搜索结果：Journal of applied gerontology : the official journal of the Southern Gerontological Society

The capability of people to engage in meaningful activities declines with the progression of major neurocognitive disorders. Cognitive strategies can help them pursue such activities, thus maintaining their dignity. They build on procedural memory and implicit retrieval, both preserves abilities, to automate the correct action sequences during learning, with repetition and while providing cues. However, few studies have implemented cognitive strategies especially in seniors' residences. Thus, the feasibility of their implementation remains unknown. This study aims to document the facilitators and barriers to the implementation of cognitive strategies with people living with neurocognitive disorders housed in a private seniors' residence. This participatory action research included training and coaching to allow care staff to integrate personalized cognitive strategies with nine residents. Qualitative interviews with 20 care staff and a focus group with 2 managers were conducted. Key facilitators identified included personalized approach rooted in life history, team awareness and engagement, alignment with organizational values, and a calm, home-like environment. Barriers included the rapid progression of neurocognitive disorder symptoms related to comorbidities, staff shortages and turnover, and disparities between organizational decisions and clinical practice. The results showed encouraging avenues to integrate cognitive strategies in long-term care settings when the care team is supported by adequate training and coaching.

Dementia's progressive nature requires care, often by unpaid family members, leading to significant caregiver burden (CB). Dementia worry (DW)-the anxiety about developing dementia-has been linked to exposure to people with dementia, but its relationship with CB remains unclear. This study investigates the role of DW in CB among Greek family caregivers, using Pearlin's Stress Process Model. A cross-sectional survey of 285 caregivers assessed CB, DW, social support, coping strategies, and perceptions of the care recipient's cognitive and behavioral symptoms. Findings revealed that caregivers' DW significantly mediated the relationship between their perceptions of the care recipient's symptoms and their own CB. Maladaptive coping strategies were directly associated with higher CB, while adaptive strategies and social support were not. These results support the inclusion of DW as a secondary intrapsychic stressor in Pearlin's model and suggest that addressing DW in interventions may help reduce CB and improve caregiver well-being.

This study identifies the long-term and short-term users of home-delivered meals, i.e., Meals on Wheels (MOW) services, and how they differ across socioeconomic and health status. The analysis relies on a nationally representative sample of 65+ Medicare beneficiaries from the 2013-2021 National Health and Aging Trends Study. A fixed effect multinomial logit model, with lagged indicators and complex survey design, predicts the probabilities of being a short-term (1 year or less) or long-term (2+ years) MOW client. Beneficiaries' characteristics predictive of long-term MOW use include identifying as Black, being on Medicaid, pre-frail, and having 2+ IADL limitations. Medicaid enrollment is one of the few statistically significant predictors for short-term MOW use. These results reveal that long-term MOW users are more heterogeneous and vulnerable than short-term users. Understanding the reasons various individuals rely on MOW services for multiple years may inform policy on the social and care needs of older adults.

BackgroundAgeism and self-perceptions of aging (SPA) are psychosocial factors associated with cognitive and mental health outcomes.Objectives(1) to identify latent profiles based on indicators of ageism and SPA and (2) to examine their differences in anxiety, depression, and cognitive functioning.MethodLatent profile analysis was conducted with a non-probabilistic sample of 305 adults aged 50 years and older from Chile. Participants completed measures of aging-related stereotypes, perceived age-based discrimination, self-perceptions of aging, anxiety symptoms, depressive symptoms, and cognitive performance.ResultsFive profiles were identified: Hopeless, Positive Aging, Neutral, Internalization, and Ambivalent. Significant differences emerged across profiles in anxiety, depression, and cognitive functioning, with the Internalization profile showing the highest psychological vulnerability and the Positive Aging profile the most favorable outcomes.DiscussionThe findings reveal heterogeneity of aging and may inform the design of interventions that promote mental health and cognitive functioning in later life.

This study investigates the association between early-life hunger and the willingness for institutional care using data from the China Longitudinal Aging Social Survey (CLASS). The empirical results indicate that early-life hunger is significantly associated with a lower willingness among older adults to enter care institutions. Heterogeneity analyses reveal that this negative association is particularly pronounced among low- and middle-income groups, individuals with sons, and the cohort exposed to famine during childhood. Furthermore, by incorporating traditional cultural factors into the analytical framework, the study finds that the intensity of regional Confucian culture acts as a moderator, reinforcing the negative relationship between early-life hunger and the willingness for institutional care. These findings enrich the literature on the long-term correlates of early-life adversity and suggest that policymakers should focus on improving the service quality of care institutions while simultaneously strengthening family support functions.

In light of global aging trends, it is crucial to understand how workplace stressors impact caregiver performance in long-term care (LTC) settings. This study, grounded in the challenge-hindrance stressor framework and empowerment theory, explores how perceived stressors influence job performance among Taiwanese LTC staff and assesses the moderating effect of perceived care recipient empowerment in self-supporting care environments. A cross-sectional survey of 462 caregivers assessed job stressors, performance, and care recipient empowerment. Hierarchical regression analyses showed that challenge stressors positively influenced job performance, while hindrance stressors had a detrimental effect. Notably, care recipient empowerment moderates both relationships-dampening the positive effect of challenge stressors and mitigating the negative effect of hindrance stressors. These findings underscore the complex role of care recipient empowerment and indicate that effective performance in LTC may depend on carefully balancing empowerment strategies with adequate support for caregiving staff.

Europe has experienced multiple crises, including inflation, rising food and living costs, the COVID-19 pandemic, and the 2007-2009 financial crisis, which have contributed to widening social inequalities. These economic pressures may threaten the material well-being of adults aged 50 and older, yet little is known about how they affect those who provide care. This study examined the risk of material deprivation among those with different caring roles in 2021-2022 using the SHARE data. The findings show that co-resident family caregivers, those experiencing financial strain, and individuals with a migrant background are particularly vulnerable to material deprivation. Women carry a disproportionate share of caregiving responsibilities and face higher deprivation risks than men. In contrast, individuals who provide care outside their households or care for grandchildren tend to exhibit better material well-being than those without these roles. Targeted policy measures that both alleviate energy poverty and financial strain are needed.

Frailty is associated with physical and psychological decline. However, many frail older adults have reported high life satisfaction, suggesting the possibility of potential psychological buffering mechanisms. This study aimed to explore whether self-transcendence mediates the relationship between frailty and life satisfaction. A cross-sectional investigation using stratified random sampling was conducted among 1,192 adults aged ≥60 years from fifteen villages and fifteen communities in Zhejiang Province. Data were analyzed using descriptive statistics, independent-samples t-tests, one-way ANOVA, correlation, and mediation analysis. Results indicated that the prevalence of frailty was 29.4%. Frailty was significantly negatively associated with life satisfaction, whereas self-transcendence was positively associated with life satisfaction. Self-transcendence partially mediated the association between frailty and life satisfaction, accounting for 37.4% of the total effect. These findings confirmed the mediating role of self-transcendence between frailty and life satisfaction, providing lower-cost intervention studies with important targeting factors.

BackgroundCaregiver burden may influence individuals' preferences for their own End-of-Life (EoL) care, but evidence remains limited.ObjectiveExamine the association between caregiver burden and preferred EoL care settings across levels of anticipated care dependency.MethodsA survey was conducted with 297 caregivers of functionally independent adults aged ≥75 in Sukagawa City, Japan. Participants selected preferred EoL care settings ("home/family home" vs. "hospital/nursing home/other") across three hypothetical scenarios reflecting low, moderate, and high levels of care dependency at their own EoL. Caregiver burden was assessed using the Burden Index of Caregivers. Modified Poisson regression was applied.ResultsHigher caregiver burden was significantly associated with preference for non-home settings in high- and low-dependency scenarios.ConclusionCaregiver burden may shape future EoL care setting preferences. Recognizing its influence could help clinicians tailor care planning discussions that reflect individuals' values and preferences. It may also inform policies aimed at reducing caregiver burden.

The underutilization of home and community-based services (HCBS) among older adults with hearing loss (HL) in rural China exacerbates health disparities. This study employed a mixed-methods design, combining an analysis of the nationally representative CHARLS database (n = 10,745) with a community-based survey experiment in Guangzhou (n = 267), to examine HCBS utilization, its determinants, and care preferences. Nationally, only 18.22% of rural older adults with HL reported using HCBS, which is lower than the level in urban areas. Health-related HCBS were the most popular choice, and offspring support, number of children, pension and medical insurance were significantly associated with HCBS utilization. Experimental results further showed that participants showed stronger preferences for interventions emphasizing family welfare and demand-side financial subsidies, indicating strong intergenerational considerations in care decisions. These findings suggest that effective HCBS expansion should integrate intergenerational incentives and targeted subsidies with a family-centered focus on health-related services.

ObjectivesPurposeful design of physical settings, including sensorial elements, may enhance participant engagement in psychosocial interventions. Yet, consideration of these settings remains limited. This review mapped evidence on whether and how purposeful physical settings are reported in protocols for group-based psychosocial interventions for older adults.MethodsUsing Arksey and O'Malley's framework, we searched four databases for protocols of group-based psychosocial interventions for older adults involving in-person sessions.ResultsOf the seventy-five included protocols, only six (8%) explicitly reported physical settings. Author consultation identified an additional 16 protocols, totaling 22 (29%) considering settings such as layout, acoustics, lighting, and thermal comfort. Physical activity interventions in community settings with smaller groups were more likely to report these elements.DiscussionUnderreporting and limited detail on physical settings highlight room for improvement. Intentionally integrating and thoroughly reporting these settings could enhance intervention designs, potentially improving outcomes and replicability of psychosocial interventions for older adults.

Subjective cognitive decline (SCD) has been associated with challenges performing instrumental activities of daily living (IADL). The purposes of this study were to assess the prevalence of SCD among older adults and examine factors associated with SCD. Using the 2022 National Health and Aging Trends Study dataset, a binary logistic regression model was fit to identify the association of IADL, self-reported falls, and depression on SCD. About 13% of participants reported SCD, 28.3% reported one or more IADL difficulty, and 39.4% reported depressive symptoms. About 24% reported one or more falls in the past year. Findings reinforce the role of functional decline, depression, and falling on cognition among older adults. The interrelated nature of these variables highlights the importance of timely cognitive function screening when subjective memory problems are recognized.

In the U.S, the roughly 70% of family caregivers who are employed face challenges balancing work and family responsibilities-which can threaten their longer-term financial well-being. Thus, the National Strategy to Support Family Caregivers (2022) focuses on increasing the availability of workplace protections and supports. This study provides stakeholder perspectives on caregiver-friendly workplace policies, drawing on data collected to support the development of the Strategy. Data were collected from qualitative interviews and focus groups with stakeholder organizations, comprising 34 individuals, aiming to identify key issues in encouraging caregiver-friendly workplaces. Respondents supported the need for systematic approaches in support of that shift and offered ideas for catalyzing it, stressing the importance of supportive workplace environments. They highlighted employer variation in capacity to adopt practices and the need for a range of options that accommodate employer and employee heterogeneity. Furthermore, they described the role of data in informing employers and policy.

As older adults' assistance needs increase, aging in place may become difficult due to high costs or limited care. A new approach of care (Vieillir chez soi, VCS) was implemented within an existing seniors' residence (SR) to provide evolving and person-centered care. Drawing on an embedded mixed-methods approach combining survey data with individual interviews, this study documented residents' (n = 10) and informal caregivers' (n = 15) perspective regarding the VCS approach. Overall, it promoted a positive long-term vision, allowing participants to continue living at the SR and engaging in meaningful activities and maintain their relationships. However, they shared a desire to be more informed and involved in care planning, highlighting communication gaps with the SR's staff. Challenges with cohabitation also emerged, such as the potential loss of belonging. This study underscores the relevance and challenges of providing evolving living environments to enable older adults to age in place despite increasing assistance needs.

Social connection is a core component of well-being. Older adults with declining physical functioning or serious health conditions are at particular risk for social isolation and loneliness, and often rely on a family caregiver to facilitate their social participation. Using data from the 2015 and 2017 National Health and Aging Trends Study and the National Survey of Caregiving, this study sought to elucidate dyadic interdependence in the relationship between physical vitality and social participation, among care recipient-caregiver dyads (152 dyads with dementia; 475 dyads without dementia). Actor-partner interdependence models reveal that physical vitality was positively associated with social participation in care recipients, regardless of their dementia status. In dyads with dementia, care recipients' physical vitality was also positively associated with caregiver social participation. The findings demonstrate the importance of physical vitality of both older adults and their caregivers in maintaining social participation in the face of health challenges.

Loneliness, a subjective feeling experienced by a considerable number of older adults, is often related to life stressors. Family functioning and self-perceptions of aging (SPA) may be associated with loneliness, but no prior research has combined them into a single explanatory model. This study examined the role of family functioning and SPA in associations between life stressors and loneliness in older adults. Participants were 317 individuals aged 65 and older, recruited from urban areas in Spain. A path analysis tested direct and indirect associations among variables. Results indicated life stressors were indirectly associated with loneliness through family functioning and negative SPA. In addition, family functioning was indirectly associated with loneliness through SPA. The model showed excellent fit and explained 48% of the variance in loneliness. Findings provide a theoretical basis for interventions to reduce loneliness by enhancing family support and promoting positive SPA.

Alzheimer's disease presents a public health challenge, with disparities in dementia literacy and resource access, particularly in rural communities. This study examines Extension professionals' perceptions of the adequacy, availability, and awareness of clinical and non-clinical dementia resources, focusing on potential urban-rural and role-based differences. Using an existing dataset (N = 132), ordinal logistic regression assessed associations between resource ratings and county rurality as well as professional role. Results indicate professionals in rural counties reported significantly lower ratings for the adequacy (OR = 0.47, p < .05), availability (OR = 0.42, p < .05), and awareness (OR = 0.49, p < .05) of clinical dementia resources compared to urban counterparts. No significant differences emerged for non-clinical resources. Findings highlight geographic and professional disparities in clinical dementia resources.

BackgroundSleep problems are common in older adults and associated with higher frailty risk.ObjectiveTo examine whether pain and social isolation explain the longitudinal association between sleep problems and frailty.MethodsData were from 925 adults aged 65+ in the 2013-2014 National Aging and Health Trends Study. Sleep problems were self-reported, and frailty was assessed using Fried's phenotype. Mediators included pain, activity-limiting pain, number of pain locations, and social isolation. Multivariable logistic regression and Karlson-Holm-Breen method were used.ResultsBaseline pain and social isolation partially mediated the association between sleep problems and frailty at one-year follow-up, with pain accounting for 13.29%, activity-limiting pain 10.24%, pain locations 19.84%, and social isolation 12.77%, and pain and social isolation combined over 24% of the association.ConclusionsPain and social isolation explain part of the association between sleep problems and frailty, informing efforts to reduce sleep-related frailty risk over time.

This study examined the effects of an integrated intervention involving exposure to aged future self and a writing task on retirement planning among 235 young and middle-aged working adults. Participants were randomly assigned into three groups: control group (CS), experimental group (FS), and experimental group with a writing task (FSW). The experimental groups viewed an age-morphed photo of their future selves while the control group saw a photo of their current selves. Afterward, the FSW group completed a five-day diary writing task about improvement plan for their aged future selves' well-being, while the FS and CS groups did not. Although no significant main effects of experimental conditions were shown, middle-aged FSW participants reported more financial and psychological retirement planning at the six-month follow-up compared to the CS group and young FSW participants. The implications for targeting specific age groups using unique psychological intervention approaches to encourage retirement planning were discussed.