Gerontologist最新文献

Background and objectives: The retirement transition is a period of major change and instability, which may challenge a person's sense of meaning in life. This scoping review sought to characterize the current research on the role of meaning in the retirement transition.

Research design and methods: This scoping review was conducted according to JBI and PRISMA reporting guidelines. Database searches of Scopus, PubMed, PsycINFO, and Social Science Database, and ProQuest Dissertations and Theses Global yielded 738 records (after duplicates removed). Accessory searches yielded an additional 286 records. Eligible articles included peer-reviewed literature and theses (qualitative and quantitative) that explored an aspect of meaning in the context of the retirement transition.

Results: A total of 30 studies (21 qualitative and nine quantitative) were included. These studies examined a broad range of research questions on different aspects of meaning - meaning in life, meaning making, meaningful engagement, and meaning of retirement. Most were single, stand-alone studies (not part of a broader research program) that included only a single time point. Only six studies were longitudinal.

Discussion and implications: This review revealed a heterogeneous set of studies and identified gaps in reporting of important participant characteristics, lack of conceptual clarity in defining meaning, and few longitudinal studies. There is a need for more theoretically driven, programs of research that include longitudinal designs, ideally using mixed methods approaches, to build a richer understanding of the role of meaning during this major life transition.

Background and objectives: Gerotranscendence, a recent adaptive aging theory developed by Tornstam, postulates a mindset shift in old age from a materialistic viewpoint to a more transcendent one. Gerotranscendence is considered a promising aging model, as it approaches specific developmental challenges in late life. However, knowledge of this theory is still maturing and lacks laypersons' perspectives to further validate its components. This study aimed to explore how older adults perceive gerotranscendence and gain insights of their understanding.

Research design and methods: Three focus group discussions were conducted with 18 participants (59-98 years old; mean: 79.5 years). The protocol included open-ended questions on what gerotranscendence, and its dimensions meant (based exclusively on their designations), as well as on the theory's components (after further explanation). The discussions were recorded and transcribed, and a content analysis was performed.

Results: The data were organized into two themes: general suppositions and personal perceptions. This second theme was divided into (i) relatable thoughts and experiences and (ii) a different and complementary understanding of the theory.

Discussion and implications: Despite the lack of knowledge of the meaning of gerotranscendence, older persons presented clear evidence that this topic was meaningful for them and that they experienced aspects of the cosmic, coherence, and solitude dimensions of gerotranscendence. However, in specific points, some participants had distinctive and complementary ideas compared with those espoused by gerotranscendence theory. Obtaining laypersons' perspectives provides a more in-depth understanding of gerotranscendence theory and the cultural aspects it may encompass.

Background and objectives: The widespread availability of evidence-based, community embedded health promotion programs for older adults represents a major achievement in gerontology. Many of these programs may also be suitable for younger adults with early-acquired disability, creating an opportunity to leverage existing resources and networks. However, the evidence base supporting these programs has often excluded people with early-acquired or long-term disability.

Research design and methods: This project represented a "bridging" partnership among a group of academic disability researchers and a community service organization serving older adults. The team identified an existing health coaching program for older adults (EnhanceWellness), engaged in a formal adaptation process, and conducted a 3-arm randomized controlled trial in 505 middle-aged adults with long-term, physical disability. Participant reported outcomes (mood, community participation and self-efficacy) were assessed at baseline, mid-intervention (3 months), post-intervention (6 months) and 12 months, utilizing PROMIS measures. Enhance Wellness was compared to health education or treatment as usual.

Results: Participants were middle-aged (M=55.8 years) and primarily women (79%), who had lived with a disability-associated health condition for an average of 23 years. Linear mixed effects modeling suggested superiority of Enhance Wellness in increasing participation outcomes, and effects were maintained at the 12-month follow-up. Intervention effects were partially mediated by improvements in disease management self-efficacy. There were no significant treatment effects on depression.

Discussion and implications: Results emphasize the potential for adaptation as a strategy to extend the existing network of older adult interventions to serve those living with long-term disability.

Background and objectives: The objective of this systematic review was to determine the outdoor environmental factors that are associated with increased risk of falls and fear of falling in middle-aged and older adults.

Research design and methods: PubMed, Medline, EMBASE, APA Psych INFO, and CINAHL electronic databases were searched through August 2024 for studies that included participants 45 years or older, falls or fear of falling as an outcome, and measure the outdoor environment (i.e., uneven sidewalks, neighborhood disorder). Title and abstract screenings, full text screenings, and critical appraisal assessments were independently reviewed.

Results: The search retrieved 7474 records, 627 full texts were reviewed, and 51 unique studies met the inclusion/exclusion criteria. The number of participants ranged from 12 to 6,720,937. There were 41 studies that included fall outcomes, 5 studies that included fear of falling outcomes, and 5 studies that included both outcomes. Micro-walkability (e.g., sidewalk quality) were the most frequently studied outdoor environmental characteristics and many studies found associations with falls and fear of falling. Macro-walkability (e.g., land use), crime and safety, socioeconomic, greenspace, terrain, physical disorder, and social features were studied to a lesser extent and had mixed findings.

Discussion and implications: The most consistent associations were found between micro-walkability features of the outdoor environment with falls whereas other environmental domains and fear of falling were studied to a lesser extent. Environmental contributors to falls should be considered in future research, policy implementation, and clinical interventions to reduce falls and their negative outcomes for older adults.

Background and objectives: The study aimed to identify key drivers of vaccine hesitancy among healthcare workers (HCWs) employed at long-term care facilities (LTCFs) within selected states. It also sought to determine which interventions, policies, and programs effectively reduced HCW vaccine hesitancy for coronavirus 2019 disease (COVID-19) and influenza.

Research design and methods: The study employed a mixed methods approach, combining secondary analysis of the Behavioral Risk Factor Surveillance System (BRFSS) data, survey research, and focus groups. BRFSS data on influenza and COVID-19 rates informed the selection of states for qualitative sampling frames. HCWs from LTCFs (i.e., skilled nursing facilities and nursing homes) were recruited to complete a survey based on the sampling frame. Additionally, administration and nursing management from participating facilities were invited to participate in focus groups.

Results: Survey results (N = 199 from 23 facilities) showed vaccine hesitancy among HCWs in LTCFs is a complex issue influenced by several factors, such as lack of knowledge, misinformation, and doubts about vaccine safety, efficacy, risks, and benefits. Focus groups (N = 25 from 15 facilities) revealed a spectrum of vaccine hesitancy, ranging from acceptance to outright refusal. The survey and focus groups identified effective interventions to reduce HCW vaccine hesitancy, including educational campaigns, onsite vaccination, and vaccine recommendations from trusted nursing staff.

Discussion and implications: This study provides important insights into addressing vaccine hesitancy among HCWs in LTCF. It highlights the moral and ethical responsibility for targeted interventions to improve vaccine uptake in the healthcare sector.

There are approximately 3,922 Age-Friendly Health Systems (AFHS) sites in the United States (US). These systems promote better healthcare for adults age 65 and older by implementing the following four elements, referred to as the "4Ms", into care provision: 1) What Matters; 2) Medication; 3) Mentation; and 4) Mobility. There are no equivalent parameters to ensure high-quality care for adults with disabilities. This is problematic because many individuals with disabilities experience conditions associated with aging well before their 65th birthday. For example, adults with Down syndrome are more likely to develop earlier onset dementia and many will be diagnosed with Alzheimer's disease in their early 50s. While AFHS are of critical importance, by focusing solely on adults over age 65, we are missing an opportunity to improve the health and well-being of people with disabilities. Many adults living with disabilities would likely benefit from providers deliberately and thoughtfully addressing what matters, medication, mentation, and mobility. In this paper, we posit that implementing the 4Ms framework with younger adults with disabilities has the potential to both enhance compliance with the ADA and lay the ground work for making an equitable, disability-friendly health system a reality.

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 6 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: 28 studies were included. 3 analytical themes were generated: "Concealment," "Stigma and fear," and "Taking control," the latter 2 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.

Background and objectives: An aging population worldwide has highlighted the need for improved care in long-term aged care homes. In Australia, such homes are called Residential Aged Care homes, and reform is underway to improve the quality and safety of aged care. A key enabler of quality improvement is increasing evidence-based practice through creating a system to support research translation. Collaborative multi-stakeholder research networks offer a potential solution by bringing together stakeholders to identify evidence-to-practice gaps, co-design research and translate knowledge into practice. The aim of this scoping review was to understand the current evidence on the creation and maintenance of multi-stakeholder aged care research networks internationally, reported facilitators and barriers, and outcomes.

Research design and methods: An academic literature search in 5 databases to identify existing multi-stakeholder aged care research networks. A grey literature search was conducted using Google, Google Scholar, grey literature databases, and a manual search of targeted websites.

Results: 10 papers and 19 web-based resources were identified, reporting on 6 multi-stakeholder research networks internationally. Enabling factors of successful networks included flexibility in structure, good governance, leveraging pre-existing research relationships, consistent and open communication, staff with dual roles in research and practice, and a focus on building long-term partnerships independent of research projects.

Discussion and implications: Collaborative multi-stakeholder research networks offer promise for improving research translation in aged care. Advancing the development of impactful multi-stakeholder aged care research networks requires internationally agreed terminology for network models, clear reporting and evaluation guidelines, and dedicated infrastructure resources.

Background and objectives: Amidst the growing global visibility of older lesbian, gay, bisexual, transgender, queer, and gender and sexually diverse (LGBTQ+) individuals, the predominantly American research has established that they face continued prejudice and discrimination. Yet, few studies outside of the United States have examined their life course experiences, including those related to adverse events. Building on the existing research, the present qualitative study uses a life-course perspective to explore older LGBTQ+ Canadians' experiences of prejudice and discrimination.

Research design and methods: We recruited and conducted multiple, in-depth, semi-structured qualitative interviews with 30 LGBTQ+ Canadian individuals, aged 65 to 83, about their life course experiences, including if and how they had been treated differently because of their gender identities, sexual orientations, and ages. Interview transcriptions were coded and analyzed using descriptive thematic analysis.

Results: All 30 participants reported traumatic and adverse experiences in patterned ways across the life course. Whereas they often faced abuse and harassment in childhood and young adulthood, they frequently reported institutionally situated prejudice and discrimination in mid-life. Despite changing laws and social norms, in later life participants were subjected to targeted mistreatment and systemic neglect and exclusion as a result of their gender identities, sexual orientations, and ages.

Discussion and implications: Findings from this study corroborate previous research and shed light on the ways that prejudice and discrimination have often permeated the lives of older LGBTQ+ Canadians. The research also points to the continued and urgent need to fight bigotry through education, policy, and progressive legislation.

Background and objectives: Research has yet to seek a more complete understanding of how people aging with intellectual disabilities experience their social relations, and how their earlier life experiences impact the development of their social relations. This study investigated the experiences of older adults with intellectual disabilities with their social relations from a life course perspective.

Research design and methods: A process of paired recruitment generated a sample of 12 adults with intellectual disabilities age 50 and over with at least one key support person each. Data collection consisted of in-depth qualitative life history interviews with the participants and their key support persons using lifelines.

Results: Thematic analysis of the interview transcripts demonstrated that the participants' social relations facilitated positive experiences in the first parts of their lives. The participants felt their lives were disrupted by several transitions as they reached young and middle adulthood such as moving out of the family home, parental divorce and the deaths of parents. Challenging social encounters such as abuse, bullying and conflicts caused distress and negatively impacted the participants' well-being at various points in their lives. Finally, participants simultaneously expressed feelings of belonging and longing as central to their social well-being in late life.

Discussion and implications: Study findings highlight complex experiences of adults with intellectual disabilities with their social relations across their lives. They promote further development of strategies for person centered planning such as social network mapping and life story work to better support adults with intellectual disabilities as they age.