Gerontologist最新文献

As society rapidly digitizes, successful aging necessitates using technology for health and social care and social engagement. Technologies aimed to support older adults (e.g., smart homes, assistive robots, wheelchairs) are increasingly applying artificial intelligence (AI), and thereby creating ethical challenges to technology development and use. The international debate on AI ethics focuses on implications to society (e.g., bias, equity) and to individuals (e.g., privacy, consent). The relational nature of care, however, warrants a humanistic lens to examine how "AI AgeTech" will shape, and be shaped by, social networks or care ecosystems in terms of their care actors (i.e., older adults, care partners, service providers); inter-actor relations (e.g., care decision-making) and relationships (e.g., social, professional); and evolving care arrangements. For instance, if an older adult's reduced functioning leads actors to renegotiate their risk tolerances and care routines, smart homes or robots become more than tools that actors configure; they become semi-autonomous actors, in themselves, with the potential to influence functioning and interpersonal relationships. As an experientially-diverse, transdisciplinary working group of older adults, care partners, researchers, clinicians, and entrepreneurs, we co-constructed intersectional care experiences, to guide technology research, development, and use. Our synthesis contributes a preliminary guiding model for AI AgeTech innovation that delineates humanistic attributes, values, and design orientations, and captures the ethical, sociological, and technological nuances of dynamic care ecosystems. Our visual probes and recommended tools and techniques offer researchers, developers/innovators, and care actors concrete ways of using this model to promote successful aging in AI-enabled futures.

Background and objectives: The central aim of the present study was to model developmental trends in communal and independent religious practices, spirituality, positive and negative religious/spiritual coping, as well as their confluence, across ages 45 to 80.

Research design and methods: Participants derived from the Notre Dame Study of Health & Well-being (NDHWB), a longitudinal study spanning 10 years in an age-heterogenous sample. Using two-level multilevel models, we estimated no change, linear change, quadratic change, and cubic change functions across ages 45 to 80 in each construct. Cohort differences were also tested.

Results: Communal and independent practices, spirituality, negative religious/spiritual coping, as well as composite religiosity/spirituality, followed cubic trajectories across mid- to later life. Communal religious practices peaked twice: once at 45 and again around age 70. Independent practices, in contrast, peaked at age 45 and then declined in a stage-like manner until age 80. Spirituality reached its nadir around age 50 and peaked in the early 70s; the reverse was true for negative religious/spiritual coping. The change trajectory in composite religiosity/spirituality most resembled that of independent religious practices. Finally, positive religious/spiritual coping followed a linear trajectory, but a cohort difference precluded its interpretation as developmental change.

Discussion and implications: Individuals appear to engage with their faith in different ways as they age, meaning extant conclusions about age-related differences and change in global R/S may be distorted.

Background and objectives: Social participation is associated with increased quality of life and well-being but declines following onset of dementia. Informal caregivers may facilitate social participation among people with dementia. This study aims to identify characteristics of informal caregivers associated with social participation of people with dementia in valued activities.

Research design and methods: This cross-sectional study used data from the 2011, 2015, and 2017 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC). NHATS respondents with possible or probable dementia and a family caregiver were included (N=1,060). Respondents were asked whether they participated in each of five social activities during the past month. Valued activities were considered somewhat or very important. Survey weighted logistic regression models were computed to identify characteristics of primary informal caregivers associated with participation of people with dementia in social activities.

Results: Social participation of people with dementia was not independently associated with sociodemographic variables or relationship to the primary caregiver (spouse/partner, adult child, or other relative/non-relative). Social participation of primary caregivers was associated with increased participation of people with dementia in the same activity for visiting friends/family (OR=1.88, p=0.016), attending religious services (OR=4.82, p<0.001), and volunteering (OR=3.25, p=0.015), while greater caregiver external support was associated with increased participation of people with dementia in organized activities (OR=1.37, p=0.022).

Discussion and implications: Assets of informal primary caregivers found to promote social participation of people dementia include traveling to the person with dementia's home, being socially active themselves and utilizing support services.

Background and objectives: Advances in artificial intelligence (AI)-based virtual assistants provide a potential opportunity for older adults to use this technology in the context of health information-seeking. Meta-analysis on trust in AI shows that users are influenced by the accuracy and reliability of the AI trustee. We evaluated these dimensions for responses to Medicare queries.

Research design and methods: During the summer of 2023, we assessed the accuracy and reliability of Alexa, Google Assistant, Bard, and ChatGPT-4 on Medicare terminology and general content from a large, standardized question set. We compared the accuracy of these AI systems to that of a large representative sample of Medicare beneficiaries who were queried twenty years prior.

Results: Alexa and Google Assistant were found to be highly inaccurate when compared to beneficiaries' mean accuracy of 68.4% on terminology queries and 53.0% on general Medicare content. Bard and ChatGPT-4 answered Medicare terminology queries perfectly and performed much better on general Medicare content queries (Bard = 96.3%, ChatGPT-4 = 92.6%) than the average Medicare beneficiary. About one month to a month-and-a-half later, we found that Bard and Alexa's accuracy stayed the same, whereas ChatGPT-4's performance nominally decreased, and Google Assistant's performance nominally increased.

Discussion and implications: LLM-based assistants generate trustworthy information in response to carefully phrased queries about Medicare, in contrast to Alexa and Google Assistant. Further studies will be needed to determine what factors beyond accuracy and reliability influence the adoption and use of such technology for Medicare decision-making.

Background and objective: Work discrimination is an important public health problem with consequences for health. This study examined the effect of chronic work discrimination on 4-year changes in HbA1c, as a reflection of glucose control and type 2 diabetes risk in older workers and assessed whether allostatic load (AL) impacted the strength of this association.

Research design and methods: We used Health and Retirement Study data (2010-2016, n=3,246). Conditional change multinomial logistic regression examined the association between chronic work discrimination, high AL (4 or more out of 8 high-risk biomarkers), and HbA1c, while accounting for relevant covariates.

Results: Black participants had the highest rates of baseline (22.7%) and follow-up (28%) HbA1c levels, AL (38%), and chronic work discrimination (39%) (p<0.01). Severe chronic work discrimination was associated with elevated HbA1c (RRR=1.61, 95%CI=1.07,2.43). AL was associated with elevated HbA1c (RRR=1.49, 95%CI=1.04,2.14). Relative to White participants, Hispanic (RRR=1.52, 95%CI=1.07,2.16, RRR=1.81, 95%CI=1.051, 3.12) and Black (RRR=2.42, 95%CI=1.82,3.23, RRR=3.00, 95%CI=1.97,4.56) participants had an increased risk of intermediate and elevated HbA1c respectively. Among those with long job tenure (≥ 5 years) both moderate (RRR=1.81, 95%CI=1.11,2.96) and severe (RRR=1.90, 95%CI=1.15,3.12) chronic work discrimination was associated with elevated HbA1c.

Discussion and implications: Chronic work discrimination, was associated with HbA1c, however no moderating effects of AL were observed. Findings underscore a need for organizational and public health measures to establish strong anti-discrimination laws in the workplace, to improve the work environment of older workers and diabetes risk.

Background and objectives: Researchers often define successful aging as freedom from disability and disease, yet the perceptions of older adults living with disability challenge this conception, demonstrating that they can indeed age successfully. This paper adapts a framework of successful aging with disability, basing it on the subjective assessment of key components contributing to success among older adults living with mobility disability due to multiple sclerosis.

Research design and methods: Employing a qualitative, theory-grounded methodology, we conducted semi-structured interviews with 20 individuals aged 60-75 who live with mobility disability attributed to multiple sclerosis. The open-ended questions explored their perspectives on the aging process, their definition of successful aging, and the coping strategies they employ in navigating challenges associated with age and their condition.

Results: Despite facing mobility disabilities, the majority (16 out of 20) expressed a sense of successful aging, identifying five key themes: accepting reality, maintaining a positive attitude, fostering independence, nurturing a social life, and preserving cognitive abilities. They achieved successful aging by focusing on alternatives, relying on external support, having a good attitude and faith, and accepting their challenges.

Discussion and implications: The themes identified in this research contribute to redefining successful aging in future studies and facilitating the development of interventions aimed at improving the quality of life for older adults coping with mobility disability.

Background and objectives: Walking enhances the health, quality of life, and independence of older adults. However, a global decline in urban walking necessitates a reevaluation of segmented, quantitative approaches to policies and theoretical frameworks in geriatric medicine for promoting walking among older adults. This study conceptualized the perceptions, experiences, and behaviors regarding walking, from a health promotion perspective, among older urban adults.

Research design and methods: Pedestrian-friendly communities were explored for older adults in Seoul, South Korea, using a grounded theory. Thirty-eight older adults actively engaged in walking were recruited between July and December 2020. A qualitative multi-method approach was used, and the collected data were analyzed using open, axial, and selective coding, with axial coding integrating textual and spatiobehavioral information.

Results: The open-coding process yielded 92 concepts, 47 subcategories, and 19 categories. Using axial and selective coding principles, a conceptual framework was developed to explain how walking shaped the daily lives of older urban adults and provided multidimensional health benefits. Walking perception attributes were characterized by "embodied subjectivity as a healthy older adult," "autonomy of movement," and "walking as a way to enrich or sustain life." Active walking facilitated interactions between older adults and their neighborhood environment within the context of compact and accessible urban living.

Discussion and implications: A healthy and age-friendly community encourages interactions between older adults and their neighborhood environment by providing opportunities for daily walking for several purposes, such as providing a sense of autonomy, increasing health-promoting behaviors, and creating a sense of community.

Background and objectives: Emerging evidence suggests music-based interventions can improve the well-being of people living with dementia, but little is known about the ways in which music might support dementia caregiving relationships as part of everyday life at home. This study examined music engagement in the context of daily life to identify patterns of music engagement and potential targets for the design of music-based interventions to support well-being.

Research design and methods: This ethnographic, in-home study of people living with dementia and their family and professional care partners used methods from ethnomusicology, including semistructured interviews and in-home participant observation with a focus on music engagement.

Results: A total of 21 dyads were purposively recruited for diversity in terms of gender, ethnicity/race/heritage, caregiving relationship, and music experiences. Despite participants' diverse music preferences, 3 distinct music engagement patterns emerged. (a) Professional care partners intentionally integrated music listening and singing into daily life as part of providing direct care. (b) Family care partners, who had prior dementia care nursing experience or family music traditions, integrated music into daily life in ways that supported their personal relationships. (c) In contrast, family care partners, who lacked dementia care experience and had high levels of caregiver burden, disengaged from prior music-making.

Discussion and implications: The distinct music engagement patterns reflect different needs on the part of dyads. It is important to continue to support dyads who engage in music daily and to consider developing music-based interventions to support well-being among dyads who have become disengaged from music.

Background and objectives: Social isolation has been recognized as a social problem with negative health consequences. Using data from 3 waves of the Health and Retirement Study, this study aimed to examine the long-term impact of social isolation on loneliness and depressive symptoms and to explore the moderating effect of resilience.

Research design and methods: This study comprised 3,681 U.S. adults aged 60 and older at the baseline wave. Social isolation index was constructed using 5 indicators, including not married or cohabitating with a partner, no social participation, and less than monthly contacts with children, family members, or friends. Loneliness was measured by the University of California Los Angeles (UCLA) Loneliness Scale and depressive symptoms were measured by the Center for Epidemiological Studies-Depression scale. The moderator of resilience was assessed by the simplified resilience score. Latent growth curve models with robust standard errors were estimated.

Results: The results of latent growth curve models showed that social isolation was significantly associated with more initial loneliness and depressive symptoms. However, social isolation was associated with a slower increasing rate of loneliness, but no significant relationship with the change rate of depressive symptoms. Furthermore, resilience significantly buffered the negative effect of social isolation on the initial level of depressive symptoms.

Discussion and implications: The findings underscore the importance of enacting strategies and interventions targeting resilience to address social isolation and its negative consequences among older adults.

This essay argues for a fuller integration of ageism and age discrimination into the productive aging framework. We briefly review the productive aging scholarship and the extent to which ageism has been considered in regard to working, volunteering, education, and caregiving. We suggest that ageism has not been adequately considered, and we identify how it permeates productive engagement in later life. We introduce modifications to the productive aging framework to more directly capture the roles of ageism and age discrimination in activity engagement and the outcomes achieved. We argue for the integration of key concepts from minority stress theory and critical race theory that may yield important insights for an increasingly diverse older population. We conclude with research directions that will guide intervention development to reduce ageism at the societal, organizational, and individual level.