Innovation in Aging最新文献

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.

Background and objectives: Residents of subsidized senior housing (SSH) need housing-based interventions to address high rates of physical inactivity and social isolation that can lead to increased risks of physical and mental health impairments. Theatre experience training (TET) programs have been shown to improve cognitive function, emotional well-being, social connection, and health-related quality of life (HR-QoL) in this population. This study evaluated the effect of an innovative TET program involving the method of physical acting on objective measures of physical functioning and emotional stress.

Research design and methods: This single-blind trial randomized SSH residents from 5 SSH communities to a 10-week, twice-weekly TET program or a waitlist control arm, with randomization conducted separately in each SSH. Participants' static balance, functional mobility, lower body strength, HR-QoL, emotional stress as measured by hair cortisol levels, and fall incidents were assessed at baseline, postprogram, and 3-month follow-up.

Results: The study enrolled 81 participants; 53 were randomized to the TET arm and 28 to the waitlist arm. TET arm participants had improved static balance and reduced falls postprogram compared with control arm participants. Some carry-over effect was observed at the 3-month follow-up. No net benefit was observed for functional mobility, lower body strength, HR-QoL, or stress levels at the postprogram or 3-month follow-up assessments.

Discussion and implications: The TET program involving the method of physical acting can improve static balance and reduce fall incidents in SSH residents. Ongoing TET programs in SSH may help residents maintain reductions in fall incidents. Clinical Trial Registration Number: NCT04582370.

Background and objectives: eHealth can help individuals improve or maintain autonomy in health management and decision-making, but using eHealth requires adequate eHealth literacy. Older adults tend to have low rates of eHealth literacy, which are worse among older Latinos in the U.S., especially those who are Spanish speaking. Evidence-based eHealth literacy interventions for older adult Spanish speakers are needed, but it is not clear which strategies are effective for this population. The objective of the present study was to understand (a) what researchers who conduct eHealth interventions with eHealth literacy outcomes do to ensure inclusion of older adult Spanish-speaking Latinos and (b) whether it is effective.

Research design and methods: Six databases were searched for peer-reviewed studies on eHealth literacy interventions for U.S.-based older adult Latinos, from November 1, 2023, to January 31, 2024. Eligibility criteria for studies were: published in 2000 or later; intervention study with Spanish-speaking Latinos; participants aged ≥ 65 years; and eHealth literacy as an outcome. Excluded studies provided no details of adaptation/strategies to include Spanish speakers, used only phone calls or texts in the intervention, or were not peer-reviewed. Search terms included "Hispanic" OR "Latin*" AND "health literacy" OR "eHealth literacy" AND "Spanish" AND "mHealth*" OR "mobile health" OR "tech*" OR "eHealth" OR "digi*" AND "older adults" OR "seniors" OR "elderly" AND "intervention*."

Results: A total of 2,362 articles were identified; 1,084 were duplicates. Titles and abstracts of 1,278 articles were screened. Seventy articles went through full-text screening, and none met the inclusion criteria.

Discussion and implications: This result was unexpected, given that several reviews have identified the need to increase eHealth literacy among older adults and Spanish speakers. This empty review demonstrates an important gap in knowledge. Intervention researchers can pull insights from adjacent literature until more evidence becomes available for this specific issue and population.

Background and objectives: Although marital status influences cognitive health, limited research has examined the effects of diverse marital histories, particularly regarding remarriage. This study investigates the relationship between remarriage, marital histories, and cognitive impairment with a focus on gender differences. Building on the stress and marital resource models, we examine whether this relationship operates through economic and health-related factors.

Research design and methods: Using the Health and Retirement Study (2004-2020; N = 11,406), we constructed 8 mutually exclusive categories based on current marital status and previous transitions, including divorce, widowhood, and multiple disruptions. We fit discrete-time hazard models to assess cognitive impairment risk across these marital trajectories. The bootstrap resampling method was used to conduct a formal mediation test.

Results: Remarriage was associated with higher risks of cognitive impairment for women, but not for men, even after controlling for economic and health-related factors. Specifically, remarried women following widowhood or multiple disruptions had 39% and 32% higher risks of cognitive impairment, respectively, compared to continuously married women. The formal mediation test revealed that remarriage after multiple disruptions has adverse impacts on cognitive impairment, in part, through unhealthy behaviors and poor health status. However, when comparing remarried and unmarried groups, remarriage was associated with lower risks of cognitive impairment for men, whereas remarried women continued to show higher risks of cognitive impairment compared to their unmarried counterparts.

Discussion and implications: This study is among the first to examine gender differences in how lifetime marital histories affect cognitive impairment risk. Remarriage, particularly following widowhood or multiple disruptions may put women at higher risks of cognitive impairment compared to those in their first marriage or those who remain single. These findings underscore the importance of considering detailed marital histories, beyond simple married/unmarried classification, when evaluating the role of social conditions in shaping cognitive impairment risk in practice settings.

The management of pain in older adults has been profoundly shaped by shifting attitudes toward acute and chronic opioid therapy. Historically, opioids have been recognized as highly effective for acute and cancer-related pain, but their use in chronic non-cancer pain, especially among older adults, remains controversial due to concerns about addiction, safety, and efficacy. Over recent decades, increased opioid prescribing has coincided with a dramatic rise in opioid misuse, addiction, and overdose deaths, prompting renewed scrutiny of prescribing practices and regulatory responses. This article traces the historical "pendulum" of opioid policy and practice, examines the unique challenges faced by older adults-including heightened vulnerability to adverse effects and polypharmacy-and highlights the ongoing debate between ensuring adequate pain relief and minimizing harm. It also explores best practices and emerging approaches, such as patient-centered care and the integration of non-opioid therapies, and calls for a balanced, evidence-based framework that addresses both the legitimate needs of older adults in pain and the societal imperative to reduce opioid-related harms.

Background and objectives: Aging is associated with both gait impairments and cognitive decline; however, the relationship between specific gait variability parameters, gray matter volume (GMV), and cognitive function remains poorly understood. This study aims to examine the associations between gait variability parameters (derived from stride length, step length, step time, and gait velocity) and GMV and its associations with cognitive function in cognitively normal older adults.

Research design and methods: Eighty-seven older adults (48 female) aged 65-80 from the AGUEDA trial participated in this cross-sectional analysis. The Optogait system was used to record gait parameters. T1-weighted brain images were acquired magnetic resonance imaging scanner, and GMV was calculated by whole-brain voxel-based morphometric analysis using SPM12. Cognitive function was calculated from different cognitive tests.

Results: Greater stride length variability was associated with lower GMV (p < .001) in clusters located in the supramarginal gyrus (t = 4.014, k = 179, β = -0.494) and hippocampus (t = 3.670, k = 334, β = -0.394), whereas greater step length variability was linked to lower GMV in the parahippocampal gyrus (t = 3.624, k = 76, β = -0.410). However, greater step time variability was associated with greater GMV in the supplementary motor area (t = 4.117, k = 274, β = 0.449). Gait velocity variability did not show any association with GMV. Furthermore, greater GMV in the supramarginal gyrus was associated with better working memory (β = 0.252, p = .008); greater GMV in the hippocampus was associated with better attentional/inhibitory control (β = 0.275, p = .010); and greater GMV in the parahippocampal gyrus was associated with better EF (β = 0.212, p = .035), attentional/inhibitory control (β = 0.241, p = .019), and working memory (β = 0.233, p = .027).

Discussion and implications: These results suggest that gait variability could be an indicator of neurocognitive decline in older adults. Understanding these associations is essential for early dementia detection and sheds light on the complex interplay between physical function, brain health, and cognitive function during aging.

Background and objectives: American Indian and Alaska Native peoples have disproportionately low rates of advance care planning (ACP). To address this problem, we culturally tailored and evaluated an intervention for ACP to the needs of a specific American Indian Tribe. The goal of our study was to examine the culturally tailored Make Your Wishes About You (MY WAY) ACP intervention with respect to 5 ACP outcomes: barriers, facilitators, readiness, self-efficacy, and notarized advance care plan completion.

Research design and methods: We engaged Tribal community members in a quasi-experimental, waitlist-controlled trial design to test the effects of the program. Our sample included 2, self-selected groups totaling 113 participants. Data were collected via interviewer-administered surveys with participants on 3 occasions. The intervention group completed an intervention baseline survey, postprogram survey, and a follow-up survey 6 months after the intervention, and the waitlist comparison group completed a control baseline survey, intervention baseline survey, and postprogram survey.

Results: Our results showed that, on average, ACP barriers decreased, and facilitators, readiness, self-efficacy, and notarized advance care plan completion increased postintervention for participants who completed the ACP program. These changes were significantly greater for the intervention group than the waitlist comparison group and were sustained at the 6-month follow-up for the intervention group. In total, 76 more individuals completed their notarized advance care plans by the end of program participation than at intervention baseline, a 79.1% increase.

Discussion and implications: The culturally tailored program was found to increase readiness and self-efficacy for ACP and increased the likelihood of a participant having a notarized advance care plan postprogram. Our study affects clinical and public health practice by testing a program that is responsive to cultural values, beliefs, and practices and shown to increase ACP among American Indian peoples.

Clinical trial registration: NCT05304117.