Innovation in Aging最新文献

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.

Background and objectives: Climate change has a substantial impact on the environment, biodiversity, and human health and well-being. Individuals in the global South are particularly vulnerable to the negative effects of the changing climate, which often trigger relocation in search of better living conditions. This study relied on a phenomenological approach to understand the decision of older Nepalese to stay in place despite increasing climate threats.

Research design and methods: Five focus group discussions with 54 Nepalese over the age of 60 (mean age 69.33 years) were analyzed using thematic analysis. All participants self-identified as non-migrants and reported experiencing severe climate change impacts.

Results: Findings reveal a predominant sense of helplessness rooted in four themes: financial incapacity, perceived age-related limitations, dependency on government support, and a bleak outlook on environmental improvements. Participants expressed that poverty restricts mobility, while advanced age and place attachment reinforce their decision to remain in place. A shared belief that government intervention is inadequate further diminishes agency. Pervasive hopelessness emerged as a core barrier to migration, with many accepting their fate as unchangeable.

Discussion and implications: The study underscores how socio-economic vulnerabilities and institutional failings contribute to older persons' inability to adapt or relocate amidst climate change. However, the findings also highlight the important role of subjective perceptions in determining one's decision to remain in place. Addressing these barriers requires integrated policy interventions that enhance livelihood resources, strengthen institutional support, and recognize the agency of vulnerable populations to foster resilience in climate-affected communities.

Background and objectives: This study sought to estimate trajectories of psychological resilience and physical functioning in adults aging with disability, to examine the alignment of those trajectories, and to explore determinants of trajectory membership over a 7-year span.

Research design and methods: Data were drawn from a longitudinal survey of 772 adults diagnosed with multiple sclerosis, muscular dystrophy, post-polio syndrome, or spinal cord injury, diagnosed before age 55 and with at least 10 years since diagnosis. Resilience and physical functioning were measured using the Connor-Davidson Resilience Scale and the PROMIS Physical Function Scale. Growth mixture modeling, contingency analysis, and multinomial logistic regression were performed.

Results: Participants averaged 55.9 years of age (SD = 10.4) and were 20.9 years since diagnosis. Four distinct trajectories emerged for both resilience (i.e., high-improving, mid-improving, low-stable, very low-stable) and physical functioning (i.e., high-stable, mid-stable, low-stable, very low-declining). Favorable resilience classes were associated with better physical function trajectories, while no individuals with high-improving resilience were classified in the very low-declining physical function class. Approximately one-third of participants concurrently exhibited low resilience and suboptimal physical functioning. Psychological factors predicted resilience trajectories, whereas health-related factors predicted physical functioning trajectories. Self-efficacy was the only determinant significantly associated with both trajectories.

Discussion and implications: Resilience and physical functioning trajectories exhibited significant concordance, suggesting a complex interdependence rather than isolated change processes. The interdependence of these trajectories supports tailored rehabilitation interventions that simultaneously target psychological factors (resilience and self-efficacy) as well as physical function in order to promote successful aging among individuals with compounded age- and disability-related vulnerabilities.

Background and objectives: Technology adoption occurs slower for older adults than other age groups. This consequently reduces opportunities for older adults to stay socially engaged and connected to community resources. Cyber-Seniors (CS) is an intergenerational technology program developed to increase older adults' digital adoption and competence through reverse mentoring provided by trained students. High school students frequently participate, but higher education is an opportune setting in which mutual benefits can be experienced, including greater positive attitudes toward aging. Despite CS's successes, research has yet to systematically assess its implementation within higher education. The objective of this study was to explore the determinants of sustainability associated with instructors' implementation of the CS program in higher education.

Research design and methods: This article presents results from the first step of a multi-stage qualitative research study. Semi-structured interviews guided by the Dynamic Sustainability Framework were conducted between April and October 2023. Partnered colleges (n = 10) and key CS representatives (n = 2) were interviewed over Zoom. Two coders analyzed the data using directed qualitative content analysis in Atlas.ti.

Results: Three themes characterized higher education and CS representative experiences implementing CS: adapting the intervention for higher education, navigating the role of resources, and negotiating external factors within higher education and communities. CS implementation was uniquely challenged due to restrictions related to the COVID-19 pandemic.

Discussion and implications: This is the first study to apply an implementation science framework to evaluate CS implementation within higher education. Individual programs are tailored to fit their specific practice setting, and several implementation barriers challenge the sustainability of programming. Results suggest that program delivery could benefit from a developed checklist of practices to improve CS implementation within higher education.