Gerontologist最新文献

Background and objectives: Subjective cognitive decline (SCD) is a common experience of self-perceived decline without objective cognitive impairment. It has been theorized that SCD is associated with participation in cognitive leisure activities (CLAs), but the evidence base is multifarious and unclear. The purpose of this systematic review was to synthesize current evidence to determine the association between SCD and CLA engagement.

Research design and methods: Systematic searches were conducted in EMBASE, MEDLINE, PsycINFO, and Web of Science (last searched April 2023). Data were extracted against a priori inclusion criteria and synthesized narratively using Synthesis without Meta-Analysis guidelines. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) and Mixed Methods Appraisal Tool (MMAT). Reporting follows PRISMA guidelines.

Results: From 4,447 records, 11 articles were included. Due to study heterogeneity, evidence on SCD and CLA association is inconclusive. Although a modest correlation was found between greater engagement in CLA and fewer reports of SCD, the heterogeneity in study designs and outcomes, particularly in those addressing only perceived memory decline and CLA engagement, challenges definitive conclusions on this relationship. Evidence from mixed-method and qualitative studies indicated that perceived memory decline may cause negative feelings, such as shame and frustration, which may influence participating in CLA.

Discussion and implications: These findings suggest that participation in CLA is moderately associated with, and may act protectively against, SCD. However, establishing a directional or causal relationship between CLA participation and SCD outcomes requires further investigation through longitudinal and/or interventional studies.

The physician, scholar, and activist Robert Butler devoted much of his life to trying to end ageism in order to create a society that provides older persons with equal rights and opportunities. His passion for fighting ageism led to his becoming the founding director of the National Institute of Aging (NIA) and set the stage for many of its achievements during the past 50 years. This article explores how Butler first became committed to overcoming ageism, how he made a strong case for setting up NIA as a headquarters to combat ageism with science, and how he launched NIA as a multidisciplinary organization that could draw on research, training, and public policy as weapons against ageism. Finally, this article highlights how Butler, through his anti-ageism activities in later life, personified the possibilities he had done so much to make available to older persons through his launch of NIA.

Mistreatment of older adults is common and has serious health consequences but is underrecognized and underreported. Screening for mistreatment of older adults and initiation of intervention in primary care clinics may be helpful, but the value of existing tools is not supported by evidence. We argue that shifting the focus to individual subtypes of mistreatment of older adults can provide improved approaches to screening and ultimately to intervention. We focus on the example of caregiver neglect, the subtype associated with highest mortality. To develop caregiver neglect screening and intervention programs and to measure their effectiveness and impact, we assert that it is critical to: (1) define the phenomenon, (2) develop a conceptual model to explain why it occurs, (3) develop measurement strategies, and (4) systematically examine existing literature. We describe here the initial components of this development process.

Background and objectives: Among community-living older adults who have limitations in completing activities of daily living (ADLs), unmet need occurs when they cannot complete an ADL task because no one was available to help. Prior research described correlates of existing unmet needs but did not consider which older adults are at risk for new onset of unmet needs. This study assessed health characteristics that increased risk for new onset of unmet needs within a year and subsequent health outcomes.

Research design and methods: Data are from 2011 to 2019 annual interviews of the National Health and Aging Trends Study. For each pair of 2 consecutive annual interviews, we determined whether new onset of unmet needs occurred between the first and second consecutive interviews. Mixed effects logistic regression models were computed to assess risks for new onset of unmet need across 14,890 paired observations from persons who needed help with mobility tasks and 12,514 paired observations from persons who needed help with self-care tasks.

Results: Although demographic characteristics and chronic conditions had modest associations with new onset of unmet need, hospitalization between the 2 consecutive interviews was associated with a twofold increase in risk for new onset of unmet need. New onset of unmet need was associated with hospitalization, nursing home placement, and death in the year following the 2 consecutive annual interviews.

Discussion and implications: The findings inform the need for frequent assessments of ADL care needs with the goal of preventing new onset of unmet needs, especially after hospitalization.

Background and objectives: Older adult-focused housing with services programs seek to improve access to supportive services, particularly among individuals residing in subsidized housing. The Right Care, Right Place, Right Time (R3) program comprises 2 on-site wellness teams responsible for 400 participants across 7 housing sites in Greater Boston. These embedded teams work directly with residents to address health-related needs and access to services. This study reports on the perceived benefits of participating in the R3 program from the perspective of housing staff and community partners.

Research design and methods: Data were derived from 24 semistructured interviews conducted as part of a program evaluation. Participants described resident, housing, and system-related reasons for deciding to participate in the R3 program and their experiences of their participation.

Results: In addition to positive overall assessments, housing partner interviewees reported concrete and psychosocial benefits for housing residents (e.g., connecting with resources, enabling longer stays, empowering residents, alleviating distress) and staffing and resident-related benefits. Community partners perceived more appropriate utilization of services by residents (e.g., reducing emergency transports).

Discussion and implications: Findings elucidate why housing and community partners might be motivated to integrate housing, health, and supportive care into affordable housing for older adults using a wellness team.

Since 1997, the Resource Centers for Minority Aging Research (RCMAR) program, supported by the Division of Behavioral and Social Research (BSR) at the National Institute on Aging, has served as BSR's flagship mentoring program for early-career scientists from diverse backgrounds. Over the years, it has undergone significant changes to address evolving institutional priorities and societal needs. This article highlights the motivations behind programmatic shifts in the fifth funding cycle (2018-2023) and the guiding principles for RCMAR VI (2023-present). Key developments in RCMAR V included the launch of RCMARs focused on Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD), a refined emphasis on behavioral and social research, and the decoupling of workforce diversity from health disparities research. Building on lessons learned from the prior funding cycle-amid challenges posed by the coronavirus disease 2019 pandemic and leadership transitions-RCMAR VI offers enriched research, training, and mentorship opportunities while introducing equitable governance structures and clearer, broader expectations for success. The new RCMAR National Coordinating Center plays a crucial role in fostering collaboration, standardizing evaluation, and leading activities to broaden the program's impact. With a renewed focus on high-priority behavioral and social research on aging, AD/ADRD, and health disparities, RCMAR VI is poised to diversify the scientific workforce and advance discoveries.

Background and objectives: Studies involving dementia caregivers are essential to transform care and inform new policies. However, identifying and recruiting this population for research is an ongoing challenge. This scoping review aimed to capture the current methodology for identifying and recruiting dementia caregivers in clinical studies. A focus was placed on methods for underrepresented populations and pragmatic trials to guide pragmatic and equitable clinical studies.

Research design and methods: Researchers conducted a literature search using PubMed, PsycINFO, EMBASE, and Web of Science databases. Studies conducted in the US that enrolled at least 10 caregivers and were published within the last 10 years (2013-2023) were included.

Results: Overall, 148 articles were included in the review. The most common method for identification was community outreach, and paper advertisements for recruitment. Caregivers were most often approached in community settings, formal organizations, and/or dementia research centers. Most enrolled caregivers were female, White, and spouses of persons living with dementia. Race and ethnicity were underreported, as were the target recruitment goals. Limited studies were self-reported as pragmatic. Additionally, limited studies reported adaptations for methods of identification and recruitment in underrepresented populations.

Discussion and implications: We identified gaps in current practices for the identification and recruitment of dementia caregivers. Future identification and recruitment methodologies should be tailored to the intervention's intent, health care setting, and the research questions that need to be answered, while balancing available resources. Additionally, transparent reporting of identification and recruitment procedures, target recruitment goals, and comprehensive demographic data is warranted.

Background and objectives: Nursing home (NH) staff job dissatisfaction and turnover are associated with lower care quality. However, little is known about the impact of being single on workplace experiences. Guided by the Job Demands-Control-Support Model, we compared job satisfaction, turnover intention, and psychological distress for single and partnered parents working in NHs.

Research design and methods: Employee and manager data from the 2011 to 2012 wave of the Work Family Health Network study were combined (N = 1,144) to define parents with complete data (N = 586). Bivariate tests and multivariate regressions clustering observations within NHs were used.

Results: Most single parents (n = 190, 32%) were nursing assistants (NAs; n = 142, 74.74%) or licensed practical nurses (LPNs; n = 29, 15.26%). Compared with partnered parents, single parents were similar on turnover intention and job satisfaction, but they were more likely to report distress (OR = 1.79, 95% CI 1.09, 2.94) observed only among NAs (OR = 2.08, 95% CI 1.12, 3.85). Psychological distress was associated with greater turnover intent (β = 0.02, p < .05) among NAs and LPNs, yet only among single parents (β = 0.04, p < .01). Distress was more likely with higher family-to-work conflict (OR = 1.67, 95% CI 1.18, 2.36) and work-to-family conflict (OR = 1.60, 95% CI 1.20, 2.14) among licensed nurses, yet the distress-work-family conflict associations were only significant for partnered parent nurses.

Discussion and implications: Supporting NH staff depends upon knowing their parental, relationship, and occupational status. Additional research is needed to understand and develop strategies to mitigate psychological distress and increase resources particularly among NA single parents employed in NHs.

Background and objectives: Pain management is often suboptimal in individuals with dementia, and their family caregivers are tasked with supporting pain management despite limited preparation. The web-based PACE-app (PAin Control Enhancement) was designed to assist caregivers in managing pain for individuals with dementia. This study aimed to evaluate the usability of the PACE-app.

Research design and methods: A convergent parallel mixed-methods design was used to evaluate the PACE-app's usability with 16 family caregivers and 6 healthcare professionals. Quantitative data were collected using the Post-Study System Usability Questionnaire (PSSUQ), and qualitative data were gathered through guided-app reviews and semistructured interviews. Quantitative data were analyzed descriptively, and qualitative data were thematically coded.

Results: The PSSUQ results indicated that both family caregivers and healthcare professionals had a highly positive experience with the PACE-app: overall scores (2.01 vs 1.68), system usefulness (1.76 vs 1.68), information quality (1.98 vs 1.80), interface quality (2.30 vs 1.60), and satisfaction (2.00 vs 1.60) were rated on a 1-7 scale (with lower scores indicating better usability). Qualitative findings supported these results, with participants endorsing the PACE-app's usefulness, ease of use, learnability, effective information presentation, aesthetics, clear layout, and overall satisfaction. Participants also provided valuable feedback for improving information quality (enhancing clarity) and interface quality (real-time coaching on pain management).

Discussion and implications: The study demonstrated favorable usability and strong satisfaction among family caregivers and healthcare professionals using the PACE-app. Incorporating participants' suggestions will guide enhancements to the app's information and interface, ensuring it better meets users' needs.

Background and objectives: There is an increasing push for broad implementation of evidence-based interventions (EBIs) targeting older adults. Successful delivery of EBIs in communities requires therapists to adhere to protocols and to be responsive to contextual factors. This study explored the real-world implementation of an EBI, the Multiple-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) in Taiwan from therapists' perspectives on fidelity, challenges, and strategies for program delivery.

Research design and methods: We used a convergent mixed-methods design. Quantitative data were collected from the 13-item Perceived Fidelity Questionnaire (PFQ), assessing the perceived importance, proficiency, and adherence to the essential skills of MCI-SET. Qualitative data were collected via 2 World Café discussions on implementation challenges and strategies, which were recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative and qualitative findings were then compared and integrated to enrich the interpretation.

Results: 47 occupational therapists completed the PFQ. They rated community-oriented skills as more important, demonstrated greater proficiency, and achieved higher adherence. Qualitative analysis revealed that therapists need to increase and sustain participation by strategically introducing the program, adapting the intervention protocol to make it engaging, relevant to everyday issues, and tailored to local needs, and building rapport. Both quantitative and qualitative findings highlighted the importance of community engagement skills and the adaptability of intervention to implementation and sustainability in communities.

Discussion and implications: Real-world scale-up of EBIs requires tailored adaptations responsive to community contexts, especially when initially introducing an intervention unfamiliar to the community. This emphasizes the need for a dynamic fidelity concept.