Gerontologist最新文献

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

Background and objective: Older adult refugees from Burma face unique challenges in third-country resettlement, yet their experiences are often overlooked in research and policy. This scoping review aims to examine the literature on refugees aged 45 and older from Burma in third-country resettlement contexts, identify factors contributing to successful integration, and elucidate the unique challenges they encounter.

Research design and methods: We systematically searched seven databases using Arksey and O'Malley's framework. Studies were selected if they included refugees from Burma aged 45 and older in third-country resettlement contexts. Data were analyzed using Ager and Strang's conceptual framework of refugee integration.

Results: Six studies met the inclusion criteria. Key findings highlighted disparities in health outcomes based on pre-resettlement environments, the interplay between chronic health issues and employment challenges, the importance of family bonds and institutional support, language proficiency barriers, and the impact of citizenship on self-perception. Instances of resilience and post-traumatic growth were noted, alongside lower reported well-being among older refugees compared to younger counterparts.

Discussion and implications: The review revealed complex interactions between health, employment, social connections, language proficiency, safety, and citizenship in the integration experiences of older refugees from Burma. Findings underscore the need for integrated support systems addressing health and employment, flexible family reunification policies, tailored language acquisition programs, and clear pathways to citizenship. Future research should focus on longitudinal studies, specific employment support strategies, and the long-term impacts of institutional support on integration.

Background and objectives: Increasing numbers of unhoused older individuals in the U.S. underscores the urgency for tailored services and support. Previous studies demonstrate prevalent negative attitudes and dehumanizing perceptions towards unhoused people. Additionally, past research highlights the influence of ageism and dehumanization on the care older adults receive. However, limited work addresses the layered dehumanization faced by unhoused aging individuals. This study investigated how dehumanizing perceptions of homelessness were associated with age.

Research design and methods: In this experimental study, participants (N = 399; M age = 23) were randomly assigned to scenarios depicting unhoused individuals who were discernibly either older or younger. Participants were prompted with different empathy tasks and assessed on dehumanization levels.

Results: Results revealed older unhoused individuals faced significantly higher levels of dehumanization compared to their younger counterparts. Findings also indicated that older participants and male participants demonstrated stronger dehumanization towards unhoused adults.

Discussion and implications: Dehumanization may be intensified for unhoused aging individuals due to their intersecting identities. In turn, this may affect willingness to provide care and the quality of services offered, impacting care settings, medical facilities, and policies focused on homelessness. This research sheds light on the complexities of dehumanization, emphasizing the urgency to address these linked biases to create more inclusive and supportive environments for unhoused aging individuals.

Background and objectives: Grandparents raising grandchildren face many challenges and stress regardless of race and ethnicity; however, they are generally resilient. The present study aims to classify resilience profiles of these grandfamilies using a person-centered approach and examine the association of race and ethnicity with these profiles.

Research design and methods: The present study analyzed cross-sectional survey data collected from grandparents raising grandchildren in the United States (N = 287). A latent profile analysis was conducted.

Results: Latent profile analysis identified two distinct latent profiles: (a) profile 1: high interpersonal support but low spirituality and family confidence, and (b) profile 2: low interpersonal support but high spirituality and family confidence. Results indicated that Black grandfamilies were more likely to be in profile 2 compared to their white counterparts.

Discussion and implications: This suggests the importance of recognizing grandfamilies' different resilience profiles, particularly between Black and white grandfamilies, to develop and implement tailored interventions that leverage their resilience to overcome challenges and stress.

Background and objectives: The analysis of daily memory lapses is an underutilized approach to understanding daily experiences of cognitive functioning. The present study adopts this approach, with the goals of exploring how the quality of family relationships predicts the frequency of daily memory lapses and moderates the link between daily memory lapses and daily affect.

Research design and methods: We used longitudinal data from the third wave of Midlife in the United States and the National Study of Daily Experiences to assess our research goals. Participants (N = 1,236; Mage= 62.48 years, SD= 10.21, range 43-91; 57% female) completed eight nightly telephone interviews that included reports of prospective and retrospective memory lapses as well as daily positive and negative affect.

Results: During a separate baseline interview, participants reported the emotional support they received from their family. Latent profile analysis models identified four family relationship types: pleasant, ambivalent, neutral, and unpleasant. Compared to pleasant relationships, ambivalent (b=.23, p<.05) and neutral (b=.35, p<.01) relationships significantly predicted a higher frequency of prospective memory lapses; this effect was not found among retrospective lapses. In addition, relative to pleasant relationships, ambivalent (b=.02, p<.05), neutral (b=.02, p<.05), and unpleasant (b=.07, p<.001) relationships were associated with increased negative affect on days with a retrospective lapse, but not prospective lapse.

Discussion and implications: This study contributes to the literature by revealing that family relationships are related to the memory lapses individuals experience in their daily lives, and identifies how lapses might contribute to affective symptom load over time.

Background and objectives: The Housing and Urban Development-Veterans Affairs Supported Housing (HUD-VASH) program provides rental subsidies, case management, and supportive services to Veterans who are currently or formerly homeless, 77% of whom are ages ≥50. Few interventions have been developed to address the needs of older Veterans in HUD-VASH.

Research design and methods: We conducted a 2-stage study to inform the development of an intervention to promote aging in place in HUD-VASH. First, we completed qualitative interviews with 21 older Veterans in HUD-VASH and focus groups with 13 staff members to identify unmet needs for supporting aging in place. Second, we used a modified Delphi process with nine staff and one Veteran to prioritize 66 intervention elements based on perceived feasibility and importance.

Results: We identified four main themes: need for services to support aging in place; expanding the HUD-VASH workforce; focus on home delivery; importance of trust. The top-rated intervention elements spanned 5 categories: (1) staffing (by social workers, primary care providers, nurses, home health aides); (2) focus (on geriatric needs, mental health needs, dementia care, medication management); (3) modality (in the home or medical center); (4) timing (delivery of the intervention when Veterans have functional impairment, memory impairment, mental health problems, trouble caring for themselves, or are new to HUD-VASH); and (5) duration (regularly scheduled or ongoing as needed).

Discussion and implications: Veterans and staff members identified key intervention elements which can help inform VA efforts to develop and implement interventions to enhance aging in place in HUD-VASH.

Background and objectives: To better understand racial/ethnic disparities in hearing aid use, we examined racial differences in discrepancies between subjective hearing ratings and objective hearing tests as a potential source of this disparity.

Research design and methods: A cross-sectional assessment was conducted using the data from the Health and Retirement Study (HRS). Our analytic sample included 2,568 participants aged 50 and older: 1,814 non-Hispanic White Americans and 754 non-Hispanic Black Americans. Discordant groups were identified based on self-ratings of hearing abilities (positive versus negative) and objective hearing test results (normal versus hearing loss).

Results: Analysis of HRS data revealed that approximately 73% of participants with objectively measured hearing loss reported positive hearing ratings. False positive hearing rates were found to be 80% among Black older adults and 70% among their White counterparts. Odds for false positive hearing ratings were significantly greater for Black older adults, men, those with less than a high school education, more health conditions and depressive symptoms, and current smoking. Racial differences were maintained after adjustment for these covariates.

Discussion and implications: While cost of hearing aids has been a predominant explanation of low hearing aid use in Black Americans, false positive perceptions of hearing abilities may also play a significant role as a psychosocial mechanism. Future studies examining racial/ethnic differences in possible psychosocial mechanisms for discrepancies between objective and subjective hearing could guide the development and evaluation of culturally appropriate educational interventions.

Background and objectives: People living with dementia experience progressive functional decline and increased dependence on caregivers. This study examined the influence of caregivers' dementia health literacy on perceptions of medical care preferences and advanced care planning (ACP) in people living with dementia.

Research design and methods: This analysis used data from a cross-sectional survey, "Care Planning for Individuals with Dementia", administered nationwide by Alzheimer's Disease Centers. We conducted binary, ordinal, and multinomial logistic regression.

Results: On average, surveyed caregivers (n=431) were 78.3 years, had 16 years of education, and were mainly white (88.5%). Most lived with (76.8%) and were the designated healthcare proxy (95.1%), with high dementia knowledge scores (mean=8.4/10). As caregivers' dementia knowledge scores increased, they were 1.27 times more likely (p=0.02) to endorse comfort care. Caregivers with greater knowledge about severe dementia were less likely to need further treatment preference-related discussions (knowing a lot: OR=0.17, p<0.001; knowing some things: OR=0.37, p=0.006). Caregivers live apart from patients were 2.71 times more likely to know about such discussions (p<0.001). Caregivers of people in earlier stages endorsed greater needs for further conversations with clinicians (no impairment & MCI: OR=7.38, p=0.002; mild impairment: OR=5.32, p=0.005) and their care recipients (no impairment & MCI: OR=5.24, p=0.02).

Discussion and implications: These findings highlight the role of dementia-specific education in ACP discussions among people living with dementia, caregivers, and healthcare clinicians. These findings are important since evidence suggests that ACP may promote quality of life, reduce iatrogenic harm, minimize healthcare overutilization, and alleviate care-related burdens.

Background and objectives: Generativity, a concern and commitment for others, has shown to be positively associated with health and well-being. Research on generativity in sexual and gender minority (SGM) communities is limited, despite its potential importance given the marginalization older SGM individuals face and limited interaction between generations. We integrate Generativity Theory and the Health Equity Promotional Model to examine key factors for generativity and subgroup differences among SGM midlife and older adults.

Research design and methods: Using 2016 data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,233), we regressed generativity on social location and adverse experiences and subsequently on psychological and social factors. We also tested the moderating effects of social location and psychological and social factors.

Results: Psychological (mastery, resilience, and critical awareness) and social (social participation, network size, social support, and SGM community engagement) factors were positively associated with generativity. Day-to-day discrimination was negatively, and lifetime violence and microaggressions were positively associated with generativity. With higher critical awareness level, day-to-day discrimination no longer had negative effects. With higher mastery level, lifetime discrimination had positive effects. Resilience and network size were stronger predictors for younger generations.

Discussion and implications: Findings highlight that psychological and social resources may foster posttraumatic growth and generativity. Critical awareness, activism, and social connections appear important to stand strong against prevalent oppression and extends generative support to younger SGM generations. This research provides insight to promote intergenerational relationships and to cultivate agentic and communal strengths in the SGM populations.

Background and objectives: The importance of social participation for older adults has been well articulated. Missing from this discourse is a critical consideration of how social participation is shaped by political, economic, and social contexts that marginalize aging and disabled bodies. We bridge this gap by applying critical gerontology and critical disability frameworks to our analysis of how access to health and social services and individual and environmental factors, are associated with engagement in valued social activities among disabled older adults.

Research design and methods: Using the National Health and Aging Trends Study (NHATS) Round 12 (n = 4,562) we conducted a series of generalized linear regression models evaluating the association between disability, access to health and social services, and participation in valued social activities.

Results: Increased limitation with Activities of Daily Living and Instrumental Activities of Daily Living, and presence of dementia were significantly associated with decreased valued social participation. Receiving unpaid support, social network size, transportation access, having a regular doctor, and employment were positively associated with valued social participation, while neighborhood disorder, low neighborhood cohesion, difficulty paying for medications, and Medicaid beneficiary status were negatively associated.

Discussion and implications: Findings indicate disabled older adults face challenges engaging in valued social activities. Applying critical gerontology and disability perspectives, calls us to reexamine the ways social participation, accessibility, and full inclusion of disabled older adults are considered. We urge gerontologists to use these findings to reimagine the structures of aging services and community to achieve social change.