Innovation in Aging最新文献

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.

Background and objectives: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality among older adults. While clinical risk factors are well documented, less is known about how perceived neighborhood environments interact with individual coping resources to influence CVD risk. Informed by the Stress Process Model and the Transactional Model of Stress and Coping, this study examines the associations between perceived neighborhood social cohesion and physical disorder and CVD among U.S. older adults, and whether cognitive activity moderates these associations.

Research design and methods: Pooled data were drawn from the 2016 and 2018 waves of the Health and Retirement Study, including 6,249 adults aged 65 and older who completed the Leave-Behind Questionnaire. Perceived neighborhood social cohesion and physical disorder were measured using validated multi-item scales. Cognitive activity was assessed based on participation in five cognitively stimulating behaviors (e.g., reading, writing, playing word games). Survey-weighted logistic regressions were conducted to estimate associations between neighborhood characteristics and CVD, including interaction terms with cognitive activity.

Results: Higher levels of social cohesion were associated with lower odds of CVD. Neither physical disorder nor cognitive activity was independently associated with CVD. However, cognitive activity moderated both neighborhood associations: the positive association between physical disorder and CVD was attenuated at higher levels of cognitive activity, whereas the protective association between social cohesion and CVD was weaker among individuals with greater cognitive activity.

Discussion and implications: Cognitive activity may buffer cardiovascular risk in physically disordered neighborhoods, while its benefits may be less apparent in socially cohesive settings. These findings suggest that cognitive engagement and neighborhood perceptions jointly shape cardiovascular risk and underscore the importance of integrated, multilevel interventions that promote both individual-level cognitive resources and neighborhood-level supports in aging populations.

Background and objectives: This study examined the association of self-perceptions of aging (SPA) and memory trajectories and the mediating role of social connections in their association.

Research design and methods: Data from 4,808 adults aged 65+ were drawn from the Health and Retirement Study (2008-2018). Latent growth curve modeling was used to examine the effects of positive and negative SPA on the intercept and slope of memory trajectories across 3 time points over 8 years. Direct and indirect effects of SPA on memory trajectories through social disconnectedness and loneliness were estimated.

Results: Both positive and negative SPA had indirect effects on the intercept of memory trajectories through loneliness but not social disconnectedness. Specifically, higher positive and negative SPA at Time 1 were linked to lower and greater loneliness at Time 2, respectively. T2 loneliness, in turn, was negatively associated with memory at Time 3. Additionally, negative SPA at baseline had direct effects on memory scores at Time 3.

Discussion and implications: Findings suggest that loneliness is a pathway via which positive and negative SPA influence memory. Interventions to reduce loneliness could be a way to mitigate the effects of SPA on memory in later life. The direct and indirect effects of negative SPA on memory suggest that negative aging stereotypes are powerful and have long-lasting impacts on cognitive function. Demystifying and reframing aging can produce positive cognitive benefits at the population and individual levels.

Background and objectives: While cross-sectional associations between any pain and sleep problems have been established, longitudinal studies examining the temporal relationship between back pain and multidimensional sleep health remain limited. We evaluated whether the association between back pain and sleep problems was bidirectional in older men aged 65 years and above.

Research design and methods: Data came from the Osteoporotic Fractures in Men Study with a sample of 1,055 older men who completed 2 clinical sleep visits. A composite sleep problems score was created using self-report and actigraphy data reflecting irregularity, dissatisfaction, lack of daytime alertness, suboptimal timing, inefficiency, and suboptimal duration. Participants were queried by mail about back pain every 4 months, and we calculated the prevalence of any, frequent, severe, and activity-limiting back pain around their 2 sleep visits. Cross-lagged panel models estimated bidirectional associations between sleep problems and subsequent back pain, and vice versa, over 6 years.

Results: Multivariable-adjusted results showed that having any back pain, frequent back pain, severe back pain, and activity-limiting back pain predicted 12%-25% greater sleep problems 6 years later (Exp(β) = 1.12; 95% confidence interval [CI] = 1.03-1.21 to Exp(β) = 1.25; 95% CI = 1.05-1.48), but sleep problems did not predict subsequent back pain.

Discussion and implications: This study highlights the long-term temporal directionality of the association between back pain and sleep problems in older men. Back pain preceded more sleep problems, but an inverse association was not observed. Our findings suggest that interventions targeting back pain may help decrease sleep problems in older men and warrant further investigation into potential mechanisms.

Background and objectives: To better support aging in place, we first must understand the needs of the older adult population. We conducted a systematic review to understand the needs of older adults in the home.

Research design and methods: We queried the PubMed, CINAHL, and ProQuest databases to identify literature related to needs assessments of older adults in the home. Records were included if: (1) the population focused on older adults (aged 65 years and older); (2) a needs assessment was conducted; (3) the older adult population was aging in place and not in a long-term care facility; (4) English language publication; (5) published since 2013; and (6) pertaining solely to older adult caregivers' needs. The needs identified in each article were extracted and categorized based on emergent themes.

Results: A total of 1,963 records were identified. After removing duplicate records and those not meeting the inclusion criteria, 65 articles were included in the final analysis. Six need-related theme domains were identified: health management needs; social needs; homecare and practical needs; information needs; technology needs; and healthcare system needs.

Discussion and implications: Through the systematic review, we identified a wide range of unmet needs for older adults aging in the home. The unmet needs of older adults are multifaceted and provide ideal targets for the development of novel technological solutions. In particular, recent advances in artificial intelligence (AI), especially generative AI such as large language models (LLMs), surface the potential for technology to address unmet needs across multiple domains. We discuss the potential for AI to lower barriers to technology uptake for older adults and create novel solutions to each of the need domains identified. Ultimately, AI-enabled solutions may increase independence for older adults and potentially increase the ability to age in place.

Background and objectives: Previous evidence showed that frailty in older age and precarious housing characteristics, respectively, contribute to poorer heat-related health outcomes. It is not known whether these conditions would interact with each other to produce a larger impact on older people's health.

Research design and methods: A cross-sectional questionnaire survey was conducted in May-July 2024 in a sample of older people aged 60 or over in Hong Kong, a city on the Southern coast of China. Frailty was measured using the Fried phenotype (five items). Housing characteristics were measured by whether it is a small flat (<100 square feet per person), living alone, inadequate housing (subdivided units or other forms), or whether the respondent had an air conditioner at home. Heat-related health outcomes were self-rated health, thermal comfort at home, and any heat-related signs/symptoms during summertime. Multivariable Poisson regression with robust standard error was used. Relative risk due to interaction was used to characterize additive interaction between housing characteristics and frailty.

Results: Among the 1,393 respondents who completed the questionnaire, about 60% reported being frail. Those who were frail were less likely to report thermally comfortable at home (RR: 0.75; 95% CI: 0.66, 0.87) and had a higher chance of reporting any heat-related signs/symptoms (RR: 1.28; 95% CI: 1.18, 1.38). We found evidence of additive interaction between frailty and living alone, in which, only for those who were robust, living alone is related to a lower risk of heat-related signs/symptoms.

Discussion and implications: Targeted interventions to improve the well-being of community-dwelling older adults during periods of extreme heat should be designed especially for those who are frail.