Gerontologist最新文献

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.

Background and objectives: Getting lost can cause profound distress for individuals with dementia and their families, while also imposing a significant burden on society. Existing literature primarily focuses on the incidence and consequences of such cases, overlooking the challenges and issues involved in locating them. To address this gap, the present study aimed to explore the firsthand experiences and efforts of police officers in charge of missing cases.

Research design and methods: This study utilized a cross-sectional research design and conducted in-depth interviews with purposefully sampled police officers responsible for missing persons with dementia in South Korea. The qualitative information gathered from the interviews was analyzed using Content and Thematic Analysis.

Results: Despite various preventive programs and tracking technologies available, traditional methods such as foot searches remain more practical due to difficulties in utilizing such means by individuals with dementia. Additionally, their unpredictable characteristics and the lack of adequate and systematic societal support make even traditional searches challenging. Therefore, cooperation and awareness from caregivers and the community are crucial for police search and rescue operations. The study also highlights the importance of tailored response measures and legal support, as well as the need for collaborative efforts across societal domains for successful outcomes.

Discussion and implications: The findings of this study are anticipated to contribute to a broader understanding of this pressing issue and provide critical insights for developing more effective response measures.

Background and objectives: Recent Medicare payment reforms aimed to improve post-acute access to skilled nursing facilities (SNFs) and home health agencies (HHAs) for patients with complex care needs, including beneficiaries with disabilities. Soon after reforms were implemented, the COVID-19 pandemic began, which disproportionately impacted older adults and people with disabilities. Leveraging Medicare administrative data to identify two distinct cohorts of beneficiaries with disabilities, this study explored changes in their SNF and HHA admission patterns during payment reform and COVID-19.

Research design and methods: Secondary analysis of 2018-2021 Medicare administrative data for two cohorts of fee-for-service beneficiaries with disabilities: 1) enrollees with disability as the reason for original entitlement (OE) and 2) enrollees qualifying based on age who have disabling conditions and/or mobility impairments (C&I). Adjusted linear mixed effects models with interaction terms for disability cohort estimated whether differences in SNF and HHA admissions following hospitalization varied over time by disability cohort.

Results: For 7,732,989 hospitalizations in the OE cohort and 7,028,195 hospitalizations in the C&I cohort, SNF admissions decreased over time while HHA admissions increased. Compared to the C&I cohort, the OE cohort experienced lower SNF admissions throughout the study and smaller changes in SNF and HHA admissions.

Discussion and implications: Both disability cohorts experienced decreased SNF and increased HHA admissions following payment reform and COVID-19. The magnitudes of changes differed between the disability cohorts. These results highlight the heterogeneity in healthcare experiences across disability cohorts and the importance of including multiple definitions of disability in research using administrative datasets.

Background and objectives: Great-grandparenthood brings a new internal dynamic to intergenerational relationships in which contact between four generations is now the norm. In this scoping review, we sought to identify the roles of great-grandparents and what those roles entail.

Research design and methods: We performed a review using PRISMA-ScR to identify peer-reviewed studies investigating the roles of great-grandparents. The reviewed articles were selected from four databases. The article selection conditions were met by 23 studies that used quantitative or qualitative methods. The studies had to be published in English; the selected publications spanned eight countries.

Results: The scoping review covers a collection qualitative and quantitative research with different types of respondents (great-grandchild, grandparents, great-grandparents, etc.). An important element was a statement on great-grandparenting from at least one of the four generations. We selected 23 articles from an initial selection of 176 studies. The studies were heterogeneous in conceptual frameworks, collection methods, and interview conduct, with qualitative methods predominating over quantitative methods.

Discussion and implications: Based on research on great-grandparenting, the roles of great-grandparents can be categorized as continuing, insignificant, or significant. Each role category has a specific function and each represents a different meaning for the great-grandparents within the family. Several factors and constraints frame the great-grandparent roles. Based on the research results, some characteristics are shared by all role categories despite the dividing elements.

This paper considers the concept of successful aging by means of a dialogue with the concept of frailty. This dialogue reveals the limits and blind spots of both concepts as well as their apparent dichotomy and the importance of understanding both the objective and subjective experience of aging. In particular, the dialogue highlights that both frailty and successful aging are social constructs that derive their meaning from what society values (autonomy, youthful capacities). They cannot by themselves account for the fact that flourishing and frailty are often found together whilst conversely successful aging may not bring satisfaction. I argue that the arts and humanities supply us with conceptual and methodological tools with which to revisit what it is to age well offering a holistic approach that combines sensitivity both to older people's lived experience and to the underpinning material conditions and embodied realities. For this purpose, and building on previous scholarship in cultural gerontology, I suggest the unique value of concepts and frameworks associated by Simone de Beauvoir. When brought into alignment with the tenets of cultural and narrative gerontology, these concepts facilitate a rich understanding of the nuances and paradoxes of flourishing in deep old age which can also aid in restorying both old age and the life course more generally. I illustrate this through two examples: a feminist self-help guide to aging, which accepts both limitations and growth and a film that imagines the possibilities of authentic aging even despite a context of poverty, patriarchy, and Alzheimer's disease.

Background and objectives: Active engagement with life (AE) is an integral aspect of successful aging. Using time diary data, this study explored how U.S. older adults structure their daily lives involving social participation and productive engagement, and the extent to which these patterns differ by race and gender.

Research design and methods: We used American Time Use Survey (ATUS) data (n = 17,990) and sequence and cluster analyses to identify distinctive daily AE patterns. Multivariable linear regression models were used to evaluate associations between AE patterns and self-rated health, and the moderating roles of race and gender.

Results: Five AE clusters were identified: Low Degree of AE (26%), Moderate Unpaid Work and Light Social Participation (39%), Persistent Unpaid Work (20%), Persistent Paid Work (10%), and Persistent Social Participation (4%). White women were the most likely and Black men the least likely to have any AE. Compared to "Low Degree of AE," all other AE clusters were associated with better self-rated health, with these associations varying by gender and race. The strongest positive association was observed for "Persistent Paid Work," especially among women. Racial differences in the association between AE and health were more prominent among women than men. Differences by AE were less pronounced among Black women in comparison to White women.

Discussion and implications: We found that the association between AE and self-rated health varies by race and gender. Persistent structural barriers may prevent older adults from historically minoritized backgrounds, particularly Black women, from benefiting from AE.