Journal of Applied Gerontology最新文献

Using a national survey of assisted living administrators (n = 2,084) and interviews with residents' bereaved next of kin (n = 30), we describe policies administrators reported complying with at the worst of the COVID-19 pandemic and explore relationships between COVID-19-related policies and bereaved next-of-kin's perceptions of end-of-life care quality, integrating findings to develop a comprehensive examination of end-of-life care in assisted living. During the pandemic, most administrators reported allowing compassionate care visits and hospice services. Next of kin described limited visitation and external care services and declines in residents' physical, mental, and social well-being, emphasizing the difficulty of missing precious time together. This study examines next-of-kin experiences of residents who died during the COVID-19 pandemic, providing evidence to inform future infection control policies.

BackgroundNurse practitioners (NPs) and physicians are essential to providing acute, episodic and palliative care in long-term care (LTC) homes and preventing unnecessary hospital transfers.ObjectivesTo explore the attributes of effective NP-physician collaboration in LTC and identify barriers to developing it.MethodsAn exploratory qualitative study was conducted using semi-structured interviews with 10 NPs and six physicians practicing in LTC homes in Ontario, Canada. Recruited individuals were not matched NP-physician dyads. Data were analyzed using inductive thematic analysis.ResultsTwo distinct NP-physician practice models emerged: one characterized by successful collaboration, and the other by failed partnership. Findings are presented in the form of vignettes illustrating key differences between the models. Successful collaboration featured resident-centered care, non-hierarchical relationships, and clearly defined roles. Barriers included lack of trust, high NP workload, and role ambiguity.ConclusionNP-physician collaboration can improve care for LTC residents. Successful implementation requires clear communication, role clarity, and leadership engagement to support NP integration and foster effective interprofessional relationships.

This study examines nativity differences in the relationship between living arrangement (living alone, with one other, or with two or more people) and cognitive impairment in older Mexican Americans (≥75 years) with moderate to high cognitive function at baseline. Using 12-year longitudinal data from 1,026 participants in the Hispanic Established Population for the Epidemiological Study of the Elderly, generalized estimating equation models revealed that US-born participants living with one other or two or more individuals had significantly higher odds of developing cognitive impairment than those living alone, whereas no significant association was observed among foreign-born participants, after adjusting for all covariates. These findings indicate that cognitive change over time for older adults in different living arrangements differs by nativity. These results emphasize the importance of considering both nativity and household structure when developing interventions to preserve cognitive function among diverse older adult populations.

Although health coaching is a well-known self-management intervention for individuals with chronic diseases, the research on its effect on older adults is limited. A total of 414 older Hong Kong adults were randomly assigned to the intervention group, which received 12-week health coaching sessions, and the control group without intervention. Participants in the intervention group completed assessments at three time points (baseline, postintervention, and three-month follow-up), and those in the control group completed baseline and three-month follow-up assessments. Generalized estimating equations first revealed a significant improvement in self-efficacy and blood pressures among the intervention group participants, and such improvements were maintained at follow-up. In addition, the self-efficacy of the intervention group significantly increased while that of the control group significantly decreased from baseline to follow-up. Thus, the overall results demonstrate the effectiveness of the health coaching intervention in improving the self-efficacy of older adults in managing their chronic diseases and health risks.

Formal long-term services and supports (LTSS) are essential to support older Americans with chronic conditions, such as Alzheimer's disease and related dementias (ADRD). However, few older adults have saved enough to pay for LTSS, and navigating Medicaid eligibility criteria presents significant challenges. We conducted semi-structured, in-depth interviews with aging services professionals and caregivers of older adults with ADRD to assess challenges to planning for and accessing LTSS coverage through Medicaid and Medicaid waivers. Using concept mapping, three main themes were identified: (1) Proactive planning, (2) decision points, and (3) the application process. Participants described misconceptions about LTSS coverage, challenges with enrollment, and lack of information about eligibility affecting the LTSS planning trajectory. Results demonstrate a critical need for resources that help caregivers estimate costs and guide them through the eligibility determination, application, and spend down processes for Medicaid programs.

Gerontological research on successful aging has received the least attention in Indian culture, possibly due to a lack of psychometric tools to assess it among Hindi-speaking older adults. This study conducted the Hindi adaptation and psychometric validation of the popular Successful Aging Scale (SAS). Following translation and language adaptation, primary data was obtained from 136 older Indian adults drawn using a stratified random sampling technique. Quantitative data was collected on the Hindi-adapted version of the SAS along with WHO Quality of Life-BREF, Self-rated physical health (SRPH), General health questionnaire (GHQ-12), and Depression Scale (of DASS) for psychometric validation purposes. The Hindi version of SAS showed excellent internal consistency (r = 0.94). The significant correlation between the Hindi version of SAS and the criterion variables indicated significant construct validity (convergent and divergent) of the scale. The exploratory factor analysis identified two underlying factors: the engagement and the functioning aspect of aging.

Despite the significance of romantic relationships in later life, relatively little research has focused on older African Americans, a population highly engaged in religious behaviors. Forgiveness often mediates the relationship between relational sanctification and various positive relational outcomes. This study examined forgiveness as a mediator between relational sanctification and family functioning among older African American couples. It used dyadic data from 194 African American couples aged 50 to 86. The relationships between men's relational sanctification and men's reports of family functioning were partially mediated by men's self-reported ability to forgive their partner (B = .045) and the sum of all men's and women's reported abilities to forgive and perceive forgiveness (B = .124). However, these associations were not statistically significant for women. These findings highlight the growing yet underrecognized need to understand the religiosity of older African American men relative to positive relational outcomes.

Background: A frailty index (FI) can identify individuals with frailty in a population of interest. Previous literature suggests a need for frailty assessment methods for older adults in China and that urbanization may impact frailty status. We used a FI to examine the association between frailty and urbanization as living in a less urbanized area may put older adults at a higher risk frailty and poor healthcare outcomes. Methods: We included adults aged 55 years and older (n = 7695) from the China Health and Nutrition Survey (2018). The FI was based on health outcomes correlating with a deficit score divided by number of health items: robust (<0.08), pre-frail (0.08-0.24), and frail (≥0.25). We used multinomial logistic regression models to examine associations between urbanization tertile (low, medium, and high) and frailty, using our novel FI. We also conducted sub-analyses examining how urbanization level modifies the relationship between frailty status and region of residence, and education and income levels. Results: Living in an area of low versus high urbanization was associated with higher odds of frail versus robust (1.5; 1.2-2.0), and pre-frail versus robust (1.6; 1.4-2.0) status in the fully adjusted model. Generally, higher odds of worse frailty status (e.g., pre-frail or frail) was associated with lower tertiles of urbanization for region, income, and education when compared to the highest urbanization tertile. Conclusions: A FI can help identify specific characteristics that may benefit from individualized interventions to counteract frailty. Living in less urbanized areas was associated with higher odds of pre-frailty and frailty. Inclusion of urbanization level, geographic residence, and social determinants of health in FI development can help identify older adults most at risk of frailty and contribute to individual and policy-level frailty prevention interventions.

People with dementia are often hospitalized from the emergency department (ED) for "borderline cases," where outpatient or inpatient management may be clinically reasonable. We sought to investigate how ED physicians make and communicate about decisions in borderline cases. Through cognitive interviews, we asked attending ED physicians from an academic hospital to share their approach to scenarios representing borderline cases with people with dementia and verbalize communication about ED disposition with patients and care partners. We deductively coded responses related to patient/care partner engagement and key features of communication and then elucidated themes related to content and phrasing of communication. Of 21 physicians, two-thirds stated they would offer the option of admission or discharge, but few explicitly communicated admission versus discharge as a choice. Shared decision-making is applicable to these situations and could provide a consistent structure to communication about disposition.

Smartwatches have potential to provide support for prospective memory (PM), the ability to remember and carry out an intention in the future. How older adults (OAs), particularly those with cognitive impairment (CI), might interact with smartwatches is undetermined. This study aimed to understand the usability of smartwatches among cognitively diverse OAs and the potential for smartwatches to serve as reminder aids for this population. Participants were 58 OAs (age 60+) with and without CI. After using a smartwatch as a reminder aid for 10 days, participants gave low usability ratings overall, and the smartwatches did not aid performance of a daily PM task. Perceived usefulness of the smartwatches was associated with subjective memory, suggesting that perceived memory challenges may play an important role in smartwatch adoption. Results can inform the development of future efficacy tests and interventions involving smartwatches.