Gerontologist最新文献

Background and objectives: Loneliness is a serious public health concern among the aging population. Not only is loneliness an unpleasant emotional experience, it is also associated with worse health, well-being, and even mortality. This is a particularly important issue among the population aging with intellectual and developmental disabilities, who are more likely to experience loneliness across the life course, and who - particularly if living in an intermediate care facility (ICF) or nursing facility - may lack social connections.

Research design and methods: We analyzed data from the 2012-2013 through 2021-2022 waves of the National Core Indicators-Intellectual and Developmental Disabilities In-Person Survey (NCI-IPS; 8 waves total), a national survey of adults with intellectual and developmental disabilities receiving state services (N = 101,374 observations drawn from 49 states). Multilevel logistic regression models examined whether loneliness varied according to living situation.

Results: Results indicated that (1) adults aging with intellectual and developmental disabilities in ICF and nursing facilities reported significantly greater loneliness than those living in the community, (2) having friends was associated with reduced loneliness overall, yet (3) having friends was associated with reduced loneliness among those living in the community, but not for those living in ICF or nursing facilities.

Discussion and implications: These results indicate not only that adults with intellectual and developmental disabilities living in institutionalized settings are at higher risk of experiencing loneliness and its detrimental effects, but that specialized interventions are required to meet their unique needs and reduce their loneliness in mid and later life.

Background and objectives: Care partners are critical for making treatment decisions in persons living with dementia. However, identifying them is challenging, hindering the broader use of interventions, such as those using digital technologies. We aimed to (i) assess the feasibility of identifying and contacting care partners using electronic health record (EHR) systems, and (ii) elicit their perspectives on electronic interventions for deprescribing.

Research design and methods: We systematically identified care partners of persons living with dementia ≥65 years of age via structured EHR data in a large healthcare system. Eligible care partners were contacted by patient portal (if they were an established proxy), mail, and phone to complete a survey.

Results: Of 4,138 eligible persons living with dementia identified, 1,084 (26%) had a care partner name recorded in the EHR. Out of 259 (6%) with sufficient care partner contact information for outreach, 74 (29%) completed the survey. Among care partners, 62 (84%) reported being confident in managing dementia medications, 59 (80%) were willing to stop ≥1 medications, and 43 (58%) were very/extremely interested in using digital tools for decision-making.

Discussion and implications: Despite the low percentage of care partners with sufficient contact information, reach rates were high for contacted care partners, suggesting feasibility for pragmatic system-level interventions. Most care partners showed great interest in using digital health tools for decision-making and managing medications. Therefore, electronic tools could help with identifying care partners and engaging them. However, scaling up interventions requires better care partner documentation or extracting information from free text.

Background and objectives: The heterogeneity of population-based trajectories of care recipients' (CRs) cognitive functioning and how they are associated with their caregivers' mental health is less studied in the United States. Informed by the stress process model, this study examines the relationship between care recipients' cognitive trajectories and caregivers' depressive symptoms, and the mediating role of caregiving burden.

Research design and methods: Data were from the National Health and Aging Trends Study (2011-2020) for 1,086 care recipients and their 1,675 caregivers from the 2021 National Study of Caregiving. We applied Bayesian group-based trajectory modeling to identify distinct cognitive trajectory groups among care recipients. Hierarchical linear models were then used to examine the associations between these trajectory group memberships and caregivers' depressive symptoms. Finally, Gelbach decomposition analysis was conducted to investigate the mediating role of physical, emotional, and financial caregiving burden.

Results: Five cognitive trajectories were identified among care recipients: "high start, stable" (11.81%), "medium-high start, slight decline" (31.83%), "medium start, slight decline" (27.72%), "medium-low start, sharp decline" (20.60%), and "low start, sharp decline" (8.04%). Worse cognitive trajectories (e.g., lower baselines and steeper slopes) were associated with increasing caregivers' depressive symptoms; financial, emotional, and physical caregiving burdens jointly explained 63.5% of this association. Emotional caregiving difficulty is the most important contributing caregiving burden, explaining 49.6% of the observed association.

Discussion and implications: When understanding caregiving experiences, it is critical to consider longitudinal cognitive course among care recipients. Interventions targeting multiple aspects of caregiving burden, especially emotional burden, should be prioritized.

Background and objectives: Information and communication technology (ICT) use has been associated with well-being among older adults. This link is often attributed to the fact that ICT use facilitates connecting with others. The purpose of this study is to assess how contact frequency and social tie strength impact the relationship between ICT use and depressive symptoms among older adults.

Research design and methods: Using data from the Detroit-based Social Relations Study collected in 2015, we use Bayesian analyses to examine the extent to which contact frequency with social network members moderates and the strength of these social tie (strong, moderate, and weak) mediate the link between ICT use and depressive symptoms among adults age 60+ (n=483).

Results: ICT use was found to be associated with fewer depressive symptoms. Furthermore, ICT use was associated with more moderate and weak ties which were, in turn, associated with fewer depressive symptoms. Finally, a moderating effect was also found as ICT use was associated with fewer depressive symptoms only among those with lower contact frequency.

Discussion and implications: Our findings suggest that for older adults who communicate with others less frequently, ICT use can prove beneficial to mental health (i.e. fewer depressive symptoms). Furthermore ICT use may be especially meaningful to connect with weaker social ties. These findings may be due in part to ICTs capabilities which enable older adults to maintain connection to a diverse array of social ties and bridge social and physical distance.

Background and objectives: The study seeks to elucidate the pathways by which the Caregiver TLC psycho-educational program impacts the psychological health of caregivers by examining the degree to which changes in self-efficacy, personal gains, and emotional support mediate the changes on perceived depression, anxiety and burden.

Research design and methods: Using pre-post data from the Caregiver TLC randomized controlled trial (n = 81) for each outcome and mediator pair, a series of multiple regression models were executed to test the degree to which the program's total effects on changes in depression, burden and anxiety from baseline to post-intervention are due to changes in each mediator variable from pre- and post-intervention assessments. Caregivers were primarily female (85%), White (62 %), Black (38%), with a median age of 62 and household income of $75,000+. Caregivers reported caring for a person with dementia (69%) or chronic health conditions (31%).

Results: Mediation path modeling indicated that changes in self-efficacy affected by participation in the Caregiver TLC program, mediating between 32% and 63% of the total treatment effect on the outcome variables. Change in personal gains and change in emotional support also demonstrated meaningful mediation effects, albeit smaller in magnitude.

Discussion and implications: Results confirm that the observed positive impact of the Caregiver TLC program is due to changes in self-efficacy (in particular) and to a lesser degree to changes in personal gains and emotional support. These results confirm that strengthening caregivers perceived self-efficacy to manage stress plays a significant role in improving psychosocial functioning.

Background and objectives: In this study we developed and validated the Internalized Caregiver Stigma Scale (ICSS) to measure internalized stigma targeting informal care for older adults (≥60 years) in Germany.

Research design and methods: The ICSS scale was developed in the Attitudes Towards Informal Caregivers (ATTIC) project based on stigma theories and (cognitive) pretesting with informal caregivers. Informal long-term caregivers (aged ≥40 years; n=433) of older relatives (aged ≥60 years) were quota-sampled from the online panel GapFish in December 2023 (twice as many female and middle-aged (aged 40-64 years) caregivers than male and younger (18-39 years) or older adults (65+ years) were included in the sample). Caregiver identification and the Social Impact Scale were used for validation of the newly developed measure. Factor structure, reliability and concurrent validity were tested.

Results: A correlated two-factor model with excellent goodness of fit criteria and good to excellent internal consistency of the factors and the total scale was confirmed for the ICSS. The negative ICSS subscale correlated highly, and the positive ICSS subscale correlated weakly, with the care-specific Social Impact Scale. Both ICSS subscales were weakly correlated with caregiver identification. Both aspects of self-stigma showed significant associations with sociodemographic and care-specific factors in the regression models.

Discussion and implications: The ICSS is the first scale measuring internalized stigma targeting informal care for older adults directly and shows excellent psychometric criteria. It provides the necessary tool for a new approach to analyze the complex psychosocial mechanisms in this highly relevant care context.

Background and objectives: People experiencing homelessness and older people experience barriers as health and social care services are increasingly delivered online, however, there is limited knowledge about how this relates to older and middle-aged women experiencing homelessness, especially those from minoritized and/or migrant communities. We aimed to explore how technology, including digital health, can help or hinder older and middle-aged women to navigate paths through and out of homelessness.

Research design and methods: This 16-month qualitative longitudinal study utilized narrative interviews and participant observations with seven older and two middle-aged women experiencing homelessness, in London, England. Additionally, we observed interactions between the women experiencing homelessness and two information and communications technology class facilitators. We collected and analyzed data using a narrative, interpretative approach. An advisory board of women with lived experiences of homelessness supported the interpretation of findings and development of practice and policy recommendations.

Results: We present our findings as three composite narrative vignettes co-constructed with the participants: (1) "No, I'm not taking this telephone appointment"; (2) "Technology doesn't judge you"; and (3) "You have to be a digital person now". The findings illuminate determinants of digital health equity related to aging, gender, and migration status among older and middle-aged women experiencing homelessness.

Discussion and implications: Using an intersectional lens, we provide recommendations about how to better align digital health to the needs of older and middle-aged women experiencing homelessness. The findings will inform intervention development.

Federal minimum standards for collecting and reporting race and ethnicity data implicitly categorize diverse individuals into broad, monolithic categories. Despite advancements in policy and practice and calls for inclusive research, data equity remains a significant issue in aging-related health research. Racially and ethnically diverse older adults are underrepresented in health research and rarely disaggregated by ethnicity in data collection, analysis, and reporting of aging-related health outcomes. Data disaggregation offers a promising approach to advancing data equity in aging research. We searched the National Institute on Health RePORT Expenditures and Results (NIH RePORTER) database to identify extramural National Institute on Aging (NIA) grants from 1985 to 2024 that proposed disaggregating race and ethnicity data for aging-related research. We found only 12 NIA-funded awards, visually demonstrating how understudied data disaggregation is within the field of aging. Most disaggregation-focused grants were awarded from 2015 onwards (92%), with 42% being R01 grants. Enhancing methodological rigor in demographic data collection and reporting reflective of the diversifying aging population is crucial for data equity. We conclude with recommendations to advance aging health research and highlight considerations and ethical issues for data disaggregation for historically surveilled racial and ethnic minoritized communities.

Background and objectives: Social engagement is positively associated with cognitive health, yet the role of these activities across the life span and in different contexts remains under-explored. This study investigates the association between social activities and two domains of cognitive functioning among middle-aged and older Chinese individuals, a population with the highest number of dementia cases in the world. We pay particular attention to the unique role of activities in midlife on cognitive decline in the later years.

Research design and methods: Using longitudinal data from the China Health and Retirement Longitudinal Study (2011-2018), we conducted mixed-effects linear models to determine the intra- and inter- individual variation on the relationship between social activity and cognitive functioning (N = 26,622 observations nested within 8,089 individuals).

Results: Across domains (episodic memory, mental intactness, and total cognition), more social activities in a given year are associated with increased cognitive functioning, independent of age. Independent of these within-individual changes, participation in social activities in midlife predicts better cognitive function across mid and later life across all domains, controlling for childhood adversities, friendship, self-rated health. However, midlife social activities do not significantly predict a slower rate of cognitive decline.

Discussion and implications: Midlife social engagement has a lasting association with cognitive health in later life, yet it is important to recognize that changes occurring throughout both midlife and later life are associated with changes in cognition. This highlights the potential for modification and improvement during this period in the lifespan for aging Chinese.

Background and objectives: Chronic kidney disease (CKD) is a major public health concern that uniquely impacts older Black Americans, a population also likely to have family members also diagnosed with CKD. This study aimed to (1) describe how participants viewed their decision preferences considering the experiences of family, and friends previously diagnosed with CKD, and (2) to understand how these social complexities informed their own decisions for future CKD care.

Research design and methods: Utilizing a phenomenologically-informed approach, this study explored participants' perceptions of how patients and their family members' experiences with CKD influenced treatment-related decision-making. A reflexive, thematic content analysis was conducted to identify patterns across participant responses (N=52). Participants were pre-dialysis, diagnosed with stage four or five chronic kidney disease, and were receiving outpatient nephrology care at a large, urban midwestern hospital.

Results: Three primary themes emerged: (1) uncertainty regarding decision-making, (2) lived experience of racism, and (3) impact of quality of care, information, and education on decision-making. These three interconnected themes centered on factors that influenced why and how decisions related to chronic kidney disease were made and how racial identity and prior family experiences with CKD influenced these decisions.

Discussion and implications: Over the next 40 years, the population of Black Americans aged ≥ 65 years will nearly triple. Because of the complex support requirements and burden(s) of care for CKD patients, there are implications for reshaping the negative and disorienting narratives that influence decision-making conflicts.