Gerontologist最新文献

Background and objectives: Montessori-based interventions (MBIs) promote quality of life among older adults living with dementia. We used Dementia Care Mapping (DCM) to evaluate the impact of a small-scale MBI. DCM is a systematic observation tool that records the behavior and mood/engagement of individuals living with dementia and can be used to improve quality of care and well-being.

Research design and methods: Pre- and post-intervention data from 15 care community residents compared: 1) residents' range and types of behaviors, 2) their mood/engagement and 3) staff behaviors that facilitated and impeded residents' personhood. In this mixed-methods study, deductive qualitative content analysis of DCM field notes further explored staff behaviors.

Results: Post-intervention, a significantly higher proportion of residents' behaviors had the potential to promote their well-being, although there was little change in mood/engagement while engaging in those behaviors. Post-intervention, there was also a significant increase in staff behaviors that facilitated, and a decrease in staff behaviors that impeded, residents' personhood. Further, post-intervention, staff interactions with residents were more open-ended and inclusive. Although some staff behaviors still excluded residents, the exclusion was more benign than pre-intervention.

Discussion and implications: DCM documented incremental changes toward person-centered care, and DCM field notes provided insight into missed opportunities for effective staff interactions with residents. Taken together, findings provide additional support for the use of MBIs and highlights the usefulness of DCM, especially its associated field notes, to help researchers and practitioners create environments that promote the personhood that individuals living with dementia deserve.

Background and objectives: The evolution of care networks accompanying older adults' changing care needs-and implications for unmet care needs-are not well described.

Research design and methods: Using group-based trajectory models, we identify 4 incident care need patterns ("care need trajectory groups") for 1,038 older adults in the 2012-2018 National Health and Aging Trends Study and 5 caregiving patterns ("caregiving trajectory groups") and a transient group among their 4,106 caregivers. We model associations between care need/caregiving trajectory groups and the rate of (approximating the proportion of rounds with) unmet care needs. We illustrate how predicted rates vary by care need trajectory groups and by network composition for networks with 2 caregivers.

Results: The percentage of rounds with unmet care needs varies from 13% among older adults with few, stable needs to 62% among those with many, stable needs (p<.01). In models, care need trajectory group is strongly associated with the rate of unmet care needs; among those with steep increasing care needs, network composition is also predictive. For older adults with steep increasing care needs, when one caregiver provides high, variable and another medium, stable care hours, the predicted rate of unmet care needs is low (0.16) and similar to those with few, stable care needs (0.12).

Discussion and implications: Findings highlight the complexity and heterogeneity of older adults' care needs and caregiving patterns over time. For those with rapidly increasing needs, identifying and assessing the evolving care network may be a fruitful direction for forestalling unmet care needs.

Background and objectives: This study explores resilience factors among sexual and gender minority (SGM) midlife and older adults, identifying historical/environmental, psychological, social, and behavioral predictors, and examining variations across racial/ethnic subgroups. By adopting a resilience-focused perspective, this research contributes to understanding strengths in the SGM community in the context of aging.

Research design and methods: Using weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this research investigates distinct risk and protective factors associated with resilience among SGM midlife and older adults. Subgroup variations were assessed using regression models. Factors moderated by race/ethnicity were integrated into final interaction models.

Results: Hispanic and Black individuals showed significantly higher resilience than non-Hispanic Whites. Lifetime victimization and day-to-day discrimination were negatively associated with resilience. Positive associations were found for higher income, identity affirmation, larger network size, greater social participation, increased physical activity, and sufficient food intake. Interaction models revealed nuanced patterns by subgroups; education negatively impacted resilience among Black individuals, while income positively influenced Hispanic individuals' resilience. The Other racial/ethnic group demonstrated unique associations between optimal sleep and resilience.

Discussion and implications: This study shifts from a deficit-based to a resilience-focused approach among SGM midlife and older adults, revealing key strengths within diverse subgroups. Results underscore the significance of recognizing racial/ethnic differences in factors promoting resilience and posing risks for SGM midlife and older adults. Tailoring interventions to address the intersectional needs of SGM aging populations is essential for enhancing their abilities to bounce back from adverse events.

Background and objectives: Family conflict is a stressor for dementia family caregivers, yet its impact may differ based on the relationship between caregivers and their recipients. This study's objectives were to categorize caregivers into groups based on family conflict, examine whether the relationship to the recipient influences group membership, and determine whether these groups are associated with engaging in abusive and neglectful behaviors.

Research design and methods: This national, cross-sectional study of 453 dementia family caregivers used latent class analysis to generate groups based on family conflict and abuse accusations. A multinomial logistic regression determined if relationship type (i.e., being a spouse, child, or grandchild to the care recipient or having a nontraditional relationship) predicted group membership. Groups were examined as predictors of abusive and neglectful behaviors using analysis of variance.

Results: A 4-class solution emerged as the best fit: 3 groups with varying probabilities of family conflict and 1 group with elevated probabilities of abuse and neglect accusations. Relationship typed predicted membership in these classes. Group membership predicted abusive and neglectful behaviors.

Discussion and implications: Adult children were more likely to experience high amounts of family conflict, whereas nontraditional caregivers were less likely to experience abuse and neglect accusations. Membership in the accusations group was a unique risk factor for abusive and neglectful behaviors. These findings support the need for continued investigation of family conflict in dementia caregivers. They also call to examine how family relationship types, including nontraditional family structures, influence caregiving outcomes.

Background and objectives: The role of social factors in diabetes onset has been obscured by wide variation in their conceptualization and operationalization. We apply 3 theoretical frameworks to categorize social relationship variables along several dimensions and identify which dimension(s) are robustly associated with incident diabetes in the older adult population.

Research design and methods: The National Social Life, Health, and Aging Project (n = 2,365) and the Health and Retirement Study (n =11,824) provided longitudinal data from 57 to 90-year-old respondents over a 4- to 5-year period. Logistic regression models were used to test associations of 15 social variables measured identically in both data sets with diabetes onset measured as respondents' first report of a physician's diagnosis.

Results: In both studies, not being married, experiencing strain in a spousal relationship, and feeling lonely were associated with increased risk for diabetes onset at follow-up. Inconsistent or null findings were observed for social support, social activity, network size, number of friends and relatives, living alone, and closeness to network members.

Discussion and implications: Robust findings in 2 large-scale surveys support the importance of the valence dimension (i.e., positive and negative); specifically, alleviating negative aspects of social life might more effectively reduce risk for diabetes than augmenting positive ones. Findings were not aligned with social variables differing on the subjectivity dimension (i.e., structural, functional, and qualitative aspects of social connections). Future work needs consistent conceptualization and measurement of social factors to correctly identify and categorize risk factors for diabetes onset and other health conditions in older adults.

The emergence of digital technologies has shown a promising potential to enhance access to goods, services, and resources. Digital technologies and interfaces differ from mechanical and analog electronic technologies as they often require internet access and are dependent on a set of activities or actions for the user to successfully implement them in their day-to-day life. We describe this set of activities as digital activities of daily living (DADLs). Much like activities of daily living, instrumental activities of daily living, and enhanced activities of living, DADLs are critical to supporting well-being and healthy aging. For example, the digitalization of tasks such as health insurance (e.g., creating a Medicare account) or banking (e.g., making a utility payment via a web portal) are all DADLs. With a growing dependence on digital technologies to participate in day-to-day life, disparities in individuals' ability to competently complete DADLs present major concerns for independence, quality of life, safety, and well-being. We developed a framework for understanding DADLs and their implication for daily life. Furthermore, we provide a guide for the development of interventions and outline implications for research, practice, and policy.

Background and objectives: Social frailty is an emerging concept characterized by state of vulnerability due to the lack or absence of social resources that enable health and well-being, particularly among older people. However, there is no consensus on how to accurately measure and assess social frailty, given the broad coverage of social dimensions affecting older individuals. This scoping review aimed to identify the existing tools and scales used to measure social frailty in older people.

Research design and methods: A scoping review methodology was employed. Articles published between January 2014 and April 2024 were searched in 6 electronic databases: PubMed, PsycINFO, ProQuest, Scopus, SocIndex, and CINAHL. The scoping review followed a 5-stage process by Arksey and O'Malley and adhered to the guidelines provided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.

Results: Nine social frailty tools were identified across the 58 papers included in this review. The individual question item commonly used in the scales were classified into main categories based on their conceptual characteristics and intentions. The most common individual questionnaire constructs used to measure social frailty included financial status, social resources, social behaviors and activities, and sense of purpose. The reviewed tools varied in terms of their robustness and the process of scale development.

Discussion and implications: Our review suggested the development of a standardized, psychometrically tested, and accurate screening tool to screen social frailty status. An accurate social frailty assessment can inform the development of useful interventions, which also has implications in preventing the development of physical frailty.

Background and objective: Work discrimination is an important public health problem with consequences for health. This study examined the effect of chronic work discrimination on 4-year changes in HbA1c, as a reflection of glucose control and type 2 diabetes risk in older workers and assessed whether allostatic load (AL) affected the strength of this association.

Research design and methods: We used Health and Retirement Study data (2010-2016, n = 3,246). Conditional change multinomial logistic regression examined the association between chronic work discrimination, high AL (4 or more out of 8 high-risk biomarkers), and HbA1c, while accounting for relevant covariates.

Results: Black participants had the highest rates of baseline (22.7%) and follow-up (28%) HbA1c levels, AL (38%), and chronic work discrimination (39%; p < .01). Severe chronic work discrimination was associated with elevated HbA1c (relative risk ratio [RRR] = 1.61, 95% confidence interval [CI] = 1.07, 2.43). AL was associated with elevated HbA1c (RRR = 1.49, 95% CI = 1.04, 2.14). Relative to White participants, Hispanic (RRR = 1.52, 95% CI = 1.07, 2.16, RRR = 1.81, 95% CI = 1.051, 3.12), and Black (RRR = 2.42, 95% CI = 1.82, 3.23; RRR = 3.00, 95% CI = 1.97, 4.56) participants had an increased risk of intermediate and elevated HbA1c, respectively. Among those with long job tenure (≥5 years), both moderate (RRR = 1.81, 95% CI = 1.11, 2.96) and severe (RRR = 1.90, 95% CI = 1.15, 3.12) chronic work discrimination was associated with elevated HbA1c.

Discussion and implications: Chronic work discrimination was associated with HbA1c; however, no moderating effects of AL were observed. Findings underscore a need for organizational and public health measures to establish strong anti-discrimination laws in the workplace to improve the work environment of older workers and reduce diabetes risk.

Background and objectives: The Individualized Positive Psychosocial Interaction (IPPI) program is an adaptable, evidence-based intervention. IPPI trains nursing home care partners to engage residents living with moderate to severe dementia in preference-based, one-to-one interactions using emotion-focused communication. We sought to understand provider-driven adaptations made to the IPPI program and whether the adaptations made were fidelity-consistent.

Research design and methods: Data were collected from n = 78 interviews with n = 23 nursing home provider champions who led a quality improvement project to implement the IPPI program with 3-5 residents per care community. Using content analysis, we report quantitative data on the adaptation characteristics according to the Framework for Reporting Adaptations and Modifications-Expanded core modules and participant quotes to illustrate adaptations.

Results: Champions reported 34 adaptations, with an average of 2.6 adaptations per nursing home. The majority of IPPI adaptations pertained to implementation (65%; n = 22), whereas 17% (n = 6) were content and 17% (n = 6) were context. Some adaptations were motivated by the organization (e.g., time constraints), while others were motivated by the recipient (e.g., cognitive capacity). Most adaptations made to the IPPI protocol by care partners were fidelity-consistent (92%; n = 33).

Discussion and implications: Care partners' adaptations to the IPPI made the intervention more resident-centric. Future healthcare intervention providers must consider the user perspective and encourage adaptations that further tailor to the user, as long as the adaptations are fidelity-consistent.

Background and objectives: Hearing loss frequently goes undiagnosed and untreated, with serious sequelae. Hearing screening facilitates diagnosis and treatment but is not routinely conducted in primary care. This study addresses the attitudes and insights of patients and primary care clinic personnel relative to the routinization of hearing screening in primary care for older adults.

Research design and methods: Data presented are from the qualitative portion of a larger study. The main study compared screening completion for 3 approaches to coordinating telephone-based hearing screening with primary care-1 offering hearing screening within the primary care encounter and 2 providing information for at-home screening ( 1 with and 1 without provider encouragement). Focus groups/interviews were conducted with personnel (n = 38) at the 6 participating clinics, patients who completed screening and were referred for diagnosis (n = 14), and patients who did not complete screening (n = 10). Analysis used the general inductive approach.

Results: Most patients had unaddressed hearing concerns prior to the study. Negative attitudes toward hearing loss/treatment were common, and experiences of family and friends influenced attitudes, but lack of urgency was the primary barrier to screening completion. Respondents favored routine primary care-based hearing screening for older adults, but clinic personnel noted challenges of time, space, workflow, and reimbursement.

Discussion and implications: Findings favor greater routinization of hearing screening in primary care. Routinization will be enhanced by improved reimbursement for screening and follow-up; specialist engagement with primary care and the public (including leveraging older adults' social networks); and further research on specific integration options.