Innovation in Aging最新文献

Background and objectives: Contemporary Chinese drug governance is shifting its focus toward the rehabilitation of people who use drugs, prioritizing restorative over punitive measures. Moving beyond previous research that has primarily focused on the importance of community-based rehabilitation mechanisms in facilitating social reintegration, this study aimed to understand aging heroin users' experiences within broader systems of power, citizenship, and social exclusion in China.

Research design and methods: We conducted fieldwork in a city in the eastern region in China in 2020-2021 and interviewed 12 heroin users aged 65-75 years. We employed Atkinson's life story interview as an approach to collect data and Abbott's group life course to examine how aging heroin users, both as individuals and as a cohort with distinct drug experiences and aging traits, narrate their interactions within the national rehabilitation programs.

Results: Our findings contend that older heroin users, even after testing positive, receive lenient institutional treatment, often exempting them from compulsory rehabilitation due to age-related health issues and care burdens. To mitigate the risk of overdose, drug enforcement authorities utilize social welfare programs as a means of promoting self-management among aging users. However, this approach neglects the general well-being needs of the older population. Moreover, drug social workers often overlook aging users as clients for their casework because of performance and tangling professional ethics. The systematic neglect thus formed, and it provokes reflection on the position of aging users and how they seek to be citizens but are excluded by the "violence of citizenship."

Discussion and implications: We found the systematic neglect experienced by aging heroin users through the judicial process, welfare programs, and service practices. This structural disadvantage, more important than their needs, underscores the urgent value of addressing the social issues surrounding their marginalized position in society.

Background and objectives: Usual source of care (USC) is a key aspect of primary care that can significantly enhance health literacy by facilitating regular health education, consistent communication with health professionals, and access to health resources. This study aims to investigate the relationship between the utilization of USC and health literacy among older adults with hypertension.

Research design and methods: This study is a cross-sectional analysis utilizing data from the Korean Health Panel from 2020 to 2021, based on Andersen's Behavioral Model of Health Services Use. The study included 1,986 older adults with hypertension (n = 821 men and 1,165 women). We employed multinomial logistic regression analysis to assess the association between USC utilization and health literacy, as well as the association between different types of USC health care settings and health literacy. Additionally, logistic regression was used to investigate the association between USC utilization and each domain of health literacy.

Results: Among older adults with hypertension, those who do not utilize USC are significantly more likely to have inadequate health literacy compared to those who do (odds ratio [OR] = 2.58, 95% confidence interval [CI] 1.81, 3.68). This association remains consistent across all five items within the disease prevention domain. Additionally, among older adults with hypertension who utilize USC, those who visit physicians' offices are more likely to have sufficient health literacy (OR = 1.42, 95% CI = 1.01, 1.99).

Discussion and implications: This study demonstrates a positive association between the utilization of a USC and health literacy among older adults with hypertension, highlighting the former's potential as an effective tool for managing hypertension. Furthermore, it suggests that future interventions should adopt tailored strategies suited to various health care settings to optimize health literacy and effectively support hypertension management.

Background and objectives: Although a large proportion of centenarians depend on assistance, many still live at home, independently or with a little formal long-term care. It is of interest to explore this group further and compare them to dependent centenarians.

Research design and methods: This register-based cohort included the entire Swedish centenarian population between 2020 and 2022. Centenarians were classified into two groups: those independent of formal long-term care and those dependent on such care. Disease trajectories were observed in historical data from age 67 and onwards and described for myocardial infarction, stroke, hip fracture, dementia, diabetes, and different cancer diagnoses, as well as hospitalizations and the number of prescribed drugs.

Results: Of the 4,277 centenarians, 36% were independent. Compared with dependent centenarians, independent centenarians had lower incidences of stroke and dementia after age 85 and a lower incidence of hip fracture from age 75. They were less often hospitalized and had lower levels of polypharmacy. In regression analysis, women, stroke, hip fracture, dementia, and more prescribed drugs were associated with an increased risk of being dependent at age 100, while being married was associated with a reduced risk.

Discussion and implications: The health differences between independent and dependent centenarians appeared mainly after life expectancy was exceeded. After this age, differences in incidences of hip fracture, stroke, and dementia became apparent between the groups. This finding underscores that these diseases affect care needs in very old age and that avoiding them is linked to a more independent life as a centenarian.

Background and objectives: The complex interplay between diet, gut microbiota, and metabolic health has gained increasing recognition as a key factor in the development of obesity and related conditions, such as sarcopenia. This study examines the relationship between the dietary index for gut microbiota (DI-GM) and sarcopenia, while exploring the potential mediating role of the body roundness index (BRI) in this association. By integrating these factors, our findings aim to shed light on the diet-gut microbiota-sarcopenia interaction and its implications for personalized dietary interventions.

Research design and methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Multivariable weighted regression analyses were conducted to assess the association between DI-GM and sarcopenia. Restricted cubic spline analyses were used to evaluate potential non-linear relationships. Additionally, mediation analysis was performed to determine whether the BRI mediated the relationship between DI-GM and sarcopenia.

Results: A total of 10,190 participants were included in the study, of whom 7.57% were diagnosed with sarcopenia. In the weighted linear regression analysis, each one-point increase in DI-GM was associated with a 12% reduction in the prevalence of sarcopenia (OR = 0.88, 95% CI: 0.82, 0.95). Specifically, a higher beneficial gut microbiota score was significantly associated with a lower prevalence of sarcopenia (OR = 0.82, 95% CI: 0.75, 0.89). Mediation analysis revealed that BRI accounted for 23% of the total effect of DI-GM on sarcopenia. Among the beneficial components, those with a significant mediation effect contributed approximately 9% of the total effect.

Discussion and implications: The DI-GM was found to be negatively associated with the prevalence of sarcopenia, with BRI playing a crucial mediating role. These findings highlight the importance of the diet-gut microbiota-sarcopenia interaction and underscore the potential for incorporating dietary and microbiota-targeted interventions in personalized therapeutic strategies for sarcopenia.

Background and objectives: Increased referrals to skilled nursing facilities (SNFs) from hospitalized people with opioid use disorder (OUD) carry risk for financial, safety, and legal consequences for poor transitions in care. We aimed to better understand the hospital to SNF referral process and identify opportunities to improve transitions and care for people with OUD, an increasing share of whom are older adults.

Research design and methods: Participants included administrative, executive leadership, and clinical staff involved in SNF admission decisions across the United States. To identify key themes, descriptive thematic analysis was used to analyze semi-structured interview data collected between March and October 2023.

Results: There were 29 participants from 27 SNFs in 19 states. We identified five themes. (1) Large variation in facility experience, stigma, and readiness to care for people with OUD: resources and willingness to care for people with OUD in SNFs varied with stigma, further impeding SNF access. (2) Conflation of OUD with pain management: participants struggled to distinguish between opioids for pain, OUD, and physiologic dependence, highlighting knowledge deficits about OUD. (3) Navigating information transfer: SNF staff screen referrals for challenges that could negatively impact patient care and perceive hospitals to sometimes omit important details to secure SNF placement. (4) Siloed regulations and care landscapes: regulatory structures complicated admissions and limited access to medications for OUD. (5) Building trust and managing expectations during transition: the hospital-to-SNF transition represents a crucial period for developing trust between people with OUD and SNF staff.

Discussion and implications: Education about OUD and stigma, enhanced information transfer and care coordination, and regulatory reforms to expand access to medications for OUD in SNFs are needed to improve transitions and care for people with OUD in SNFs. Since SNF transitions increase with aging, these findings can inform efforts to address OUD in older adults.

Background and objectives: Early detection of mild cognitive impairment (MCI) is vital for managing cognitive decline in older adults. Hand movements are closely linked to cognitive function, prompting this study to develop a virtual reality (VR)-based wearable system to capture detailed hand movements. The main goal was to assess the system's potential in predicting cognitive health and aiding MCI diagnosis.

Research design and methods: The study involved 607 participants aged 60-84 (mean age 67.41 ± 4.71 years). Each completed four VR tasks while wearing the system, which recorded fine hand movement data. Cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ). Statistical analyses were conducted to correlate hand movement metrics with cognitive performance.

Results: Participants with cognitive impairments performed worse on VR-based fine motor tasks. Metrics from tests like the Pegboard, Block Placement-Flipping, and Tapping Tests were predictive of cognitive abilities. Indicators related to finer movements and non-dominant (left) hand use showed superior predictive power, achieving an AUC of 0.687 for predicting MCI, comparable to machine learning models such as Random Forest (0.762) and SVM (0.644).

Discussion and implications: Hand movement data can provide valuable insights into cognitive function in older adults, highlighting the importance of fine motor skills in early MCI detection. This VR-based system could serve as a useful clinical tool for assessing cognitive health and supporting MCI diagnosis, enabling timely intervention strategies for cognitive decline.

Background and objectives: Previous research on the effects of age at marriage in low- and middle-income countries has predominantly examined the influence of child marriage on women's reproductive, sexual, and mental health outcomes. However, this research has focused on younger populations and has not examined how age at marriage may affect health in later life. We posit that the experience of adversities associated with child marriage has an enduring influence on cognitive and psychological health in later life. In addition, we investigate whether getting married in India at age 21, the current legal age at marriage for men, is associated with better health outcomes for both men and women.

Research design and methods: We analyze data from the second wave of the World Health Organization's Study on Global Ageing and Adult Health (2015) and use regression analysis to examine the relationship between marriage at or before 18 years and marriage at or after 21 years, and depressive symptoms and cognitive scores of men and women over the age of 50. We also conduct inverse probability weighted regression adjustment analysis to account for selection into the age at marriage.

Results: Our findings show that child marriage is associated with a higher probability of depressive symptoms and lower cognitive scores only among women. Men are not disadvantaged when married as children. Conversely, getting married at or after age 21 is linked to health benefits for both men and women.

Discussion and implications: This is the first study to document the adverse role of child marriage on later-life health among women. These findings indicate that healthcare systems should remain attentive to and address the ongoing health concerns of women who were married as children, even as they age.

Background and objectives: Research has established that unpaid family members, friends, or others who care for persons with dementia (ie, caregivers) may encounter socioemotional and physical health concerns as a consequence of providing extensive assistance. Similarly, caregivers for people living with traumatic brain injury (TBI) often experience a range of stressors and negative mental health outcomes due to care demands. Individuals with TBI often develop Alzheimer's disease and Alzheimer's disease-related dementia (AD/ADRD). This history of TBI may introduce complications to AD/ADRD caregiving. A comprehensive intervention grounded in the understanding of the complex caregiving context of both diagnoses is warranted to address the unique needs and concerns of TBI-AD/ADRD caregivers.

Research design and methods: This study evaluated the feasibility of the TBI-AD/ADRD Caregiver Support Intervention (TACSI) psychoeducational program, designed to support the unique subset of caregivers facing the challenge of assisting relatives with AD/ADRD and a history of TBI. TACSI, a 6-session telehealth intervention, provides tailored psychosocial and psychoeducational coaching. In partnership with the 2 national healthcare centers, 15 caregivers enrolled in the 3-month feasibility study evaluating the design and subsequent refinement of TACSI. Mixed methods data were collected from 3-month follow-up surveys and qualitative data from postintervention interviews.

Results: The feasibility, utility, and acceptance of TACSI were established. Caregivers liked the telehealth delivery and the personalized nature of TACSI, yet some expressed it would have been more beneficial earlier in their caregiving journey.

Discussion and implications: Caregivers valued the TACSI program. Their feedback has been applied to improve TACSI content and delivery for a larger pilot randomized controlled trial that is currently underway.

Background and objectives: The older Chinese American population is growing rapidly in the United States, but they have limited access to culturally responsive dementia prevention services. Cognitive training has benefits for cognitive health, yet these interventions have not been tailored to older Chinese Americans. To inform the codesign of a culturally relevant, mobile-based cognitive training, this study explored perspectives of older Chinese Americans and their adult children on dementia prevention and cognitive training.

Research design and methods: We conducted 4 focus groups with older Chinese Americans (n = 21) and 2 focus groups with adult children (n = 9) in Mandarin over Zoom,and applied rapid qualitative analysis using the Health Belief Model.

Results: Five themes emerged. Both older adults and adult children had partial knowledge of dementia and were able to list learning new things and social activities as cognitively stimulating activities. Both groups expressed strong interest in cognitive training, but were also concerned about transportation and language barriers. Both groups viewed promoting cognition as an advantage, and eyestrain and dementia-related stigma as disadvantages of mobile-based cognitive training. Adult children were eager to support their older parents, whereas older adults preferred to participate in training independently. Facilitators to participation included recommendations from healthcare professionals and having a peer support community.

Discussion and implications: The study provides new information on the perspectives of older Chinese Americans and adult children on cognitive training as an underpinning for codeveloping a culturally relevant, mobile-based cognitive training to promote cognitive health among this population.