Journal of Applied Gerontology最新文献

More than 4 million people in the United States live alone with cognitive impairment or early dementia, yet research on their experiences is limited. Previous research has shown this population has higher levels of unmet care needs and lower financial resources than their married peers. By exploring the experiences of people living alone with cognitive impairment (PLACI), this research examines the successes and barriers within their journey to inform how interventions can improve their quality of life. We conducted qualitative interviews with 15 PLACI (median age 69, 87% white, and 80% female) to explore perceptions of future care needs and resources. Through a modified ideal-type analysis, participants' thought processes and actions regarding help-seeking were mapped to the five stages of the transtheoretical model. These perspectives suggest opportunities such as connecting them to community social work that could help facilitate their understanding of their needs, help them identify resources, and promote proactive aging.

Guided by the lifecourse perspective and social determinants of health framework, this study examined the association of childhood housing with old age health among Chinese and its midlife mediators. Respondents were middle-aged and older adults (aged 45+) from the China Health and Retirement Longitudinal Study (N = 12,842). They were asked about their childhood housing conditions (e.g., if their houses had clean water, water toilet, and electricity). Adulthood socioeconomic and medical history and middle- and old-age health were measured. Causal mediation analysis showed childhood better housing was directly associated with fewer depressive symptoms and better cognition in middle- and older-age, and indirectly through increasing education level. However, the proportion-mediated estimate had very wide confidence intervals. Our findings suggested the importance of broad infrastructure development and adult continuing education programs among those who grew up in poor housing conditions to promote mental health in older age.

A recent Canadian study conducted in one province identified family caregiver support needs and essential support services when caring for older community-based family members requiring assistance with activities of daily living. Weekly interviews of 150 volunteer caregivers over 6 months identified 11 support needs and 5 essential support services. Scoping literature reviews of the 11 needs found they had all been identified before. Program logic investigations of the 5 support services identified a patch-work of temporarily available support services in existence across the province. Two governmental policies are recommended: (a) provincial policy assuring access to the five support services, and (b) federal policy for federal-provincial funding transfers to address the provincial cost of assured community-based support services. Family caregivers require this support to maintain their own and their family member's well-being, particularly as this caregiving prevents or delays older family member hospitalizations and nursing home entry.

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Given that women are disproportionately affected by dementia on several levels and assistive technology (AT) is increasingly used to manage the care of the growing number of people with dementia (PwD), there is an urgent need to understand the role of sex and gender regarding adoption of AT in dementia care. We conducted a scoping review following the framework of Arksey and O'Malley. All identified topics of sex and gender analysis (compatibility, attitude, usage, acceptance, access, usefulness, and well-being) were related to AT adoption, where the majority revealed sex and gender differences. Relevance of topics is discussed in relation to generation, culture, and mental health, including a switch of perspective to the gender of the technology. Even though we demonstrated sex and gender differences in AT adoption, their practical implications need to be further elaborated on in future research.

Research suggests that nursing facility structural characteristics are important contributors toward residents' quality of care. We use 2021 data from 220 Maryland nursing facilities to examine associations between two different quality-of-care metrics: family satisfaction and Care Compare five-star quality ratings. We used descriptive statistics to explore differences in quality metrics across facility ownership (for-profit vs. non-profit), geographic location (urban vs. rural), and resident census (1-60, 61-120, and 121+). Relationships were examined across overall ratings, as well as across subdomains of the two frameworks (e.g., staffing). Family members of residents in non-profit, rural, and low-census facilities rated facilities higher. Non-profit and low-resident census facilities were more likely to be rated four or five stars, while no significant association was observed across geographic location, or interactions across structural factors. Findings emphasize the need for comprehensive quality-of-care frameworks that explore quality care across stakeholders and types of facilities.

Psychosocial function is associated with cognitive performance cross-sectionally and cognitive decline over time. Using data from the COMPASS-ND study, we examined associations between psychosocial and cognitive function in 126 individuals with mild cognitive impairment, an at-risk group for Alzheimer's disease (AD). Psychosocial function was measured using questionnaires about mental health, social support, and social engagement. Composite scores for five cognitive domains were derived using principal component analysis. Multiple linear regression models were used to test the effects of various psychosocial factors on cognitive performance, controlling for age, sex, education, MoCA scores, and living circumstances. We found that low current participation in one's social networks, over other psychosocial factors, was associated with worse verbal fluency and processing speed scores than those endorsing normal or high social participation. Our findings provide groundwork for further psychosocial-cognitive analyses in individuals at-risk for AD to better understand the role of poor social engagement in cognitive decline.

The daily Internet use among older adults has increased. This study examines how Internet usage affects depressive symptoms among older adults, focusing on gender differences. Using data from the 2015 National Health and Aging Trends Study (N = 6380), weighted multinomial logistic regression analysis was conducted. Men tended to access the Internet more for instrumental purposes and health-related matters compared to women. Conversely, women used social networking sites (SNSs) more frequently. Men were more inclined to use the Internet for personal tasks and health concerns than women. SNS use was positively associated with mild and major depression in men, while email or texting was negatively linked to their major depression. Internet use for health matters was negatively associated with major depression in women. The discussion emphasizes potential service and policy innovations aimed at leveraging digital technology to improve the mental health of older individuals, considering gender differences.

Improving early detection, management, and treatment of comorbid conditions to dementia in residential care could slow down cognitive and functional decline, and increase residents' quality of life. We conducted a Delphi study comprising three rounds (two surveys and an interview) to identify the most difficult dementia comorbidities to deal with in residential care and related issues. Participants were 15 UK-based experts including academics, residential care workers, geriatricians, and neuropsychologists. In the first-round of the Delphi, experts mentioned 15 comorbid health conditions to dementia and 19 issues. In the following rounds of the Delphi mental illnesses, delirium, and sensory impairments were identified as the most difficult comorbidities to dementia to deal with. Medication management, symptom management, shortage of staff, lack of training among staff, and limited resources from the broader healthcare system were identified as the most difficult issues when dealing with dementia comorbidities.

Background: During 2020-21, states established essential caregiver (EC) programs which allowed nursing home residents to receive in-person supports during the COVID-19 pandemic. This study presents comparative data on the designs of these programs. Methods: We conducted on-line searches for federal and states' nursing home visitation and reopening guidelines published in 2020-22. We also compared differences between states with and without an EC program in COVID-19 infection and death rates among nursing home residents or the general population, nursing home staff shortage rates, and rankings on restrictiveness of social distancing policies. Among states with an EC program, we summarized key program characteristics. Results: Twenty states established nursing home EC program from late 2020 to early 2021. Compared to states without an EC program, states with the program had slightly higher COVID-19 infection rate but slightly lower COVID-19 death rate, similar nurse staffing and nursing aids shortage rates in nursing homes, and somewhat lower rankings on the restrictiveness of social distancing measures. Compared to CMS guidelines that banned indoor visits to nursing homes under defined circumstances from March 2020 to November 2021, state EC programs were much less restrictive in specifying caregiver visits, for example, visits were allowed when county COVID-19 positivity rate>10% (18 programs), when the resident was not vaccinated (20 programs), or when the nursing home was in a COVID-19 outbreak (13 programs). However, state EC programs might still prohibit EC visits in certain situations, such as when the resident was in transmission-based precautions (13 programs), that is, when the resident had a confirmed COVID-19 infection, had COVID-19 symptoms although not yet confirmed, or was in observation for developing COVID-19 infection in the 14 days of nursing home (re)admission. Conclusion: States with and without a nursing home EC program did not differ appreciably in COVID-19 infection and death rates, or staffing shortage rates in nursing homes, although states with an EC program might have slightly less restrictive social distancing policies. State EC programs varied substantially in key designs. Comparative evaluations are needed to understand the effectiveness of these programs.