Innovation in Aging最新文献

Background and objectives: Disasters can worsen behavioral symptoms in people living with dementia, leading to disorientation, anxiety, and paranoia. In such situations, psychotropic medications may be inappropriately used to manage these symptoms. This study estimated the receipt of new, or changes to existing, psychotropic prescription medications post-disaster among fee-for-service Medicare beneficiaries with a dementia diagnosis.

Research design and methods: Medicare administrative claims data were used to examine the relationship between hurricane exposure and receipt of antipsychotic prescriptions among people living with dementia with no prior use. The primary outcome was a daily count of new psychotropic prescriptions per beneficiary, from Part D claims, residing in exposed and unexposed counties 12 months after the hurricane landfall. The secondary outcome was a daily count of increases in the dosage of psychotropic prescriptions. Federal Emergency Management Agency disaster declarations were used to determine disaster-exposed groups.

Results: A total of 70 307 traditional fee-for-service beneficiaries with a dementia diagnosis were included in the study. In analyses adjusted for age, sex, race/ethnicity, Part D low-income subsidy status, rurality and number of Elixhauser comorbidities conducted over a 12-month period following the three hurricanes, beneficiaries exposed to the hurricanes had a 10% higher rate of starting new antipsychotic prescriptions compared to those in unexposed counties (IRR: 1.10, 95% CI: 1.04-1.17). Analyses conducted by individual hurricanes revealed substantial differences, with higher rates of initiating antipsychotics following Hurricane Harvey (IRR: 1.21, 95% CI: 1.07-1.36), and no change after Hurricanes Irma (IRR: 0.97, 95% CI: 0.88-1.08) and Florence (IRR: 0.92, 95% CI: 0.80-1.05).

Discussion and implications: Psychotropic prescribing increased after Hurricane Harvey but not after Irma or Florence, suggesting context-specific factors may influence clinical responses during disasters. Our findings highlight the importance of incorporating person-centered care and appropriate behavioral health responses into disaster preparedness planning for the dementia population.

Background and objectives: Robotic technologies will likely be part of the caregiving needs for older adults in the future. In this study, we assessed the acceptance of several robotic functions among a representative sample of adults in Switzerland and tested (a) the acceptance of different robotic functions, and (b) explored how different sets of predictors explained variance in the acceptance of 2 robotic functions: (a) "robots for assistive support" and (b) "robots for companionship."

Research design and methods: A survey was administered to a randomly selected group of adults from the 3 official linguistic regions of Switzerland using computer-aided-telephone-interviews. Data obtained were weighted for the Swiss adult population and analyzed using descriptive statistics, multilevel modeling, and sequential regression analysis.

Results: A total of 1,211 adults responded to the survey. Acceptance was higher for using "robots for assistive support" than "robots for companionship," with no significant statistical difference between linguistic regions. Usefulness of robotic functions in reducing caregiving stress explained the most variance in our model for both outcome variables. External predictors such as the fear of robots and the fear that robots will replace human care explained the least amount of variance.

Discussion and implications: When robots are used in the care of older adults, user adoption is likely to be positive when the end-users (older persons and their caregivers) perceive that their use meaningfully reduces caregiving stress. More research is needed to further test the role of external factors for technology adoption, especially those that touch the notion of human contact.

[This corrects the article DOI: 10.1093/geroni/igae098.].

Background and objectives: Family caregivers in the United States provide substantial value of unpaid care to older adults while less recognized are the employment-related costs they endure and the trajectory of these costs. We estimate the replacement cost of unpaid family caregiving to U.S. adults aged 70 and older with and without dementia and the opportunity costs of forgone earnings and lost productivity between 2011 and 2060.

Research design and methods: We match caregivers to older adults from the National Study of Caregiving with similar noncaregivers from the Panel Study of Income Dynamics. We use population projections alongside current and historical data on educational attainment, wages, inflation, and average wages for in-home care aides to approximate total replacement and opportunity costs.

Results: Current annual replacement cost of unpaid family care is between $96 and $182 billion, 44% of which is accounted for by dementia caregiving. By 2060, it will increase to $277-571 billion, and 53% will be for dementia caregiving. The opportunity costs of forgone earnings and productivity loss, however, will grow faster, increasing from current levels of $107 billion and $26 billion to $380 billion and $102 billion, respectively, in 2060. Projections show that opportunity costs of family caregiving will be increasingly borne by caregivers of older adults with dementia and racial/ethnic minoritized caregivers.

Discussion and implications: As the employment-related opportunity costs of family caregiving for older adults are on a trajectory to become increasingly similar in value to associated replacement costs of unpaid care, policymakers, health insurance payers, and employers should focus on supporting unpaid family caregivers to remain attached to the labor force through efforts such as strengthening paid family leave options, expanding consumer-directed in-home services options, and offering increased work flexibility.

Background and objectives: Falls are a major public health concern among older adults, often leading to injuries, impaired mobility, and loss of independence. Dual-task walking, where a secondary task is performed while walking, simulates real-life challenges and is linked to fall risk. This study aimed to investigate how dual-tasking affects stepping strategies, inter-joint coordination, and coordination variability during walking in older adults with and without a history of falls.

Research design and methods: Twenty community-dwelling older adults (10 fallers, 10 non-fallers), aged 65 and older, completed a 2-min walking test under three conditions: single-task (ST) walking, motoric dual-task (MDT) walking (holding a glass of water), and cognitive dual-task (CDT) walking (serial subtractions). Gait data were collected using inertial measurement units. Stepping strategies were quantified by the changes in cadence and stride length, while inter-joint coordination was analyzed using vector coding. Two-way repeated measures ANOVA was used to assess task and group effects on variables.

Results: Task-specific adaptations were observed: MDT prompted greater stride length adjustments, while CDT led to more balanced cadence and stride length adjustments (F = 8.346, p = .010, η ²p = .317). Fallers exhibited more anti-phase coordination in hip flexion-knee flexion than non-fallers during dual-task conditions (p ≤ .042). In CDT walking, fallers showed a lower frequency of distal phase in hip flexion-knee flexion and a higher frequency of anti-phase in hip flexion-ankle dorsiflexion compared to ST (p ≤ .044). Coordination variability decreased during MDT for hip flexion-ankle dorsiflexion in both groups compared to ST (p ≤ .027).

Discussion and implications: This study provided better understanding on the differences of stepping strategies and phase-specific coordination patterns between older adult fallers and non-fallers, particularly under dual-task walking conditions. The conservative motor control strategies in fallers suggest a prioritization of stability over adaptability, potentially increasing fall risk during complex walking tasks.

Background and objectives: The literature indicates an association between social isolation and substance use. Though related, social withdrawal is a construct that has received less attention. Given that prescription drugs are commonly misused by older adults, this paper contributes to the literature by examining the association between social withdrawal and prescription opioid misuse.

Research design and methods: We use data from 2009 to 2022 U.S. National Survey on Drug Use and Health, focusing on respondents 50+ (N = 111,386; 54.8% female; 74.1% non-Hispanic White). Social withdrawal is measured with 3 items from the WHO Disability Assessment Scale, individually and as a scale, capturing the level of social withdrawal severity experienced when going out of the home, dealing with strangers, and participating in social activities. Our outcome is past-year prescription opioid misuse. Logistic regression models consider the association between these 2 measures. Models account for underlying mental health alongside additional covariates.

Results: Levels of social withdrawal and prescription opioid misuse remained relatively constant across observation years. A significant association exists between social withdrawal and past-year prescription opioid misuse. We find increasing odds of past-year prescription opioid misuse across social withdrawal severity levels. Severe social withdrawal across measures is associated with 1.59 (95% CI = 1.28, 1.98) to 2.1 (95% CI = 1.74, 2.48) times higher odds of past-year prescription opioid misuse relative to no social withdrawal. Predicted probabilities of misuse are 1% among those with no social withdrawal, but 6% among those experiencing severe social withdrawal. A nonsignificant interaction shows this relationship is consistent across years. These estimates are robust to numerous controls and alternative specifications.

Discussion and implications: Prescription opioid misuse is associated with social withdrawal. Social withdrawal is bound up with, and yet independent of, mental and physical health. Addressing the social causes of social withdrawal, as well as mental and physical health, could advance addressing opioid misuse among older adults.

Background and objectives: China's population aging, especially increasing numbers of older people with disability and dementia, challenges the public health care system. Long-term care insurance (LTCI) is essential to provide care for China's fast-growing aging population, yet there is a lack of evidence on how the health risks of disability and dementia influence the acceptance of LTCI in China. This study explores the effects of health risk information about disability or dementia on the LTCI intentions of the Chinese aged 50-70.

Research design and methods: Using stratified random sampling and convenience sampling methods, we designed a survey of 1 025 respondents aged 50-70 from 8 provinces in China. We randomly assigned respondents to control (n = 354), disability risk (n = 339), and dementia risk (n = 332) groups, and used multinomial logit models to investigate the information intervention effects on respondents' different LTCI (No/Uncertain/Yes) intentions. Also, we analyzed the heterogeneity of respondents' education level and whether living in LTCI pilot/nonpilot policy cities.

Results: Both disability and dementia risk information significantly decreased the probability that respondents were unwilling relative to being willing to enroll in LTCI. The marginal prediction results show that pretest LTCI intentions played a key role in shaping postintention LTCI. In the analysis of heterogeneity, we found that disability information was associated with an increased likelihood of respondents with lower levels of education answering "uncertain," and dementia information was associated with a decreased likelihood of answering "no" for respondents living in the LTCI pilot policy cities.

Discussion and implications: Disability and dementia risk interventions significantly improved LTCI intentions among Chinese aged 50-70. To improve the acceptance of LTCI, we recommend that policymakers adopt the strategies of information interventions for LTCI policy advocacy and differentiate dementia-related and disability-related risk information by individuals with different educational levels and residents in LTCI pilot/nonpilot policy cities.

Background and objectives: The prevalence of depression in people living with dementia is 40% in the United States. However, since pharmacological treatments tend to produce undesirable side effects, we developed a nonpharmacological, innovative depression intervention, Caregiver-Provided Life Review (C-PLR) for people living with dementia with mild depressive symptoms. We trained family caregivers in interview skills of the evidence-based depression intervention, life review, and caregivers conducted the intervention with people living with dementia at home. This paper reports the intervention outcomes and implementation recommendations.

Research design and methods: This 8-week pre- and postintervention study used a mixed-methods design with 45 caregiver-people living with dementia dyads (N = 90). We recruited participants across the United States and measured people living with dementia's depressive symptoms (primary outcome), life satisfaction, caregiver burden, rewards, and dyads' relationship quality (secondary outcomes) quantitatively, and interviewed caregivers about their intervention experience qualitatively.

Results: Caregivers were 58 years old on average, married, college-educated, working, female, and in good/excellent health while people living with dementia were on average 81 years old, widowed, retired, female, and in poor/fair health. Their depressive symptoms significantly improved after intervention (p < .001), as did caregiving rewards (p = .029), and relationship quality (p = .041). Caregiver burden did not change (p = .519). Caregivers' interviews supported the quantitative results. The results of fidelity check-in calls confirmed high adherence to the C-PLR protocol. Caregivers confirmed the feasibility of virtual training and confidence in conducting life reviews.

Discussion and implications: Training family caregivers to conduct life reviews may be an acceptable and cost-effective way to improve depressive symptoms among people living with dementia while improving caregiver experiences. C-PLR seems to be an easy and convenient depression intervention for people living with dementia in terms of delivery method, delivery setting, delivery schedule, and delivery cost, and thus, has the potential to reach a wide range of participants.

Background and objectives: In the United States, Medicaid plays a prominent and growing role as a primary payer for home- and community-based services (HCBS) to help adults remain living independently in the community. While Medicaid HCBS programs vary significantly across states, limited historical, systematic data about Medicaid HCBS program components exist. We presented a systematic, reproducible approach to capture comprehensive characteristics of Medicaid HCBS waivers.

Research design and methods: We used current and historical documentation of Medicaid 1915(c) waivers serving adults ages 65 or older from 2010 to 2019. We described waiver services available over time, specifically respite, transport, meals/dietary/nutrition services, caregiver training, and payments to family members for personal care services. We extracted data from waiver documents using HTML parsing.

Results: We extracted data systematically from 419 of 431 waiver documents (97%) across 46 states. During a manual quality control review of data extracted, 9% of waiver documents required any manual corrections, with only 4% requiring significant corrections impacting analysis (eg, missing services). We observed that the percentage of waivers offering each service increased over time for most services except caregiver training, which decreased.

Discussion and implications: This study fills a critical gap in data availability by demonstrating a systematic approach by which researchers can construct a historical, waiver-level database of Medicaid HCBS waiver characteristics.

Older adults with opioid use disorder (OUD) are a growing population with high levels of multimorbidity and social complexity. While treatment gaps for OUD exist across the lifespan, older adults face specific barriers to diagnosis, treatment, and harm reduction services. Current care models are often poorly equipped to address medical and social complexity or provide integrated care, and the geriatric workforce has traditionally had little training on managing OUD and other substance use disorders. There are also specific payment and insurance coverage gaps that may disproportionately impact older adults, including limited service coverage and poor reimbursement for integrated care and wraparound services. To address these gaps, there are opportunities to shape policy and redesign systems to improve access and quality of care. We must continue to adapt our care models to provide integrated treatment that is age-friendly, appropriate, and acceptable to older adults with OUD. Maintaining and expanding insurance coverage-including preserving Medicaid access, expanding Medicare coverage, and improving reimbursement within the care continuum-is a critical lever to ensuring older adults receive accessible, high-quality OUD care. There are also opportunities to improve workforce training and support across acute, postacute, and outpatient care settings. Methadone reform is another important area that could disproportionately improve care for older adults and those with multimorbidity. Finally, tailoring low-barrier, telehealth, and other nontraditional OUD care models to serve older adults is an important but underexplored area. By leveraging policy strategies to promote the incorporation of age-friendly care within the addiction space, clinicians and policymakers can promote access and bolster the quality of addiction care across the continuum.