Innovation in Aging最新文献

Background and objectives: Previous research has highlighted the connections between individuals' exposure to green spaces and various health outcomes. However, the unique post-retirement context of older adults, characterized by changes in activity patterns and mobility, has not been thoroughly examined on a global scale. This scoping review aims to map the evidence on how different representations and metrics of green spaces relate to diverse health outcomes among older adults and to identify the key factors that differentiate these relationships.

Research design and methods: Following Arksey and O'Malley 5-stage framework, a systematic search was conducted in 4 major databases: Web of Science, PubMed, Scopus, and EBSCO. Articles were included if they focused on green space exposures and older adults' health outcomes.

Results: A total of 40 studies, primarily cross-sectional and conducted in different countries, were included. These studies spanned a wide range of green space metrics and health outcomes. Overall, they consistently found that exposure to green spaces correlates with improved perceived physical and mental health among older adults, while these relationships vary due to the influence of confounders, moderators, and medicators.

Discussion and implications: The findings suggest a positive association between green space exposure and health among older adults, though the cross-sectional nature of most included studies limits the ability to establish causality. This review also outlines potential pathways linking green spaces to health benefits, providing a comprehensive framework for future investigations. These insights can guide further research, particularly longitudinal or intervention-based studies, to deepen our understanding of how green spaces can promote healthy aging.

Background and objectives: We previously demonstrated that a telehealth-supported community health worker (CHW) intervention significantly improved clinical outcomes in diabetes care. However, the extent to which these benefits vary across different age groups remains unclear. This study evaluated the effectiveness of a CHW-led multidimensional diabetes intervention in reducing HbA1c across age groups.

Research design and methods: We conducted a retrospective analysis of 10 studies (n = 301) that focused on low-income Hispanic adults with or at risk for type 2 diabetes. The intervention included CHW-participant coaching via mobile Health (mHealth), monthly CHW-led group education, and bidirectional mHealth feedback among participants, CHWs, and clinicians. Outcomes included HbA1c changes from baseline to 6 months and an analysis of CHW-participant conversation data.

Results: HbA1c levels improved across all age groups from baseline to 6 months, with statistically significant reductions observed in individuals aged 40-66 years (p < .05). As age increased from 40 to 49 years (n = 78), HbA1c reductions ranged from -0.83% to -1.18% (p = .013 to p < .001). By age 50-65 years (n = 182), the trend reversed, with smaller improvements observed as age increased (-1.16% to -0.61%, p < .001 to p = .016). Beyond 65 years (n = 27), HbA1c changes plateaued and were not statistically significant. Medication-related concerns were more prevalent among adults ≥65 years (73.7%) compared to those <65 years (44.1%) (p = .014).

Discussion and implications: HbA1c improved across all ages except in older adults, suggesting that age may play a role in intervention effectiveness. Targeted strategies and further research are needed to understand and address these age-related differences.

Background and objectives: Prospective memory (PM), the ability to remember to execute an intention in the future, is critical for performing everyday tasks contributing to health, financial, and social outcomes. PM declines with greater age and in the presence of a cognitive impairment. Toward the goal of developing technology-based support for older adults experiencing cognitive challenges, this study aimed to assess the attitudes of older adults with subjective cognitive complaints (SCCs) toward technology to support PM and their preferences regarding device type and the type of activity being supported.

Research design and methods: In an online survey, 188 older adults with SCCs and 190 older adults without SCCs indicated their attitudes toward 3 technologies to support PM (mobile apps, smartwatches, voice-activated assistants) and toward 6 PM-related activity areas (relationships and social activities, healthcare activities, transportation, shopping, housework and laundry, managing finances).

Results discussion and implications: Results showed that attitudes toward technology to support PM among older adults with SCCs were relatively positive overall and (1) differed based on the type of device and the type of activity the technology is meant to support, (2) were more positive than attitudes of older adults without SCCs, and (3) were associated with individual difference factors such as general attitudes toward technology, technology proficiency, frequency of memory failures, health, and age. Results indicate older adults with SCCs might prefer using mobile apps relative to other devices and technology to support healthcare relative to supporting other activities. Further, older adults with SCCs showed privacy concerns for voice-activated assistants and technology to manage finances. Older adults with SCCs are a promising population to target using technology-based solutions, and the type of device and type of activity being supported are important to consider while developing technology solutions to enhance independence and well-being.

Background and objectives: Home and community-based services (HCBS) intend to allow individuals to age in their home or a home-like environment. The relationship between receiving specific types of HCBS and person-reported HCBS quality remains unclear.

Research design and methods: We linked data on HCBS quality from 1413 respondents of the 2018 Minnesota National Core Indicators-Aging and Disability survey with claims from the Minnesota Department of Human Services Medicaid Management Information System. Among this sample of HCBS users, we used linear regression to evaluate the association between using specific types of HCBS (home health services; non-medical transportation; personal care assistant services; case management; adult day care; durable medical equipment/home modifications; and homemaker services and person-centered HCBS quality). Our regression models included an interaction between HCBS utilization and whether a respondent had a diagnosis of dementia. We stratified analyses between people living in the community and assisted living.

Results: Using personal care assistant services was associated with significantly higher-quality scores among community-dwelling HCBS users. Using home health care, durable medical equipment/home modifications, non-medical transportation, homemaker services, and adult day care were not significantly associated with quality scores among HCBS users. On average, HCBS users with dementia reported lower quality scores than their counterparts without dementia. Among assisted living residents, quality was lower for people with dementia who did not use non-medical transportation or case management; however, this difference was not significant among users of these services. In the assisted living sample, analyses of quality subdomains found significant associations with service use that were not present when evaluating overall quality scores.

Discussion and implications: Personal care assistant services may be associated with higher quality among people in the community because this service supports activity of daily living and provides social interaction.

Background and objectives: Engaging long-term care residents and families in decisions and as active partners in care can improve the quality of care. However, barriers to effective communication among the care team, residents, and families remain. This study aimed to assess the feasibility, acceptability, and satisfaction with an intervention to engage residents, their family, and team members in a collaborative approach to care planning to support person- and relationship-centered care.

Research design and methods: A multi-method approach was utilized. The intervention included: leadership coaching sessions; an education session with team members and leaders for communication skills training; and resident- and family-led care planning conversations (huddles) that included huddle training.

Results: The intervention was found to be feasible to implement and was acceptable to participants. The leadership coaching sessions and the huddles could be feasibly conducted in-person or virtually. Participants were satisfied with the leadership coaching and the huddles, and the communication tool was found to be useful. Suggestions were made to further innovate huddles.

Discussion and implications: Huddles provided a structured approach and relational process that facilitated communication among team members, residents, and families. The communication tool provided a common language for discussing resident care. The leadership coaching sessions and huddles were feasible to implement and can be adapted for virtual delivery. Huddles are a promising practice for engaging residents and families in care planning, but further testing is needed.

Clinical trial registration: NCT04026698.

Background and objectives: In 2021, the National Council on Aging developed the Self-Management Curriculum for Wellness and Pain Relief (NCWPR), a peer-based pain self-management program that provides person-centered pain management strategies, credible information on pain management methods and medications, and safe practices for the use of OTC drugs. This study describes a larger-scale, controlled intervention study of the NCWPR implemented to demonstrate its efficacy and readiness for more rigorous translation studies of the NCWPR's impact on participants.

Research design and methods: This intervention efficacy study enrolled 90 adults (50 years and older) in a pre-/post-intervention design with a baseline control. Eight cohorts took the workshop series and were surveyed pre-study, 6 weeks post-control, on completing the curriculum, and 6 weeks later.

Results: Of 34 practices, therapies, or activities in the curriculum, participants showed robust, statistically significant increases in engagement and uptake on 23 following the curriculum, which was largely retained in the follow-up survey 6 weeks later. Participants showed statistically significant increases in knowledge around medications and sources of information about pain management, improved self-reported health, and a diminished experience of pain in daily life.

Discussion and implications: The NCPWR fills an important gap for community-dwelling older adults who are living with pain but still able to engage in exercises at home as well as other professional therapies available in behavioral, traditional, or alternative medical care. It is accessible, peer-based, non-clinical, and able to be provided with minimal training to trainers.

Background and objectives: Although considerable evidence shows that various neighborhood characteristics are related to cognitive function, we propose the concept of cognitive capital as a theoretically informed and parsimonious way to guide research on how neighborhood contextual factors may influence cognitive function in later life.

Research design and methods: Data in 2010 from the National Neighborhood Data Archive were linked to data from the Health and Retirement Study (2010-2018). Cognitive function was measured with a modified version of the Telephone Interview for Cognitive Status. Using a latent variable modeling approach, cognitive capital was measured with eight indicators of neighborhood context based on census tracts (e.g., museums, fitness centers).

Results: Trajectory analyses revealed that adults between ages 60 and 82 residing in areas with greater cognitive capital manifested higher baseline cognitive function and later onset of cognitive decline compared to those with low cognitive capital.

Discussion and implications: Cognitive capital is a useful conceptual framework for (a) studying the relationship between neighborhood characteristics and trajectories of cognitive function and (b) designing effective interventions to preserve cognitive function during later life.

Background and objectives: Caregiving for people with dementia is especially challenging in rural areas of the United States, where services and support are often limited. This study explores how contextual factors-environmental conditions, resource availability, and family and social dynamics-intersect to shape experiences of rural family caregivers.

Research design and methods: This secondary analysis uses qualitative data from a nationwide randomized controlled trial of an online workshop for rural family caregivers. Semi-structured interviews with 55 participants explored how living in a rural, farming, or small town area influenced their caregiving experiences. Narrative analyses were conducted to identify themes.

Results: Three themes emerged: navigating rural tranquility and environmental challenges, caregiving in resource-limited settings, and variable support from family, friends, and neighbors. Caregivers described the dual impact of their environment-while rural tranquility and perceived safety were valued, they were offset by the need for constant vigilance and the physical demands of land maintenance when caring for a person with dementia. Caregivers also reported challenges accessing specialized care, citing limited availability and inadequate dementia-specific communication from providers that impeded access to information and resources. As a result, many managed care independently to fill critical gaps. While family support was essential for some, it was not always available. Despite familiar surroundings, many caregivers felt isolated, as friends or neighbors remained distant observers rather than hands-on helpers.

Discussion and implications: These findings highlight the complex realities of rural dementia caregiving, where environmental conditions, resource limitations, and social factors intersect to shape caregiver experiences. Aging in rural areas offers comfort but burdens caregivers significantly. Addressing gaps in service accessibility, improving provider communication, and strengthening informal support networks are critical steps toward reducing caregiver burden and enhancing well-being for caregivers and people with dementia.

Background and objectives: Person-centered communication is critical in dementia care, yet personal support workers (PSWs) often lack sufficient training, which can reduce care quality. Be EPIC is an in-person training that teaches learners to build person-centered communication skills using actor-based simulations. A virtual reality (VR) version of Be EPIC was developed to expand access and consistency. Two pre-implementation studies explored factors influencing Be EPIC-VR's implementation by assessing readiness for VR training among managers and realism and usability from PSWs' perspectives.

Research design and methods: Study 1 used the Consolidated Framework for Implementation Research (CFIR) to assess readiness for VR training through semi-structured interviews with managers of PSWs (n = 9) in long-term and home care settings. Interviews focused on CFIR's innovation, inner setting, and outer setting domains. Guided by Fox's taxonomy of VR research, Study 2 involved PSWs (n = 7) who completed a Be EPIC-VR simulation and were interviewed about its realism, usability compared to live actors, and implementation factors related to CFIR's innovation and inner setting domains.

Results: Study 1 identified 4 themes: external pressures for organizational sustainability, organizational culture supporting staff development, staffing and training logistics, and openness to VR for training. In Study 2, PSWs described VR simulations as immersive and realistic, though some reported limited mobility and headset incompatibility. While managers expressed concerns about the use of VR technology, PSWs noted that clear onboarding and facilitator guidance ensured accessibility. Both groups confirmed sufficient structural resources for implementation.

Discussion and implications: Successful implementation of VR-based training in dementia care depends on aligning implementation readiness, organizational culture, and logistical resources. Early end-user engagement and an iterative approach enabled continual refinement of Be EPIC-VR based on managers' openness to VR and PSWs' user experiences. The findings position VR training as a promising method to improve dementia care.

Background and objectives: Caregiver burden among spouse caregivers is associated with mental health burdens, including suicide. However, longitudinal studies on suicide risk among spouses of dementia patients are limited. This study aimed to investigate suicide risk among spouses of patients with dementia and to examine how sociodemographic factors and healthcare service utilization influence this risk.

Research design and methods: We conducted a population-based cohort study using the 2008-2021 National Health Insurance Research Database (28,696 dementia patient-spouse dyads and matched non-dementia patient-spouse dyads). Dementia and suicide behaviors were identified using diagnostic codes from the national registry. Incident rates of suicide among patients' spouses were calculated following the diagnosis of dementia. A Cox proportional hazards model assessed suicide risk among spouses of dementia patients relative to spouses of non-dementia patients, stratified by sociodemographic characteristics. We also examined the association between healthcare service utilization by patients with dementia and suicide behavior among their spouses.

Results: Overall suicide risk was similar between spouses of dementia patients and those of non-dementia patients. However, among those in the lowest insurance premium group, spouses of patients with dementia had a 3.2-fold higher (95% confidence interval [CI]: 1.3-8.0) risk of suicide compared to spouses of patients without dementia. The incidence rate ratio of suicide decreased following the diagnosis of dementia but rebounded 10 years after diagnosis. Healthcare utilization was higher among patients with dementia compared to those without dementia, and patient hospitalization was associated with a 2.6-fold increase (95% CI: 1.3-5.3) in suicide risk among their spouses.

Discussion and implications: The increased suicide risk among spouses of patients with dementia in the later stages of the disease may be related to the financial burden caused by healthcare service utilization. Affordable long-term care services for spouses of patients with dementia should be developed.