European Journal of Ageing最新文献

The concept of active aging (AA) was defined as the process of optimizing opportunity for health, security, and social participation for older people. While several questionnaires were developed to measure AA, there is no universal consensus on how to measure it, underlining a lack of clarity about what aspects to consider in the evaluation. To contribute to fill this gap, the aims of these two studies were to provide a guide for aging care professionals to choose the most appropriate questionnaire(s) based on a scoping review of the specialist literature and on a content analysis of the questionnaire, that is, the University of Jyvaskyla Active Aging Scale (UJACAS). Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were used. We found 25 records introducing questionnaires. The content validity evaluation of the most complete questionnaire (in terms of inspected content areas), i.e., UJACAS, was conducted to obtain a complete framework of evaluated aspects. Among the selected questionnaires, heterogeneity was found regarding investigated aspects and relative terms used to describe it. Only two questionnaires were found to be validated in other languages besides the original one. The content validity evaluation of UJACAS revealed its comprehensiveness in covering various aspects of AA. Specifically, five items mainly addressed one content area, while the others encompassed more than one content area. In terms of assessed aspects and translations, the UJACAS scale could be considered the most complete questionnaire for AA evaluation. Furthermore, recognizing the heterogeneity of the terms related to the aspects investigated could help professionals in selecting assessment tools with greater precision.

The Mini-Mental State Examination (MMSE) is widely used in cognitive screening, including in primary care settings. This study evaluated the diagnostic performance of the MMSE using data from 390 community-dwelling older adults aged 65 to 98 years (M = 75.76, SD = 6.76). The MMSE's accuracy was assessed against clinical diagnoses and symptom severity levels based on the Global Deterioration Scale (GDS). Receiver operating characteristic (ROC) analysis, evaluating the ability to distinguish individuals with dementia from those without, provided an area under the curve (AUC) of .75 (95% CI: 0.67-0.84, p < .001). The optimal cutoff based on Youden Index was 21 and resulted in a sensitivity of .77 (95% CI [.728, .812]) and specificity of .65 (95% CI [.603, .697]), whereas the more conventional cutoff (24) showed lower sensitivity (.50; 95% CI [.450, .550]) but higher specificity (.82; 95% CI [.782, .858]). At the suggested cutoff, the MMSE identified all cases at the severe stage, 88% at the moderate stage, and 31% at the mild stage of dementias, as classified by the GDS. In contrast, the Quick Mild Cognitive Impairment screen (Qmci) identified nearly all cases across severity levels. Against previous dementia diagnoses, when employing a cutoff score of 24 the MMSE had a positive predictive value of .52 (95% CI [.395, .645]) and a negative predictive value of .81 (95% CI [.726, .894]), indicating modest diagnostic reliability in a primary care context. Similar results were obtained applying a cutoff score of 21. These findings highlight how base rates and test characteristics shape test accuracy and should guide decision-making. Overall, our findings highlight that the MMSE can produce a substantial number of false positives in contexts with a relatively low prevalence of dementia, such as primary care, challenging the common assumption of its low false-positive rate. More broadly, our study emphasizes the importance of considering the prevalence of the condition in a given context, as differences in prevalence can drastically affect the interpretation of results, particularly the positive predictive value, even when sensitivity and specificity remain unaffected.

The global ageing population presents growing challenges for health and social care systems, particularly during transitions from hospital to home for older adults. These high-risk periods are associated with functional decline, hospital readmissions, and reduced quality of life. This systematic review synthesised evidence from 25 randomised controlled trials (RCTs), involving 17,542 participants aged 65 and older, to evaluate the effectiveness of transitional care interventions. A comprehensive search of PubMed, CINAHL Complete, and Scopus was conducted for studies published between January 2013 and March 2024. Outcomes were categorised using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy into four domains: clinical outcomes, life impact, resource use, and death/adverse events. Most interventions were multicomponent, combining structured discharge planning, caregiver involvement, follow-up, and home-based support, typically delivered by multidisciplinary teams. Interventions were frequently associated with improvements in functional status, mood, and nutritional outcomes, as well as modest reductions in hospital readmissions and emergency department visits in the short term. Few studies assessed outcomes beyond six months, and sustained effects were uncommon. Few interventions demonstrated effects on mortality or adverse events. Caregiver engagement, particularly involving informal caregivers, and early post-discharge follow-up emerged as key enablers of success. Due to considerable heterogeneity in intervention design and outcomes, findings were synthesised narratively. This review highlights the potential of personalised, interdisciplinary transitional care models tailored to the complex needs of older adults. Future research should prioritise long-term outcomes, patient-reported experiences, and the development of scalable, context-sensitive strategies, including digital tools and caregiver-inclusive approaches.

Social ties amongst older adults were immediately affected by the COVID-19 pandemic-both by the deaths occurring disproportionately amongst older adults and by the policies limiting social contact implemented by governments to curb the spread of the virus. We explore changes in close social networks amongst older-aged adults before and during the pandemic across 13 European countries using panel data from the Survey of Health, Ageing and Retirement in Europe. We utilise four waves of data collected over a decade, the latest of which was during the COVID-19 pandemic in 2021-2022. The social network is measured based on respondents' reports on confidants, individuals with whom respondents discuss important matters, whether in-person or remotely. Results from individual fixed and random effects models indicate that while it appears that the number of confidants older adults have is not associated with the pandemic, the churning of these confidants was considerable. Older-aged adults lost members of their close network much more over the pandemic period than they did beforehand, though new social ties were also made. Across all waves, and especially over the pandemic, we find significant instability of social resources, which could have important implications for older adult well-being.

The predictive value of patient-reported outcome measures (PROMs), such as self-esteem in advanced age in relation to biological age (frailty), remains to be elucidated. In a secondary analysis of a randomised controlled trial (RCT), 107 hospitalised patients (mean age 77.2 (SD 7.1) years, 56% female) underwent a comprehensive geriatric assessment (CGA). Assessments included the Multidimensional Prognostic Index (MPI), the Rosenberg Self-Esteem Scale (RSES), evaluation of geriatric syndromes and resources, the EQ-5D-5L quality-of-life scale, and the Geriatric Depression Scale (GDS). Follow-up data were collected via telephone six months later. After adjusting for age, sex, intervention, and MPI, baseline RSES were significantly associated with pressure ulcer risk (p = 0.009), nutritional status (p = 0.042), number of geriatric syndromes (p = 0.003), geriatric resources (p < 0.001), depressive symptoms (GDS, p < 0.001), and quality of life (EQ-5D-5L, p = 0.020). These findings show that self-esteem appears to be an independent mediator of multiple geriatric outcomes, including geriatric resources and syndromes, as well as of PROMs, beyond what is explained by MPI-based frailty. Incorporating self-esteem measures into CGA may enhance the identification of at-risk individuals and guide interventions.

Background: To explore whether the impact of community spiritual comfort service (CSCS) on cognitive function is mediated by social participation and moderated by genetic factors.

Methods: Data were derived from the Chinese Longitudinal Healthy Longevity Survey conducted in 2008, 2011, 2014, and 2018, involving 3598 participants. A Random Intercept Cross-Lagged Panel Model was utilized to determine the relationship between CSCS and cognitive function, as well as the mediating role of social participation and the moderating effect of genetics on the identified CSCS and cognitive function relationship.

Results: Lower levels of CSCS at earlier assessment points were significantly associated with lower cognitive function at subsequent assessment points. Social participation partially mediated the prospective relationship between CSCS and cognitive function. Distinct genetic polymorphisms showed significant differences in effect sizes, with the Val group experiencing a significantly greater impact of CSCS on subsequent social participation, and of social participation on subsequent cognitive function, compared to the Met group.

Conclusion: Enhancements in CSCS can predict subsequent improvements in cognitive function. The relationship between CSCS and cognitive function can be mediated by social participation and is moderated by genetic factors. Multidisciplinary interventions aimed at improving the quality of CSCS and enhancing social participation will benefit the cognitive and psychological health of the older adults.

Strengths-based models of care are increasingly popular with policymakers, but evidence of their effectiveness is currently limited. This study examines the impact that a strengths-based care programme-community led support (CLS)-has had on new and existing clients in England. Specifically, we used a difference-in-difference approach to estimate the treatment effect of CLS on care provision, reviews, and expenditure, using the Short and Long Term (SALT) dataset published by NHS Digital (2016 to 2021). Within local authorities that implemented CLS, we found evidence of changing care pathways for new clients, including a ten-percentage-point reduction in funded care provision-though evidence for increased signposting to alternative services in this dataset was mixed. For existing clients, we found evidence of general improvements in the quality of practice, as indicated by higher ratios of planned to unplanned care reviews. These improvements were also realised without concomitant increases in expenditure rates. We believe these results can contribute towards an evidence base for CLS and for strengths-based practice more generally.

Initial empirical evidence and theories suggest that decision-making may become more avoidant with age. However, recent studies provide inconsistent evidence for this effect. We conducted a systematic review and meta-analysis of 19 studies (N = 7969) to assess evidence for an association between age and avoidant decision-making style. We included studies that used the avoidant subscale of the General-Decision-Making Style (GDMS) questionnaire or the buck-passing subscale of the Melbourne Decision-Making Questionnaire (complete avoidance), or the dependent subscale of the GDMS (partial avoidance). We also assessed potential moderators of the effect, including age range for each sample, gender, culture, participant sample type, publication year, decision style subscale, and degree of avoidance (complete vs. partial). Surprisingly, the data revealed a small association between older age and less avoidant decision-making style. Moderator analysis revealed that this association applied to complete decision avoidance (the avoidant and buck-passing subscales) and not partial avoidance (the dependent subscale). Additionally, moderation by sample type suggests that decision style does not become less avoidant until after middle age. We discuss important future directions for research aimed at investigating nuances that may contribute toward avoidant decision-making style in older age.

Earlier research has found that adult children's caregiving for older parents is associated with a decline in life satisfaction. However, other research indicates that emotional stress in adult children might be related to the declining health and frailty of their older parents rather than caregiving per se. Hence, there is a possibility that the first set of findings (declining life satisfaction when giving care) reflects factors not specified in statistical models rather than the care provided by adult children. This study tests this possibility by investigating changes in life satisfaction among 3,094 adult children from panel data in Norway that includes multiple indicators of health and care needs in older parents, together with data on who is providing care. Declining life satisfaction was observed among daughters but not among sons, and these changes were driven by the frailty and care needs of their parents rather than caregiving per se. The findings indicate that it is not caregiving that affects life satisfaction but the circumstances leading to caregiving. In these situations, adult daughters may struggle with sources of distress beyond providing support and care. Further research should investigate these relationships in countries with different distributions of care between families and public care institutions.

There are considerable interindividual differences regarding when individuals perceive someone as "old" (i.e., perceived individual onset of old age). Individuals might also differ in when they believe that society considers someone as "old" (i.e., perceived societal onset of old age). We investigated how multiple indicators of views on aging (age stereotypes, subjective age, age knowledge, perceived ageism), socio-demographic factors (age, sex, education, region of residence), and self-rated health are related to perceptions of individual vs. societal onset of old age and with the difference between both measures in an age-heterogeneous sample. In the Age_ISM Germany survey, a representative sample of 2,000 Germans was recruited (age range 16-96 years, M = 56.6 years). We ran structural equation models with sampling weights and found that individuals report a perceived individual onset of old age that was on average more than eight years later than their perceived societal onset of old age. Perceived ageism was associated with an earlier perceived individual and societal onset of old age as well as with a greater discrepancy between both indicators. Feeling younger was associated with a later perceived individual onset of old age. Associations of views on aging, socio-demographics, and self-rated health with perceived individual onset of old age did not vary across age groups, whereas age-group differences emerged for perceived societal onset of old age. Our findings advance theoretical frameworks on views on aging by demonstrating a meaningful discrepancy between perceived individual and societal onset of old age, which are uniquely associated with views on aging.