Gerontologist最新文献

Background and objectives: Mobility limitations have 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.

Research design and methods: A population-based cohort of 9,695 cognitively intact participants (mean age = 65.4 years, standard deviation [SD] = 10.4) was assessed. Mobility limitation scores ranging from 0 to 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 9,250 participants underwent 2 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% confidence interval [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 preserve cognition.

This article celebrates the National Institute on Aging (NIA)'s successes over the past 50 years in advancing the science base and informing the need for and response to dementia caregiving. In parallel with other public and private efforts, insightful NIA leadership supported by funding initiatives established the field of dementia caregiving research. In support of the health and well-being of family caregivers, NIA was a catalyst of innovation that led to numerous evidence-based caregiving interventions informed by basic research on care tasks and consequences. As evidence of the impending burden of dementia care on US families mounted, NIA-funded multidisciplinary collaboratives of researchers generated comprehensive models of family caregiving across diverse populations. Today, the dementia caregiving evidence base is shaping public policy and making possible dementia caregiving support services in health systems and community-based organizations. NIA continues to support the scientific study of dementia caregiving with a collaboration of leading scientists and by making available state-of-the-art datasets and encouraging standardized research methodologies. NIA's leadership in the field of dementia caregiving research has never been more significant, as the number of persons living with dementia in the United States approaches 7 million and the value of family caregiving is estimated to be $350 billion.

Background and objectives: End-of-life (EOL) doulas (EOLD) are an emerging role providing nonmedical 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 EOL care.

Research design and methods: A systematic and comprehensive search of 9 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: 25 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.

The physician, scholar, and activist Robert Butler devoted much of his life to trying to end ageism in order to create a society that provides older persons with equal rights and opportunities. His passion for fighting ageism led to his becoming the founding director of the National Institute of Aging (NIA) and set the stage for many of its achievements during the past 50 years. This article explores how Butler first became committed to overcoming ageism, how he made a strong case for setting up NIA as a headquarters to combat ageism with science, and how he launched NIA as a multidisciplinary organization that could draw on research, training, and public policy as weapons against ageism. Finally, this article highlights how Butler, through his anti-ageism activities in later life, personified the possibilities he had done so much to make available to older persons through his launch of NIA.

For 50 years, the National Institute on Aging (NIA) has supported and promoted research on religious involvement among older adult populations. This article discusses the ways that NIA funding has 1) broadened our understanding of how religious involvement is conceptualized and measured; 2) explored the important role of social networks and interactions within religious communities in relation to congregants' health; 3) supported research on national samples of the U.S. population to explore demographic variability in religious practices and beliefs, as well as their social correlates; and 4) examined health-relevant frameworks and topics in relation to religion's association with physical and mental health and well-being. The article focuses on research on African Americans and Mexican Americans as well as work that compares these populations to non-Latino Whites and Black Caribbeans. In this article, we provide an overview of selected research topics in the area of religion and aging, including Conceptualization and Measurement of Religious Participation; Religion and Mental Health; Religion and Physical Health; Church-Based Informal Support; Church Support and Mental and Physical Health; Religious Coping, and the Use of Clergy for Serious Problems. Scholarship and research supported by the NIA have fundamentally contributed to a deepening understanding of why and how religion matters for the health and social well-being of African American, Black Caribbean, and Mexican American older adults.

Background and objectives: Alzheimer's disease and related dementias (ADRD) remain a pressing concern in the US, which also has one of the highest incarceration rates worldwide. Existing research has analyzed dementia risk and care among currently incarcerated and homeless populations; this paper fills a gap by examining later-life cognitive disparities facing formerly incarcerated and/or homeless individuals.

Research design and methods: Using Health and Retirement Study data (HRS; 1998-2018), we tested whether formerly homeless and/or incarcerated people had earlier onset of cognitive decline, and whether they were more likely to have modifiable risk factors for ADRD than those without such experiences. We estimated prevalence of mild cognitive impairment (MCI), dementia, and self-reported ADRD diagnosis. We also used repeated observations of cognitive functioning coupled with nested nonlinear regression to examine the onset of accelerated cognitive decline.

Results: Adjusting for demographic variables, formerly homeless and/or incarcerated participants have increased odds of having risk factors for dementia, including smoking, drinking alcohol, depression, mental illness, and discrimination from healthcare providers and police. Diagnosis of MCI and ADRD were more common among participants reporting a history of incarceration or homelessness. Nested nonlinear regression revealed that previous experiences of incarceration or homelessness-alone or together-are associated with earlier onset of accelerated cognitive decline compared to those who experienced neither.

Discussion and implications: This study suggests that, even if they occur earlier in life, homelessness and incarceration experiences may increase risk of poorer cognitive health in late life. Future work is warranted to understand the lifelong consequences linked to this adversity.

Background and objectives: Pain management is often suboptimal in individuals with dementia, and their family caregivers are tasked with supporting pain management despite limited preparation. The web-based PACE-app (PAin Control Enhancement) was designed to assist caregivers in managing pain for individuals with dementia. This study aimed to evaluate the usability of the PACE-app.

Research design and methods: A convergent parallel mixed-methods design was used to evaluate the PACE-app's usability with 16 family caregivers and 6 healthcare professionals. Quantitative data were collected using the Post-Study System Usability Questionnaire (PSSUQ), while qualitative data were gathered through guided app reviews and semi-structured interviews. Quantitative data were analyzed descriptively, and qualitative data were thematically coded.

Results: The PSSUQ results indicated that both family caregivers and healthcare professionals had a highly positive experience with the PACE-app: overall scores (2.01 vs. 1.68), system usefulness (1.76 vs. 1.68), information quality (1.98 vs. 1.80), interface quality (2.30 vs. 1.60), and satisfaction (2.00 vs. 1.60) were rated on a 1-7 scale (with lower scores indicating better usability). Qualitative findings supported these results, with participants endorsing the PACE-app's usefulness, ease of use, learnability, effective information presentation, aesthetics, clear layout, and overall satisfaction. Participants also provided valuable feedback for improving information quality (enhancing clarity) and interface quality (real-time coaching on pain management).

Discussion and implications: The study demonstrated favorable usability and strong satisfaction among family caregivers and healthcare professionals using the PACE-app. Incorporating participants' suggestions will guide enhancements to the app's information and interface, ensuring it better meets users' needs.

Background and objectives: Comprehensive definitions of social issues and populations can set the stage for the development of responsive policies and practices. Yet despite the rise of late-life homelessness, the phenomenon remains narrowly understood and ill-defined.

Research design and methods: This article and the definition that ensued are based on the reconceptualization of interview data derived from a critical ethnography conducted in Montreal, Canada, with older homeless persons (N = 40) and service providers (N = 20).

Results: Our analysis suggests that definitions of late-life homelessness must include 4 intersecting components: (1) age, eligibility, and access to services; (2) disadvantage over the life course and across time; (3) social and spatial processes of exclusion that necessitate aging in "undesirable" places; and (4) unmet needs that result from policy inaction and nonresponse.

Discussion and implications: The new definition derived from these structural and relational components captures how the service gaps and complex needs identified in earlier works are shaped by delivery systems and practices whose effect is compounded over time. It provides an empirically grounded and conceptually solid foundation for the development of better responses to address homelessness in late life.

Background and objectives: Acculturation is a critical aspect of social experience for immigrants, including Asian immigrants. Existing literature has shown mixed findings on the health impacts of acculturation and largely relied on cross-sectional studies, preventing drawing definitive conclusions. This study aimed to examine the long-term effects of acculturation on depressive symptoms and activities of daily living (ADL) limitations in a large sample of older Chinese immigrants in the United States.

Research design and methods: Data were drawn from 2,811 older Chinese immigrants from the Population Study of Chinese Elderly in Chicago. Acculturation was assessed at baseline, and questionnaires on depressive symptoms and ADL limitations were completed at 4 assessments.

Results: Overall, results showed that acculturation was not associated with depressive symptoms at baseline but was associated with a faster decline in depressive symptoms over time. No associations were found between acculturation and ADL limitations. Stratified analyses showed that the significant relationship between acculturation and a faster decline in depressive symptoms was only evident among female participants. Also, acculturation was associated with a lower risk of reporting ADL limitations at baseline in female participants but a higher risk of reporting ADL limitations in male participants.

Discussion and implications: This study indicates the long-term benefits of acculturation on mental health among older Chinese immigrants in the United States, particularly among females. Initiatives supporting the acculturation process need to consider sex disparities and individual preferences, aiming to foster sustained benefits for healthy aging in this population.

Background and objectives: Physical capability, social support, loneliness, depression, and anxiety predict life satisfaction in older adults. Currently, no systematic review and meta-analysis have been conducted to investigate the strength of these associations globally. Therefore, this study quantified the strength of these associations.

Research design and methods: A systematic literature search was conducted using MEDLINE, EMBASE, APA PsycINFO, Web of Science, and Scopus. We included observational studies assessing the association between physical capability, social support, loneliness, depression, and anxiety with life satisfaction in adults aged 65+.

Results: In total, 10,552 articles were identified, of which 78 studies in 164,478 participants were included in the systematic review and 57 were included in the meta-analysis. Greater life satisfaction was significantly associated with greater physical capabilities (odds ratio [OR] = 2.64; 95% confidence interval [CI]: 2.01-3.45; p < .001, k = 35, n = 33,732), higher social support (OR = 3.27; 95% CI: 2.59-4.13, k = 20 studies, n = 13,228), reduced loneliness (OR = 3.30; 95% CI: 2.53-4.30, k = 11, n = 33,638), depression (OR = 4.76; 95% CI: 3.10-7.32, k = 24, n = 64,097), and anxiety (OR = 5.10; 95% CI: 2.21-11.78, k = 5, n = 43,368). The strength of associations did not vary between Western and Eastern countries, year of publication, or quality. Gender was a moderator: Loneliness was more strongly associated with life satisfaction in females. Age was also a moderator; the association between social support and life satisfaction weakened with increasing age.

Discussion and implications: Improving the physical capabilities of older individuals, fostering social support, and alleviating feelings of loneliness, depression, and anxiety may help build life satisfaction in older individuals, which policy-makers and healthcare professionals should prioritize when implementing strategies.