Gerontologist最新文献

Background and objectives: Researchers often define successful aging as freedom from disability and disease, yet the perceptions of older adults living with disability challenge this conception, demonstrating that they can indeed age successfully. This paper adapts a framework of successful aging with disability, basing it on the subjective assessment of key components contributing to success among older adults living with mobility disability due to multiple sclerosis.

Research design and methods: Employing a qualitative, theory-grounded methodology, we conducted semi-structured interviews with 20 individuals aged 60-75 who live with mobility disability attributed to multiple sclerosis. The open-ended questions explored their perspectives on the aging process, their definition of successful aging, and the coping strategies they employ in navigating challenges associated with age and their condition.

Results: Despite facing mobility disabilities, the majority (16 out of 20) expressed a sense of successful aging, identifying five key themes: accepting reality, maintaining a positive attitude, fostering independence, nurturing a social life, and preserving cognitive abilities. They achieved successful aging by focusing on alternatives, relying on external support, having a good attitude and faith, and accepting their challenges.

Discussion and implications: The themes identified in this research contribute to redefining successful aging in future studies and facilitating the development of interventions aimed at improving the quality of life for older adults coping with mobility disability.

Background and objectives: Emerging evidence suggests music-based interventions can improve the well-being of people living with dementia, but little is known about the ways in which music might support dementia caregiving relationships as part of everyday life at home. This study examined music engagement in the context of daily life to identify patterns of music engagement and potential targets for the design of music-based interventions to support well-being.

Research design and methods: This ethnographic, in-home study of people living with dementia and their family and professional care partners used methods from ethnomusicology, including semistructured interviews and in-home participant observation with a focus on music engagement.

Results: A total of 21 dyads were purposively recruited for diversity in terms of gender, ethnicity/race/heritage, caregiving relationship, and music experiences. Despite participants' diverse music preferences, 3 distinct music engagement patterns emerged. (a) Professional care partners intentionally integrated music listening and singing into daily life as part of providing direct care. (b) Family care partners, who had prior dementia care nursing experience or family music traditions, integrated music into daily life in ways that supported their personal relationships. (c) In contrast, family care partners, who lacked dementia care experience and had high levels of caregiver burden, disengaged from prior music-making.

Discussion and implications: The distinct music engagement patterns reflect different needs on the part of dyads. It is important to continue to support dyads who engage in music daily and to consider developing music-based interventions to support well-being among dyads who have become disengaged from music.

This essay argues for a fuller integration of ageism and age discrimination into the productive aging framework. We briefly review the productive aging scholarship and the extent to which ageism has been considered in regard to working, volunteering, education, and caregiving. We suggest that ageism has not been adequately considered, and we identify how it permeates productive engagement in later life. We introduce modifications to the productive aging framework to more directly capture the roles of ageism and age discrimination in activity engagement and the outcomes achieved. We argue for the integration of key concepts from minority stress theory and critical race theory that may yield important insights for an increasingly diverse older population. We conclude with research directions that will guide intervention development to reduce ageism at the societal, organizational, and individual level.

Background and objectives: Throughout the coronavirus disease 2019 (COVID-19) pandemic, older adults developed coping strategies to adapt to the necessary social distancing precautions; however, over time, especially as vaccines became available, their need and ability to adapt and cope shifted. This longitudinal, mixed-methods study investigates changes in older adults' perceptions of coping across the first 2 years of the pandemic.

Research design and methods: Between April 2020 and June 2022, 5 waves of interviews were conducted with 76 Midwestern older adults aged 70-97. At each timepoint, participants rated their level of perceived coping. They also answered a series of open-ended questions about their current daily life, experiences, and perceptions during the pandemic.

Results: Repeated-measure ANOVA indicated participants' perceived coping significantly increased over 2 years and qualitative explanations contextualized these shifts. Thematic coding of interview transcripts identified themes of: (1) taking problem-focused approaches and (2) cultivating emotional resiliency, with multiple subthemes nested within each. Subtheme meanings shifted once vaccines were available, as participants adapted to a "new normal" lifestyle and appreciated their own resilience.

Discussion and implications: Findings suggest older adults had nuanced and shifting coping experiences throughout the initial 2 years of the pandemic, but overall coped by drawing on life experiences. Our discussion highlights variability in older adults' coping over time and directions for future study and practice.

Background and objectives: Social isolation has been recognized as a social problem with negative health consequences. Using data from 3 waves of the Health and Retirement Study, this study aimed to examine the long-term impact of social isolation on loneliness and depressive symptoms and to explore the moderating effect of resilience.

Research design and methods: This study comprised 3,681 U.S. adults aged 60 and older at the baseline wave. Social isolation index was constructed using 5 indicators, including not married or cohabitating with a partner, no social participation, and less than monthly contacts with children, family members, or friends. Loneliness was measured by the University of California Los Angeles (UCLA) Loneliness Scale and depressive symptoms were measured by the Center for Epidemiological Studies-Depression scale. The moderator of resilience was assessed by the simplified resilience score. Latent growth curve models with robust standard errors were estimated.

Results: The results of latent growth curve models showed that social isolation was significantly associated with more initial loneliness and depressive symptoms. However, social isolation was associated with a slower increasing rate of loneliness, but no significant relationship with the change rate of depressive symptoms. Furthermore, resilience significantly buffered the negative effect of social isolation on the initial level of depressive symptoms.

Discussion and implications: The findings underscore the importance of enacting strategies and interventions targeting resilience to address social isolation and its negative consequences among older adults.

Background and objectives: Nowadays people increasingly try to take control over the end of their lives by anticipating end-of-life choices. Explication of these choices is encouraged using advance care planning (ACP). We aim to deepen our understanding of how choice-making processes are lived in real life, exploring the experience of community-dwelling older adults and their close ones over time.

Research design and methods: A multiperspective and longitudinal approach grounded in phenomenology was chosen. Ten triads consisting of an older adult (75+) and 2 close ones (n = 30) were interviewed, twice individually and once as a group, over 20 months (=70 interviews). Data were thematically analyzed both longitudinally and from all 3 perspectives.

Results: The essential meaning of anticipatory choice-making processes was described as a dynamic and relationally entangled decisional process, to navigate between paradoxical choices for an opaque future. Three fields of tension were created due to ambivalence in these choice-making processes: navigation between having and losing control, between taking away and burdening with responsibility, and between expressing and holding back oneself.

Discussion and implications: Anticipation of choices for hypothetical end-of-life scenarios turned out to be complex and ambivalent. Most older adults resisted ambivalence and ignored complexity in an attempt to stay in control over their end of life. The burdening impact of choices on close ones illuminated the relationality of choice-making processes. These aspects of end-of-life choice-making processes should be integrated into ACP in order to better understand and care for people and their close ones faced with these choices.

Background and objectives: The prevalence of resident obesity in nursing homes has increased dramatically from 22% to 28% between 2005 and 2015. To provide care for people with obesity, nursing homes have changed their admissions, staffing, and equipment, but underlying these changes are increased resources and financial costs of care. The purpose of this study is to describe nursing home organizational aspects of caring for older adults with obesity, with a focus on economic factors, from the perspective of nursing home staff and leadership.

Research design and methods: This qualitative study used descriptive approaches; data were collected through semistructured telephone interviews. Of 77 nursing home staff and leaders identified as potential study participants, 6 were ineligible, and 71 participated in the study through interviews conducted from 2019 to 2022.

Results: A total of 4 primary themes described the issues surrounding the cost of care for obesity in nursing homes: inefficient and risky use of staff time in a setting of persistent staff shortage, expensive and unique equipment needs, inadequate general reimbursement with an absence of obesity-specific reimbursement supplements, and competing short- and long-term management solutions.

Discussion and implications: This qualitative study of nursing home staff and leadership underscores a need for improved approaches to funding obesity care within existing nursing payment models. The increasing prevalence of obesity and the burden of the costs of obesity care for nursing homes will escalate this need over the coming decade.

Background and objectives: Care partners of persons living with dementia perform complex legal planning tasks. The purpose of this study was to survey care partners in the United States to understand their confidence and experience in performing legal planning tasks.

Research design and methods: This study used a parallel mixed-methods research design. We administered a web-based survey to 318 adults who self-identified as care partners of persons living with dementia. The survey contained Likert scale questions and open-ended questions about legal planning tasks. Multivariate linear regression was used to analyze quantitative data and inductive thematic analysis was used to analyze qualitative data.

Results: Care partners were, on average, 53 years of age and 78% female. The three topics in which participants were least confident were: protecting oneself legally as a care partner; options when legal documents are not in place and a family member is not legally competent; and circumstances when legal documents should be updated or renewed. We observed significant differences in legal planning confidence between newer and more experienced care partners (p < .001); lower- and higher-income care partners (p = .01); and adult child versus spousal care partners (p < .001). Thematic analysis revealed that legal planning challenges include initiating a conversation with the person living with dementia, understanding and using legal materials, and accessing materials that accommodate individual differences.

Discussion and implications: It is vital to develop legal planning interventions that are tailored to specific subgroups of care partners, and to maximize the clarity, comprehensiveness, and accessibility of available legal planning education.

Background and objectives: This research critically examined the concept of age-friendliness from the perspectives of older Black lesbian women living in New York City (NYC). The primary aim was to extend existing age-friendly frameworks to more inclusively meet the needs of older lesbian, gay, bisexual, transgender, and queer adults of color, promoting greater equity and justice.

Research design and methods: Applying principles from critical participatory action research, we collected and analyzed data from 5 focus groups consisting of 5 older Black lesbian women. Participants shared their daily experiences living in NYC and proposed ideas to enhance the age-friendliness of the city to better accommodate their unique needs and experiences.

Results: Participants called for greater attention to the interaction between identities and structures in relation to age-friendly communities. Historic and contemporary experiences of violence and discrimination, as well as the ever-shifting political context were identified as a key factor shaping their aging experiences. The need for affirming spaces with positive representation of their layered identities was emphasized in the context of age-friendly interventions.

Discussion and implications: While dominant age-friendly frameworks are universally accepted for improving the health and wellbeing of older adults, the specific challenges of aging with multiple intersecting marginalized identities necessitate a critical perspective. Gerontology needs to take seriously how privilege and oppression operate within society, shaping health and aging trajectories of vulnerable and underserved populations.

Background and objectives: This study examined the performance of the Modified Caregiver Strain Index (MCSI) in a sample of Black and White caregivers of persons living with dementia.

Research design and methods: Data on 153 dyads enrolled in the Care Ecosystem dementia care management program were analyzed, including sociodemographic variables, dementia severity, and caregiver burden and wellbeing. Factor structure, item-response patterns, and concurrent validity were assessed across racial groups.

Results: Differences between Black and White caregivers included gender, dyad relation, and socioeconomic disadvantage. Factor structure and item loadings varied by racial cohort, with parameters supporting a 3-factor model. For Black caregivers, finances and work, emotional and physical strain, and family and personal adjustment items loaded together on individual factors. For White caregivers physical and emotional strain items loaded on separate factors, although personal and family adjustment items loaded with work and financial strain items. Item-level analysis revealed differences between groups, with Black caregivers endorsing physical strain to a greater degree (p = .003). Total MCSI scores were positively correlated with concurrent measures like the PHQ-9 (White: r = 0.67, Black: r = 0.54) and the GAD-2 (White: r = 0.47, Black: r = 0.4), and negatively correlated with self-efficacy ratings (White: r = -0.54, Black: r = -0.55), with a p < .001 for all validity analysis.

Discussion and implications: The MCSI displayed acceptable statistical performance for Black and White caregivers of persons living with dementia and displayed a factor structure sensitive to cultural variations of the construct. Researchers results highlight the inherent complexity and the relevance of selecting inclusive measures to appropriately serve diverse populations.