Gerontologist最新文献

Background and objectives: We describe nursing home staff perspectives implementing Montessori approaches to person-centered care (MAP-VA) in Veterans Administration Community Living Centers (CLCs) during the COVID-19 pandemic. We investigated staff perspectives on implementing MAP-VA to promote resident autonomy, engagement, and connection in the context of pandemic-related safety precautions.

Research design and methods: We used longitudinal data from a stepped-wedge, randomized clinical trial examining implementation and effectiveness of MAP-VA. Implementation support included 5-weeks during pre-implementation, staff MAP-VA training, 6-months each of implementation facilitation and sustainment support. Normalization Process Theory informed data collection and analyses. Staff (N = 1,117) from eight CLCs participated. No site was COVID-19 free: all sites except one experienced at least one month where 5% or more of residents were infected; one site experienced rates of 16%. We completed individual or group interviews with 162 staff, at baseline, 3-, 6-, 9-, and 12-months between September 2021 and October 2023. We coded transcripts using content analysis and graphed COVID-19 rates over 18-months during implementation.

Results: We identified four themes related to implementing MAP-VA during the pandemic: The waves of COVID-19 and changing precautions were associated with (a) barriers to Veteran engagement and connection; (b) staffing-related barriers to implementation; and during COVID, MAP-VA was a positive force that (c) increased Veteran wellbeing; and (d) improved staff morale.

Discussion and implications: Results indicate that supporting person-centered care in nursing home settings is possible-and perhaps even protective for staff and residents-during crises and periods of increased safety concerns.

Background and objectives: Family caregivers face elevated risks for mental and physical health issues but have difficulty accessing informational and supportive resources. Chat-based artificial intelligence (AI) tools, such as chatbots using large language models (LLMs), may offer scalable, personalized support. This scoping review maps the existing literature on chatbots for family caregivers.

Research design and methods: Following our preregistered protocol and following the PRISMA-ScR checklist, we searched PubMed, Embase, Web of Science, and CINAHL (Jan-Feb 2025) for English-language, peer-reviewed articles on AI/chatbots and caregivers. Eligibility included any article on the use of a chatbot in the caregiving context. Screening and data extraction were performed in duplicate using Covidence. Articles were charted by article type [1: existing chatbots (e.g., ChatGPT) applied to caregiving context; 2: new chatbots developed for caregiving context; 3: 'other' article types] and synthesized narratively.

Results: Of 505 records screened, 30 met inclusion criteria. Seventeen evaluated existing chatbots (primarily ChatGPT), nine described development of new chatbots, and four were commentaries, reviews, or qualitative studies. Most focused on dementia or cancer caregiving. The majority of new or existing chatbot articles focused on provision of informational support, and less often on emotional support or local resources. Chatbot evaluations were typically conducted by experts assessing response accuracy and readability; few reported evaluations by caregivers.

Discussion and implications: Evidence suggests chatbots provide largely accurate, accessible caregiving-related information, though findings for emotional support and safety were limited and mixed. Research remains early-stage, with no randomized controlled trials.

Background and objectives: There are to date only a few culturally appropriate evidence-based psychoeducational interventions to support Hispanic dementia caregivers. The program Cuidando Juntos has recently been shown to be a culturally appropriate adaptation of one such programs. The current paper presents a follow-up quantitative assessment of (a) user-reactions to the Cuidando Juntos program and (b) the preliminary efficacy of the Cuidando Juntos to improve caregiver subjective health & well-being (SHWB).

Research design and methods: A one arm clinical trial was conducted, with a pre-post data collection methodology. User-reactions were assessed via a set of 24 items assessing four domains: 1) helpfulness of program, 2) strategy utilization, 3) skill utilization, and 4) website usefulness. Caregiver SHWB was operationalized as perceived general health, caregiving self-efficacy, depression, stress, and caregiving burden.

Results: Caregivers (N = 31) were mostly female (98%), White (77%), of Mexican origin (71%). Most user reactions were quite positive, with most participants rating all aspects as quite or very positive. Analysis of SHWB indicated significant improvement from pre- to post-intervention, on average, on all five measures. Effect sizes ranged from small (d = .33; general health) to medium (d = .59 to .77; depression, stress and burden) to large (d = 1.17; self-efficacy).

Discussion and implications: Results indicate the program generates positive user-reactions, and participation in the program can yield a small to large positive impact on caregivers' self-reported health and well-being. Further examination of the key psychological factors impacting dementia caregivers SHWB is encouraged.

Clinical trial identifiers: NCT06394388, Unique Protocol ID: 24-0291-01.

Background and objectives: As China accelerates artificial intelligence (AI) integration in care of older adults to address population aging, understanding older adults' (65+) engagement with assistive technologies becomes imperative. However, their intention to engage with these innovations may be significantly influenced by expectation confirmation, which refers to how individuals compare their initial expectations with their actual experience of use. This effect is shaped by framing-the way in which information is presented. This study extends Expectation-Confirmation theory by investigating (a) how expectation confirmation affects older adults' intention to use AI, and (b) whether the performance frame moderates this relationship.

Research design and methods: Through a 3 (expectation confirmation: positive or negative disconfirmation vs. confirmation) × 3 (performance frame: positive or negative frame vs. no frame) experiment (N = 291), we tested our hypotheses by manipulating experienced confirmation and descriptive frames of AI performance.

Results: Expectation confirmation significantly predicted the behavioral intention to use AI (F(2, 281) = 57.376, p < 0.001), and performance frame moderated this relationship (F(4, 275) = 2.830, p < 0.05). The positive frame mitigated the adverse effects of negative expectation disconfirmation, and enhanced the effect of expectation confirmation. The absence of frame was most effective in stimulating the power of positive expectation disconfirmation.

Discussion and implications: Our findings extend Expectation-Confirmation theory by identifying age-specific framing contingencies in AI adoption. Contrary to Technology Acceptance Model emphasizing perceived ease of use and usefulness, our results suggest expectation-frame also impacts older adults' AI adopting willingness.

Synthetic imagery produced by Generative Artificial Intelligence (GenAI) is rapidly transforming how aging is visually represented and culturally understood. However, the accuracy and representational adequacy of these outputs require further examination, particularly when addressing minority or discipline-specific concepts, such as successful aging. This study critically examines GenAI imagery in East Asian contexts, focusing on how representations of gender, class, and successful aging are constructed and circulated. Drawing on the updated successful aging concepts, we integrate visual semiotics with cultural gerontology to treat synthetic images as algorithmic artifacts that reflect and reinforce normative ideals of later life. Using critical visual experimentation, we used Midjourney to generate 288 images for analysis, guided by prompts addressing social, affective, and environmental dimensions of aging. A total of 36 textual prompts were designed and grouped into three thematic categories: minimal descriptive prompts, scene-based prompts, and value-coded prompts. Our findings reveal gendered aesthetic norms, class-coded relational tropes, and algorithmic failures tied to ageist language. Particularly, images generated with prompts containing the phrases "successful aging" and "aging successfully" suggest that the image-generating tool embedded with natural language processing does not adequately interpret these expressions. We argue that GenAI compresses the complexity of aging into stylized, stereotypical, and reductive forms that risk amplifying cultural biases. At the crossroads of achieving reframing aging, our study calls for age-inclusive, culturally grounded AI design and contributes to interdisciplinary debates on synthetic visuality, representational justice, and AI-mediated culture, helping to advance a more inclusive and nuanced account of aging.

Background and objectives: Despite the high prevalence of hearing and vision impairment among people living in long-term care (LTC) and their impact on quality of life, these sensory challenges are often disregarded. Hence, this systematic review aims to identify the actors and factors influencing hearing and vision care behavior in LTC and construct a literature informed behavioral systems map to demonstrate this complex system.

Research design and methods: A systematic review across five databases yielded 23 articles from 3644 screened (January 2013-September 2024). Data on sensory care behaviors in LTC (screening, referring, receiving care, device use, and communication adaptation) were extracted, coded, and mapped to the COM-B (Capability, Opportunity, and Motivation-Behavior) framework with associated actors. A behavioral systems mapping prototype was developed with the synthesized data.

Results: Actors included residents, family members, care staff, LTC management, and hearing and vision professionals. Analysis revealed 31 factors across the COM-B framework related to the five sensory care behaviors. Seventeen factors affected multiple behaviors. Most salient among the interconnecting factors were collaborative care, family engagement, infrastructure, and perception of value. The synthesized behavioral systems map revealed ten feedback loops driving sensory care behaviors.

Discussion and implications: The behavioral systems map provides crucial groundwork for developing comprehensive solutions to enhance hearing and vision care across LTC settings globally. It reveals that hearing and vision care involves multiple stakeholder groups and interconnected COM-B factors, whose components of capability, opportunity and motivation collectively influence care through feedback dynamics, creating emergent, self-organizing behaviors requiring multifaceted approaches.

Background and objectives: Americans live in largely age-segregated worlds. The aims of this study are to (1) characterize the age composition of individuals' social networks and daily social interactions and (2) investigate cross-sectional and longitudinal associations between age diversity metrics and participant outcomes: fluid cognitive ability, emotional well-being, and mortality.

Research design: In Study 1, N = 309 participants aged 25-85 reported on the age of each member in their social network and completed an experience sampling protocol (6 times per day for 10 days), in which they reported on the age of their most recent social interaction partner. In Study 2, we examine longitudinal data (N = 184, Wave 1; N = 191, Wave 2; N = 178, Wave 3; five years between waves) from participants aged 18-94 who followed a similar protocol, with mortality outcomes assessed over a 13-year follow-up period.

Results: We found that participants reported the most social network partners and interactions with people close to them in age. Participants reported the most positive experiences with children and older adults. Positive associations between age diversity and fluid cognitive ability, but not emotional well-being, were consistently observed. Participants with more age-diverse networks and interactions were more likely to have survived the 13-year observation period.

Discussion and implications: Findings highlight potential benefits associated with having a wide variety of ages represented in one's social world. Age-diverse social environments may support cognitive functioning across adulthood and longevity. Encouraging intergenerational connection may be a promising avenue for promoting healthy aging.

Background and objectives: The lifespan of adults with an intellectual/development disability has increased. Caregiving for these adults is often provided by their parents. Few programs address the needs of these older parents, and even fewer have been reviewed for their effectiveness. Our purpose was to answer the question, what are the conditions and features of support programs or interventions that are effective in improving the psychological and social aspects of the lives of parents of adults who have an intellectual/developmental disability?

Research design and methods: The authors conducted a rapid realist review of interventions for parents of adults with an intellectual/developmental disability. We applied midrange theories of family systems, life course perspective, and caregiving to focus on the participant contexts, program mechanisms, and intervention outcomes that were effective.

Results: The interventions in the review were psychoeducation, financial grants, mindfulness, acceptance and commitment therapy, peer support, expressive arts therapy, and institutional placement. All of the interventions reported some success in improving parent wellbeing.

Discussion: We developed five program theories: "Do not add to my burden", "I am in need of self-care", "My needs change as I age" "My life is complex" and "Peer knowledge and support are valuable to me." We also recommended that programs accommodate parents' time constraints, include other family members and caregivers and address the eventual transition of caregiving from parents to others.

Implications: Program theories and our observations are offered to support the development of new interventions and to improve the effectiveness of existing programs.

Background and objectives: Concerns exist about the implications of ownership change on nursing home performance. The objective of this study was to examine relationships between facility and resident characteristics to ownership change in American nursing homes during the COVID-19 pandemic.

Research design and methods: A retrospective cohort of nursing homes was obtained from the Centers for Medicare and Medicaid Care Compare open datasets in the United States, to assess the incidence proportion of ownership change, and conversion during the COVID-19 pandemic. Linkage was made at the facility-level of nursing home at seven semi-annual cross-sectional survey cycles between March 2020 to March 2023. Structural equation modeling examined relationships between ownership change and variables comprising domains in Donabedian's structure-process-outcome model for care quality.

Results: Of the 9,256 for-profit nursing homes with an organization owner that completed two or more semi-annual surveys, 62.8% had an ownership change. Among government (n = 745) and non-profit (n = 2,555) nursing homes with an organization owner, the incidence proportion of ownership change was 48.6% and 42.7%, respectively. Approximately 22.7% of government nursing homes converted to for-profit ownership. Predominant ownership type of facility at baseline modified the association between ownership change and total weighted health inspection score, occupancy ratio, resident seasonal influenza and SARS-CoV-2 vaccination, and the prevalence of long-stay residents having pressure ulcers.

Discussion and implications: Ownership change was prevalent throughout the COVID-19 pandemic period. Factors associated with a change in ownership were related to several care quality metrics, suggesting that ownership change was driven by poorer care quality.