Innovation in Aging最新文献

Background and objectives: In a cluster randomized trial, we found that augmenting adult day services (ADS) with a multicomponent caregiver support program, ADS Plus, reduced caregiver depressive symptoms and increased ADS use. Unclear is whether the program was implemented with fidelity across sites and the relationship of fidelity to site characteristics and caregiver outcomes.

Research design and methods: Sixteen ADS sites were randomly assigned to ADS Plus (n = 102 caregivers), which offered dementia education, referrals/linkages, validation/support, and strategies for self-care and caregiver-identified challenges. Sites were categorized with high, moderate, or low fidelity based on the number of caregivers enrolled (delivery), care challenges addressed, and prescriptions (strategies) provided (receipt). We examined staff documentation of delivery, receipt, and enactment characteristics, the relationship of fidelity to site characteristics, and caregiver outcomes (depressive symptoms, stress) collected by interviewers 3, 6, and 12 months postbaseline.

Results: Of 102 caregivers, 79.5% were in high (n = 58, 56.9%) or moderate (n = 23, 22.6%), versus 20.6% (n = 21) in low-fidelity sites. High/moderate versus low-fidelity sites delivered more sessions and spent less preparatory time. Caregiver receptivity to sessions was high across all sites. Caregivers with enactment data (n = 43) reported reduced difficulties and upset in high/moderate fidelity sites, and enhanced confidence managing care challenges in high-fidelity sites (p < .0001). Sites with higher percentages of White, non-Hispanic families (p = .006) and dementia clients (p = .004) had better fidelity. At three and 12 months but not at 6 months, caregivers in high/moderate fidelity sites had greater reductions in depressive symptoms and stress (p<.05) compared to those in low-fidelity sites.

Discussion and implications: Most caregivers received ADS Plus with moderate to high fidelity. High/moderate fidelity sites delivered more sessions to more caregivers with substantially stronger caregiver benefits. As fidelity varied by site characteristics, adaptations to staff training and the program appear needed for low-fidelity sites.

Clinical trial registration number: NCT02927821.

Background and objectives: Caregiving for older adults often leads to increased social isolation and depression among primary caregivers. Secondary caregiver networks (SCNs) may provide crucial support, potentially mitigating these adverse outcomes. This study aimed to identify the SCN support patterns and examine their impacts on primary caregivers' social isolation and depression over 2 years, as well as potential differences in the associations by gender and race.

Research design and methods: Data from the 2015 and 2017 National Study of Caregiving (NSOC) and National Health and Aging Trends Study (NHATS) were used. Latent profile analysis identified distinct SCN support patterns. Mixed-effects models assessed associations between SCN patterns, social isolation, and depression.

Results: Among 782 primary and 1,003 secondary caregivers, three SCN support patterns (low, medium, and high) were identified. Higher SCN support was associated with lower social isolation at baseline, but increased social isolation over time. Depression increased over time, but was not associated with SCN support. No significant gender and racial differences were found.

Discussion and implications: While SCN support initially reduces social isolation among primary caregivers, its effectiveness diminishes over time. The study highlights the necessity for continuous social and mental health support for primary caregivers, regardless of SCN support level, to better address the evolving demands of caregiving.

Background and objectives: Approximately 11 million people in the United States self-identify as Deaf and use American Sign Language (ASL) as their primary form of communication. Yet, little is known about the challenges and solutions in everyday activities of individuals who are aging with long-term deafness.

Research design and methods: We used a community-engaged research approach to understand everyday challenges and solutions of 60 older ASL users who self-identified as Deaf. Semi-structured interviews were conducted in ASL to probe challenges and responses to those challenges across six everyday activity categories: Activities Within the Home; Activities Outside the home; Transportation; Managing Health; Shopping and Finances; and Basic Daily Activities.

Results: Older Deaf adults shared their lived experiences and reported challenges with unreliable technology, communication, and accessibility in the context of engaging in a myriad of everyday activities. For instance, they reported that technology alerts (e.g., airport announcements) are typically auditory, and healthcare accessibility is poor due to a lack of ASL interpreters. When probed about their solutions to these everyday challenges, participants reported relying on hearing family members, using their own methods, such as self-advocating, and using devices/technologies.

Discussion and implications: Everyday challenges experienced by older Deaf adults may be mitigated by improving the reliability and accessibility of technologies used by this population, as well as improving communication accessibility across various public and private settings. Including older Deaf community members in the needs assessment and design process is critical for development of technology solutions to improve engagement in everyday activities.

Background and objectives: The occurrence of chronic low-grade inflammation during aging, also referred to as "inflammageing," can impair immunological homeostasis and threaten healthy ageing. Different physical exercise interventions have been proposed to tackle inflammageing. The aim of this umbrella review was to appraise current evidence from systematic reviews, with or without meta-analyses, on the effect of exercise interventions on circulating levels of inflammatory markers C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), and the anti-inflammatory marker interleukin 10 (IL-10) in community-dwelling older adults.

Research design and methods: Thirteen systematic reviews on the effects of long-term exercise on CRP, TNF-α, IL-6, and IL-10 in adults aged 60 years and older were selected from a systematic search in databases PubMed and Web of Science and were included in this umbrella review.

Results: Overall, a variety of long-term exercise modalities were able to reduce levels of CRP in older adults. Moreover, most exercise interventions were also able to decrease TNF-α. Some studies showed that long-term exercise can diminish IL-6, but the results are less conclusive. The long-term effects of exercise on IL-10 were less described in the literature, with only two systematic reviews showing increases, decreases, or no effects.

Discussion and implications: Results obtained in this umbrella review show that different exercise modalities can decrease circulating pro-inflammatory parameters CRP, TNF-α, and IL-6 in older adults. More research is needed to appraise the effect of exercise interventions on IL-10 in older adults.

Background and objectives: Physical inactivity and excessive sedentary time (ST) are associated with poor cognitive health in older adults. However, current literature largely relies on cross-sectional designs or in-lab cognitive assessments, which do not adequately reflect cognitive function in naturalistic settings. Further, existing studies have largely overlooked the variability or the instability in daily cognitive function, which represents a critical marker of cognitive decline. This ambulatory assessment study examined the temporal associations of daily movement behaviors with the mean levels and the variability of cognition among older adults at risk of dementia.

Research design and methods: 96 older adults from the community (68.3 ± 7.1 years) participated in this 14-day study. They wore an accelerometer and completed smartphone-based cognitive tests up to 4 times per day. The cognitive tests assessed both performance-based and subjective cognition. The movement behaviors collected from the accelerometers include daily light-intensity physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and ST. Mixed-effects location-scale models were applied to estimate the within- and between-person associations of movement behaviors and cognitive outcomes in terms of the mean levels and the degree of variability. A total of 1,269 day-level observations were analyzed.

Results: Older adults' between-person levels of daily MVPA and steps were associated with better mean cognitive performance and lower variability across cognitive measures. Older adults' daily LPA was positively associated with subjective cognition in both mean levels and variability. The increases in within-person levels of ST were negatively associated with older adults' variability of all cognitive outcomes.

Discussion and implications: Study results suggest that moving more and sitting less in day-to-day life may sustain proximal cognitive health. Applying ambulatory assessments can advance aging research by examining the temporal dynamics between daily movement activities and within-person variability of cognition to inform strategies for promoting healthy aging in daily life.

Background and objectives: Contemporary Chinese drug governance is shifting its focus toward the rehabilitation of people who use drugs, prioritizing restorative over punitive measures. Moving beyond previous research that has primarily focused on the importance of community-based rehabilitation mechanisms in facilitating social reintegration, this study aimed to understand aging heroin users' experiences within broader systems of power, citizenship, and social exclusion in China.

Research design and methods: We conducted fieldwork in a city in the eastern region in China in 2020-2021 and interviewed 12 heroin users aged 65-75 years. We employed Atkinson's life story interview as an approach to collect data and Abbott's group life course to examine how aging heroin users, both as individuals and as a cohort with distinct drug experiences and aging traits, narrate their interactions within the national rehabilitation programs.

Results: Our findings contend that older heroin users, even after testing positive, receive lenient institutional treatment, often exempting them from compulsory rehabilitation due to age-related health issues and care burdens. To mitigate the risk of overdose, drug enforcement authorities utilize social welfare programs as a means of promoting self-management among aging users. However, this approach neglects the general well-being needs of the older population. Moreover, drug social workers often overlook aging users as clients for their casework because of performance and tangling professional ethics. The systematic neglect thus formed, and it provokes reflection on the position of aging users and how they seek to be citizens but are excluded by the "violence of citizenship."

Discussion and implications: We found the systematic neglect experienced by aging heroin users through the judicial process, welfare programs, and service practices. This structural disadvantage, more important than their needs, underscores the urgent value of addressing the social issues surrounding their marginalized position in society.

Background and objectives: Usual source of care (USC) is a key aspect of primary care that can significantly enhance health literacy by facilitating regular health education, consistent communication with health professionals, and access to health resources. This study aims to investigate the relationship between the utilization of USC and health literacy among older adults with hypertension.

Research design and methods: This study is a cross-sectional analysis utilizing data from the Korean Health Panel from 2020 to 2021, based on Andersen's Behavioral Model of Health Services Use. The study included 1,986 older adults with hypertension (n = 821 men and 1,165 women). We employed multinomial logistic regression analysis to assess the association between USC utilization and health literacy, as well as the association between different types of USC health care settings and health literacy. Additionally, logistic regression was used to investigate the association between USC utilization and each domain of health literacy.

Results: Among older adults with hypertension, those who do not utilize USC are significantly more likely to have inadequate health literacy compared to those who do (odds ratio [OR] = 2.58, 95% confidence interval [CI] 1.81, 3.68). This association remains consistent across all five items within the disease prevention domain. Additionally, among older adults with hypertension who utilize USC, those who visit physicians' offices are more likely to have sufficient health literacy (OR = 1.42, 95% CI = 1.01, 1.99).

Discussion and implications: This study demonstrates a positive association between the utilization of a USC and health literacy among older adults with hypertension, highlighting the former's potential as an effective tool for managing hypertension. Furthermore, it suggests that future interventions should adopt tailored strategies suited to various health care settings to optimize health literacy and effectively support hypertension management.

Background and objectives: Although a large proportion of centenarians depend on assistance, many still live at home, independently or with a little formal long-term care. It is of interest to explore this group further and compare them to dependent centenarians.

Research design and methods: This register-based cohort included the entire Swedish centenarian population between 2020 and 2022. Centenarians were classified into two groups: those independent of formal long-term care and those dependent on such care. Disease trajectories were observed in historical data from age 67 and onwards and described for myocardial infarction, stroke, hip fracture, dementia, diabetes, and different cancer diagnoses, as well as hospitalizations and the number of prescribed drugs.

Results: Of the 4,277 centenarians, 36% were independent. Compared with dependent centenarians, independent centenarians had lower incidences of stroke and dementia after age 85 and a lower incidence of hip fracture from age 75. They were less often hospitalized and had lower levels of polypharmacy. In regression analysis, women, stroke, hip fracture, dementia, and more prescribed drugs were associated with an increased risk of being dependent at age 100, while being married was associated with a reduced risk.

Discussion and implications: The health differences between independent and dependent centenarians appeared mainly after life expectancy was exceeded. After this age, differences in incidences of hip fracture, stroke, and dementia became apparent between the groups. This finding underscores that these diseases affect care needs in very old age and that avoiding them is linked to a more independent life as a centenarian.

Background and objectives: The complex interplay between diet, gut microbiota, and metabolic health has gained increasing recognition as a key factor in the development of obesity and related conditions, such as sarcopenia. This study examines the relationship between the dietary index for gut microbiota (DI-GM) and sarcopenia, while exploring the potential mediating role of the body roundness index (BRI) in this association. By integrating these factors, our findings aim to shed light on the diet-gut microbiota-sarcopenia interaction and its implications for personalized dietary interventions.

Research design and methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Multivariable weighted regression analyses were conducted to assess the association between DI-GM and sarcopenia. Restricted cubic spline analyses were used to evaluate potential non-linear relationships. Additionally, mediation analysis was performed to determine whether the BRI mediated the relationship between DI-GM and sarcopenia.

Results: A total of 10,190 participants were included in the study, of whom 7.57% were diagnosed with sarcopenia. In the weighted linear regression analysis, each one-point increase in DI-GM was associated with a 12% reduction in the prevalence of sarcopenia (OR = 0.88, 95% CI: 0.82, 0.95). Specifically, a higher beneficial gut microbiota score was significantly associated with a lower prevalence of sarcopenia (OR = 0.82, 95% CI: 0.75, 0.89). Mediation analysis revealed that BRI accounted for 23% of the total effect of DI-GM on sarcopenia. Among the beneficial components, those with a significant mediation effect contributed approximately 9% of the total effect.

Discussion and implications: The DI-GM was found to be negatively associated with the prevalence of sarcopenia, with BRI playing a crucial mediating role. These findings highlight the importance of the diet-gut microbiota-sarcopenia interaction and underscore the potential for incorporating dietary and microbiota-targeted interventions in personalized therapeutic strategies for sarcopenia.