,000/month) and not receiving means-tested welfare predicted lower preference for this option [odd ratios (OR) = 0.27]; and (b) having medical facilities within reach (OR =9.02); and (c) an elderly center in the area (OR = 2.98) were associated with a preference for aging in place, after controlling for demographic, and functioning characteristics.

DISCUSSION

Low-income elderly Chinese city-dwellers prefer to age in place, given appropriate neighborhood support. These findings can be interpreted in light of Lawton's ecological theory of aging and suggest a service model similar to the Naturally Occurring Retirement Community with Supportive Service Programs.

Perceived participation after stroke: the influence of activity retention, reintegration, and perceived recovery

OBJECTIVE

We sought to determine the extent to which perceptions of participation in everyday occupations were affected in a sample of people with predominantly mild stroke. Demographic variables, stroke severity, community integration, participation in everyday occupations, and perceptions of recovery were examined as potential contributors to their perceptions of participation.

METHOD

We conducted a cross-sectional study with 116 people with mild to moderate first stroke assessed approximately 6 mo after stroke.

RESULTS

Perceptions of participation assessed using the Stroke Impact Scale varied (range = 19-100), with a mean score of 82. Regression analyses revealed three factors that contributed to perceptions of participation: retention of previous activities, reintegration in home and community, and perception of stroke recovery.

CONCLUSION

Although the majority of participants reported a high level of perceived participation, more than a third failed to report successful participation.

Activity Participation Differences Between Younger and Older Individuals with Stroke

The purpose of this study was to describe differences in activity participation between younger and older individuals with stroke to inform transition after stroke. This was a cross-sectional study with individuals six-months poststroke (n = 177). All individuals completed an outcomes assessment battery that included the Stroke Impact Scale, the Reintegration to Normal Living Index and the Activity Card Sort. The sample was divided into two groups: (1) Young — those under the age of 65 (n = 89); and (2) Old — those 65 or older (n = 88). Analysis was completed to examine differences between the groups on the primary outcome measures of the study and to look at differences between the groups on individual questions/items on the specific measures. The results of this study demonstrate: (1) significant differences in both the quantity and nature of activity participation prior to and after stroke between younger and older stroke survivors and (2) total scores and measures of central tendency do not necessarily provide therapists with the information they need to guide treatment. Rehabilitation professionals should focus on providing clients with the tools they will need to be successful in transitioning back to home and community environments once rehabilitation has ended.

Negotiating the joint career: couples adapting to Alzheimer's and aging in place

To understand the impact of memory loss on aging in place, this paper investigated dyads where one spouse had been diagnosed with memory loss. In-depth qualitative interviews were conducted with ten couples (N = 20). Grounded theory methods were used to collect, code, and analyze data into themes. Data revealed consensus among and between dyads that it was best to focus on living, rather than what had been or might someday be lost. Nonetheless, differences according to gender and cognitive status (e.g., diagnosed or spouse) were reported. Given population aging, identifying the impact of gender roles and social norms on the potential for aging in place with memory loss is critical. Community services and care practices must be sensitive to the ways that couples prioritized and organized their relationship prior to diagnosis in order to encourage positive patterns of care between couples, foster successful adaptation to changing needs, and support in-home arrangements as long as possible.

Occupational Participation of Older Adults: Reliability and Validity of the Activity Card Sort—Puerto Rican Version

The Activity Card Sort was developed to measure the level of participation of older adults in instrumental, social, and leisure activities. The purpose of this study was to determine the psychometric properties of the translated and culturally adapted Puerto Rican Spanish version of the Activity Card Sort (PR-ACS). This study included 106 community-dwelling older adults aged 60 years and older and 40 adults with multiple sclerosis aged 50 years and older. Results showed that the PR-ACS was able to discriminate between clients with different levels of functioning ( t = 6.86; p < .001), and was positively associated with the Puerto Rican version of the RAND-36 Short Form Health Survey ( r = 0.66; p < .001). Good test—retest reliability (intraclass correlation coefficient = 0.82) and high internal consistency (Cronbach's alpha = 0.91) were demonstrated. Initial evidence of construct validity, concurrent validity, internal consistency, and test—retest reliability was found to support the use of the PR-ACS to assess occupational participation of Puerto Rican older adults living in the community.

Occupations of Older Adults: A Cross Cultural Description

Participation in everyday occupations influences people's health and well-being. To enable individuals to do the activities they want and need to do is the main concern of occupational therapy practice. Many daily occupations are universal, but they also depend on culture. The development of the Activity Card Sort in eight countries has offered the opportunity to describe occupations across cultures. In the developmental process of culturally relevant versions of the Activity Card Sort by occupational therapists in each country, the instrument versions included samples of older adults ( N = 468). These data are used in the current description with the aim of identifying central activities across cultures and central activities for Asian and Western cultures. Te n activities were identified as being central across cultures (i.e., more than half of the older adults in all eight countries performed them). They were the following: shopping in a store, doing grocery shopping, doing dishes, doing laundry, reading books or magazines, sitting and thinking, watching television, listening to radio or music, visiting with friends and relatives, and talking on the telephone. Further, 16 additional activities central to Asian culture and 18 activities central to Western culture were identified. The identification of central activities deepens knowledge of activities with cultural significance. This knowledge is needed in clinical practice and multicultural research. This description provides a starting point for further exploration of everyday occupations among older adults.

Social Support Networks and Expectations for Aging in Place and Moving

This study investigated the relationship of social support networks with expectations for aging in place and moving in a sample of relatively healthy, community-dwelling adults ( N = 4,611). Results indicated that those with aging in place expectation and those with moving expectation were comparable in sociodemographics, self-rated health, and social support networks. Knowledge of home- and community-based services (HCBS) availability was associated with respondents reporting an older age at which they expected regular help and moving. When compared with those who did not offer an age prediction, knowledge of HCBS availability, information sources for personal care, and social activity engagement were important in understanding the choices of age ranges at which respondents expected to age in place and to move. Findings point to the importance of expanding social support networks, providing opportunities for social activity, and strengthening information networks with the emphasis on targeting older adults and their caregivers.

Planning and Decision Making for Care Transitions

The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults' lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions.

In-Home Occupational Performance Evaluation (I-HOPE)

OBJECTIVE

We describe the development and preliminary psychometric properties of an assessment to quantify the magnitude of an environmental barrier's influence on occupational performance.

METHOD

The assessment was developed and then piloted on a group of 77 older adults before and after an occupational therapy intervention focused on environmental barrier removal. Refinements were made to the assessment before it was evaluated for interrater reliability in a sample of 10 older adults using 2 raters.

RESULTS

The In-Home Occupational Performance Evaluation (I-HOPE) is a performance-based measure that evaluates 44 activities in the home. The 4 subscales of Activity Participation, Client's Rating of Performance, Client's Satisfaction With Performance, and Severity of Environmental Barriers are sensitive to change in the environment. The subscales' internal consistency from .77 to .85, and intraclass correlation coefficients ranged from .99 to 1.0.

CONCLUSION

This preliminary study suggests that the I-HOPE is a psychometrically sound instrument that can be used to examine person-environment fit in the home.

Consistency and construct validity of the Activity Card Sort (modified) in measuring activity resumption after stem cell transplantation

OBJECTIVE

We assessed the psychometrics of a self-administered survey modification of the Activity Card Sort (modified; ACSm) when used to track activity resumption after stem cell transplantation (SCT).

METHOD

Thirty-six participants completed the ACSm for a descriptive pilot study of recovery after SCT. Reliability was assessed by determining the longitudinal consistency of participants' designation of an activity as never done versus done previously and by calculating internal consistency. Construct validity was assessed by correlating the ACSm scores with measures of quality of life, performance status, and perceived cognitive impairment.

RESULTS

Participants gave consistent designations for 72% of items. Internal consistency of the total score was alpha > 0.86 at all assessments. The ACSm scores were correlated with quality of life (r = 0.51, p = .0019), functional well-being (r = 0.59, p = .0002), and performance status (r = 0.42, p = 0.011) and not associated with cognitive impairment (r = .22, p = .19).

CONCLUSION

The ACSm demonstrated provisional evidence of reliability, internal consistency, and construct validity.

NORC supportive services model implementation and community capacity

As community residents age, service delivery systems may not be equipped to meet their changing needs. The Naturally Occurring Retirement Community (NORC) model has emerged as a strategy to utilize existing resources and develop a comprehensive approach to maintaining older adult functional status. However, little has been written about how community capacity influences NORC implementation. A community capacity framework was used to analyze the themes that emerged from participant and service provider interviews at two diverse NORC sites. The findings revealed that perceptions of a sense of community and partnership management influenced the NORC experience for participants and providers.

Client-centred home modifications improve daily activity performance of older adults

BACKGROUND

Remaining at home is a high priority for many older adults, but the capacity to "age in place" often is threatened by environmental barriers.

PURPOSE

To describe a client-centred occupational therapy home modification intervention program and examine the impact of the intervention on daily activity performance over time.

METHODS

Using a competence-environmental press framework, a client-centred home modification program for older adults was implemented. In this quasiexperimental, single group prospective study, participants'subjective ratings of daily activity performance were evaluated before and after the intervention (baseline/post/post).

FINDINGS

After home modification, participants'perception of their daily activity performance at home improved significantly and was maintained 2 years post-modification.

IMPLICATIONS

Home modification may benefit older adults attempting to age in place.

Older Adults Seeking Mental Health Counseling in a NORC

The authors used the Andersen model to compare older adults’ help seeking from clergy to help seeking from other sources of formal mental health services. Data were from the Naturally Occurring Retirement Community Demonstration Project. Multinomial logistic regression was used to compare sources from which help was sought.The results indicate that older adults sought help from clergy more frequently than from other formal sources. Increased stress levels, higher intrinsic religiosity, and being younger were related to seeking help from clergy. Greater stress and attendance at religious services were related to help seeking from other sources. Only greater frequency of attending religious services was associated with a greater likelihood of seeking help from clergy versus other formal providers.The increasing elderly population and the attendant crisis in mental health services might best be addressed through public-private partnerships in which mental health professionals assist clergy in identifying problems and making appropriate referrals.

Clergy as mental health service providers to older adults

Older adults tend to seek help for emotional problems from clergy at greater rates than they do from other sources. However, their help-seeking from clergy is largely understudied. We used data from the Naturally Occurring Retirement Community (NORC) Demonstration Project to examine older adults' patterns of help-seeking from clergy. We studied a sample of adults aged 65 or older (n = 317) to determine which factors were related to help-seeking from a religious leader. This study was framed within the Behavioral Model of Health Services Utilization. Results of hierarchical logistic regression analyses indicated that having less social support and greater frequency of attendance at religious services was related to help-seeking from clergy for this sample, while other predisposing, enabling, need and religiosity variables were not found to be related to help-seeking from clergy. Discussion focuses on the need for mental health workers to be aware of the important role that clergy play in service provision and to find ways to leverage knowledge and skills to enhance provider-clergy relationships in order to improve services that older adults receive.