Gerontologist最新文献

Background and objectives: Age-Friendly Community Initiatives (AFCIs) have gained recognition as essential responses to the needs of aging populations. Despite their growing significance, there is a notable lack of effective measurement tools to assess the planning, implementation, and sustainability of AFCIs. The purpose of this study was to develop and validate a survey tool for evaluating AFCIs.

Research design and methods: A sequential exploratory mixed-method design was used in two phases. First, we identified key themes from interviews with AFCI leads to generate AFCI survey items and regional workshops. Then, we conducted a pilot of the survey and assessed its measurement properties.

Results: Thematic analysis of interviews with 68 key informants from 58 AFCIs revealed four main themes: AFCI priorities, enablers, challenges, and benefits. These themes, combined with feedback from AFCI stakeholders at the regional workshops and a AFCI conference, informed the development and refinement of a reliable and valid AFCI survey in 2019, supported by a high Cronbach's Alpha value (α = 0.881). Steps were identified to maintain and sustain the AFCI survey over time.

Discussion and implications: The survey accommodates AFCIs' diverse demographics, governance structures, and priorities with a standardized and flexible approach for effective measurement. This research contributes to the academic understanding of AFCIs and aids community leaders and policymakers in planning, implementing, and evaluating AFCIs.

Background and objectives: Despite higher risks of developing Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) among racial/ethnic minority populations, some maintain good cognition until old age. This study aimed to investigate heterogeneous cognitive trajectories among non-Hispanic Black and Hispanic older adults, examine cognitive impairment prevalence across trajectory classes, and identify associated social and behavioral determinants.

Research design and methods: Using 11 waves of data from the Health and Retirement Study (1996-2016), 1,322 non-Hispanic Black and 747 Hispanic adults aged 50 + with normal cognition in 1996 were included. Latent class growth modeling and multinomial logistic regressions were performed to examine cognitive trajectories and associated determinants.

Results: For both racial/ethnic groups, three trajectory classes were identified: high, medium, and low cognition. In the low cognition class, 87% and 100% of non-Hispanic Black and Hispanic participants developed cognitive impairment. For both racial/ethnic groups, older age and living in rural areas during school time increased the likelihood of being in the low cognition class, while more education was associated with a lower likelihood. Unique risk and protective determinants for non-Hispanic Black and Hispanic participants were also identified.

Discussion and implications: This study reveals the heterogeneity of cognitive trajectories among racial/ethnic minority older adults and various associated social and behavioral determinants. More prevention interventions and accessible, affordable diagnosis and treatment should be provided to older racial/ethnic minorities with these characteristics to reduce disparities. More research is needed to further explore associations between unique determinants and cognition in racial/ethnic minority populations to better inform interventions.

Background and objectives: The busy ethic for retirement, as proposed by Ekerdt (1986), is a prescriptive norm that esteems an occupied, active lifestyle. This research is a first attempt to measure the busy ethic in a standardized way and apply it to a population-based sample. Objectives are: to examine whether a busy ethic is affirmed by retirees; to test busy ethic endorsement by different segments of the retired population; and to examine whether endorsement is associated with selected activities.

Research design and methods: We developed a scale measuring the busy ethic for a survey among 1,143 Dutch retirees. We tested two sets of hypotheses about social factors that might explain subscription to a busy norm: a hypothesis about modernization (i.e., individual autonomy from social control) that would reduce busy ethic endorsement and a hypothesis about differential exposure to expectations.

Results: Greater consent to the busy ethic was associated with circumstances that enable active lifestyles (perceived income adequacy, self-reported health), that raise one's social value (education), and that entail more social connectedness (religious service attendance). Busy ethic agreement was positively associated with engagement in paid work, productive social activities, and group recreation.

Discussion and implications: We found substantial endorsement of the importance of activity for oneself and others. The idealization of a busy retirement as a good retirement may be a seeming way for retirees to defer old age. At the same time, a prescriptive norm of activation may put strain on older adults who are less capable of conforming.

Background and objectives: In conversations about expanding age-friendly ecosystems, the concept of "age-friendliness" has not been explored in relation to residential settings.

Research design and methods: This multiple case study compared four residents' perspectives on the age-friendliness of a retirement and assisted living community, combining individual semi-structured interviews with observational data and organizational document analyses in a contextualist thematic examination.

Results: Three themes depict (A) existing experiences of the setting as "age-friendly" and the tension of the built design vs. identity; (B) resident-to-resident microaggressions, delineated into four sub-themes including identity-related, intergenerational, condition-related microaggressions and their influence on social isolation; and (C) desired experiences of the setting as "age-friendly" reflecting the social design. In cases of visibly perceptible diversity (white cane, darker skin tone), residents fared worse in experiencing microaggressions stemming from ableism, racism, and age differences. Conversely, in cases of visibly imperceptible diversity, residents had more positive or entirely positive experiences. Although the setting met many environmental and healthcare needs, it lacked design factors prioritizing meaningful social relationships between residents, impacting social isolation.

Discussion and implications: Resident-to-resident social relationships are key in the experience of a retirement and assisted living community as age-friendly. Resident-to-resident microaggressions undermine perceptions of the community as age-friendly, and influence social isolation. We reflect on the organizational role in mitigating against negative social relationships and social isolation to maximize dignity.

Background and objectives: Older adult-focused housing with services programs seek to improve access to supportive services, particularly among individuals residing in subsidized housing. The Right Care, Right Place, Right Time (R3) program comprises two on-site wellness teams responsible for 400 participants across seven housing sites in Greater Boston. These embedded teams work directly with residents to address health-related needs and access to services. This study reports on the perceived benefits of participating in the R3 program from the perspective of housing staff and community partners.

Research design and methods: Data were derived from 24 semi-structured interviews conducted as part of a program evaluation. Participants described resident, housing, and system-related reasons for deciding to participate in the R3 program and experiences of their participation.

Results: In addition to positive overall assessments, housing partner interviewees reported concrete and psychosocial benefits for housing residents (e.g., connecting with resources, enabling longer stays, empowering residents, alleviating distress) and staffing and resident-related benefits. Community partners perceived more appropriate utilization of services by residents (e.g., reducing emergency transports).

Discussion and implications: Findings elucidate why housing and community partners might be motivated to integrate housing, health, and supportive care to affordable housing for older adults using a wellness team.

Background and objectives: Mobility limitations has been linked to cognition. However, little is known about the relationship between mobility decline and cognitive decline. This study investigated the effect of mobility limitations and decline on cognitive decline in a population-based cohort of older adults.

Result design and methods: A population-based cohort of 9695 cognitively intact participants (mean age = 65.4 years, standard deviation [SD] = 10.4) was assessed. Mobility limitation scores ranging from 0-10 were assessed at baseline (wave 4) by using self-reporting difficulty in a set of 10 activities, and a higher score indicated worse mobility. A subset of 9250 participants underwent two mobility assessments at waves 3 and 4, and were categorized into normal mobility or mobility decline (defined as wave 4 - wave 3 > 1 SD of wave 3). Linear mixed models were used to assess the longitudinal contribution of mobility limitations and decline to cognitive decline.

Results: During a median follow-up period of 9.4 years (SD 1.8), the participants in the highest quartile of mobility scores displayed an accelerated cognitive decline (-0.191 SD/year, 95% CI = -0.223, -0.159) compared with those in the lowest quartile. Notably, individuals experiencing mobility decline exhibited a marked cognitive decline (-0.179 SD/year, 95% CI = -0.220, -0.139), potentially influenced by factors such as physical activity and depression.

Discussion and implications: Mobility limitations and decline significantly correlate with cognitive decline in older adults, highlighting that mobility-focused interventions in healthcare strategies to preserve cognition.

While the gold standard for intervention science is the randomized controlled trial (RCT), there is growing emphasis on the practical implementation and evaluation of evidence-based programs into community agencies. Assessment of program efficacy by community-based organizations can confirm planned delivery of services, implementation fidelity, and demonstrate positive outcomes, which can provide justification for funding. Methods and measures used in an RCT, however, often cannot be implemented in non-research settings and different approaches are needed. This manuscript reviews the emerging literature on program evaluation work and draws upon the authors' experiences conducting evaluations with three community-based organizations funded by Administration for Community Living to implement programs for individuals with dementia and their family care partners. This manuscript argues for an examination of the expectations of evaluation efforts for translation of research-based trials to practice and emphasizes three main strategies for assessment: (1) Development of brief tailored assessments; (2) Measuring fidelity of implementation of the program; and (3) Measuring acceptability of the program to clients.

Background and objectives: End-of-life doulas (EOLD) are an emerging role providing non-medical support and advocacy for the dying and their families. Research about EOLD is new and currently highlights a need for more clarity in role definition and application. This review aims to comprehensively analyze existing knowledge regarding EOLD and their role in end-of-life care.

Research design and methods: A systematic and comprehensive search of nine bibliographic databases identified all published academic articles related to EOLD (as named, self-identified, and/or trained) research from inception to June 2023. This review utilized an integrative approach and textual narrative synthesis to summarize the existing body of research findings related to EOLD.

Results: Twenty-five articles were identified, representing multiple disciplines including health and medicine, public health, social/behavioral sciences, and humanities. Research on EOLD has rapidly increased in recent years and is showing signs of maturation. The review focuses specifically on summarizing the breadth and depth of identified research on EOLD and critically analyzes emergent themes from the review: Application, Perception, Identity, and Future Research Directions.

Discussion and implications: This review provides the most comprehensive review of the research literature on EOLD to date. Thematic findings for future research directions have provided the basis of a redirected research agenda to guide the field going forward. There is still a need to clarify who EOLD are and how they are being conceptualized by multiple stakeholders. Future research must address these missing voices to fully grasp the value and unique role that EOLD contribute to EOL care.

Background and objectives: Montessori-based interventions (MBIs) promote quality of life among older adults living with dementia. We used Dementia Care Mapping (DCM) to evaluate the impact of a small-scale MBI. DCM is a systematic observation tool that records the behavior and mood/engagement of individuals living with dementia and can be used to improve quality of care and well-being.

Research design and methods: Pre- and post-intervention data from 15 care community residents compared: 1) residents' range and types of behaviors, 2) their mood/engagement and 3) staff behaviors that facilitated and impeded residents' personhood. In this mixed-methods study, deductive qualitative content analysis of DCM field notes further explored staff behaviors.

Results: Post-intervention, a significantly higher proportion of residents' behaviors had the potential to promote their well-being, although there was little change in mood/engagement while engaging in those behaviors. Post-intervention, there was also a significant increase in staff behaviors that facilitated, and a decrease in staff behaviors that impeded, residents' personhood. Further, post-intervention, staff interactions with residents were more open-ended and inclusive. Although some staff behaviors still excluded residents, the exclusion was more benign than pre-intervention.

Discussion and implications: DCM documented incremental changes toward person-centered care, and DCM field notes provided insight into missed opportunities for effective staff interactions with residents. Taken together, findings provide additional support for the use of MBIs and highlights the usefulness of DCM, especially its associated field notes, to help researchers and practitioners create environments that promote the personhood that individuals living with dementia deserve.

Background and objectives: The evolution of care networks accompanying older adults' changing care needs-and implications for unmet care needs-are not well described.

Research design and methods: Using group-based trajectory models, we identify 4 incident care need patterns ("care need trajectory groups") for 1,038 older adults in the 2012-2018 National Health and Aging Trends Study and 5 caregiving patterns ("caregiving trajectory groups") and a transient group among their 4,106 caregivers. We model associations between care need/caregiving trajectory groups and the rate of (approximating the proportion of rounds with) unmet care needs. We illustrate how predicted rates vary by care need trajectory groups and by network composition for networks with 2 caregivers.

Results: The percentage of rounds with unmet care needs varies from 13% among older adults with few, stable needs to 62% among those with many, stable needs (p<.01). In models, care need trajectory group is strongly associated with the rate of unmet care needs; among those with steep increasing care needs, network composition is also predictive. For older adults with steep increasing care needs, when one caregiver provides high, variable and another medium, stable care hours, the predicted rate of unmet care needs is low (0.16) and similar to those with few, stable care needs (0.12).

Discussion and implications: Findings highlight the complexity and heterogeneity of older adults' care needs and caregiving patterns over time. For those with rapidly increasing needs, identifying and assessing the evolving care network may be a fruitful direction for forestalling unmet care needs.