Innovation in Aging最新文献

Background and objectives: Narrative care, an essential component of person-centered care (PCC), individualized care that respects unique life stories and preferences, uses personal narratives to foster understanding, trust, and emotional well-being. Digital storytelling has emerged as a valuable tool to collect and preserve these narratives. This scoping review explored digital tools used to capture life stories of older adults, summarizing their benefits, limitations, and implications for PCC.

Research design and methods: Studies addressing digital storytelling, life review, or life story work with older adults, published in English or Spanish, and reporting cognitive, psychological, social, or care-related outcomes were included. A systematic search was conducted in Web of Science, SCOPUS, PubMed, and PsycInfo in December 2024, identifying 615 records. After screening and full-text review, 21 studies were included. Data were extracted on study design, sample characteristics, digital tools, outcomes, and limitations. Digital resources were classified into short or long videos, digital albums/collages, digital books/stories, and other formats.

Results: The review encompassed 1,551 participants (age _M = 75.86 years). Digital storytelling improved emotional well-being, preserved personal identity, fostered social connections, and stimulated cognitive functions. Short formats proved particularly suitable when cognitive or digital literacy limitations were present, whereas longer formats supported in-depth reflection and memory preservation. Albums and digital books enhanced intergenerational communication. Key limitations included technological barriers, varying digital literacy levels, and lack of methodological standardization.

Discussion and implications: Digital storytelling enhances PCC by embedding personal narratives into care, but successful implementation requires addressing digital inequalities and standardizing methodologies through interdisciplinary collaboration.

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.

Background and objectives: Social isolation and loneliness are significant public health concerns associated with increased healthcare utilization among older adults. This review aims to synthesize evidence on the associations between social isolation, loneliness, and healthcare utilization.

Research design and methods: Five databases were searched from inception to March 21, 2025, using keyword groups related to social isolation/loneliness, older adults, and healthcare utilization (primary care, emergency visits, inpatient care, and outpatient care). Methodological quality was assessed using the Newcastle-Ottawa Scale. Random-effects models were employed to pool effect sizes (incidence rate ratios [IRRs], odds ratios [ORs]).

Results: A total of 44 studies were included in the systematic review, and 34 were included in the meta-analysis (N = 309,023). Due to insufficient data, meta-analyses for the association between social isolation and primary care or outpatient care utilization were not conducted. Social isolation was statistically associated with increased inpatient care utilization (IRRs = 1.37, 95% CI: 1.24-1.53) but not with emergency department visits. For loneliness, meta-analyses for outpatient care were not feasible due to limited studies. Loneliness was statistically associated with increased emergency department visits (IRRs = 1.15, 95% CI: 1.06-1.24) and inpatient care utilization (OR = 1.13, 95% CI: 1.07-1.20) but not with primary care use.

Discussion and implications: This is the first meta-analysis to comprehensively synthesize the associations between social isolation, loneliness, and 4 types of healthcare utilization among older adults. The findings highlight the importance of addressing social isolation and loneliness as potential strategies to reduce avoidable healthcare utilization.

Background and objectives: While early detection of Alzheimer's disease and related dementias (ADRD) can help delay progression and improve outcomes, limited research is available on dementia-related health behavior, such as screening intention among American Indian/Alaska Native communities. Guided by the Theory of Reasoned Action, the Theory of Planned Behavior, and the Health Belief Model, this study examines whether self-efficacy mediates the association between dementia knowledge and intention to seek ADRD screening among American Indian adults.

Research design and methods: Using a community-based participatory research approach, a cross-sectional survey was conducted with 248 American Indian adults (18 years and over) from a partner tribal community in the Northern Plains region in 2024. Measures included dementia knowledge, self-efficacy, screening intention, perceived susceptibility, stigma, and demographic factors. Mediation was tested using the Baron and Kenny framework and Sobel-Goodman tests.

Results: Dementia knowledge significantly predicted both ADRD screening intention and self-efficacy. Self-efficacy also significantly predicted screening intention and partially mediated the relationship between knowledge and intention. Approximately 32% of the effect of dementia knowledge on screening intention was mediated by self-efficacy.

Discussion and implications: Findings underscore self-efficacy as a critical mechanism through which dementia knowledge translates into ADRD screening intention in American Indian communities. Interventions to promote early ADRD detection could enhance both knowledge and individual confidence. Future research should include more diverse groups within American Indian communities to identify common and unique dynamics among knowledge, self-efficacy, and screening intention, informing effective intervention strategies to reduce stigma and confidence in seeking timely ADRD screening.

Background and objectives: Categorizing older adults by their medication and deprescribing beliefs may support tailored communication and shared decision-making. We aimed to identify latent classes of patients using the Patient Deprescribing Typology.

Research design and methods: This cross-sectional study used survey responses from 1,131 primary care patients (≥65 years, ≥5 medications) in 14 countries between May 2022 and December 2023. A latent class analysis was conducted using the 4-item Patient Deprescribing Typology, which captures older adults' views on medication importance, learning styles, decision-making preferences, and attitudes toward stopping medications. A multinomial logit model was used to compare the latent classes.

Results: Among the 1,131 participants, 55.2% (n = 624) were female, and on average, participants were taking 7 regular medications (SD = 2.3). Three latent classes were identified: (1) Would consider deprescribing (n = 760, 67.2%), (2) Attached to medications (n = 249, 22.0%), and (3) Defers decision-making to others (n = 122, 10.8%). Compared with participants who Would consider deprescribing, those Attached to medications were significantly less likely to want to deprescribe one of their specific medications (odds ratio [OR] = 0.04, 95% CI: 0.02-0.09, p < .001). Participants who Defer decision-making to others reported lower trust in their GP (OR = 0.47, 95% CI: 0.32-0.67).

Discussion and implications: While most participants expressed openness to deprescribing, their preferences for information sources, perceived medication importance, and decision-making roles varied. Our findings highlight the need to account for patient differences in deprescribing attitudes. Typologies offer a practical basis for personalized communication and patient-centered interventions.

Background and objectives: Being homebound with cognitive impairment (CI) presents major public health challenges, increasing home healthcare costs and contributing to caregiver burden, social isolation, and reduced quality of life. As loneliness and social isolation rise among this population, socially focused intelligent assistive technologies (SFIATs) have emerged as increasingly viable solutions. This scoping review examined the current body of literature on SFIATs and the barriers and facilitators to their support of homebound older adults with CI and their caregivers.

Research design and methods: Using Arksey and O'Malley's framework, we searched 12 databases with MeSH terms related to older adults, CI, SFIATs, and homebound status. Data were analyzed descriptively using themes, with findings mapped across the socioecological framework.

Results: Nineteen studies conducted in 12 high-income countries were included. Robots, tablets, telephones, computers, virtual avenues, and other smart devices were among the SFIATs utilized in caregiving for older individuals who were homebound or had CI. SFIATs facilitated social interaction, engagement, and connectedness among older adults and caregivers. Challenges and benefits associated with their use were evident at individual, interpersonal, community, organizational, and policy levels.

Discussion and implications: Research suggests significant potential in SFIATs, but their implementation faces multi-level challenges, often due to limited direct input from end-users, leading to concerns that impact their utilization. SFIAT development must adopt co-creation approaches to ensure its contextual appropriateness. Further research is needed, particularly in low- and middle-income countries, to understand the landscape, benefits, and challenges of SFIATs in diverse global settings.

Background and objectives: Subjective cognitive decline (SCD) is a preclinical stage of mild cognitive impairment (MCI). Although dance training has been shown to be beneficial for mental health, cognitive function, and neural activity in older adults with MCI, its effect on SCD remains unclear. This study aimed to examine the effects of dance training on the aforementioned factors and on oxytocin secretion in older adults with SCD.

Research design and methods: Participants (aged 65-84 years) were assigned to either the intervention group (n = 22) with a 12-week dance training program or the control group without any alternative training (n = 22). Apathy, depression, Montreal Cognitive Assessment scores, urinary oxytocin levels, and resting-state functional magnetic resonance imaging indices, including amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC), were evaluated pre- and post-intervention.

Results: Compared to the control group, the intervention group exhibited significantly higher urinary oxytocin levels and significantly higher ALFF in the left medial orbitofrontal cortex post-intervention. Moreover, the intervention group showed more enhanced FC between the left medial orbitofrontal cortex and the left precuneus post-intervention than the control group. However, mental health or cognitive performance was not significantly different between the groups.

Discussion and implications: Our results are particularly important in light of previous findings that older adults with SCD show a reduced FC between the medial orbitofrontal cortex and the precuneus, and that oxytocin levels are positively associated with the prefrontal-amygdala oxytocinergic circuit in socioemotional processing. Thus, dance training may contribute to socioemotional resilience-related neural and molecular adaptations in SCD.

Background and objectives: Transportation is crucial to maintaining social engagement in later life. Lack of transportation is significantly associated with depressive/anxiety symptoms in older adults. In this study, we examined the extent to which loneliness mediates the relationship between transportation barriers and depressive/anxiety symptoms.

Research design and methods: Using the 2023 National Health and Aging Trends Study (N = 7,547; age 65+), we defined transportation barriers as transportation problems that kept older adults from visiting family/friends, attending religious services, attending club meetings, or going out for enjoyment. We fitted a path model, and to test the mediation effect, we used bootstrapped analysis to obtain estimates of the indirect effects and their 95% confidence intervals (CIs).

Results: Of the study population, 4.4%, or 2 million people, reported transportation barriers. We found significant direct effects of transportation barriers on loneliness and depressive/anxiety symptoms and indirect effects of loneliness (0.40, 95% CIs = [0.23, 0.57], z = 4.57, p < .001) on depressive/anxiety symptoms. The ratio of the indirect effect to the total effect of transportation barriers on depressive/anxiety symptoms (indirect effect [0.40] + direct effect [0.50] = 0.90) was 0.44. The ratio of the indirect effect of loneliness to the direct effect of transportation barriers on depressive/anxiety symptoms was 0.80.

Discussion and implications: Loneliness significantly mediates the association between transportation barriers and depression/anxiety in older adults. Transportation should be recognized as both a mobility and a mental health issue. Policies to enable older adults to continue social engagement, decrease loneliness, and alleviate depression/anxiety are needed.