Gerontologist最新文献

Background and objectives: We assess differences in retirement knowledge between older Hispanic and non-Hispanic White adults, and the extent to which individual, household, and neighborhood characteristics account for these differences. We also evaluate whether the relationships of retirement knowledge with financial outcomes (i.e., wealth) and health differ between Hispanic and non-Hispanic White older adults.

Research design and methods: We analyzed the Retirement Knowledge Scale (RKS) included in the 2020 Health and Retirement Study (N = 1,350). We use a regression approach with a Blinder-Oaxaca decomposition analysis.

Results: The average RKS was significantly lower among Hispanic than among White older adults. The top three factors explaining differences in retirement knowledge between Hispanic and White older adults were educational attainment, financial literacy, and neighborhood socioeconomic characteristics. RKS was significantly (p < .05) and positively associated with financial account balances and the likelihood of reporting very good or excellent health. We find that the association of RKS with wealth is of smaller magnitude for Hispanic than for White older adults. However, the relationship between retirement knowledge and health did not differ across racial/ethnic groups. Finally, differences between Hispanic and White older adults on the RKS were larger for men than for women.

Discussion and implications: The results suggest that reducing gaps in financial literacy and education, and acknowledging the role of neighborhood characteristics, can be helpful channels for reducing differences in retirement preparedness among Hispanic and White older adults. It is also significant that retirement knowledge is more strongly linked to wealth among White older adults.

Background and objectives: Becoming spousal caregivers for persons with young-onset dementia (YOD) is an unexpected event that deviates from the normal life course trajectory, creating unique and profound challenges. Understanding their burden, its primary sources, and their coping resources is essential for developing tailored support.

Research design and methods: We employed a mixed-methods approach to comprehensively understand the caregiving burden experienced by 11 community-dwelling spousal caregivers of YOD. We used the Zarit Burden Interview to quantify caregiving burden and conducted semi-structured qualitative interviews to explore the caregiving experience in depth. A joint display method was used to integrate and present the converging findings from quantitative and qualitative data, offering a holistic perspective on the caregiving burden.

Results: All participants experienced varying degrees of burden, with the average burden level being moderate. Four themes emerged regarding their caregiving burden experiences: diverse sources of caregiving burden, unexpected changes in personal and interpersonal interactions, complex emotional experiences, and inadequate social support and resources. Quantitative and qualitative results converged and supported each other. The burden was mainly driven by care recipients' excessive dependence and dynamic care needs. Spousal caregivers faced significant challenges in maintaining their personal identity and social life. Caregiving reshaped family dynamics. The inadequate support resources and overwhelming responsibilities imposed substantial psychological stress on them.

Discussion and implications: There is an urgent need to develop family-centered community support services and respite care to provide younger spousal caregivers with the time and space to manage their personal lives and alleviate their burden.

Background and objectives: As their cognitive function declines, people with dementia often lose decision-making capacity (DMC) for choosing certain medical treatments, but some retain the capacity to designate a surrogate (CDS) decision maker. There is currently no tool for assessing the CDS. The purpose of this study is to validate a novel capacity assessment tool for evaluating CDS for people with a clinical diagnosis of dementia.

Research design and methods: A concurrent mixed-methods design was used to evaluate 52 participants' ability to (a) consistently name a surrogate, (b) understand the role of the surrogate, and (c) provide a rationale for why they chose their surrogate. A basic difference of means was used to test differences in CDS scores between participants who had and did not have DMC. Thematic analysis was applied to the narrative data on reasons for the participants' choice of surrogate.

Results: The CDS instrument demonstrated high interrater reliability and evidence of validity. On every dimension, the CDS tool identified participants who otherwise lacked DMC who nonetheless had full understanding of the need, process, and role of a surrogate. Thematic analysis revealed 33 unique reasons participants chose their surrogate, which were then grouped into three overarching themes.

Discussion and implications: The CDS tool shows that there are patients who may otherwise lack DMC but who can validly designate a surrogate. The CDS tool may be a highly useful instrument to promote patient-centered care among vulnerable patients deemed to lack capacity for treatment decisions.

Background and objectives: This study investigates how friendships serve as a social pathway underlying the health effects of self-perceptions of aging (SPA). We adopt a conceptual framework integrating stereotype embodiment theory and the differential investment of resources (DIRe) model.

Research design and methods: This study used longitudinal data from the Health and Retirement Study (HRS), which tracks a nationally representative sample of 9,098 participants aged 50 and older over 8 years (Time 1: 2008/10, Time 2: 2012/14, Time 3: 2016/18). We examined the direct and indirect effects of both positive and negative SPA on physical, mental, and cognitive health through friendships. Positive and negative SPA were assessed separately. Friendships were measured through the number of close Friends, frequency of contact with friends, and positive and negative friendship quality. Health outcomes were measured across three domains: physical (functional disabilities), mental (depressive symptoms), and cognitive (cognitive functioning). Structural equation modeling was employed to examine the direct and indirect effects.

Results: Positive SPA was associated with more friends and more frequent contact. Negative SPA was associated with lower positive and higher negative friendship quality. Contact frequency with friends mediated the associations between positive SPA and physical, mental, and cognitive health. Positive and negative friendship quality mediated the associations between negative SPA with physical and mental health.

Discussion and implications: These findings identify friendships as critical pathways linking SPA to health. Interventions and community programs that promote positive aging beliefs and support friendship-building may be effective strategies to enhance later-life health and well-being.

Background and objectives: This qualitative study explores the impact of a culturally safe life review program using self-created picture books on the psychological and cultural well-being of Indigenous older adults in Taiwan. This study aims to understand how visual-narrative methods can support emotional healing, reinforce cultural identity, and promote narrative agency among Indigenous elders.

Research design and methods: Grounded in interpretivism and narrative inquiry, this study engaged 10 female participants from five Indigenous communities. The intervention included three life review interviews, five visual storytelling workshops, and one post-intervention reflection session. Data were analyzed using reflexive thematic analysis to capture participants' experiences and outcomes.

Results: Three overarching themes emerged: emotional release and psychological healing, reinforcement of cultural identity, and enhanced narrative agency. Participants described renewed pride, reinterpretation of past struggles, and strengthened intergenerational connections. Cultural safety was fostered through language autonomy, symbolic inclusion, and participant-led storytelling.

Discussion and implications: This study highlights the effectiveness of culturally safe, visual-narrative interventions in promoting psychological well-being and cultural resilience among Indigenous older adults. These findings underscore the importance of integrating culturally responsive approaches into long-term care policies and practices. By honoring Indigenous storytelling traditions, this research advances gerontology's goals of equity, resilience, and culturally grounded care.

Background and objectives: Lucid episodes (LEs) in advanced dementia are characterized by spontaneous, transient recovery of functional abilities. Despite recent increases in research on this previously understudied phenomenon, standard definitional criteria are lacking, presenting challenges for research. Researchers have proposed a preliminary framework to guide uniform labeling and operationalization of salient data elements for investigating LEs and developing definitional criteria. This study leverages this framework to characterize reports of LEs from caregivers and advance their definition and measurement.

Research design and methods: Family caregivers (N = 259) completed an electronic survey with quantitative and open-ended questions about LEs they witnessed (N = 479 episodes). Respondents were purposively sampled for qualitative interviews. Open-ended question responses (n = 208) and in-depth interviews (n = 24) were analyzed using content analysis.

Results: Caregiver descriptions suggest that the content and context of LEs are heterogeneous. Descriptions included observable changes from baseline, with behavior or communication that was distinguishable from routine cognitive fluctuations. LEs were sometimes, but not always specified by logically organized actions; recognition or awareness of people, emotions, and surroundings; and insight of their cognitive limitations. Many LEs required deep personal knowledge to attribute it as a meaningful shift.

Discussion and implications: Findings suggest that definitional features may universally specify a significant return of ability with more flexible criteria for how this return manifests in observed actions and domains of recovery (i.e., insight, function, and communication). The impact of LEs on observers may be better measured separately, although further research should explore this.

Background and objectives: Self-directed programs can steer positive trajectories after life-changing health events. This study evaluated if one such program (Take Charge) could improve quality of life (QoL) after diagnosis of mild cognitive impairment (MCI) or mild dementia compared with lifestyle education.

Research design and methods: Two-arm, open-label, randomized controlled trial including people with MCI or mild dementia in Adelaide, Australia. Participants were assigned to Take Charge intervention (n = 80) or control group (lifestyle education with waitlist option) (n = 80). The primary outcome was QoL measured using the Physical Component Summary (PCS) score of the Short Form 36 (SF-36) at three months following baseline comparing Take Charge to control. Secondary outcomes included the mental component summary (MCS) score of SF-36, hope, mood (depression scale), and activity engagement at three and six months. A subset of participants participated in an interview about their experiences with Take Charge.

Results: Participants had a mean age of 79.6 years (SD 7.2) and 51.2% were female. The mean Mini-Mental State Examination score was 24.2 (SD 3.2). No significant differences were found in PCS scores between groups at three months (-0.53; 95% CI: -4.23, 3.17; p = .78). However, interviews suggested that those actively engaged in Take Charge felt more positive about the future.

Discussion and implications: There was no significant difference between the Take Charge and control groups, and Take Charge did not improve physical health-related QoL for people living with MCI or mild dementia. More work is needed to establish the appropriateness and efficacy of self-directed programs for this population.

Background and objectives: Cognition may be influenced by health-related factors such as blood pressure (BP). However, variations in BP may differentially affect cognition across race. This study investigates BP and cognitive decline in older Black and White adults.

Research design and methods: A total of 2,284 participants (1,139 Blacks, 1,145 Whites, MAge = 73.4) from three harmonized cohorts of older adults from the Rush Alzheimer's Disease Center, were divided into three groups (normal, high, variable) based on systolic BP mean and standard deviation. Cognitive scores were computed from 18 neuropsychological tests and averaged to summarize five domains (episodic memory, semantic memory, working memory, processing speed, visuospatial ability) and a measure of global cognition. Linear mixed-effects models examined racial differences between BP and cognition over an average of 6.7 years.

Results: White adults with high BP declined faster in global cognition, perceptual speed, semantic memory, and working memory compared to Black adults with high BP, whereas White adults with variable BP had faster rates of decline in global cognition, all cognitive domains, compared to Black adults with variable BP. No differences in rate of cognitive decline were observed between Black and White older adults with normal BP.

Discussion and implications: Variations in BP differentially relate to cognitive decline in Black and White older adults, highlighting the interplay between BP and cognitive health, and the importance of race in understanding this relationship.

Background and objectives: Loneliness is a significant public health concern affecting over a quarter of older adults worldwide. Emerging research suggests that artificial intelligence (AI)-enabled social robots may offer a viable alternative for providing a new form of social support and reducing loneliness. This meta-analysis evaluates the effectiveness of AI-enabled social robots in reducing loneliness among older adults and examines the conditions under which these interventions are most effective.

Research design and methods: A systematic search was conducted through October 2024. Effect sizes from 19 studies (N = 1,083) were synthesized using robust variance estimation (RVE) in meta-regression. Moderation analyses examined how social robots' effectiveness differs by contextual factors such as participants' backgrounds and studies' characteristics.

Results: Our findings indicated that social robots significantly reduced loneliness among older adults. However, studies with control groups indicate a higher effect size. Moreover, greater reductions in loneliness are observed among individuals in institutional settings compared to those living independently. In addition, stronger intervention effects reported in Japan and Turkey than in the United States. However, age, cognitive status, robot type, duration of intervention, and year of publication did not significantly influence intervention effectiveness.

Discussion and implications: Findings underscore the potential of social robots as an effective and scalable approach for addressing loneliness among older adults, particularly within institutional care environments. Policymakers, gerontologists, and care providers should consider integrating AI-enabled social robots into existing care frameworks, emphasizing culturally sensitive and inclusive implementation strategies.