Gerontologist最新文献

Background and objectives: Chronic health conditions affect the physical and financial well-being of millions of older adults, including those who themselves provide care to relatives and friends. As well, certain conditions cost more than others to manage, and older caregivers may be especially at risk of experiencing financial burden from an illness. This study investigated the association between caregiving and longitudinal change in health cost burden by measuring condition-specific expenses in a nationally-representative sample of older caregivers and non-caregivers.

Research design and methods: Three waves of the Health and Retirement Study (HRS) were used in the analysis. Caregiver socio-demographic and financial status was matched with updated treatment and lost-wage costs for chronic conditions developed by the Milken Institute. Profiles of health cost burden were created for community-dwelling adults 60 years and older who completed the HRS core survey for all three wave years from 2016 through 2020 (N = 10,540). Bivariate and regression analyses were used to examine differences in health cost burden between caregivers and non-caregivers over time.

Results: Compared to non-caregivers, caregivers were healthier and less burdened at baseline. Yet, holding other variables constant, caregivers showed steeper increases in chronic condition prevalence and costs over a four-year period after initiating caregiving activities.

Discussion and implications: Findings suggest that whereas older caregivers may appear to select into the caregiving role while healthier, they are more likely to experience increased economic and health burdens over time - both from medical treatment and lost wages - related to chronic conditions.

Background and objectives: Goal-concordant transition to hospice is an important facet of end-of-life care for people living with dementia. The objective of this integrative review was to appraise existing evidence and gaps focused on interventions and predictors of transition to hospice and end-of-life care for persons living with dementia across healthcare to inform future research.

Research design and methods: Using integrative review methodology by Whittemore and Knafl, five databases were searched (PubMed, CINAHL, Web of Science, Google Scholar, Cochrane Database for Systematic Reviews) for articles between 2000 and 2023. The search focused on dementia, hospice care, transitions, care management and/or coordination, and intervention studies.

Results: Fourteen articles met inclusion criteria after critical appraisal. Most were cross-sectional in design and conducted in nursing homes and hospitals in the U.S. persons living with dementia had multiple chronic conditions including cancer, diabetes, heart disease, and stroke. Interventions included components of hospice decision-making delivered through advance care planning, checklist-based care management for hospice transition, and palliative care for those with severe dementia. Predictors included increasing severity of illness including functional decline, organ failure, intensive care use, and the receipt of palliative care. Other predictors were related to insurance status, race and ethnicity, and caregiver burden. Overall, despite moderate to high-quality evidence, the studies were limited in scope and sample and lacked racial and ethnic diversity.

Discussion and implications: Prospective, multisite randomized trials and population-based analyses including larger and diverse samples are needed for improved end-of-life dementia illness counseling and hospice care transitions for persons living with dementia and their caregivers.

Background and objectives: LGBTI+ older adults have experienced historical and systemic discrimination. Such discrimination has led to health inequities and avoidance of services. As LGBTI+ people age, they may need to access services, but information about this experience is situated in small scale qualitative studies. As such this, meta-synthesis aimed to bring together the perspectives and experiences of LGBTI+ older adults in literature about engagement with long-term care services.

Research design and methods: A meta-synthesis with a meta-ethnographic approach was conducted with qualitative published and grey literature. Findings were then confirmed through community consultation conducted with LGBTI+ adults aged 50.

Results: A total of 55 qualitative studies were included in the meta synthesis. LGBTI+ older adults' perspectives and experiences were synthesised into 4 key themes: 1) We see it as being heterosexualised, 2) With no-one there to guard us, 3) You have to hide 90% of yourself, 4) I don't want a different service, I want a good service.

Discussion and implications: Overarching heterosexism, experiences of discrimination, and complexities in maintaining identity all contributed to a predominately negative experience for LGBTI+ adults when engaging with long-term care. These experiences were found to align with 'minority stress' theory. Our review found a multilevel approach that included staff education, LGBTI+ affirmative care and signs and symbols of inclusivity was required to reduce the impact of minority stress experienced by LGBTI+ older adults and increased their engagement in long-term care services.

Background and objectives: This study examines the relationship between lifetime victimization and health in later life and asks whether level of lifetime victimization is associated with an earlier onset of an IADL limitation.

Research design and methods: Using data from the Health and Retirement Study (N=11,143), we construct three levels of lifetime victimization (none, monovictimization, and polyvictimization). We use Weibull accelerated failure time models to examine the relationship between level of lifetime victimization and onset of an IADL limitation.

Results: Monovictimization and polyvictimization were associated respectively with a 9% and 18% earlier time to onset of an IADL limitation compared to individuals who did not experience victimization. Additionally, polyvictimization respondents had an earlier onset of an IADL limitation compared to monovictimization respondents.

Discussion and implications: Lifetime victimization is a life course antecedent to IADL limitations in later life, especially among individuals who have experienced multiple types of victimization. Future research should examine resources that slow health declines among people who have experienced victimization.

Background and objectives: Most studies examining combined cognitive and physical activity are conducted in laboratory settings. This randomized controlled trial (RCT) examines the effects of a real-life cognitively enriched walking program on cognitive functioning and moderate-to-vigorous physical activity (MVPA) in adults aged ≥65 years.

Research design and methods: A three-arm RCT was conducted, comparing the cognitively enriched walking program (WALK+, doing cognitive tasks while walking) with a walking program without enrichment (WALK-only) and a passive control condition (CONT). Both WALK+ and WALK-only had a duration of six months, with two outdoors, supervised group-based sessions/week (60-90 minutes/session). Cognitive functioning (short- and long-term memory, executive functioning and processing speed) and MVPA were measured at baseline, three, six and 12 months using the Cambridge Neuropsychological Test Automated Battery (CANTAB) and ActiGraph GT3X+ accelerometers respectively.

Results: A total of 148 community-dwelling adults (median age: 69 years, range: 65-85; 72% (n=107) female) were included. Comparing WALK+ to WALK-only and CONT, and WALK-only to CONT, there were no significant intervention effects on cognitive functioning at three, six or 12 months. MVPA decreased with 13 minutes/day in WALK+ between baseline and 12 months, whilst it increased between baseline and six months with 12 minutes/day in WALK-only and between three and six months with 16 minutes/day in CONT.

Discussion and implications: The WALK+ program did not lead to statistically significant benefits for cognitive functioning or MVPA compared to WALK-only or CONT. Future studies should explore for whom combined interventions may work and determine the optimal dosage.

Background and objectives: Loneliness is a modifiable risk factor for health decline in older adults and its level may change over time. This study aimed to explore how loneliness changes across four years in older adults and investigate potential between-person and within-person predictors of this trajectory.

Research design and methods: Using growth curve modeling, we analyzed data collected annually between 2017 and 2020 from 128 older adults (Mage = 77.91) in independent-living or retirement communities.

Results: A quadratic model best fit the loneliness trajectory, showing loneliness decreased first and then increased over four years. At baseline, social relationship factors and health status, especially depressive symptoms, were correlated with the level of loneliness. None of the baseline variables had significant associations with the linear rate of change in loneliness. Increases in depressive symptoms and decreases in physical functioning were separately related to an increased level of loneliness. A secondary analysis showed the COVID-19 pandemic influenced the rate of change in loneliness.

Discussion and implications: Findings suggest the loneliness trajectory for older adults follows a nonlinear trend, and that within-person variability exists in this trajectory. Social relationships and health indicators contribute to the trajectory of loneliness, and depressive symptoms were the most salient predictor of change in loneliness. The COVID-19 pandemic also influenced the uptick in loneliness in 2020. More attention and support should be offered to older adults who are less socially connected or experience health declines, to prevent loneliness and thus increase the healthy longevity of our older population.

Background and objectives: Limited access to preventive healthcare among undocumented immigrants may increase healthcare needs with age, leading to higher Emergency Department (ED) utilization and hospitalizations. While county programs like My Health LA (MHLA) in Los Angeles County (LAC), California, provide primary care to older undocumented adults, our understanding of the group's specific health issues prompting ED visits and potential legal status differences in ensuing hospital admissions is limited.We compared legal status differences in the likelihood of an ED-originating hospital admission among older immigrant patients in LAC. We examined the top 10 diagnostic categories for undocumented (MHLA and non-MHLA participants) and documented patients to understand the health conditions that bring older immigrants to the ED and those that result in hospital admission.

Research design and methods: This retrospective study analyzed 239,861 ED encounters from 2016 to 2020 across three LAC safety-net hospitals involving immigrant patients aged 50+. Multivariable mixed-effects models estimated the relationship between patient legal status and odds of ED-originating hospital admission.

Results: Undocumented patient encounters, both MHLA (OR=0.75, 95% CI: 0.71-0.78) and non-MHLA (OR=0.88, 95% CI: 0.85-0.91), were less likely to result in ED-originating hospital admissions than documented patient encounters. The top clinical reasons for treat-and-release (i.e., ED visits discharged home) visits and ED-originating hospital admissions among undocumented immigrants were similar to those of their documented counterparts.

Discussions and implications: Older undocumented patients in MHLA were less likely to be admitted following an ED visit. Health programs should be designed for both documented and undocumented patients.

Aging research has conceptualized disablement via two primary frameworks. Paradigms of successful aging frame substantial disablement in aging as universally abnormal. These models have often been challenged as narrow and ableist, leaving out common experiences among people with chronic conditions. By contrast, steady decline paradigms frame substantial disablement in aging as universally normal. These models have invited challenges due to ageism inherent in automatically conflating older age and disability. Both frameworks juxtapose monolithic and rigid ideas of normalcy-and thus limit our understanding of dynamic possibilities in later life health and functioning. Given that people with progressive conditions often experience wide variability in daily status and inconsistency in long-term outcomes, current later-life disablement models may overlook such experiences. We thus propose additional nuance in later-life disablement modeling that brings innovative stochastic frameworks of daily health and functioning to longitudinal trajectory concepts. Using an "aging with progressive disease perspective," we outline gaps and opportunities in the current landscape of later-life disablement modeling. We then engage our standpoints from lived experience with progressive conditions to recommend new directions in conceptualizing relationships between aging and disability. Including such conditions in later-life disablement models can improve health care and supportive services for affected individuals.

Background and objectives: On the National Institute on Aging's (NIA's) timeline of major milestones, the 1961 White House Conference on Aging (WHCOA) and the 1971 WHCOA are credited with recommending the creation of a separate National Institute on Aging. This article explores the relationship between NIA and the WHCOA, and how the two entities have worked together to increase research in the mechanisms of aging, diseases of older people, and long-term care..

Research design and methods: Historical analyses of past WHCOA Final Reports, supplemental documents, websites, and interviews with key participants, including Dr. Richard Hodes, director of the NIA, from 1993 until the present.

Results: The results affirmed that NIA has been an active and collaborative partner of past WHCOAs, especially regarding the shared objective of increased funding for Alzheimer's disease.

Discussion and implications: While not always a primary partner, NIA has played a key role in advising and assisting organizers of past WHCOAs, assuring that research remains an underlying theme and content generator of each conference. The Older Americans Act Reauthorization of 2024 (S. 4776) calls for a 2025 Conference to be planned and directed under the Secretary of HHS in cooperation with the Assistant Secretary for Aging and the Director of the NIA, among others.

Background and objectives: Social isolation is an increasing public health concern. Older residents in subsidized housing may be susceptible to isolation given high rates of chronic illness/disabilities, low income, and living alone. This cross-sectional study examined correlates of social isolation among over 3,000 older adults from nearly 100 subsidized housing communities across the US.

Research design and methods: Respondent Lubben Social Network Scale-6 scores, demographic data, and health information were collected in 2019 by a non-profit housing organization and linked to the Neighborhood Atlas Area Deprivation Index. Associations between social isolation and other variables were assessed using logistic regression.

Results: The mean respondent age was 75.9 years; 67% were female, 33% were male, 38.8% were white, 15.5% were Black, 7.8% were Hispanic, and 27.5% were Asian. Among all respondents, 29.8% were isolated. Adjusting for demographics, multi-level logistic regressions demonstrated significant associations between isolation and poor self-rated health, functional impairment, mental health distress, and knowing/relying on fewer neighbors.

Discussion and implications: This study sheds light on the prevalence and correlates of social isolation among older adults who live in subsidized housing managed by a large non-profit housing organization. The findings from this study suggest that contextual and structural factors must be further investigated to better understand social isolation among older subsidized housing residents. Ultimately, this work informs efforts to identify socially isolated older adults and evidence-based interventions to address this public health concern.