Journal of Applied Gerontology最新文献

Objective: This study evaluates clinical characteristics, hospitals outcomes, and mortality determinants in older sepsis patients before and during COVID-19. Methods: Retrospective of sepsis cases (aged 65+) from nine hospitals (2018-2020) using ICD codes. Multivariate logistic regression was used to analyze mortality predictors. Results: Of 4635 sepsis patients, 515 (11.1%) passed in-hospital, with mortality rising to 13.9% during the pandemic from 10% prior (p < .01). Pandemic admissions had more racial minorities and severe comorbidities. Patient safety indicator events decreased during the pandemic (14.8% vs. 17.9%, p < .01), while home discharge rates remained consistent. Pandemic admission and lack of insurance correlated with increased mortality, alongside advanced age, ICU admission, and opioid and sedative use. Conclusion: COVID-19 pandemic admission and socioeconomic factors heightened mortality risks in older sepsis patients, highlighting the need for targeted care strategies.

Objective: This study investigates changes in clinical encounters due to falls before and after the onset of the COVID-19 pandemic.

Methods: De-identified health record data from a large mid-western health system was used to examine the frequency of emergency department (ED) and inpatient (IP) encounters for falls by month among adults age 50+ (N = 485, 886 patients) using joinpoint regression analysis. Also, overall rates before and during the pandemic were compared using log-binomial models.

Results: Fall rates increased following the onset of the COVID-19 pandemic for IP encounters but not for ED encounters. There were no differences by age, gender, race, or nSES. Monthly IP fall rates increased by 0.68% per month both before and after the onset of the COVID-19 pandemic.

Conclusion: Pandemics may occur in the future, and interventions are needed to prevent falls in older adults during the next public health emergency.

This study examined the psychometric properties of the eight-item Hospice Philosophy Scale (HPS-8) through confirmatory factor analysis; differential item functioning by age, gender, race, and professional discipline; and internal consistency reliability. We administered the HPS-8 to a national convenience sample of 471 interdisciplinary hospice clinicians. Confirmatory factor analysis results supported a one-factor model with an error correlation between two similarly worded items, χ²(19) = 48.38, p < .001 (RMSEA = .06, SRMR = .03, CFI = .98, TLI = .97). "Multiple indicators, multiple causes" model results indicated differential item functioning by age, race, and/or professional discipline on five items. However, subsequent uncorrected and differential item functioning-corrected models detected no statistically significant HPS-8 mean differences by grouping variables. Composite reliability results (CR = .82) demonstrated acceptable internal consistency reliability. Our results support the HPS-8 as a valid and reliable measure of attitudes toward the hospice philosophy of care in hospice clinicians.

Older adults with Alzheimer's disease and related dementias (ADRD) had a high risk of COVID-19-related mortality. Racial and ethnic minorities were disproportionally impacted by the pandemic. The variations in disparities, including racial and ethnic disparities and disparities across communities, in COVID-19-related mortality across the different stages of the COVID-19 pandemic among the ADRD population are unknown. This observational study estimated linear probability models for community-dwelling older adults with ADRD who were diagnosed with COVID-19 in 2020 and 2021 using multiple national data (e.g., Medicare data), accounting for individual and community characteristics. Disparities in 30-day mortality were compared between 2020 and 2021. The socioeconomic disparity in COVID-19-related mortality across communities became insignificant during the later stage of the pandemic, ethnic differences in COVID-19-related mortality decreased but persisted, and racial disparity remained largely unchanged. The study provides insights into interventions to mitigate lingering disparities in health outcomes among the vulnerable population.

Accessible housing for the aging population is important, but large-scale reliable information on accessibility problems in ordinary housing is lacking. This study aimed to describe the prevalence of environmental barriers and analyze potential accessibility problems in the Swedish housing stock and to evaluate the validity and representativeness of housing data collected in a citizen science project. Data on environmental barriers in 1181 dwellings were collected by members of the public. Prevalence of barriers and potential accessibility problems were analyzed using descriptive statistics and ranking methodology. Validity and representativeness were addressed by comparisons with public statistics and research, and analysis of data properties. It was found there are substantial numbers of environmental barriers in dwellings across Sweden that generate accessibility problems for people with functional limitations. The results suggest that with user-friendly data collection tools and instructions, data validity and representativeness can be achieved in citizen science projects involving older adults.

Pain medication is commonly used among older adults with arthritis, elevating the risk of falling. We examined fall risks related to the frequency of taking pain medication among community-dwelling older adults with arthritis by analyzing a nationally representative sample of community-dwelling Medicare beneficiaries aged >65 with self-reported arthritis (n = 4,225) in the 2015 National Health and Aging Trends Study. The survey-weighted logistic regression revealed that after controlling for confounding factors, recent falls were associated with taking pain medication daily compared to never (OR = 1.45, 95% CI: 1.06, 1.96). The other categories of medication frequency, compared to never, were not associated with fall risk. Findings suggest that more prudent use of pain medication should be stressed by health care providers for older adults with arthritis to help reduce the risk of falls and fall injuries. Nonpharmacological pain management is encouraged to support active living among older adults with arthritis.

We evaluated the relationship between neighborhood disadvantage (measured by the Area Deprivation Index [ADI]) and frailty. We performed a secondary analysis, pooling cross-sectional data collected from 209 people with HIV (PWH) aged ≥50 years enrolled in studies in Colorado (CO) and Missouri (MO). MO participants (N = 137) had a higher ADI (µ= 70, ơ² = 25) compared to CO (µ= 32, ơ² = 15; p < .001). No significant differences in ADI were observed between frailty categories when cohorts were examined either separately or combined; however, when comparing individual frailty criteria, the most apparent differences by neighborhood disadvantage were seen among those with limited physical activity (μ = 67, ơ² = 28) compared to those without (μ = 55, ơ² = 29, p = .03). Neighborhood disadvantage was associated with low physical activity but not with overall frailty status. Future research should examine how access to physical activity spaces varies based on ADI, as this could be crucial in preventing frailty.

Reminiscence has been found to be an effective therapy for older adults and researchers and practitioners have identified a range of benefits, from cognitive stimulation to the reconciliation of past experiences. In this qualitative study, the authors explore the experiences of older adults engaged in a technology-enhanced form of reminiscence therapy (RT) using three-dimensional (3D) printed objects from peoples' past. Content analysis of individual interviews with seven participants (n = 7) revealed three themes: (1) positive experiences with the RT intervention; (2) reflections on the use of 3D printed objects; and (3) the development of relationships between participants and researchers. These findings suggest that RT using 3D printed objects can be effective, but only if objects are accurate and if it suits participants' personalities. Researchers and practitioners may find that the use of 3D printed objects can enhance their RT interventions and thereby enrich the lives of older adults.

Knowledge about COVID-19 enters into many aspects of decision making, especially for older people who are at increased risk of severe disease or death. Yet little is known about the resources that supported older people's uptake of COVID-19 knowledge. Here, we hypothesized that higher pre-pandemic health and financial literacy was associated with higher COVID-19 knowledge. Participants were 434 community-based older people without dementia. COVID-19 knowledge was assessed via a 5-item measure, and health and financial literacy was assessed via a 32-item measure. In an ordinal regression model adjusted for age, gender, and education, higher literacy was associated with higher COVID-19 knowledge (p < .0001), and this association persisted after further adjusting for robust measures of global cognition or one of five specific cognitive domains (all p's ≤ .0001). These findings suggest that literacy plays a key role in supporting older people's acquisition of impactful knowledge in the real world.

This study investigated the benefits and challenges of intergenerational tutoring in a post-pandemic context. We explored how the benefits of intergenerational tutoring vary among subgroups of volunteers-first-time tutors, male tutors, tutors who are caregivers, and tutors with moderate or severe loneliness. Older adult tutors (N = 319) were surveyed before and after the 2021-2022 school year, and the data were analyzed with structural equation multivariate regression and thematic analysis. Results indicated that while public health measures like mask-wearing posed challenges for some tutors, there were positive outcomes for tutors, especially first-time tutors, who experienced more health and well-being benefits, and tutors who are caregivers, who experienced improved civic attitudes towards public education. These results can help programs attract subgroups of volunteers who are likely to benefit the most, as well as attend to the unique challenges of pandemic-related policies.