Gerontologist最新文献

Background and objectives: Substantial heterogeneity in cognitive aging trajectories has been observed among older adults, with some individuals maintaining exceptional cognitive function ("superagers" or "successful cognitive aging (SCA)"). The biological mechanisms underlying SCA remain unclear. This systematic review synthesizes current evidence on quantifiable SCA biomarkers to address this critical gap.

Research design and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Scopus, PsycINFO, and Web of Science (up to December 2024). After screening 6699 records, 62 studies met the inclusion criteria. Data from included studies were extracted, assessed for risk of bias, and synthesized for integrated findings.

Results: We identified 34 SCA definitions, categorized them into three types, and analyzed biomarkers across six domains: (1) genetic/epigenetic biomarkers, (2) biofluid biomarkers, (3) histological biomarkers, (4) positron emission tomography (PET) biomarkers, (5) structural magnetic resonance imaging (MRI) biomarkers, and (6) functional neuroimaging biomarkers. Integrated findings suggest SCA is driven by unique multi-domain biological mechanisms (e.g., young DNA methylation age, high von Economo neuron density, and efficient glucose metabolism, etc), not merely resistance to age-related neuropathology such as amyloid-β and tau. Neuroimaging findings highlight the role of brain reserve, maintenance, and compensation on SCA, particularly within a newly defined "cingulate gyrus-medial temporal lobe-frontal cortex" brain signature.

Discussion and implications: This systematic review advances our understanding of SCA's biological substrates, provides theoretical frameworks for future SCA biomarker research, and offers a foundation for future strategies to promote cognitive health in aging populations.

Background and objectives: While participatory arts are thought to benefit older adults' well-being, evidence has focused on dementia. This umbrella review synthesizes evidence from systematic reviews (SRs) and meta-analyses (MAs) on the impacts of participatory arts for older adults without dementia, and conceptually organizes findings using the proposed "Aesthetic-Engagement-Creativity" (AEC) framework.

Research design and methods: Following PRIOR guidelines, we searched MEDLINE, PubMed, PsycINFO, Cochrane review and grey literature to September 2023, with an update in June 2025. Study characteristics and well-being outcomes were extracted. We used the AEC framework for conceptual categorization, assessed primary study overlap using the corrected covered area (CCA) and the methodological quality with the AMSTAR 2.

Results: Eighteen reviews were included, with minimal study overlap (CCA = 1.96%). However, the evidence base was weak; 12 reviews were of low or critically low quality. A synthesis of the six moderate-to-high quality reviews revealed that dance was the most studied modality, associated with improved physical well-being. The benefits for other well-being domains and art modalities were mixed, and significant heterogeneity in study designs and measures complicated comparisons. Our retrospective application of the AEC framework suggests that considering participants' aesthetic preferences and optimizing engagement and creativity levels may be important, but this link is speculative.

Discussion and implications: Participatory arts show potential for promoting well-being of older adults, but robust conclusions are constrained by the poor quality, underrepresented art modalities, and heterogeneity of the existing evidence. The AEC framework is offered as a conceptual tool requiring future empirical validation.

Background and objectives: Ageism often emerges in childhood, yet rigorously evaluated school-based interventions-especially in multicultural settings-are scarce. The study evaluated the efficacy of a 90-min educational intervention to reduce ageism among Israeli Jewish and Arab middle school students.

Research design and methods: Using a randomized controlled trial (RCT) design, 606 Israeli Jew and Arab middle school students (aged 12 to 16, 53.3% girls) were assigned to either an intervention (N = 314) or a control group (N = 292), with measures of stereotypes, prejudice, and discrimination collected at three time points.

Results: In contrast to successful pilot findings, the intervention yielded no significant improvements over time on the measured outcomes. An exploratory analysis revealed that the pattern of change over time did not significantly differ across Israeli Jews and Arabs.

Discussion and implications: Results highlight challenges associated with reducing ageism in early adolescence. Our null findings contribute valuable knowledge that can guide future intervention design and advance cross-cultural ageism research.

Background and objectives: Problems with vision or hearing in midlife and old age can have a detrimental impact on individuals' autonomy in everyday life, social participation, and quality of life. However, little is known about historical trends in self-reported vision and hearing trajectories among middle-aged adults and how these differ across nations.

Research design and methods: We used harmonized data (n = 96,896; data collection 1996-2020) on self-reported near and distant vision as well as hearing from nationally representative panel surveys across a total of 16 countries (U.S., Mexico, South Korea, England, and countries in Continental, Mediterranean, and Nordic Europe) in order to compare historical change in middle-aged adults' sensory functioning trajectories. We included sex, age, education, chronic conditions, and depressive symptoms as moderators of historical change.

Results: Longitudinal multilevel regression models revealed that at age 50 and across most birth year cohorts, U.S. individuals had poorer self-reported hearing as well as poorer self-reported near and distant vision than individuals in England, Nordic Europe, and Continental Europe. For the U.S., there was no evidence of historical change in self-reported hearing and distant vision. Across most countries, including the U.S., there was a historical decline in self-reported near vision. Women reported better hearing than men; this sex discrepancy narrowed across historical time. Education and depressive symptoms were more closely associated with self-reported sensory functioning in the U.S. than in most other regions.

Discussion and implications: Our findings suggest that there is little evidence for global historical improvements in self-reported sensory functioning.

Background and objectives: Effective education on Alzheimer's disease (AD) requires methods fostering empathy, confidence, and knowledge. Artificial intelligence (AI)-enhanced virtual reality (VR) provides immersive experiences potentially superior to traditional modalities. No previous studies have compared VR immersive learning experiences to analogous computer-based or in-person embodiment exercises. This quasi-experimental study compared the efficacy of an AI-enhanced VR scenario, "Beatriz," with computer-based and face-to-face methods in improving students' confidence, empathy, and knowledge of AD.

Research design and methods: A quasi-experimental design included 173 undergraduate health science students assigned to AI-enhanced VR, computer-based, or face-to-face modalities depicting early, middle, and late AD stages. Confidence, empathy, and knowledge were measured via pre-post surveys. Repeated measures ANOVAs determined significant differences.

Results: All groups significantly improved confidence across AD stages post-intervention. The VR group showed greater improvement specifically in early-stage confidence. VR also significantly increased empathy compared to other modalities. No modality significantly improved factual knowledge of AD symptoms.

Discussion and implications: AI-enhanced VR effectively improved empathy and early-stage confidence, suggesting strong benefits for dementia education. However, it did not surpass traditional methods in improving factual knowledge. AI-driven VR has promising implications for enhancing therapeutic and caregiving practices for aging populations. Further research should explore long-term impacts and direct older adult care applications.

Background and objectives: As the global population of people living with cognitive impairment grows, Home Monitoring Technologies (HMTs), such as cameras, motion sensors, wearable trackers, and artificial intelligence enabled ones are increasingly used to enhance safety and support aging in place. However, these technologies raise ethical concerns, particularly regarding privacy, autonomy, trust, and transparency. This scoping review explores these ethical implications and identifies key themes to inform future research, practice, and policy development.

Research design and methods: Following Arksey and O'Malley's scoping review framework, systematic searches were conducted in PubMed, EMBASE, CINAHL, and PsycINFO (Arksey & O'Malley, 2005). Studies were included if they examined HMTs for people living with cognitive impairment and addressed ethical concerns. Our eight central themes were derived inductively during data synthesis, and the Rubeis' 4D Risks Framework offered a valuable conceptual scaffold to organize and interpret the broader patterns of ethical risk.

Results: A total of 110 publications from 30 countries were reviewed. Ethical concerns were identified in each of the 4 areas of the framework, including privacy violations, loss of autonomy, erosion of trust, and unintended consequences such as social isolation and reduced human interaction. Person-centered design approaches, which engage both people with cognitive impairment and caregivers, were identified as crucial for mitigating risks and fostering ethical implementation.

Discussion and implications: Findings underscore the need for evidence-informed guidelines that explicitly incorporate ethical frameworks to ensure consideration of the balance of health and safety with autonomy and dignity.

Background and objectives: The Sarcopenia and Calf Circumference (SARC-CalF) tool has been proposed to enhance the detection of sarcopenia. A comprehensive systematic review evaluating the diagnostic performance of the SARC-CalF could support its broader adoption as a valid screening instrument. Thus, this study aimed to assess the diagnostic accuracy of the SARC-CalF in detecting sarcopenia risk among older adults.

Research design and methods: A systemic review was conducted in six electronic databases and Google Scholar. The values of sensitivity, specificity, and area under the curve were estimated simultaneously using a bivariate model. Evaluation of the quality of individual studies included in this review was conducted with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

Results: Our systematic review included 18 studies, with 10,367 older adults. The pooled sensitivity and specificity of the SARC-CalF were 53.3% (95% confidence interval [CI]: 0.46-0.60) and 87.3% (95% CI: 0.84-0.90), respectively. The pooled diagnostic odds ratio was 7.34 (95% CI: 5.87-9.19), and the area under the curve was 0.78 (95% CI: 0.73-0.81), indicating moderate diagnostic accuracy. Subgroup analyses revealed variations based on reference standards and calf circumference cutoff values.

Discussion and implications: This study highlights the SARC-CalF as a practical, cost-effective screening scale for sarcopenia of older people in community settings. Further research is required to establish optimal calf circumference cutoff values and validate its utility in various clinical environments. Combining the SARC-CalF scale with other functional measures may be useful and optimal tools for sarcopenia among older adults.

Background and objectives: Despite interest in using real-time location systems (RTLS) to improve quality and efficiency of care and to collect data for the development of clinical algorithms, research on their implementation and use in long-term care homes is scarce. This study examines RTLS implementation in one long-term care home identifying failure points, ethical tensions, and sociotechnical misalignments that led to abandonment.

Research design and methods: Semistructured interviews were conducted with 47 participants (residents, care partners, direct care staff, managers, administrators) across two time points; all also completed a demographic survey. Thematic analysis of the data was guided by the Non-Adoption, Abandonment, Scale-up, Spread and Sustainability framework, and Sociotechnical Systems theory.

Results: Initial enthusiasm for RTLS stemmed from safety and efficiency expectations, but misaligned functionalities, limited staff engagement, and ethical tensions undermined adoption. Stakeholders anticipated real-time monitoring and fall detection, neither of which were provided. Residents frequently removed the wearables, citing discomfort and privacy, while staff encountered barriers due to the limited integration of the RTLS into workflows. Ethical tensions emerged as residents' autonomy and preferences were overridden by care partners.

Discussion and implications: These failures underscore the need for iterative and participatory approaches to implementation, transparent communication, and stakeholder alignment. The findings highlight the sociotechnical complexities of implementing surveillance technologies in long-term care. Ethical concerns surrounding resident autonomy, workforce surveillance, and data governance, must be addressed in future implementations to ensure that RTLS supports rather than compromises the dignity and rights of residents and staff.

This article explores an innovative new framework that addresses system-level complexity in long-term care research through the lens of culture change. We first discuss the current findings and gaps in culture change research and explore how a lack of system-level research may have slowed culture change adoption. After a review of potential system-level theories, we identify a conceptual framework that integrates the theoretical constructs of the Consolidated Framework for Implementation Research (CFIR) and Complex Adaptive Systems (CAS) for a more advanced conceptual modeling of culture change implementation. To illustrate the integration of CFIR and CAS as a conceptual framework to research culture change at a system-level, we create a crosswalk using two prominent implementation tools that support culture change: The Preferences for Everyday Living Inventory and the Artifacts of Culture Change 2.0. We argue for the value of this novel conceptual framework in highlighting the complexity of systems in long-term care research.

Dementia is a prevalent and growing concern among Indigenous communities. Research on the lived experience, culture, and context of the dementia journey has improved our understanding of Indigenous Peoples' experiences. This research study elucidates the deep understanding of healthy brain aging from interviews with seven Anishinaabe/Ojibwe Traditional Knowledge Sharers from Manitoulin Island in Ontario, Canada. Using a community-based participatory research (CBPR) approach and Indigenous methodologies, researchers worked with a Community Advisory Council (CAC) to develop the study. Interviews with Traditional Knowledge Sharers were recorded, transcribed, and shared with a local Anishinaabe/Ojibwe artist for his interpretation and artistic representation of the key healthy brain aging teaching that arose from the interview. The artist developed six paintings based on these teachings for Anishinaabe/Ojibwe people, titled: Perseverance, Anishinaabe Cognition, Presence, Healing Step, Benevolence, and Linkages. A seventh painting was also developed, with the shared teaching of Bebaminojmat-one who goes around and shares their healing gifts. We describe these teachings and the cross-cutting themes that arose from the post-analysis. This study contributes to the field of aging by revealing cultural and philosophical concepts related to healthy brain aging specifically for Anishinaabe/Ojibwe people. The findings can be used to guide healthcare providers in supporting healthy brain aging in culturally meaningful ways and developing culturally safe health education interventions. Artistic analysis and representation proved to be an effective vehicle for exploring cultural values central to the development of programs and education aimed at addressing existing brain health disparities.