Innovation in Aging最新文献

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.

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.