Innovation in Aging最新文献

People living with physical disability (PD) receiving long-term services & supports (LTSS) experience greater unmet service needs. It is unclear if having a case manager for service coordination modifies PD-associated LTSS outcomes. To fill this knowledge gap, we evaluated associations of PD with emergency department (ED) visits and community integration among older LTSS consumers with and without a case manager. Among 6,756 respondents (age, ≥65 years) from the National Core Indicators- Aging & Disability Survey (2018-2019), we evaluated three dichotomized outcomes (yes vs no): ED visits (over 12 months); and self-reported community integration indicated by both- activity (i.e. being as active in community as preferred) and enjoyment (i.e. enjoying things outside home). We used logistic regression, adjusting for consumers' sociodemographic and health-related characteristics, with random intercept for state. PD was documented in 60% of survey respondents. People living with PD were 27% more likely to report not having a case manager (p < 0.001). Among those without a case manager, PD was associated with significantly greater odds of ED visits (odds ratio [OR], 1.80, 95% CI, 1.48-2.19) and lower odds of community integration [activity: OR, 0.75, 95% CI, 0.62-0.90; enjoyment: OR, 0.69, 95% CI, 0.58-0.83]. These associations were attenuated among consumers with a case manager [ED visits: OR, 1.09, 95% CI, 0.94-1.25; activity: OR, 0.86, 95%CI, 0.75-1.00; enjoyment: OR, 0.85, 95% CI, 0.73-1.00]. Older LTSS consumers living with documented PD are more likely to report not having a case manager; and having a case manager might mitigate PD-associated adverse LTSS outcomes.

Background and objectives: While traditional topic modeling methods have been applied to analyze social media content from dementia caregivers, they often struggle with semantic understanding and coherent topic generation. This study explores the direct application of large language models (LLMs) for topic modeling of caregiver tweets, aiming to leverage their advanced semantic comprehension capabilities.

Research design and methods: We analyzed 231 870 tweets from dementia caregivers after preprocessing using ChatGPT as the primary topic modeling tool. To address context length limitations, we developed a 2-stage approach: first splitting the dataset into 226 batches of 1000 tweets each for initial topic extraction, then combining these results through a second-stage prompt for final topic synthesis. We compared our approach against 11 baseline methods, including Latent Dirichlet Allocation (LDA), Gibbs Sampling Dirichlet Multinomial Mixture Model (GSDMM), their term-weighted variants, and state-of-the-art BERTopic models. Topic quality was evaluated using Sentence-BERT-based coherence scores, and topic comprehensiveness was assessed through both ChatGPT and human expert evaluation.

Results: Our LLM-based approach achieved a coherence score of 0.358, significantly outperforming all baseline methods. Traditional approaches like GSDMM (0.317) and LDA (0.320), their term-weighted variants (ranging from 0.264 to 0.302), and BERTopic variants (approximately 0.30) showed lower coherence scores. The 2-stage batching strategy effectively handled the large dataset while maintaining topic quality and representativeness. Expert evaluation confirmed the topics' relevance to caregiver experiences and their comprehensive coverage of key themes.

Discussion and implications: This study introduces a novel methodology for applying LLMs to large-scale topic modeling tasks, demonstrating superior performance over traditional and state-of-the-art approaches. The significant improvement in coherence scores suggests that LLMs can better capture the semantic relationships within topics. Our approach addresses key challenges in context length limitations and prompt engineering, while providing more coherent and interpretable insights into caregiver experiences that can inform targeted support strategies.

Background and objectives: Homesharing provides a strategy for addressing housing insecurity by pairing home providers, often older adults, with an extra room in their house with home seekers needing housing. Despite 5 decades of use, research on this intervention remains limited. This study aims to build on this sparse scholarship to provide insight into the motivations for participating as either home seekers or home providers.

Research design and methods: This community-engaged qualitative project includes data from 24 in-depth interviews and short demographic surveys with a diverse group of home providers (n = 13) and home seekers (n = 11) recruited from 2 nonprofit homesharing organizations. Interviews were recorded and professionally transcribed. The researchers used constant comparison techniques to identify patterns and unique perspectives in the transcripts.

Results: Home providers and home seekers had a mean age of 67.92 (SD = 9.39) and 52.09 (SD = 19.03), respectively and were racially/ethnically diverse. The overall sample was primarily female (71%), though more home providers were female (85%) than home seekers (55%). Participants described a range of motivations for participating in homesharing, including financial motivations, the desire for companionship, the result of a disaster or life change, the desire for a task exchange arrangement, the need for administrative/third-party support for housing (including a need for safety and security), and altruistic reasons.

Discussion and implications: This article provides important new data in a vastly understudied area that can inform policy and practice to support affordable housing options for older adults-particularly through nonprofit homesharing programs.

Background and objectives: Noise during cognitive assessments may impact cognitive performance and lead to biases in estimates of dementia prevalence, especially in developing regions where optimal test conditions may be harder to ensure. However, evidence on noise during testing and older adults' cognitive performance remains limited. To fill this gap, this study aimed to analyze the role of noise during cognitive assessments in older adults' cognitive scores, using data from a population-based study in India.

Research design and methods: Using data from the second wave of the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (n = 3,509), we examined the associations between noise during testing and cognitive scores, and whether these associations varied by respondents' hearing ability.

Results: Noise during testing was significantly associated with lower scores of general cognitive performance and individual cognitive domains. The association between loud noise exposure and cognitive performance was stronger for respondents with normal hearing range and severe hearing loss.

Discussion and implications: Noise during assessments may contribute to biases in cognitive performance in population-based surveys. Further research is needed to better understand the implications of noise during cognitive tests.

Background and objectives: This study estimates life expectancy with basic activities of daily living (ADL) and instrumental ADL (IADL) limitations by living arrangements at age 60 for Mexican adults, using the Mexican Health and Aging Study (MHAS) data from 2012 to 2021. We extend previous research by examining assistance with ADL and IADL as a measure of disability severity and exploring the association of disability assistance and mortality.

Research design and methods: Generalized estimating equations were used to examine the relationship between receiving help and living arrangements (living alone, with spouse only, or in extended households). Cox proportional hazards regression assessed the effect of receiving help on mortality. Multistate life table models were used to estimate life expectancy with and without help for ADL and IADL limitations, by gender and living arrangements.

Results: At age 60, those living alone spent a larger share of post-disability life without receiving assistance (ADL: 68.1%; IADL: 19.9%) than those living with others (ADL: 61.6%; IADL: 15.8%). Compared with co-residers, older adults living alone had higher odds of not receiving help with ADL and IADL. Individuals receiving help had higher mortality (ADL hazard ratio [HR] = 1.57; IADL HR = 1.62), consistent with help being a marker of greater severity, not a causal effect.

Discussion and implications: Extended households enable individuals with disabilities to receive assistance for a longer period. Disability assistance was associated with increased mortality risk, highlighting its role as an indirect measure of disability severity.

Background and objectives: Work occupies a significant portion of adult life, and work conditions are associated with health among workers. This study examined the association between work conditions and mortality, heart disease, stroke, osteoporosis or osteoporotic fracture, and frailty in later life.

Research design and methods: This study included a cohort of 4,192 community-dwelling adults ≥55 years old. A matrix of work conditions by occupation was constructed using a representative national survey in Taiwan. Psychosocial work conditions were assessed using the Job Content Questionnaire, focusing on job control and psychological demands. Mortality and physical morbidity were identified through physician diagnoses recorded in the National Health Insurance Database.

Results: During 10 years of follow-up, 25.0% of the participants died, and 14.2% were diagnosed with heart disease, 17.6% with stroke, 19.4% with osteoporosis or osteoporotic fractures, and 48.66% with frailty. After adjusting for confounding factors, high-skill-discretion jobs (vs low) were associated with a 0.84-fold hazard of mortality (95% confidence interval [CI]: 0.73-0.97), a 0.60-fold hazard of hemorrhagic stroke (95% CI: 0.40-0.90), a 0.79-fold lower hazard of heart disease (95% CI: 0.64-0.97), and a lower multimorbidity frailty index (95% CI: -7.75 to -2.49). Additionally, high psychological demands (vs low) were associated with a 0.85-fold risk of mortality (95% CI: 0.75-0.97) and osteoporosis or osteoporotic fractures (95% CI: 0.73-0.99).

Discussion and implications: High skill utilization and psychological demands were associated with reduced risks of mortality and morbidity in later life. Decent working conditions constitute a modifiable factor that supports healthy aging.