Gerontologist最新文献

Falls are a serious problem confronting older adults. Evidence demonstrates that multifactorial interventions that target multiple risk factors can reduce falls. However, resource and access constraints impact intervention uptake and sustainability. In comparison, digitally enabled interventions have the potential to provide greater support and convenience whilst being tailored to an individual. While digital advancements present an opportunity to improve access, scalability and sustainability, there is limited knowledge on how to digitally enable traditional interventions. In this article, we summarise the academic literature on digital falls prevention and propose future research directions for digital falls prevention. We examine barriers and enablers to digital falls prevention in aged care, although, given the scarcity of evidence, we draw on lessons from other digital healthcare innovations.

Background and objectives: The paucity of research and policy on the impact of COVID-19 on the experiences of Black older adults in Canada and around the world has intensified the enduring impacts of racism on their health and well-being. To bridge this gap, our study explored the mental health of Black older adults in Montreal during the early period of the pandemic.

Research design and methods: Using an Afro-emancipatory mixed-method research design, we collected and analyzed data from three sources: a survey, focus group interview with service providers from Black community organizations, and individual interviews with Black older adults.

Results: Our findings reveal that Black older adults struggled with mental health challenges, including loss, grief, and intergenerational tensions, and encountered systemic barriers in accessing services. Despite these adversities, participants demonstrated remarkable resilience, drawing upon their faith and community networks for support.

Discussion and implications: This study illuminates the complex experiences of Black older adults during the pandemic and underscores the imperative of addressing mental health and systemic barriers. Understanding ongoing challenges is crucial for developing targeted interventions and policies that promote long-term resilience and equitable healthcare for Black older adults.

Background and objectives: The Everyday Cognition Scale (ECog) is widely employed for the subjective rating of functional activities of daily living in older adults. This study aimed to examine the psychometric properties of both informant-rated and self-rated ECog in Taiwanese older individuals to assess its applicability in this context.

Research design and methods: A total of 1166 subjects, including older adults (n = 583) and their primary caregivers or family members (n = 583), were recruited. Both self-rated and informant-rated ECog assessments were administered twice within a one-month period. The study evaluated internal consistency, test-retest reliability, random measurement error, discriminative validity, construct validity, and concurrent validity using the Mini-Mental State Examination (MMSE) as a gold standard.

Results: The informant-rated ECog demonstrated high internal consistency, acceptable to good test-retest reliability, small to moderate random measurement error, good discriminative validity, and moderate correlations with the MMSE. Additionally, a seven-factor model of the informant-rated ECog was supported. Conversely, the self-rated ECog exhibited high internal consistency, acceptable test-retest reliability, moderate to large random measurement error, adequate discriminative validity, and small correlations with the MMSE. Notably, only the domains of memory, verbal, planning and organization were supported by a one-factor model.

Discussion and implications: The psychometric properties of the informant-rated ECog surpassed those of the self-rated ECog. However, the self-rated ECog is recommended as a supplementary tool for assessing individuals' awareness of their cognitive function, particularly in the domain of memory.

Background and objectives: This paper aims to add to the literature on successful ageing in minoritized ethnic groups. Concurring with the critiques of 'successful ageing' for focusing on values and abilities more attainable by white middle-class older people, it explores alternative discourses according to which older people from minoritized groups consider themselves to be 'ageing well'.

Research design and methods: The paper draws on original empirical material derived from a longitudinal research project focused on five minority ethnic groups living in a city (and surrounding areas) of the UK known for its diverse population. It draws on photovoice methods conducted with the participants and analyses the material through (i) a focus on intersectionality as a framing device that is dynamic over time and (ii) phenomenological approaches to old age as a distinct life stage existentially.

Results: Although intersectionality is framed in the literature almost exclusively in terms of disadvantage, older participants made use of assets as well as deficits (which they often turned into assets) to construct a sense of meaning and purpose that enabled them to age well and flourish in often challenging circumstances.

Discussion and implications: The images and narratives presented here challenge the normative depictions of a good or successful old age constructed from the perspective of white and middle-class older adults. They add a diverse range of alternative depictions of ageing well which will be of help for clinicians and others in supporting diverse older people to flourish in conditions of health as well as frailty.

Background and objectives: While Hispanic/Latino populations in the U.S. are remarkably diverse in terms of birthplace and age at migration, we poorly understand how these factors are associated with cognitive aging. Our research seeks to operationalize a life course perspective of migration and health and contribute new understanding of Alzheimer's disease / Alzheimer's disease related dementias among U.S.-based Hispanic/Latino older adults.

Research design and methods: Harnessing the Hispanic Community Health Study/Study of Latinos (n=16,415) and the Study of Latinos-Investigation of Neurocognitive Aging (n=6,377) data, we compare baseline cognition and 7-year cognitive change among U.S./mainland-born Hispanic/Latino adults relative to foreign/island-born immigrants by age of migration (four groups: born in mainland U.S., immigrated <16 years, 16-34 years, >34 years). Global cognition was calculated as a composite measure, and domain specific measures were considered in secondary analyses. We employed linear regressions, ANOVA contrasts and Blinder-Oaxaca decomposition techniques.

Results: All Hispanic/Latino immigrant adults, regardless of age at migration, have a cognitive health disadvantage (at each visit and over time) relative to U.S./mainland-born Hispanic/Latino individuals. Differences did not endure the inclusion of covariates and were explained predominantly by first socio-economic and then acculturative factors, and far less by health and health behaviors. Acculturative factors are particularly important for individuals who migrated after childhood.

Discussion and implications: Socio-economic and acculturation factors have outsized roles in explaining gaps in cognitive aging among U.S.-born and migrant Hispanic/Latino adults. It is then vital to examine whether disrupting socio-economic and acculturation inequalities closes such gaps in cognitive aging.

This review summarizes research projects supported by the National Institute on Aging (NIA) that have contributed scholarship on intergenerational relationships and support provided to older adults that frequently precedes, and is often complementary to, intensive caregiving. We review NIA-supported projects that have almost exclusively focused on intergenerational relationships and involved primary data collections, and others making use of omnibus aging and family studies that have allowed a variety of investigations on this topic. Where the former set of studies has generated deeply phenotypic analyses-comprehensive fine-grained analyses of relational data in specialized samples-the latter set has focused on analyses of secondary data, often from national samples which include information on intergenerational relationships. Early research funded by NIA addressed the factors underlying cohesion across generations, including the Longitudinal Study of Generations. Subsequent studies shed light on the dynamics of ties between siblings or across multiple generations in navigating support and affection. Studies have revealed important information about transfers of tangible and non-tangible resources, loss of parent or child, and diversity by race, ethnicity, and gender. NIA funding has made important inroads in understanding a relationship that is of primary importance in individuals' lives for their health and well-being.

Background and objectives: There is a large and growing population of older, formerly homeless adults living in permanent supportive housing, and there are concerns about how to address their healthcare needs. This study compared veterans aged 55 years and older residing in the Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program to an age-matched group of independently housed veterans receiving care through the U.S. Department of Veterans Affairs (VA) healthcare system on health and healthcare service use characteristics.

Research design and methods: Cross-sectional analyses were performed on 1,436,537 (66,072 HUD-VASH vs. 1,370,465 housed) eligible veterans with index encounter dates between October 1, 2021, and July 31, 2022, using linked data from the VA's Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. Propensity-score adjusted logistic regression models were constructed to compare aging HUD-VASH vs. housed veterans on outpatient and inpatient healthcare utilization.

Results: HUD-VASH veterans were more likely to have physical and mental health morbidities, including substance use disorder than their independently housed counterparts. HUD-VASH veterans were less likely to utilize outpatient medical services, and more likely to use emergency and inpatient care services than independently housed veterans.

Discussion and implications: Older veterans in the HUD-VASH program have greater healthcare needs and different patterns of healthcare utilization than their independently housed counterparts. Targeted interventions that better engage and reduce barriers to care among aging populations in supported housing are needed.

Background and objectives: Older people with cognitive impairment are unrepresented in clinical research. Our objective was to review evidence for strategies to support their research inclusion and participation.

Research design and methods: Systematic review of published reports of inclusion and participation strategies for older people with cognitive impairment in clinical research (PROSPERO CRD42020212092). Five databases were searched September 2020, March 2023 and April 2024. Screening, full text review and data extraction were independently performed. Risk of bias was assessed using Scottish Intercollegiate Guidelines Network Methodology Checklists. Outcomes were participant characteristics, recruitment and consent processes, retention, experience, involvement of others, adverse events, and other reported outcomes.

Results: Of 4564 identified sources, 12 studies were included. Nine compared recruitment strategies; three examined consent processes. Of 4,208 participants (mean age 78.3 years), 61% were female. Median (interquartile range) monthly recruitment rate was 10.3 (5.6-14.8). Participants had mild cognitive impairment, dementia and/or delirium and two-thirds of studies involved proxies or study partners. Community outreach or population screening had higher recruitment compared to primary care referral and/or screening. Formal capacity and consent methods achieved lower rates of consent compared to informal. A memory and organisational aid increased participants' ability to provide informed consent compared to standard assessment. Few studies reported participants' or recruiters' subjective experience, and no studies reported participant retention or adverse events.

Discussion and implications: Targeted, tailored and multi-pronged recruitment and consent strategies to support inclusion of older people with cognitive impairment appear promising. Higher quality studies are needed to confirm this finding.

Background and objectives: Given the stigma of dementia, individuals with the condition may be wary to disclose their diagnosis to other people, both in face-to-face and digital settings. While sharing one's dementia diagnosis with others is essential for accessing valuable support for social, cognitive, and physical well-being, this area of research has largely been neglected. In this meta-synthesis, we aimed to systematically review qualitative research on the factors associated with online and offline self-disclosure in people with dementia.

Research design and methods: We conducted a systematic search in six electronic databases. Inclusion criteria comprised qualitative and mixed-methods studies describing experiences with self-disclosure in people with any type of dementia. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The meta-synthesis was conducted in NVivo using a thematic synthesis approach.

Results: Twenty-eight studies were included. Three analytical themes were generated: 'Concealment', 'Stigma and fear', and 'Taking control', the latter two with subthemes. Findings from this review were corroborated with people with dementia and family carers as part of Patient and Public Involvement meetings. Our findings reveal that while stigma plays a pivotal role, people with dementia can take control of the meaning of their diagnosis through self-disclosure.

Discussion and implications: Self-disclosure is complex and multifaceted. People with dementia, particularly those experiencing stigma, can benefit from post-diagnostic support that encompasses resources and interventions for self-disclosure. Further research is required to investigate people with dementia's disclosure decision-making process.

Background and objectives: Older people with memory problems living in temporary hostel accommodation have longer stays and higher care needs than those without memory problems. In this ethnographic study, we aimed to elucidate how staff currently support older hostel residents with memory problems, what contextual factors determine support given and, what facilitates positive and meaningful outcomes for staff and residents.

Research design and methods: We conducted interviews and participant observations with older people (≥50 years) experiencing memory problems and homelessness (interviews n=17, observations n=13), hostel staff and managers (interviews n=15, observations n=20) from seven residential facilities (six hostels and one care home), and health and social care practitioners (interviews n=17, observations n=7), from September 2021-December 2022 in London, England. We analyzed thematically from a critical realist position.

Results: We identified four overarching themes: (1) Compensatory strategies and routines, (2) hostels are not homes, (3) meeting challenging interactions with compassion, and (4) facilitating opportunities for meaningful interactions. Social interactions for people with memory problems were restricted and, although sheltered by living in hostels, this did not equate to safety or provide opportunities for positive interactions.

Discussion and implications: Staff worked hard to connect with older residents with memory problems, in resource and time-poor contexts, often left to provide care beyond their roles in contexts of unmet need. Our ethnographic account has informed co-design of a support intervention for hostel staff working with older people with memory problems, alongside recommendations for policy and practice.