Gerontologist最新文献

Background and objectives: An ageing 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 five 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 six 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: Healthy ageing is a multidimensional construct, where various factors play a role in influencing wellbeing in older age. Many studies heavily emphasise the importance of physical activity, negating other aspects such as psychosocial or cognitive influences. This review aimed to evaluate the effectiveness of non-exercise-based interventions on the quality of life (QoL) and life satisfaction of community-dwelling, healthy older adults.

Research design and methods: A systematic review and meta-analysis of randomised controlled trials was conducted. Four electronic databases were searched from inception. Three independent reviewers screened the articles and appraised the risk of bias. Data relating to study characteristics, intervention and outcomes were extracted. The mean difference and standardised mean difference with 95% confidence intervals were synthesised to pool effect sizes. Outcomes that could not be included in the meta-analysis were synthesised narratively.

Results: Thirty-six articles from 35 randomised controlled trials, involving 6,127 older adults, were included. Most were multi-component interventions and involved supporting lifelong learning. Most participants were females (70.2%). Pooled analyses revealed small but statistically significant effects on overall QoL (SMD=0.26, CI: 0.00 to 0.53), and QoL subscales relating to mental health and psychological wellbeing (SMD=0.26, CI: 0.12-0.41) and environment (SMD=0.31, CI: 0.03-0.58). Effects on social health and functioning, and role functioning related to physical health were marginal. There were no improvements in other subscales. Results revealed non statistically significant improvements in life satisfaction.

Discussion and implications: Multicomponent non-exercise-based interventions that support lifelong learning in older adults can support healthy ageing, particularly in improving overall QoL, and mental health, social health and environment QoL subscales.

Background and objectives: Screening for elder abuse can improve detection, but many health providers lack the necessary skills and confidence. To address this, training for health providers on elder abuse screening was co-designed as part of a trial aimed at improving elder abuse detection and response.

Research design and methods: Between March and April 2023, 7 health providers and 10 older people and family carers participated in two national Australian online codesign workshops. Using the World Café method, discussions focused on what knowledge and skills health providers needed for screening; clinical and social issues affecting screening and referral; and support older people needed throughout the process. Data were thematically analyzed.

Results: Participants said health providers should take a trauma-informed, person-centered approach to screening, and explain the limits of confidentiality to older people. Clinical, social, and systemic issues such as dementia, ethnic diversity, and housing availability complicated screening and referrals. To facilitate disclosure, participants said health providers needed to reflect on whether they held ageist views. There were differing opinions on the length of the training and if all health providers or only social workers should screen for abuse.

Discussion and implications: Participants' feedback on trauma-informed care, consent, and cognitive impairment concorded with evidence on best practice responses to elder abuse and were integrated in the training. Given operational constraints in health services, feedback from health providers about the training length and the inclusion of all health providers in screening were prioritized. The training is being evaluated in a national trial.

Background and objectives: Among community-living older adults who have limitations in completing Activities of Daily Living (ADLs), unmet need occurs when they cannot complete an ADL task because no one was available to help. Prior research described correlates of existing unmet needs but did not consider which older adults are at risk for new onset of unmet needs. This study assessed health characteristics that increased risk for new onset of unmet needs within a year and subsequent health outcomes.

Research design and methods: Data are from the 2011-2019 annual interviews of the National Health and Aging Trends Study. For each pair of two consecutive annual interviews, we determined whether new onset of unmet needs occurred between the first and second consecutive interviews. Mixed effects logistic regression models were computed to assess risks for new onset of unmet need across 14,890 paired observations from persons who needed help with mobility tasks and 12,514 paired observations from persons who needed help with self-care tasks.

Results: Although demographic characteristics and chronic conditions had modest associations with new onset of unmet need, hospitalization between the two consecutive interviews was associated with a two-fold increase in risk for new onset of unmet need. New onset of unmet need was associated with hospitalization, nursing home placement, and death in the year following the two consecutive annual interviews.

Discussion and implications: The findings inform the need for frequent assessments of ADL care needs with the goal of preventing new onset of unmet needs, especially after hospitalization.

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 2011-12 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 to 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: Since the early 2000s, a global age-friendly communities (AFC) movement has called for improving the built, social, and service environments of localities for aging. Yet research on the outcomes of AFC initiatives, as programmatic efforts toward AFC progress, remains in its nascence. Drawing on "The Water of Systems Change" framework, our study aimed to address this gap by exploring the extent to which accomplishments of AFC initiatives are indicative of altering six conditions for systems change: policies, organizational practices, resource allocations, power dynamics, relationships, and mental models.

Research design and methods: We analyzed qualitative data from 26 key informant interviews across eight mature AFC initiatives in the northeastern United States. We engaged in iterative phases of thematic analysis to explore how the initiatives' accomplishments, as described by the participants, align with each of six focal conditions for systems change.

Results: We found especially robust and consistent evidence for outcomes in terms of enhanced organizational practices on aging; resource flows; connections within and across communities; and mental models about older adults. Evidence for outcomes concerning changes in power dynamics and policy was more limited.

Discussion and implications: Conceptualizing AFC initiatives as systems-change interventions can bolster research, evaluation, and program development as the movement proliferates and diversifies into the 21st century. Insights can help to advance praxis that empowers AFC leaders as changemakers for "successful aging" at the level of society.

Background and objectives: Care Recipient Self-Perceived Burden (CR-SPB) to Caregivers is an important but overlooked aspect within the caregiver-care recipient relationship. This study aimed to 1) develop and validate the CARE-2B (Care Recipient's Two Burden) Scale, assessing both CR-SPB and their proxy assessment of caregiver burden (Proxy-CB); 2) examine whether the CR-SPB and Proxy-CB differ from caregiver burden's own assessment and other health and social care constructs.

Research design and methods: Data were collected from 504 caregiver-care recipient dyads in the US using an online panel between August 2022 and February 2023. Care recipients completed the CARE-2B Scale, which includes two subscales: their self-perceived burden (CR-SPB) and their proxy assessment of caregiver burden (Proxy-CB). Care recipients also completed measures related to health, well-being: SPB-scale, EQ-5D-5L, and EQ-HWB. Caregivers completed CarerQoL and ASCOT-Carer. Psychometric analysis included exploratory and confirmatory factor analysis, item response theory (IRT), and construct validity.

Results: CR-SPB correlated strongly with the SPB-Scale (r=0.73), while Proxy-CB correlated more strongly with caregiver-reported burden (r=0.61). Both CR-SPB and Proxy-CB items demonstrated good discrimination and information coverage in IRT analysis. EFA further supported the distinctiveness of CR-SPB and Proxy-CB, with CR-SPB items loading on a separate factor from caregiver burden and health constructs, while Proxy-CB aligned with caregiver-reported burden.

Discussion and implications: The CARE-2B Scale innovatively assesses both CR-SPB and Proxy-CB from the care recipient's perspective, providing new insights into the caregiving relationship. This dual-perspective measure has implications for enhancing care strategies for individuals with chronic conditions or disabilities and their caregivers.

Background and objectives: Active engagement with life (AE) is an integral aspect of successful aging. Using time diary data, this study explored how U.S. older adults structure their daily lives involving social participation and productive engagement, and the extent to which these patterns differ by race and gender.

Research design and methods: We used American Time Use Survey (ATUS) data (n = 17,990) and sequence and cluster analyses to identify distinctive daily AE patterns. Multivariable linear regression models were used to evaluate associations between AE patterns and self-rated health, and the moderating roles of race and gender.

Results: Five AE clusters were identified: Low Degree of AE (26%), Moderate Unpaid Work & Light Social Participation (39%), Persistent Unpaid Work (20%), Persistent Paid Work (10%), and Persistent Social Participation (4%). White women were the most likely and Black men the least likely to have any AE. Compared to "Low Degree of AE", all other AE clusters were associated with better self-rated health, with these associations varying by gender and race. The strongest positive association was observed for "Persistent Paid Work", especially among women. Racial differences in the association between AE and health were more prominent among women than men. Differences by AE were less pronounced among Black women in comparison to White women.

Discussion and implications: We found that the association between AE and self-rated health varies by race and gender. Persistent structural barriers may prevent older adults from historically minoritized backgrounds, particularly Black women, from benefiting from AE.

Background and objectives: Older adults living with a disability (LWD) face both ageism and ableism, but there are few interventions to address this significant and growing social problem.

Research design and methods: Drawing on the PEACE (Positive Education about Aging and Contact Experiences) Model, three online studies involved participants randomly assigned to watch four brief online videos providing education about aging and disability and exposure to positive contact between younger adults and older adults/older adults LWD (experimental condition) or videos about interior design (control condition). Studies 1 (community sample) and 2 (university sample) included an immediate post-test whereas Study 3 (2 university samples) additionally included a pre-test and delayed post-test.

Results: Experimental condition (vs. control) participants reported greater agreement with older adults LWD as contributors to society (immediate post-test in Studies 1 and 2; immediate and delayed post-test in Study 3), lesser (greater) endorsement of negative (positive) stereotypes of older adults and older adults LWD, lesser agreement with older adults LWD as burdensome, lesser intergenerational tension with older adults (immediate post-test in Study 2; immediate and delayed post-test in Study 3), and greater openness to careers working with older adults and older adults LWD (immediate and delayed post-test in Study 3).

Discussion and implications: Brief online interventions that involve education about aging and disabilities as well as exposure to positive intergenerational contact can be an effective means of reducing ableism and ageism toward older adults and older adults LWD.

Background and objectives: While recognizing the acknowledged difference in dementia prevalence between Indigenous and non-Indigenous populations, most previous studies were conducted in the Global North. This study aims to examine the relationship between Indigenous ethnic identity and dementia status with a special focus on urban-rural differences among older adults in Ecuador.

Research design and methods: Data came from Ecuador's Survey of Health, Welfare, and Aging (SABE), derived from a probability sample of households in Ecuador. The final sample comprised 4,984 adults aged 60 or older. Dementia status was assessed through three indicators: low scores on a cognitive assessment, the number of difficulties in instrumental activities of daily living (IADL), and self-reported dementia diagnosis. Logistic regression and multivariate decomposition analyses were utilized.

Results: Indigenous participants, even after adjusting for sociodemographic and health-related factors, exhibited a higher likelihood of having dementia compared to their non-Indigenous counterparts. Among Indigenous participants, those residing in rural areas had higher likelihood of having dementia status, while there was no significant urban-rural difference observed among non-Indigenous participants. Rural residency and covariates explain 91.0% of the observed difference in dementia prevalence between Indigenous and non-Indigenous older adults.

Discussion and implications: Indigenous older adults who are living in rural areas are at particularly high risk of having dementia largely because they have presently recognized modifiable risk factors. These findings underscore the urgent need to prioritize provisions of appropriate and equitable service related to dementia for Indigenous People living in rural areas outside high-income countries.