Dr. Barker's research interests focus broadly on the anthropology of health, illness, and medicine and particularly as it applies to ethnicity, gender, and age. Her research interests focus on such problems as the day-to-day management of chronic illness, organization of community-based care, and substance abuse. Other substantive interests include the impact of migration and social change on health status and provision of services, and Pacific societies, especially Polynesia and New Zealand.
CURRENT & RECENT RESEARCH
"Experience and Management of Urinary Incontinence among Older Adults" (Barker, PI with L. Mitteness). Urinary incontinence is a problem for a significant percentage of older Americans. The care and management of incontinence has been estimated to cost $10 billion per year or more. Very little was known about the lives of people with incontinence. This series of studies was designed to determine how elderly people with incontinence manage on a daily basis and what strategies they have used to seek help for their incontinence. Two studies were done, one with relatively healthy elderly people living in subsidized housing and one with home-bound elderly people receiving in-home health care services.
Key Findings: More than half of incontinent people had never reported their incontinence to a physician. Incontinence is regularly under-reported and under-treated, partly because of misconceptions by both elderly people and their physicians that incontinence is an irreversible and normal part of the aging process. Management strategies revolved around keeping incontinence a secret, as public incontinence is considered to be evidence of incompetence. The management strategies used by incontinent elderly people include (in decreasing order of frequency): use of pads, pants and catheters; strategies aimed at strengthening control, such as controlling fluid intake; or strategies aimed at redefining control, such as withdrawing into one's home, so that accidents happen only at home. The only people who are publicly incontinent are those few who have cognitive problems that interfere with their ability to manage.
Applications to Policy or Interventions: The results of this study could be used to identify target populations for early interventions to maintain continence or to intervene effectively with incontinence.
"Non-kin Caregivers to Dependent Older Adults." (National Institute on Nursing Research. Barker, PI,, 09/30/95-07/31/2000) This project examines the social processes whereby unrelated people voluntarily take on and continue caregiving to frail older community-living adults. This semilongitudinal study examines over a 12-month period, the processes of formation, maintenance, and stability of such ties. It recruits older participants form four sources: Probate Court, home health care agency, voluntary organizations such as churches, and the general community. A total of 160 non-kin caregiving dyads will be interviewed in the course of this study.
Utility of Findings: Knowledge of how non-kin relationships are formed and maintained could lead to policy change to better support such relationships.
"Healthy Mommas: HIV Education/Prevention Intervention Research Project," (Barker, PI, AIDS Clinical Research Center, 1994-1995) This study investigates the effectiveness of a specific educational message aimed at low-income, ordinary African-American women with elementary school children.
"Ethnicity and the Meaning of Smoking among Older Age Groups," (Barker, PI, California Tobacco-Related Disease Research Program, 1991-1994). This study investigates the social and cultural factors that sustain smoking among people in four ethnic groups: Anglo-Americans, Mexican Americans, American Indians and Blacks. It examines the role that smoking plays in the lives of men and women aged 50 to 70 years who currently smoke and seeks the factors that sustain smoking in light of the mounting evidence that smoking is harmful to one's health and is becoming socially unacceptable.
Findings: Older smokers' opinions about health risks relate to their experiences with smoking, not to population-based research and risk assessments. Health problems were not generally attributed to smoking; instead these older adults believed there are transient periods of vulnerability to health over the life-course (e.g., during infancy or having certain illnesses). Only during these vulnerable periods would smoking be likely to induce risk of subsequent disease.) Older urban American Indians are a high risk for smoking-associated morbidity and mortality.
Utility of Findings: The model of risk used by the scientific and clinical communities is very different from that of older smokers. Recommends ways to devise and implement culturally appropriate and age sensitive smoking cessation programs that incorporate the beliefs of American Indians.
"Management of Smoking in Long-Term Care Facilities, I." Funded by the Academic Senate, University of California San Francisco. (Barker, Co-PI with L.S. Mitteness, and D.E. Lewis, Jr.,.
"Management of Smoking in Long-Term Care Facilities, II." Funded by the Tobacco Related Diseases Research Fund administered by the University of California, 1990-93. (Barker, Project Director, Co-P.I.s L.S. Mitteness and D.E. Lewis, Jr.)
These two projects investigate some central dilemmas surrounding the management of smoking by elderly patients in long term care, focusing especially on the issues of patient autonomy vs. institutional authority. People in nursing homes are both patients in a health care institution which wants to restrict their smoking for health reasons, and residents who can do as they like within their own home. Administrators have to balance the rights of smokers to smoke with the rights of non-smokers to avoid smoke. Staff have to implement policy and manage safely both non-smokers and smokers, including demented smokers. The inherent conflicts in this situation and their resolution are being investigated. Part I focused on administrators' views on smoking in 20 SNFs in S.F.
"Tobacco Use among Older Urban American Indians in Southern California,"(Barker, Co-P.I.) American Indians have some of the highest smoking prevalence rates in the U.S. today. But little is known about smoking rates among American Indians in urban areas, and even less is known about smoking by American Indians over the age of 50. This study assessed smoking prevalence by a needs assessment survey involving 282 domiciled American Indian elders who self-reported tobacco use, and examined smoking behaviors and beliefs in interviews with a convenience sample of 30 current smokers, both male and female, aged 50-70 years.
Findings: About one quarter of older urban American Indians were smokers. Smoking was linked to age and alcohol consumption. Respondents believed that smoking was linked to no health consequences other than respiratory conditions and lung cancer. Smoking was not believed to cause poor health but rather to exacerbate existing poor health.
Utility of findings: This study fills a gap in the literature by reporting on smoking by older American Indians in an urban context. It makes recommendations to devise and implement culturally appropriate and age-sensitive smoking cessation programs that incorporate the existing beliefs of this population about vulnerability and risks for tobacco-related disease.
"Alcohol Consumption among Older Urban American Indians" (Barker, Co-P.I.) This survey describes the pattern of alcohol consumption by older urban American Indians in Los Angeles. Data come form a cross-sectional community health survey with a convenience sample of 282 non-homeless American Indians.
Findings: Most elders did not drink alcohol. More women than men, and more individuals aged 60+ than people under 60 years, abstained. Elders in single generation households tended to consume more alcohol than those in multi-generational households. Among the 76 people who reported drinking, significantly more people under age 60 than over age 60 consumed four or more drinks per sitting, and those who lived alone were more likely than drinkers living with others to consume alcohol at least once a week. Age seemed to be a salient marker of alcohol consumption with fewer people 60+ years of age drinking as much or as often as people under this age. Abstainers are not necessarily lifetime teetotalers, but my be former drinkers who have quit, and may still on occasion go on short-term binges.
Utility of Findings: Results of this study replicate findings from surveys of the general elderly population, suggesting that older urban American Indians are not different from other older people with respect to alcohol consumption.
"Homelessness among Older American Indians in Los Angeles" (Barker, Co.-P.I.) This is a survey of 335 older American Indians living in Los Angeles County.
Findings: A large proportion (16%) of older American Indians living in Los Angeles are homeless. Compared to domiciled older American Indians, homeless older American Indians were younger but reported higher rates of physical and mental health problems including hypertension, shortness of breath, diabetes, chest pains, alcoholism, depression, sadness, and loneliness. All those 60 or older lived on the street year-round, but fully 70% of those less than 60 years of age rented rooms for shelter at least occasionally. Institutional and cultural barriers prevented some homeless individuals from accessing social and welfare services.
"Home Health Study of Physicians and Use of Adult Day Care." (Barker, Co-P.I. with Mitteness) This study investigates physicians' knowledge of adult day health care for the elderly.
Findings: Seventy-one percent of 54 physicians interviewed knew about adult day health care. However, only 41% of doctors expressed willingness to refer specific patients for such care, and even fewer (13%) had done so.
Utility of findings: Medical schools and continuing education courses should encourage doctors to recognize their role as gate keepers, able to facilitate the entry of frail elderly into a variety of long-term care services.
"Older Home Health Care Patients and Their Physicians: Assessments of Functional Ability." (Barker, P.I.) This study examines the agreement between functional assessments reported by 54 physician-patient dyads. Physicians were typical of those providing services to elderly patients in an urban area. Patients, were aged 65 or more years, were community living, and had been referred by these physicians for in-home health care services.
Findings: Physicians generally reported less impairment than did their patients, and functional assessments of doctors and patients matched completely in only 15 out of 54 (28%) dyads. Underestimation of patient impairment occurred most commonly with respect to stair climbing, control of the urinary bladder, and bathing but was also substantial for dressing, walking, and toileting. Few patient or doctor characteristics predicted congruence or lack thereof in assessment of functional impairments.
"Demographic Study of Iu-Mien in Western U.S." (Barker, P.I.) This study investigates Iu-Mien refugees living in Merced, California.
Findings: Older people comprise a larger than expected proportion (7%) of the Iu-Mien community. The large households remain traditional in composition with many older Mien acting as patriarch to several generations of lineal kin. Women, who are usually widows, tend to live with the families of sons or sons-in-law. Intergenerational disaffection has been reported in the literature, in part due to the status losses by older people and role reversals so common among refugees.