Gerontologist最新文献

Background and objectives: The coronavirus disease 2019 pandemic negatively affected nursing home administrators (NHAs). This study explores licensed and employed NHA's perceptions about what work stress events would drive their turnover intentions (TI) in year 3 of the pandemic.

Research design and methods: As part of a larger survey-based research project collecting numerical and textual data, this study conducted content analysis with qualitative data. Narrative data from 3,859 discrete responses of 1,139 NHAs, from 50 states and Washington, DC, on 2 open-ended electronic survey questions asking about their work stress and TI were collected from February to March 2022. Categories and subcategories were counted and discussed in context as themes.

Results: We identified 4 main narrative categories with subcategories about NHA's stress about the regulatory system (e.g., excessive, conflicting, changing regulations), staffing (e.g., insufficient, agency staff), organizational pressures (e.g., work overload), and macro system stressors (e.g., media representation of nursing homes). Three main TI categories with subcategories were identified: the long-term care (LTC) setting and system (e.g., regulatory demands, staffing, facility surveys); personal factors (e.g., stress, career opportunities); and others (e.g., "I would never quit" or "I already decided to quit").

Discussion and implications: Whole community disaster planning, person-centered surveyor training, improved regulatory guidance, simplified reporting, adequate guidance assistance, and adequate staff could mitigate NHA stress and TI during crises. Administrator resilience should be recognized. Solutions for supporting NHAs can include long-term care industry participation in public health disaster preparedness coalitions, consistent regulatory guidelines with established communication channels, and ongoing crisis leadership training for administrators.

Spanning nearly 30 of the 50 years in which the National Institute on Aging (NIA) has existed, the Resource Centers for Minority Aging Research (RCMAR) program represents one of the most successful initiatives for advancing minority aging research and diversifying the scientific workforce within the Institute and across the National Institutes of Health. This article celebrates the genesis of the RCMAR program, beginning with the need to enhance this work, ranging from theories underlying the then-nascent field of health disparities research to study design, measurement, and analytic procedures. It describes the companion focus on preparing, expanding, and diversifying generations of future scholars/scientists to carry forward these advances. RCMAR's emphasis on promoting a comprehensive approach to research career development and building supportive learning communities heralded a more holistic approach to training than was previously the case. The discussion describes the evolution of the structure and emphases of the RCMAR program as it has responded to the frequently changing political, funding, and research environments. The article concludes by highlighting the major successes of this initiative, the challenges it faces, and opportunities afforded future growth as individual centers, the program at large, and NIA as a whole continue to innovate as they collectively address the original goals that remain relevant today and in the near future.

Background and objectives: Many family caregivers to people with dementia experience persistent physical pain. Though caregivers' pain is associated with poor caregiving outcomes, there is little research on how pain challenges caregiving to yield poor outcomes. This study developed a typology of caregiving challenges from pain among family caregivers to people with dementia.

Research design and methods: We conducted semistructured, in-depth interviews with 25 family caregivers living with persistent pain and caring for people with dementia. We inductively analyzed data via a thematic analysis approach, wherein we identified and categorized caregiving challenges stemming from caregivers' pain. We then analyzed how challenges were related to one another and their consequences for caregiving outcomes.

Results: Analysis revealed 3 interrelated categories of caregiving challenges from living with pain: (a) physical (e.g., difficulty lifting care recipient), (b) psychological/emotional (e.g., worry about future care if their pain condition worsens), and (c) familial/relational (e.g., resentment toward family without pain for not helping with care). Caregivers reported that these challenges compounded one another in ways that made both caregiving and pain management more difficult. Moreover, challenges led to caregivers delaying or skipping care tasks. The nature of challenges and their connection to caregiving outcomes were dependent on various supporting factors, such as whether caregivers reported benefits from their own pain (e.g., greater empathy).

Discussion and implications: The resulting typology informs a conceptual model to guide future translational research on caregivers' pain, including illuminating promising intervention targets of pain self-management programs for family caregivers to people with dementia.

Background and objectives: Nursing home (NH) staff job dissatisfaction and turnover are associated with lower care quality. However, little is known about the impact of being single on workplace experiences. Guided by the Job Demands-Control-Support Model, we compared job satisfaction, turnover intention, and psychological distress for single and partnered parents working in NHs.

Research design and methods: Employee and manager data from the 2011 to 2012 wave of the Work Family Health Network study were combined (N = 1,144) to define parents with complete data (N = 586). Bivariate tests and multivariate regressions clustering observations within NHs were used.

Results: Most single parents (n = 190, 32%) were nursing assistants (NAs; n = 142, 74.74%) or licensed practical nurses (LPNs; n = 29, 15.26%). Compared with partnered parents, single parents were similar on turnover intention and job satisfaction, but they were more likely to report distress (OR = 1.79, 95% CI 1.09, 2.94) observed only among NAs (OR = 2.08, 95% CI 1.12, 3.85). Psychological distress was associated with greater turnover intent (β = 0.02, p < .05) among NAs and LPNs, yet only among single parents (β = 0.04, p < .01). Distress was more likely with higher family-to-work conflict (OR = 1.67, 95% CI 1.18, 2.36) and work-to-family conflict (OR = 1.60, 95% CI 1.20, 2.14) among licensed nurses, yet the distress-work-family conflict associations were only significant for partnered parent nurses.

Discussion and implications: Supporting NH staff depends upon knowing their parental, relationship, and occupational status. Additional research is needed to understand and develop strategies to mitigate psychological distress and increase resources particularly among NA single parents employed in NHs.

Background and objectives: Getting lost can cause profound distress for individuals with dementia and their families, while also imposing a significant burden on society. Existing literature primarily focuses on the incidence and consequences of such cases, overlooking the challenges and issues involved in locating them. To address this gap, the present study aimed to explore the firsthand experiences and efforts of police officers in charge of missing cases.

Research design and methods: This study utilized a cross-sectional research design and conducted in-depth interviews with purposefully sampled police officers responsible for missing persons with dementia in South Korea. The qualitative information gathered from the interviews was analyzed using Content and Thematic Analysis.

Results: Despite various preventive programs and tracking technologies available, traditional methods such as foot searches remain more practical due to difficulties in utilizing such means by individuals with dementia. Additionally, their unpredictable characteristics and the lack of adequate and systematic societal support make even traditional searches challenging. Therefore, cooperation and awareness from caregivers and the community are crucial for police search and rescue operations. The study also highlights the importance of tailored response measures and legal support, as well as the need for collaborative efforts across societal domains for successful outcomes.

Discussion and implications: The findings of this study are anticipated to contribute to a broader understanding of this pressing issue and provide critical insights for developing more effective response measures.

Background and objectives: Recent Medicare payment reforms aimed to improve post-acute access to skilled nursing facilities (SNFs) and home health agencies (HHAs) for patients with complex care needs, including beneficiaries with disabilities. Soon after reforms were implemented, the COVID-19 pandemic began, which disproportionately impacted older adults and people with disabilities. Leveraging Medicare administrative data to identify two distinct cohorts of beneficiaries with disabilities, this study explored changes in their SNF and HHA admission patterns during payment reform and COVID-19.

Research design and methods: Secondary analysis of 2018-2021 Medicare administrative data for two cohorts of fee-for-service beneficiaries with disabilities: 1) enrollees with disability as the reason for original entitlement (OE) and 2) enrollees qualifying based on age who have disabling conditions and/or mobility impairments (C&I). Adjusted linear mixed effects models with interaction terms for disability cohort estimated whether differences in SNF and HHA admissions following hospitalization varied over time by disability cohort.

Results: For 7,732,989 hospitalizations in the OE cohort and 7,028,195 hospitalizations in the C&I cohort, SNF admissions decreased over time while HHA admissions increased. Compared to the C&I cohort, the OE cohort experienced lower SNF admissions throughout the study and smaller changes in SNF and HHA admissions.

Discussion and implications: Both disability cohorts experienced decreased SNF and increased HHA admissions following payment reform and COVID-19. The magnitudes of changes differed between the disability cohorts. These results highlight the heterogeneity in healthcare experiences across disability cohorts and the importance of including multiple definitions of disability in research using administrative datasets.

Background and objectives: Great-grandparenthood brings a new internal dynamic to intergenerational relationships in which contact between four generations is now the norm. In this scoping review, we sought to identify the roles of great-grandparents and what those roles entail.

Research design and methods: We performed a review using PRISMA-ScR to identify peer-reviewed studies investigating the roles of great-grandparents. The reviewed articles were selected from four databases. The article selection conditions were met by 23 studies that used quantitative or qualitative methods. The studies had to be published in English; the selected publications spanned eight countries.

Results: The scoping review covers a collection qualitative and quantitative research with different types of respondents (great-grandchild, grandparents, great-grandparents, etc.). An important element was a statement on great-grandparenting from at least one of the four generations. We selected 23 articles from an initial selection of 176 studies. The studies were heterogeneous in conceptual frameworks, collection methods, and interview conduct, with qualitative methods predominating over quantitative methods.

Discussion and implications: Based on research on great-grandparenting, the roles of great-grandparents can be categorized as continuing, insignificant, or significant. Each role category has a specific function and each represents a different meaning for the great-grandparents within the family. Several factors and constraints frame the great-grandparent roles. Based on the research results, some characteristics are shared by all role categories despite the dividing elements.

Background and objectives: There is an increasing push for broad implementation of evidence-based interventions (EBIs) targeting older adults. Successful delivery of EBIs in communities requires therapists to adhere to protocols and to be responsive to contextual factors. This study explored the real-world implementation of an EBI, the Multiple-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) in Taiwan from therapists' perspectives on fidelity, challenges, and strategies for program delivery.

Research design and methods: We used a convergent mixed-methods design. Quantitative data were collected from the 13-item Perceived Fidelity Questionnaire (PFQ), assessing the perceived importance, proficiency, and adherence to the essential skills of MCI-SET. Qualitative data were collected via two World-Café discussions on implementation challenges and strategies, which were recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative and qualitative findings were then compared and integrated to enrich the interpretation.

Results: Forty-seven occupational therapists completed the PFQ. They rated community-oriented skills as more important, demonstrated greater proficiency, and achieved higher adherence. Qualitative analysis revealed that therapists need to increase and sustain participation by strategically introducing the program, adapting the intervention protocol to make it engaging, relevant to everyday issues, and tailored to local needs, and building rapport. Both quantitative and qualitative findings highlighted the importance of community engagement skills and the adaptability of intervention to implementation and sustainability in communities.

Discussion and implications: Real-world scale-up of evidence-based interventions requires tailored adaptations responsive to community contexts, especially when initially introducing an intervention unfamiliar to the community. This emphasizes the need for a dynamic fidelity concept.

Background and objectives: "Successful aging" concerns the process of growing older while maintaining physical, cognitive, and social wellbeing, emphasizing independence for overall satisfaction and quality of life. We investigate the impact of e-health literacy on reducing loneliness and sustaining wellbeing during the pandemic, comparing middle- and high-income countries.

Research design and methods: Online surveys were conducted between April 4, 2020, and September 30, 2021, collecting responses (N=2091) from medium- and high-income countries in Europe, Asia, and North America. T-tests and ANOVAs were used to test how sociodemographic predictors were associated with differences in e-Health literacy, loneliness, and wellbeing.

Results: Respondents from high-income countries reported significantly higher wellbeing scores than those from middle-income countries and respondents from high-income countries had significantly higher e-HEALS (e-health literacy) scores compared to middle-income countries. No significant difference was observed in loneliness scores between high-income and middle-income country respondents. Wellbeing is associated with age, with younger adults (18-29 years) and those aged 40+ reporting higher levels. Higher education and income are linked to greater wellbeing. Gender differences are observed, with females and those with a partner reporting higher wellbeing. In middle-income countries, higher education levels are more linked to loneliness, while in higher-income countries, loneliness is observed across education levels.

Discussion and implications: Future interventions by governments and policymakers should consider intersectionality in e-Health planning and offer digital literacy and digital skills training to those with lower education levels.

Background and objectives: Few people who are ages 80+ meet the criteria of successful aging (SA) proposed by Rowe and Kahn. Going beyond the individual-level conceptualization, we argue that SA always operates in multiple contexts and that context may become most critical in advanced old age. However, we are not aware of any previous study providing an empirical test of how contexts for SA unfold across persons 80 years and older, including those living in institutions.

Research design and methods: We estimated and compared prevalences of SA based on a classic versus context-enriched understanding of SA in multiple large surveys of older adults, that is, the D80+ study (N = 3.233) and the NRW80+ study (N [baseline] = 1.863). In addition to replication across independent samples, we investigated the stability of context-related SA across time.

Results: Prevalences of SA according to Rowe and Kahn were 9.1% in adults aged 80-84 and 0.7% in persons 90 years or older. However, prevalence rates for those with good contexts at their disposal even if not fulfilling Rowe and Kahn's criteria were much higher across all age groups (80-84 years: 54.9%, 90 years and older: 44.4%). Greater 2-year stability was observed for contextual compared to individual criteria. Notably, positive effects of context on SA were stronger at onset compared to late fourth age.

Discussion and implications: Our findings support a contextualized understanding of SA and inform policy that furthering SA in the fourth age requires the optimization of multiple contexts at the community level.