Gerontologist最新文献

Background and objectives: There is a large and growing population of older, formerly homeless adults living in permanent supportive housing, and there are concerns about how to address their healthcare needs. This study compared veterans aged 55 years and older residing in the Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program to an age-matched group of independently housed veterans receiving care through the U.S. Department of Veterans Affairs (VA) healthcare system on health and healthcare service use characteristics.

Research design and methods: Cross-sectional analyses were performed on 1,436,537 (66,072 HUD-VASH vs. 1,370,465 housed) eligible veterans with index encounter dates between October 1, 2021, and July 31, 2022, using linked data from the VA's Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. Propensity-score adjusted logistic regression models were constructed to compare aging HUD-VASH vs. housed veterans on outpatient and inpatient healthcare utilization.

Results: HUD-VASH veterans were more likely to have physical and mental health morbidities, including substance use disorder than their independently housed counterparts. HUD-VASH veterans were less likely to utilize outpatient medical services, and more likely to use emergency and inpatient care services than independently housed veterans.

Discussion and implications: Older veterans in the HUD-VASH program have greater healthcare needs and different patterns of healthcare utilization than their independently housed counterparts. Targeted interventions that better engage and reduce barriers to care among aging populations in supported housing are needed.

Background and objective: There is a dearth of literature regarding the communication needs of family caregivers of institutionalized older adults and the degree to which these needs are fulfilled. This study aimed to clarify those needs regarding communication with staff in geriatric facilities during older non-communicative residents' end-of-life.

Research design and methods: Personal interviews were conducted with 135 family caregivers from two geriatric medical centers and two nursing homes in Israel. Questions referred to quality of available communication and family caregivers' communication needs. We utilized inductive content analysis to identify these needs.

Results: The first and last authors independently examined all the qualitative data regarding family caregivers' needs, and identified themes and categories based on similarities. These were further discussed and modified until agreement was reached. Family caregivers wished to have an available staff member to approach when needed, to be kept current on their older relatives' condition, to feel supported during a difficult time in their lives, and to overcome language and cultural barriers.

Discussion and implications: This is the first study to examined family caregivers' communication needs using a broad perspective that relates to overall needs rather than specific ones, thus yielding a fuller understanding of family caregivers' emotional and practical needs, as well as language and cultural barriers. Translating these needs into practice by offering guidelines on how to fulfill them and developing tailored interventions and tools to assess them may improve not only communication, but also end-of-life care for residents of geriatric facilities.

Background and objectives: COVID-19 negatively influenced resident wellbeing in nursing homes (NHs). We examine perceptions and experiences of U.S. NH staff during the COVID-19 pandemic regarding resident wellbeing.

Research design and methods: We sampled 68 NHs (out of 13,423) in strata defined by quality ratings, urban/rural location, and whether they served a resident population of <70% White. We enrolled 10 NHs and interviewed 11 nursing staff (8 certified nursing assistants/aides, 3 registered or licensed practical/vocational nurses), 12 managerial staff (4 administrators, 8 Directors of Nursing), and 5 infection preventionists. Thematic analysis identified themes related to challenges of quarantine/isolation, attempted solutions, and lessons learned concerning resident wellbeing.

Results: NH managerial, infection prevention and nursing staff described how COVID-19 policies contributed to increased resident loneliness and declines in physical and cognitive wellbeing. Solutions/strategies employed across the U.S. and in low-and high-quality NHs included proactive mental health support, resident-centered family visitation, increased communication and care planning with families and efforts to maintain resident normalcy.

Discussion and implications: Strategies to mitigate and alleviate concerns with resident wellbeing were both structural and made via staff choices. NH leadership needs to proactively plan how to adapt processes and structures that prioritize resident wellbeing along with resident care in times of crisis. Research is needed to outline the planning, implementation, and recommendations required to operationalize these strategies into practice. Determining the most effective ways to implement these structural changes within NH practices and workflows is critical to ensure that staff have sufficient time to spend with residents.

Background and objectives: Older people with cognitive impairment are unrepresented in clinical research. Our objective was to review evidence for strategies to support their research inclusion and participation.

Research design and methods: Systematic review of published reports of inclusion and participation strategies for older people with cognitive impairment in clinical research (PROSPERO CRD42020212092). Five databases were searched September 2020, March 2023 and April 2024. Screening, full text review and data extraction were independently performed. Risk of bias was assessed using Scottish Intercollegiate Guidelines Network Methodology Checklists. Outcomes were participant characteristics, recruitment and consent processes, retention, experience, involvement of others, adverse events, and other reported outcomes.

Results: Of 4564 identified sources, 12 studies were included. Nine compared recruitment strategies; three examined consent processes. Of 4,208 participants (mean age 78.3 years), 61% were female. Median (interquartile range) monthly recruitment rate was 10.3 (5.6-14.8). Participants had mild cognitive impairment, dementia and/or delirium and two-thirds of studies involved proxies or study partners. Community outreach or population screening had higher recruitment compared to primary care referral and/or screening. Formal capacity and consent methods achieved lower rates of consent compared to informal. A memory and organisational aid increased participants' ability to provide informed consent compared to standard assessment. Few studies reported participants' or recruiters' subjective experience, and no studies reported participant retention or adverse events.

Discussion and implications: Targeted, tailored and multi-pronged recruitment and consent strategies to support inclusion of older people with cognitive impairment appear promising. Higher quality studies are needed to confirm this finding.

Background and objectives: Given the stigma of dementia, individuals with the condition may be wary to disclose their diagnosis to other people, both in face-to-face and digital settings. While sharing one's dementia diagnosis with others is essential for accessing valuable support for social, cognitive, and physical well-being, this area of research has largely been neglected. In this meta-synthesis, we aimed to systematically review qualitative research on the factors associated with online and offline self-disclosure in people with dementia.

Research design and methods: We conducted a systematic search in six electronic databases. Inclusion criteria comprised qualitative and mixed-methods studies describing experiences with self-disclosure in people with any type of dementia. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The meta-synthesis was conducted in NVivo using a thematic synthesis approach.

Results: Twenty-eight studies were included. Three analytical themes were generated: 'Concealment', 'Stigma and fear', and 'Taking control', the latter two with subthemes. Findings from this review were corroborated with people with dementia and family carers as part of Patient and Public Involvement meetings. Our findings reveal that while stigma plays a pivotal role, people with dementia can take control of the meaning of their diagnosis through self-disclosure.

Discussion and implications: Self-disclosure is complex and multifaceted. People with dementia, particularly those experiencing stigma, can benefit from post-diagnostic support that encompasses resources and interventions for self-disclosure. Further research is required to investigate people with dementia's disclosure decision-making process.

Mistreatment of older adults is common and has serious health consequences but is under-recognized and under-reported. Screening for mistreatment of older adults and initiation of intervention in primary care clinics may be helpful, but the value of existing tools is not supported by evidence. We argue that shifting the focus to individual sub-types of mistreatment of older adults can provide improved approaches to screening and ultimately to intervention. We focus on the example of caregiver neglect, the subtype associated with highest mortality. To develop caregiver neglect screening and intervention programs and to measure their effectiveness and impact, we assert that it is critical to: (1) define the phenomenon, (2) develop a conceptual model to explain why it occurs, (3) develop measurement strategies, and (4) systematically examine existing literature. We describe here the initial components of this development process.

Background and objectives: Older people with memory problems living in temporary hostel accommodation have longer stays and higher care needs than those without memory problems. In this ethnographic study, we aimed to elucidate how staff currently support older hostel residents with memory problems, what contextual factors determine support given and, what facilitates positive and meaningful outcomes for staff and residents.

Research design and methods: We conducted interviews and participant observations with older people (≥50 years) experiencing memory problems and homelessness (interviews n=17, observations n=13), hostel staff and managers (interviews n=15, observations n=20) from seven residential facilities (six hostels and one care home), and health and social care practitioners (interviews n=17, observations n=7), from September 2021-December 2022 in London, England. We analyzed thematically from a critical realist position.

Results: We identified four overarching themes: (1) Compensatory strategies and routines, (2) hostels are not homes, (3) meeting challenging interactions with compassion, and (4) facilitating opportunities for meaningful interactions. Social interactions for people with memory problems were restricted and, although sheltered by living in hostels, this did not equate to safety or provide opportunities for positive interactions.

Discussion and implications: Staff worked hard to connect with older residents with memory problems, in resource and time-poor contexts, often left to provide care beyond their roles in contexts of unmet need. Our ethnographic account has informed co-design of a support intervention for hostel staff working with older people with memory problems, alongside recommendations for policy and practice.

Background and objectives: Studies involving dementia caregivers are essential to transform care and inform new policies. However, identifying and recruiting this population for research is an ongoing challenge. This scoping review aimed to capture the current methodology for identifying and recruiting dementia caregivers in clinical studies. A focus was placed on methods for underrepresented populations and pragmatic trials to guide pragmatic and equitable clinical studies.

Research design and methods: Researchers conducted a literature search using PubMed, PsycINFO, EMBASE and Web of Science databases. Studies conducted in the United States that enrolled at least 10 caregivers and were published within the last 10 years (2013-2023) were included.

Results: Overall, 148 articles were included in the review. The most common method for identification was community outreach, and paper advertisements for recruitment. Caregivers were most often approached in community settings, formal organizations, and/or dementia research centers. Most enrolled caregivers were female, White, and spouses of persons living with dementia. Race and ethnicity were underreported, as were the target recruitment goals. Limited studies were self-reported as pragmatic. Additionally, limited studies reported adaptations for methods of identification and recruitment in underrepresented populations.

Discussion and implications: We identified gaps in current practices for the identification and recruitment of dementia caregivers. Future identification and recruitment methodologies should be tailored to the intervention's intent, health care setting, and the research questions that need to be answered, while balancing available resources. Additionally, transparent reporting of identification and recruitment procedures, target recruitment goals, and comprehensive demographic data is warranted.

Older adults on the autism spectrum exhibit a broad array of strengths and limitations. While exceptional abilities may be masked by difficulties in presentation and communication, hidden disabilities can lead to unmet needs for accommodation and support. Critical to the recognition of disabilities is subjects' readiness to disclose potentially stigmatizing conditions or concerns-weighing the benefits of self-disclosure (e.g., for effective medical care) versus risks (exposure of weaknesses or vulnerabilities). Strategic self-disclosure, based on reading of immediate social contexts, can be problematic for autistic persons who have difficulty processing social cues demarcating situationally appropriate boundaries. Disclosure of autism by older patients in clinical settings can lead to troubled interactions that reinforce stereotypes of aging conflated with disability and educe implicit biases regarding older patients and autistic persons. Future gerontological research and policy initiatives should be designed to empower older autistic adults (and others with lived experience of disability and marginalization) by including them as expert partners in the quest for needed societal change-challenging ableist assumptions embedded in traditional definitions of successful aging, promoting an open awareness context that normalizes the occurrence of disability, and fostering expectations of interdependence (as opposed to helpless dependency or complete independence).

Background and objectives: Previous studies have indicated that married people are generally healthier than unmarried people, with lower mortality rates. Most work in this area has employed cross-sectional data, and few studies have examined change in marital status from married to unmarried as a potential social ecological determinant of dental health behavior. Here, we used longitudinal data to examine change in dental behavior over time following marital status change, and to explore whether self-reported gender may play a modifying role in any behavioral change.

Research design and methods: Employing panel data from the Health and Retirement Study (1996-2018) to follow all individuals who entered the study in married/partnered status, and using both 2-way fixed effects and group-time average difference-in-difference models, we analyzed the association between any change in marital status and dental care use, compared with individuals who remained married. All analyses were stratified by gender.

Results: Both types of difference-in-difference analyses indicated that both widowhood and divorce were associated with a decrease in dental care use in both genders. Divorced men saw the greatest decrease in dental care use. We found gender had a moderating effect on strength of association in all analyses.

Discussion and implications: This research suggests that any change in marital status from married to unmarried has a detrimental effect on dental health behavior for both genders. Future research might investigate other potential barriers to dental care access these populations might face, in order to develop effective interventions.