Innovation in Aging最新文献

Background and objectives: Polypharmacy, the concurrent use of multiple medicines, is a growing concern among older adults and those with chronic conditions. Deprescribing through dose reduction or discontinuing selected medicines is a strategy for reducing medicine-related harm. The Patient Deprescribing Typology was developed using qualitative methods to describe the varying factors that are important to older adults when they consider deprescribing. The objective of this study was to use quantitative methods to define distinct classes of older adults via the Patient Deprescribing Typology.

Research design and methods: This study used a cross-sectional experimental design in which data was collected via an online survey from participants 65 years and older in Australia, the Netherlands, the United Kingdom, and the United States. A latent class analysis was performed using the 4-item Patient Deprescribing Typology that collected data about the beliefs about the importance of medicines, how older adults learn about medicines, medicine decision-making preferences, and attitudes towards stopping medicines.

Results: Older adults (n = 2,250) were a median of 70 years and 2-thirds reported that their highest level of education was an associate's degree or trade school or less. We identified 4 distinct Patient Deprescribing Typology classes: Class 1 "Trusts their doctor" (41.6%), Class 2 "Makes own decisions" (30.2%), Class 3 "Avoids deprescribing" (15.5%), and Class 4 'Medicines not important' (12.7%).

Discussion and implications: Older adults report diverse perspectives about deprescribing, emphasizing the need for tailored communication strategies in clinical settings. Additional research is needed to examine older adults' preferences in real-world contexts to refine and improve deprescribing interventions.

Clinical trial registration: NCT04676282.

Background and objectives: Cognitive, visual, and physical performance are associated with driving safety. However, there are few comprehensive models that empirically evaluate how such factors together affect driving safety in older adults. The present study used structural equation modeling (SEM) to evaluate Anstey's original Multifactorial Model of Driving Safety (MMDS) (2005) as well as a modified MMDS that incorporates recent research.

Research design and methods: We used the baseline data from the Advanced Cognitive Training for Independent and Vital Elderly study. Participants (n = 2,391) were drivers with a reported mean age of 73.28 (SD = 5.70; range 65-91), 75.7% White, and 73.3% women.

Results: Using SEM, Anstey's original MMDS did not achieve adequate fit (CFI = 0.850, TLI = 0.777, RMSEA = 0.074). However, the modified MMDS had a good fit (CFI = 0.961, TLI = 0.934, RMSEA = 0.040). We found that better physical function was correlated with less driving avoidance (β = 0.28, p < .01) and a lower crash risk (β = -0.14, p < .01). Better cognitive abilities were associated with less driving avoidance (β = 0.08, p <.01) and better self-reported driving quality (β = 0.19, p < .01). Driving avoidance partially mediated the relationship between physical function and crash.

Discussion and implications: This study highlights the importance of cognition and physical function in older adults safe driving. Implications for future directions and public policy considerations are discussed. Future research should examine possible dynamic changes between these predictors and driving in a longitudinal model.

Background and objectives: This study draws upon local coronavirus disease 2019 (COVID-19) mortality rates as a proxy for pandemic severity to determine if the COVID-19 pandemic disrupted long-term services and supports (LTSS) for adults with dementia, relative to adults with care needs unrelated to dementia.

Research design and methods: We used the Health and Retirement Study to estimate associations between local COVID-19 mortality rates from March 2020 through April 2021 and LTSS outcomes (receiving paid and unpaid help, monthly hours of paid and unpaid help, number of paid and unpaid helpers, living in a residential care setting, or living with adult children). We compared 2 groups of adults ages 51 and older: those with dementia (n = 522) and those without dementia but having difficulty with at least one activity of daily living (n = 2,036).

Results: We found that higher local COVID-19 mortality rates were associated with a reduction in paid care and living in residential care settings for both groups of adults with care needs. In addition, higher local COVID-19 mortality rates were associated with a greater likelihood of living with adult children among those without dementia and greater hours of unpaid help among those with dementia.

Discussion and implications: Although we did not find differences in disruptions of LTSS between persons with and without dementia, observed declines in paid LTSS and increases in unpaid care in the first year of the pandemic may nevertheless have different implications for persons with dementia. Future research should investigate if COVID-19 related disruptions in LTSS led to differential changes in health and unmet needs among adults with dementia, increased strain for their caregivers, and the equitable availability of high-quality paid care.

Background and objectives: Nursing home (NH) quality often varies across socioeconomic gradients. The purpose of this study was to explore the relationship between social deprivation and NH quality.

Research design and methods: Integrating resource dependence theory with Donabedian's structure-process-outcome model, this study utilized 2019 data from Payroll Based Journal, Care Compare: Five-Star Quality Rating System, and LTCFocus.org. The analytic file included 12,900 free-standing NH observations. The primary variable of interest was severe social deprivation index (SDI) defined as SDI ≥85/100. Structural equation modeling was used to explore the effects of severe deprivation on NH structural (nursing staff), processes (antipsychotic medications [APMs]), and outcomes (falls, pressure ulcers, activities of daily living [ADL] decline, and hospitalizations) quality indicators among long-stay NH residents.

Results: Nursing homes in communities with severe SDI showed a decrease of 0.02 registered nurse (RN) hours per resident day (PRD) (p < .001) and an increase of 0.03 certified nursing assistant (CNA) hours PRD (p = .01). Higher licensed practical nurse (LPN) hours PRD (β = -1.03; p = .003) and higher CNA hours PRD (β = -0.80; p < .001) were significantly associated with reduced APM use. Increased APM use was significantly associated with ADL decline (β = 0.03; p < .001) and hospitalizations (β = 0.001; p = .013). Severe SDI indirectly resulted in higher hospitalizations (β = 0.01; p = .01) and falls (β = 0.01; p = .001) through lower RN staffing but lower pressure ulcers (β = -0.07; p < .001) through higher CNA staffing. Directly, severe SDI increased pressure ulcers (β = 0.69; p < .001) and hospitalizations (β = 0.09; p < .001) and decreased falls (β = -0.53; p < .001).

Discussion and implications: Severe social deprivation affected nursing staff patterns, affecting care quality. These findings highlight the importance of considering environmental factors in the NH quality policymaking process.

Background and objectives: Routine activity theory (RAT) asserts that a suitable target's exposure to a motivated offender in the absence of capable guardians increases their likelihood of crime victimization. We use these principles to assess the extent to which engaging in risky routine activities-for example, entering sweepstakes drawings, answering unknown calls-is associated with victimization frequency among older adult mass marketing fraud victims across five types of scams: investment fraud, sweepstakes and lottery fraud, romance and family/friend imposter scams, fake products and services, and charity scams. We also examine whether financial and social vulnerability characteristics (loneliness, preference for taking financial risks, financial fragility) are associated with victimization frequency in older adults.

Research design and methods: A survey was administered to households that the U.S. Postal Inspection Service identified as having recently responded to one or more mail scam solicitations. Respondents answered questions on their behaviors, financial risk preferences, social and demographic characteristics, and number of past-year victimization experiences with 5 types of fraud.

Results: As predicted based on RAT, routine activities that increase a target's exposure to motivated offenders are positively associated with fraud victimization frequency, although more frequent online activity was negatively associated with victimization frequency contrary to hypotheses. Precarious financial and emotional states such as financial fragility and loneliness also were associated with greater victimization frequency, and more frequent social engagement and living with others (the presence of capable guardians) had no effect.

Discussion and implications: Target suitability factors such as loneliness, financial fragility, and risky financial preferences and behaviors are associated with a higher frequency of fraud victimization among older adults. Consumer education should include information on reducing risky behaviors that can increase fraud exposure. More frequent social engagement may not be protective. Older adults who are financially fragile and experiencing loneliness require more safeguards.

Background and objectives: As the population ages there is an increasing need for caregiver training programs, but little is known about how to deliver implementation support for diverse sites in large-scale implementation efforts. External group-based implementation facilitation may be one promising approach. This study's objective is to detail the development and delivery of a pragmatic implementation facilitation approach to support the national rollout of caregiver training, Caregivers FIRST, at over 140 Veterans Health Administration (VHA) sites.

Research design and methods: Using administrative, survey, and project data, we describe the process of developing and delivering enhanced support to 13 VHA sites unable to meet adoption benchmarks as part of a national mandate. Enhanced support consisted of 4 group-based calls delivered within a 12-week period that used tailored external facilitation to address barriers, facilitators, and strategies for program implementation. We present key implementation barriers, implementation strategies, and sites' perceptions of highly valued elements of enhanced support.

Results: Enhanced support calls focused on 3 implementation barriers commonly identified by implementing staff (n = 25) in a site-level needs assessment survey: recruiting and retaining caregivers (83%), balancing program delivery alongside competing demands (57%), and support from other departments in program delivery (44%). Sites attended a median of 3 out of 4 enhanced support calls. In postimplementation quantitative surveys, the average response of perceived helpfulness of enhanced support (ranging from 1 to 5) was 3.4 at 6 months, increasing to 4.2 at 12 months. Respondents valued collaborative problem-solving and the ability to learn best practices from other implementing sites during enhanced support calls.

Discussion and implications: Describing the process of developing and delivering enhanced support via group-based external facilitation for Caregivers FIRST in VHA may provide useful information to guide similar efforts in other healthcare systems as they broadly disseminate interventions to support caregivers across diverse sites.

Clinical trial registration: NCT05319535.

Background and objectives: Regular resistance exercise (RE) showed a promising effect in reducing frailty in older adults. However, the participation of RE among this population remains low. This study was, therefore, aimed at developing a complex intervention tailored to community-dwelling frail older adults in China to promote participation in RE and reduce frailty ultimately.

Research design and methods: Using a multimethods qualitative study design, this study included 2 parts: (1) a qualitative study was performed to explore barriers and facilitators for participation in RE among frail older adults through stakeholder interviews. The interview was guided by the comprehensive framework of implementation research; (2) two rounds of expert consultation, guided by the social cognitive theory, were conducted to identify the key barriers and facilitators, and corresponding implementation strategies for promoting participation in RE. A complex intervention was developed accordingly.

Results: Interviews were conducted with 16 frail older adults (mean age = 72.9) and 10 community workers (mean working years = 11.2). A total of 10 barriers and 16 facilitators were identified; safety concerns, decline in physical function, and lack of knowledge were frequently mentioned barriers, while health needs, social support, and professional guidance were common facilitators. Then 10 experts (mean working years = 20.9) were consulted to determine the main barriers and facilitators, and a list of corresponding implementation strategies was developed subsequently. Thus, a tailored complex intervention delivered by community workers in the community setting, including the core component of "group elastic-band RE," and supplementary components of "community education, feedback, goal setting, and reinforcement guidance" was developed.

Discussion and implications: This study constructed a list of key barriers and facilitators as well as corresponding implementation strategies for promoting participation in RE among community-dwelling frail older adults. A tailored complex intervention was developed accordingly, which will facilitate the management of frail older adults in the Chinese community setting.

Background and objectives: This study evaluates the feasibility of virtual reality (VR) wayfinding training with aging adults and assesses the impact of the training on wayfinding performance.

Research design and methods: 49 participants were recruited using a convenience sample approach. Wayfinding tasks were conducted by 3 participant groups: active VR training, passive video training, and no training, assigned randomly. The training featured 5 tasks in a digital version of a real building. Post-training assessments used 10 tasks in this same building, half of the tasks familiar from the training and half new. The study was double-blinded, with each intervention lasting 10 min. The primary outcomes include the Distance Traveled and Duration for each wayfinding task, with a fixed 10-min limit.

Results: Participants in the VR group reported moderate usability and a high sense of Self Location in the environment with respect to the training intervention. No significant differences were found in performance for the first group of similar wayfinding tasks; however, in the subsequent set of new tasks the VR group significantly outperformed the Control group. This suggests a possible spatial learning effect across multiple exposures (VR training followed by similar task). No adverse effects were reported during or post intervention.

Discussion and implications: This study provides preliminary evidence that VR training can help to improve wayfinding performance in older adults with no reported adverse effects.