Innovation in Aging最新文献

Background and objectives: Increased referrals to skilled nursing facilities (SNFs) from hospitalized people with opioid use disorder (OUD) carry risk for financial, safety, and legal consequences for poor transitions in care. We aimed to better understand the hospital to SNF referral process and identify opportunities to improve transitions and care for people with OUD, an increasing share of whom are older adults.

Research design and methods: Participants included administrative, executive leadership, and clinical staff involved in SNF admission decisions across the United States. To identify key themes, descriptive thematic analysis was used to analyze semi-structured interview data collected between March and October 2023.

Results: There were 29 participants from 27 SNFs in 19 states. We identified five themes. (1) Large variation in facility experience, stigma, and readiness to care for people with OUD: resources and willingness to care for people with OUD in SNFs varied with stigma, further impeding SNF access. (2) Conflation of OUD with pain management: participants struggled to distinguish between opioids for pain, OUD, and physiologic dependence, highlighting knowledge deficits about OUD. (3) Navigating information transfer: SNF staff screen referrals for challenges that could negatively impact patient care and perceive hospitals to sometimes omit important details to secure SNF placement. (4) Siloed regulations and care landscapes: regulatory structures complicated admissions and limited access to medications for OUD. (5) Building trust and managing expectations during transition: the hospital-to-SNF transition represents a crucial period for developing trust between people with OUD and SNF staff.

Discussion and implications: Education about OUD and stigma, enhanced information transfer and care coordination, and regulatory reforms to expand access to medications for OUD in SNFs are needed to improve transitions and care for people with OUD in SNFs. Since SNF transitions increase with aging, these findings can inform efforts to address OUD in older adults.

Background and objectives: Early detection of mild cognitive impairment (MCI) is vital for managing cognitive decline in older adults. Hand movements are closely linked to cognitive function, prompting this study to develop a virtual reality (VR)-based wearable system to capture detailed hand movements. The main goal was to assess the system's potential in predicting cognitive health and aiding MCI diagnosis.

Research design and methods: The study involved 607 participants aged 60-84 (mean age 67.41 ± 4.71 years). Each completed four VR tasks while wearing the system, which recorded fine hand movement data. Cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ). Statistical analyses were conducted to correlate hand movement metrics with cognitive performance.

Results: Participants with cognitive impairments performed worse on VR-based fine motor tasks. Metrics from tests like the Pegboard, Block Placement-Flipping, and Tapping Tests were predictive of cognitive abilities. Indicators related to finer movements and non-dominant (left) hand use showed superior predictive power, achieving an AUC of 0.687 for predicting MCI, comparable to machine learning models such as Random Forest (0.762) and SVM (0.644).

Discussion and implications: Hand movement data can provide valuable insights into cognitive function in older adults, highlighting the importance of fine motor skills in early MCI detection. This VR-based system could serve as a useful clinical tool for assessing cognitive health and supporting MCI diagnosis, enabling timely intervention strategies for cognitive decline.

Background and objectives: Previous research on the effects of age at marriage in low- and middle-income countries has predominantly examined the influence of child marriage on women's reproductive, sexual, and mental health outcomes. However, this research has focused on younger populations and has not examined how age at marriage may affect health in later life. We posit that the experience of adversities associated with child marriage has an enduring influence on cognitive and psychological health in later life. In addition, we investigate whether getting married in India at age 21, the current legal age at marriage for men, is associated with better health outcomes for both men and women.

Research design and methods: We analyze data from the second wave of the World Health Organization's Study on Global Ageing and Adult Health (2015) and use regression analysis to examine the relationship between marriage at or before 18 years and marriage at or after 21 years, and depressive symptoms and cognitive scores of men and women over the age of 50. We also conduct inverse probability weighted regression adjustment analysis to account for selection into the age at marriage.

Results: Our findings show that child marriage is associated with a higher probability of depressive symptoms and lower cognitive scores only among women. Men are not disadvantaged when married as children. Conversely, getting married at or after age 21 is linked to health benefits for both men and women.

Discussion and implications: This is the first study to document the adverse role of child marriage on later-life health among women. These findings indicate that healthcare systems should remain attentive to and address the ongoing health concerns of women who were married as children, even as they age.

Background and objectives: Research has established that unpaid family members, friends, or others who care for persons with dementia (ie, caregivers) may encounter socioemotional and physical health concerns as a consequence of providing extensive assistance. Similarly, caregivers for people living with traumatic brain injury (TBI) often experience a range of stressors and negative mental health outcomes due to care demands. Individuals with TBI often develop Alzheimer's disease and Alzheimer's disease-related dementia (AD/ADRD). This history of TBI may introduce complications to AD/ADRD caregiving. A comprehensive intervention grounded in the understanding of the complex caregiving context of both diagnoses is warranted to address the unique needs and concerns of TBI-AD/ADRD caregivers.

Research design and methods: This study evaluated the feasibility of the TBI-AD/ADRD Caregiver Support Intervention (TACSI) psychoeducational program, designed to support the unique subset of caregivers facing the challenge of assisting relatives with AD/ADRD and a history of TBI. TACSI, a 6-session telehealth intervention, provides tailored psychosocial and psychoeducational coaching. In partnership with the 2 national healthcare centers, 15 caregivers enrolled in the 3-month feasibility study evaluating the design and subsequent refinement of TACSI. Mixed methods data were collected from 3-month follow-up surveys and qualitative data from postintervention interviews.

Results: The feasibility, utility, and acceptance of TACSI were established. Caregivers liked the telehealth delivery and the personalized nature of TACSI, yet some expressed it would have been more beneficial earlier in their caregiving journey.

Discussion and implications: Caregivers valued the TACSI program. Their feedback has been applied to improve TACSI content and delivery for a larger pilot randomized controlled trial that is currently underway.

Background and objectives: The older Chinese American population is growing rapidly in the United States, but they have limited access to culturally responsive dementia prevention services. Cognitive training has benefits for cognitive health, yet these interventions have not been tailored to older Chinese Americans. To inform the codesign of a culturally relevant, mobile-based cognitive training, this study explored perspectives of older Chinese Americans and their adult children on dementia prevention and cognitive training.

Research design and methods: We conducted 4 focus groups with older Chinese Americans (n = 21) and 2 focus groups with adult children (n = 9) in Mandarin over Zoom,and applied rapid qualitative analysis using the Health Belief Model.

Results: Five themes emerged. Both older adults and adult children had partial knowledge of dementia and were able to list learning new things and social activities as cognitively stimulating activities. Both groups expressed strong interest in cognitive training, but were also concerned about transportation and language barriers. Both groups viewed promoting cognition as an advantage, and eyestrain and dementia-related stigma as disadvantages of mobile-based cognitive training. Adult children were eager to support their older parents, whereas older adults preferred to participate in training independently. Facilitators to participation included recommendations from healthcare professionals and having a peer support community.

Discussion and implications: The study provides new information on the perspectives of older Chinese Americans and adult children on cognitive training as an underpinning for codeveloping a culturally relevant, mobile-based cognitive training to promote cognitive health among this population.

Background and objectives: Disasters can worsen behavioral symptoms in people living with dementia, leading to disorientation, anxiety, and paranoia. In such situations, psychotropic medications may be inappropriately used to manage these symptoms. This study estimated the receipt of new, or changes to existing, psychotropic prescription medications post-disaster among fee-for-service Medicare beneficiaries with a dementia diagnosis.

Research design and methods: Medicare administrative claims data were used to examine the relationship between hurricane exposure and receipt of antipsychotic prescriptions among people living with dementia with no prior use. The primary outcome was a daily count of new psychotropic prescriptions per beneficiary, from Part D claims, residing in exposed and unexposed counties 12 months after the hurricane landfall. The secondary outcome was a daily count of increases in the dosage of psychotropic prescriptions. Federal Emergency Management Agency disaster declarations were used to determine disaster-exposed groups.

Results: A total of 70 307 traditional fee-for-service beneficiaries with a dementia diagnosis were included in the study. In analyses adjusted for age, sex, race/ethnicity, Part D low-income subsidy status, rurality and number of Elixhauser comorbidities conducted over a 12-month period following the three hurricanes, beneficiaries exposed to the hurricanes had a 10% higher rate of starting new antipsychotic prescriptions compared to those in unexposed counties (IRR: 1.10, 95% CI: 1.04-1.17). Analyses conducted by individual hurricanes revealed substantial differences, with higher rates of initiating antipsychotics following Hurricane Harvey (IRR: 1.21, 95% CI: 1.07-1.36), and no change after Hurricanes Irma (IRR: 0.97, 95% CI: 0.88-1.08) and Florence (IRR: 0.92, 95% CI: 0.80-1.05).

Discussion and implications: Psychotropic prescribing increased after Hurricane Harvey but not after Irma or Florence, suggesting context-specific factors may influence clinical responses during disasters. Our findings highlight the importance of incorporating person-centered care and appropriate behavioral health responses into disaster preparedness planning for the dementia population.

Background and objectives: Robotic technologies will likely be part of the caregiving needs for older adults in the future. In this study, we assessed the acceptance of several robotic functions among a representative sample of adults in Switzerland and tested (a) the acceptance of different robotic functions, and (b) explored how different sets of predictors explained variance in the acceptance of 2 robotic functions: (a) "robots for assistive support" and (b) "robots for companionship."

Research design and methods: A survey was administered to a randomly selected group of adults from the 3 official linguistic regions of Switzerland using computer-aided-telephone-interviews. Data obtained were weighted for the Swiss adult population and analyzed using descriptive statistics, multilevel modeling, and sequential regression analysis.

Results: A total of 1,211 adults responded to the survey. Acceptance was higher for using "robots for assistive support" than "robots for companionship," with no significant statistical difference between linguistic regions. Usefulness of robotic functions in reducing caregiving stress explained the most variance in our model for both outcome variables. External predictors such as the fear of robots and the fear that robots will replace human care explained the least amount of variance.

Discussion and implications: When robots are used in the care of older adults, user adoption is likely to be positive when the end-users (older persons and their caregivers) perceive that their use meaningfully reduces caregiving stress. More research is needed to further test the role of external factors for technology adoption, especially those that touch the notion of human contact.

[This corrects the article DOI: 10.1093/geroni/igae098.].

Background and objectives: Family caregivers in the United States provide substantial value of unpaid care to older adults while less recognized are the employment-related costs they endure and the trajectory of these costs. We estimate the replacement cost of unpaid family caregiving to U.S. adults aged 70 and older with and without dementia and the opportunity costs of forgone earnings and lost productivity between 2011 and 2060.

Research design and methods: We match caregivers to older adults from the National Study of Caregiving with similar noncaregivers from the Panel Study of Income Dynamics. We use population projections alongside current and historical data on educational attainment, wages, inflation, and average wages for in-home care aides to approximate total replacement and opportunity costs.

Results: Current annual replacement cost of unpaid family care is between $96 and $182 billion, 44% of which is accounted for by dementia caregiving. By 2060, it will increase to $277-571 billion, and 53% will be for dementia caregiving. The opportunity costs of forgone earnings and productivity loss, however, will grow faster, increasing from current levels of $107 billion and $26 billion to $380 billion and $102 billion, respectively, in 2060. Projections show that opportunity costs of family caregiving will be increasingly borne by caregivers of older adults with dementia and racial/ethnic minoritized caregivers.

Discussion and implications: As the employment-related opportunity costs of family caregiving for older adults are on a trajectory to become increasingly similar in value to associated replacement costs of unpaid care, policymakers, health insurance payers, and employers should focus on supporting unpaid family caregivers to remain attached to the labor force through efforts such as strengthening paid family leave options, expanding consumer-directed in-home services options, and offering increased work flexibility.

Background and objectives: Falls are a major public health concern among older adults, often leading to injuries, impaired mobility, and loss of independence. Dual-task walking, where a secondary task is performed while walking, simulates real-life challenges and is linked to fall risk. This study aimed to investigate how dual-tasking affects stepping strategies, inter-joint coordination, and coordination variability during walking in older adults with and without a history of falls.

Research design and methods: Twenty community-dwelling older adults (10 fallers, 10 non-fallers), aged 65 and older, completed a 2-min walking test under three conditions: single-task (ST) walking, motoric dual-task (MDT) walking (holding a glass of water), and cognitive dual-task (CDT) walking (serial subtractions). Gait data were collected using inertial measurement units. Stepping strategies were quantified by the changes in cadence and stride length, while inter-joint coordination was analyzed using vector coding. Two-way repeated measures ANOVA was used to assess task and group effects on variables.

Results: Task-specific adaptations were observed: MDT prompted greater stride length adjustments, while CDT led to more balanced cadence and stride length adjustments (F = 8.346, p = .010, η ²p = .317). Fallers exhibited more anti-phase coordination in hip flexion-knee flexion than non-fallers during dual-task conditions (p ≤ .042). In CDT walking, fallers showed a lower frequency of distal phase in hip flexion-knee flexion and a higher frequency of anti-phase in hip flexion-ankle dorsiflexion compared to ST (p ≤ .044). Coordination variability decreased during MDT for hip flexion-ankle dorsiflexion in both groups compared to ST (p ≤ .027).

Discussion and implications: This study provided better understanding on the differences of stepping strategies and phase-specific coordination patterns between older adult fallers and non-fallers, particularly under dual-task walking conditions. The conservative motor control strategies in fallers suggest a prioritization of stability over adaptability, potentially increasing fall risk during complex walking tasks.