Gerontologist最新文献

Background and objectives: Circumstances more common with aging may challenge the ability for older adults to maintain appropriate housing. The objective of this scoping review was to identify the risk factors and conditions associated with homelessness in older adults.

Research design and methods: We searched OVID, CINAHL, Embase, PsycINFO, CENTRAL, and Social Works Abstracts from inception to February 2023. We included studies of older adults (defined as 50 years of age or older) or completed subgroup analyses accounting for older adults. We mapped the risk factors and conditions using an ecological framework (individual, relational, and structural/societal components).

Results: Sixty-five studies were included. Individual factors included identifying membership in a racialized group, and experiencing psychiatric illnesses or substance use disorders. Relational factors included being unmarried, relationship breakdown, and adverse childhood events. Structural factors included the lack of affordable housing or income supports, and systemic discrimination. Those experiencing first-onset late life homelessness were more likely to be female, had relative lifelong socioeconomic stability, but experienced sudden relational or economic changes. Those experiencing chronic homelessness were more likely to be male, often facing persistent structural vulnerabilities with comorbid substance use or psychiatric disorders. Important research gaps include measures of social support, and age and sex disaggregated analyses.

Discussion and implications: Key individual, relational, and structural factors are associated with homelessness in older adults. Adverse experiences and structural factors such as social losses and isolation have important implications towards the risk of homelessness at different stages in life. sFurther research evaluating age-appropriate interventions is paramount.

Background and objectives: Population aging underscores the need for a comprehensive understanding of the multi-level factors that support aging in place. Physical environments are closely linked to social environments, and caregivers often observe how these environmental features shape the everyday experience of people with memory problems. This study examines how caregivers' perceptions of neighborhood built environments are associated with their perceptions of the social inclusion of people with memory problems in communities.

Research design and methods: A statewide survey was conducted in Texas, involving 95 caregivers of individuals with memory problems (defined as having significant memory impairment that impacts daily functioning). Descriptive statistics summarized neighborhood characteristics and caregivers' perception of the community's social inclusion. Logistic regression predicted two target outcomes of social inclusion for people with memory problems: (1) respect and support and (2) intergenerational exchange (e.g., age-integrated social interactions).

Results: For neighborhood characteristics, legibility-related environmental features were more commonly present than those related to accessibility or safety. For social inclusion, caregivers perceived positive community respect and support for people with memory problems but limited intergenerational interaction. Legibility of neighborhood environments was positively associated with caregivers' perceptions of respect and support for people with memory problems, while accessibility was associated with intergenerational exchange.

Discussion and implications: The findings underscore the role and potential of neighborhood environments for improving social inclusion for people living with memory problems. They suggest that improving legibility and accessibility of neighborhood environments can foster respect and social support and intergenerational exchanges central to aging in place.

Background and objectives: Employee background checks can help protect older adults in long-term care facilities. The National Background Check Program (NBCP) offers federal support to strengthen employee background check systems. Yet, regulations on provider requirements, disqualifying offenses, and administrative processes differ across states. We examine differences between NBCP (N = 27) and non-NBCP (N = 23) states across three domains: (1) types of LTC providers required to conduct background checks (2) disqualifying offenses considered by each state, and (3) processes used to administer background checks. We also assess regulatory changes across these domains from 2005 to 2024 across all 50 states.

Research design and methods: We conducted policy surveillance of state regulations on employee background check programs applicable to individuals seeking work at long-term care facilities. Our sample includes all 50 states, with 27 receiving an NBCP grant. We assess current regulations across three policy domains and review how these regulations have evolved since 2005, when the NBCP pilot program was initiated.

Results: NBCP states have expanded background check regulations to include a broader range of long-term care providers and disqualifying offenses following the grant. However, minimal differences were observed between the two groups in background check processes such as fingerprinting and registry reviews.

Discussion and implications: While many NBCP states have adopted measures like disqualifying offenses and RAP back systems, their overall impact on hiring practices, F-tags and quality of care remains uncertain.

Background and objectives: Sexual and gender minority (SGM) older adults are more likely to use long-term care (LTC) than their cisgender, heterosexual counterparts. However, LTC settings may lack SGM-affirming policies necessary for inclusive care. This study analyzed the prevalence of SGM-affirming policies in nursing homes (NH) and assisted living facilities (ALF) in Minnesota and examined differences across facility characteristics.

Research design and methods: A survey was conducted across 165 NH and 266 ALF in Minnesota. Facilities were assessed by their explicit inclusion of 28 SGM-affirmative policies, like nondiscrimination and training policies, with a mean index score calculated to determine the overall prevalence of affirming policies. Differences by facility type (NH vs ALF), location (rural vs. urban), ownership (non-profit vs. for-profit), and religious affiliation (religious vs. secular) were assessed in multinomial logistic regression. Latent class analysis compared lower (n = 244) and higher (n = 153) performers across facility characteristics.

Results: Across LTC facilities, there was an average of 11.30 SGM-affirming policies out of 28 policies assessed. Lower performing facilities reported fewer SGM-affirming policies (mean = 7.34) than higher performing facilities (mean = 17.24). No significant differences in policy prevalence were found between NH and ALF; between rural and urban facilities or by ownership status. However, striving facilities were more likely to be secular than religious.

Discussion and implications: The prevalence of SGM-affirming policies was distributed binomially, suggesting facilities fall within two categories (lower performers and high performers). Efforts should focus on adopting SGM-affirmative policies across all LTC facilities to ensure equitable and inclusive care for SGM older adults.

Hearing loss affects an estimated 18 million UK adults and is the third leading cause of years lived with disability worldwide. Hearing loss diminishes quality of life, activities of daily living, mental health, and negatively impacts the economy. When left unaddressed, hearing loss exacerbates health inequalities and is associated with an increased risk of developing dementia. Hearing loss and dementia frequently co-occur and have overlapping risk factors. People from disadvantaged backgrounds typically access hearing and memory services at a more progressed stage of their conditions. Early intervention is essential to mitigate negative effects and reduce disease burden. Universal adult hearing screening is not currently recommended by the UK National Screening Committee, despite evidence of cost-effectiveness and international recommendations. We argue that the UK should adopt targeted, risk-stratified screening that prioritises those at greatest risk of dementia and people in deprived communities, where unmet need is highest. Such an approach is practical, equitable, and consistent with the Governments' prevention and personalised care agenda set out in the 10-year Health Plan for England. We outline the evidence, discuss implementation pathways, and call on policymakers to commission a targeted, risk-stratified adult hearing screening pilot. A successful programme would address unmet need, reduce inequalities, and further inform global debates on hearing screening strategies.

Background and objectives: Falls are a leading cause of injury and death among older adults (65+). The CDC's STEADI initiative aims to reduce falls by screening to find at-risk individuals, evaluation, and then addressing modifiable risk factors. This study evaluated the effectiveness of implementing a STEADI-based multi-component fall prevention approach via telemedicine in primary care.

Research design and methods: A randomized controlled quality improvement trial (STEADI Options) was conducted during the COVID-19 pandemic (07/2020-12/2021). Primary care professionals (PCPs) were randomized to either standard-of-care (SOC) or intervention. The intervention included a fall risk assessment by a research nurse, who shared STEADI-based recommendations with PCPs. Recommended interventions were administered at the discretion of PCPs. Outcomes included self-reported falls (primary), medically treated falls, fall-related service utilization (physical therapy, occupational therapy, eye care, podiatry), and medication changes, assessed over one year. Analyses followed an intent-to-treat approach.

Results: Among 660 participants (353 SOC; 307 intervention), the cohort was predominantly female (67.7%), aged 65-79 (73.6%), and non-Hispanic White (56.1%). Intervention participants had higher average Stay Independent Screener (SIS) scores (6.3 vs. 5.2; p < 0.001). Overall, 5.5% reported a fall in the past 12 months. No significant differences were observed between groups in fall-related outcomes (e.g., medically treated falls odds ratio (adjusted for SIS): 0.741; 95% CI: 0.411-1.336).

Discussion and implications: Although no significant differences were found, limited recruitment, low baseline fall rates, and unmeasured adherence may have impacted results. Further research is needed to evaluate the feasibility and effectiveness of telemedicine-based STEADI interventions in primary care.

Background and objectives: Emerging public health discourse increasingly frames brain health and dementia prevention as matters of personal responsibility and urge individuals to adopt modifiable behaviours across the life course. This study examines how adults at different life stages perceive dementia risk and engage with brain health practices, with particular attention to how these behaviours are socially structured and culturally mediated.

Research design and methods: Using a life course perspective and an abductive critical realist approach, this qualitative study draws on semi-structured interviews with 33 participants (aged 19-81) recruited across three generational cohorts: younger adults (n = 11), middle-aged adults (n = 8), and older adults (n = 14). Abductive thematic analysis was employed to examine how participants understand brain health, dementia, and responsibility for the management and prevention of these aspects of late-life health.

Results: Participants articulated diverse and age-contingent understandings of brain health. While younger adults associated prevention with aspirational self-optimisation, middle-aged adults emphasised routine, sustainability and caregiving-informed insight. Older adults, often informed by lived proximity to dementia, described adaptive strategies to preserve brain health amidst physical limitations. Across all groups, health practices were framed through an ethos of personal accountability, though often enacted within structurally constrained contexts.

Discussion and implications: Findings emphasise the need to critically engage with how dementia prevention discourse is differentially internalised across the life course. Public health strategies should balance behavioural interventions with honest acknowledgement of the structural conditions which stratify distributions of brain health risk and opportunities for prevention.

In 2005, congressional support led to the creation of the Healthy Brain Initiative (HBI) and the collaboration between the Alzheimer's Association and the Centers for Disease Control and Prevention to prioritize brain health in public health practice. Over 20 years, the HBI has developed and implemented the HBI Road Map Series to increase the capacity of health departments to integrate dementia into health departments nationwide, aligning frameworks like the Essential Public Health Services and focusing on health equity across the life course. A growing number of HBI partners now work together to implement public health strategies that promote brain health, address dementia, and support people living with dementia and caregivers. Recognizing opportunities to influence the trajectory of public health action, the HBI prioritizes growing the availability and use of dementia-related public health data and equipping the public health workforce with the knowledge and confidence to make change. This article documents the history and evolution of the HBI, including a description of current efforts and the broader public health context to which it has contributed; efforts of the HBI and partners in national, state, local, territorial, and tribal public health agencies have led to transformative change.

The Centers for Disease Control and Prevention-funded Building Our Largest Dementia (BOLD) Infrastructure's Public Health Center of Excellence on Dementia Caregiving (PHCOE-DC) is one of three national centers designed to help public health departments strengthen and grow their Alzheimer's disease and related dementia initiatives. The PHCOE-DC specializes in disseminating tools and resources to help public health agencies develop programming and partnerships that support family caregivers of individuals with dementia. Through its reach and dissemination efforts, the PHCOE-DC has helped to elevate dementia caregiving as a priority for public health departments. Since 2020, the PHCOE-DC has increased visibility for the role of public health in strengthening the support infrastructure for family caregivers of individuals with dementia and has established a network of national leaders in dementia caregiving. This article summarizes PHCOE-DC's past work and potential future activities as the Center continues to elevate dementia caregiving as a priority for public health.