Journal of Applied Gerontology

This community-based cluster randomized trial evaluated the efficacy of a 4-week multimedia educational intervention followed by telephone consultations at Weeks 12 and 24 on the selection of a hospice program for end-of-life care and completion of an advance directive (AD) in case of future advanced dementia. One hundred twenty-three cognitively intact older adults from five community centers in Taiwan were randomly assigned to two groups. The study showed that 100% of participants in the intervention group (two community centers, n = 52) selected hospice program care for end-of-life care and signed ADs, whereas those in the control group were less likely to do both (p < .001). Participants in the intervention group also had a positive change in knowledge, subjective norms, perceived behavioral control, and behavioral intention of advance care planning (ACP) for advanced dementia. The theoretically based multimedia educational program was effective in assisting ACP implementation and completing ADs among community-dwelling older adults.

Caregivers of terminally ill patients are at risk for anxiety, depression, and social isolation. Social support from friends, family members, neighbors, and health care professionals can potentially prevent or mitigate caregiver strain. While previous research documents the importance of social support in helping end-of-life caregivers cope with caregiving demands, little is known about differences in social support experiences among caregivers at different life course stages. Using life course theory, this study analyzes data from in-depth interviews with 50 caregivers of patients enrolled in hospice services to compare barriers to mobilizing social support among caregivers at two life course stages: midlife caregivers caring for parents and older adult caregivers caring for spouses/partners. Older adult caregivers reported different barriers to mobilizing social support compared with midlife caregivers. Findings enhance the understanding of how caregivers’ life course stage affects their barriers to mobilization of social support resources.

The Hospice Philosophy Scale (HPS) is the only scaled instrument that measures health professionals’ attitudes about end-of-life care consistent with the hospice philosophy. This study tested the properties of a modified version of the HPS to provide preliminary validation data on internal consistency, convergent validity, and factorability in a broad population of adults. A cross-sectional telephone survey designed to assess the general population’s attitudes regarding hospice use was administered. exploratory factor analysis elicited an eight-item instrument (HPS-8). The HPS-8 produced a Cronbach’s alpha of .73 and demonstrated sufficient convergent validity, including positive associations with a scale measuring the importance of relevant end-of-life issues (r = .41, p < .001), a personal preference for hospice (ρ = .36, p < .001), and, among those who had experienced hospice care, satisfaction with hospice care (ρ = .28, p < .01). Our evidence suggests the HPS-8 is a reliable and valid instrument for use with a general adult population.

Parkinson’s disease (PD) is the second-most common age-related neurodegenerative disorder. Despite recommendations for a palliative approach, little is known about what palliative needs are unmet by standard care. This study aims to (a) identify palliative needs of PD patients, (b) determine the relationship between palliative needs and health-related quality of life (HRQoL), and (c) probe into factors affecting HRQoL. PD patients and neurologists were recruited for a survey on palliative need; a subset of patients was interviewed. Significant differences between physicians and patients were found in Physical, Psychological, Social, Financial, and Spiritual domains. Physical and Psychological needs predicted HRQoL. Primary themes across interviews included (a) lack of healthcare education and (b) need for care coordination. Secondary themes included (a) the importance of support groups, (b) the role of spirituality/religion, and (c) the narrow perceived role of the neurologist. Findings highlight the importance of coordinated individualized care.

Most transfers of long-term care (LTC) facility residents to the emergency department (ED) via 911 calls are necessary. Avoidable transfers can have adverse effects including increased confusion and dehydration. Around 20% of transfers are perceived to be avoidable or unnecessary, yet decision making around transfers is complex and poorly understood. Using a qualitative-focused ethnographic approach, we examined 20 health care aides’ (HCAs) perceptions of decision processes leading to transfer using experiential interview data. Inductive analysis throughout iterative data collection and analysis illuminated how HCAs’ familiarity with residents make them vital in initiating care processes. Hierarchical reporting structures influenced HCAs’ perceptions of nurse responsiveness to their concerns about resident condition, which influenced communications related to transfers. Communication processes in LTC facilities and the value placed on HCA concerns are inconsistent. There is an urgent need to improve conceptualization of HCA roles and communication structures in LTCs.

Prior studies have not described strategies for implementing transitional care in skilled nursing facilities (SNFs). As part of the Connect-Home study, we pilot tested the Transition Plan of Care (TPOC) template, an implementation tool that SNF staff used to deliver transitional care. A retrospective chart review was used to describe the impact of the TPOC template on three implementation outcomes: reach to patients, staff adoption of the template, and staff fidelity to the intervention protocol for transition care planning. The template reached 100% of eligible patients (N = 68). Adoption was high, with documentation by four disciplines in 90.6% of patient records (N = 61). Fidelity to the intervention protocol was moderately high, with 73% of documentation that was concordant with the protocol. Our findings suggest an electronic medical record (EMR)-based implementation tool may increase the ability of staff to prepare older adults and their caregivers for self-care at home. Further research is needed to test the efficacy of the protocol on patient outcomes after transitions from SNF to home.

Minnesota’s Return to Community Initiative (RTCI) assists private-pay nursing home (NH) residents to return to the community. Using data from a 1-year admission cohort of RTCI-targeted NH residents, we examined why residents who at admission expressed a desire for discharge, were paying privately, and had relatively low-care needs chose to remain in the NH. Characteristics of those who remained were compared with those who discharged using logistic regression, and barriers to discharge were summarized. Residents who were older, more cognitively impaired (OR = 1.8), unmarried (OR = 1.4), had behavior problems (OR = 1.6), or diagnosed with dementia (OR = 2.0) were more likely to remain than discharge to the community. Between admission and their 90-day assessment, residents remaining in the facility had a small decline in cognitive status, yet their continence improved and they became more independent in activities of daily living (ADLs). Seventy-four percent reported a perception of health-related barriers to discharge.

The traditional model of emergency care no longer fits the growing needs of the over 20 million older adults annually seeking emergency department care. In 2007 a tailored “geriatric emergency department” model was introduced and rapidly replicated among hospitals, rising steeply over the past 5 years. This survey examined all U.S. emergency departments self-identifying themselves as Geriatric Emergency Departments (GEDs) and providing enhanced geriatric emergency care services. It was guided by the recently adopted Geriatric Emergency Department Guidelines and examined domains including, GED identity, staffing, and administration; education, equipment, and supplies; policies, procedures, and protocols; follow-up and transitions of care; and quality improvement. Results reveal a heterogeneous mix of GED staffing, procedures, physical environments and that GEDs’ familiarity with the GED Guidelines is low. Findings will inform emergency departments and gerontologists nationwide about key GED model elements and will help hospitals to improve ED services for their older adult patients.

Research suggests that baby boomers entering older adulthood may possess unique alcohol use patterns over time. Using the life course perspective as a guiding framework, this empirical study sought to examine correlates of alcohol use disorders among baby boomers by examining representative data from the National Survey on Drug Use and Health at two points in time, 1998 (N = 6,213) and 2010 (N = 5,880). Results from logistic regression analyses suggest that predictors of alcohol use disorders evolve over time as baby boomers continue to age. Risk factors for alcohol use disorders among baby boomers may include concurrent unprescribed pain reliever use, p < .01, while protective factors such as income, p < .01, and social supports, p = .01, may be of increased importance. Based on the findings of this study, practice implications and future research are discussed.

Problem-solving skills in the context of technologically complex modern societies have become increasingly important to health management in later life. This study is designed to investigate the associations between problem-solving skills in technology-rich environments (PSTRE) and health, and to explore whether age differences exist. Using data from the 2012/2014 Program for the International Assessment of Adult Competencies (PIAAC), we used logistic regression to examine the relationship between PSTRE and self-reported health among a representative sample of American adults aged 35 years and older (N = 3,260). Overall, greater PSTRE (odds ratio [OR] = 1.012, p < .001) was significantly associated with better self-rated health even after adjusting for the sociodemographic characteristics. Yet, PSTRE was only partially predictive of health in some age groups. Our findings highlight the potential of PSTRE to reduce health disparities among middle-aged and older adults living in modern technology and information-rich societies.

The long-term services system has changed substantially since the mid-1970s, when the landmark book Last Home for the Aged argued that the move to the nursing home was the last move an older person would make until death. Using detailed nursing home utilization data from the Minimum Data Set, this study tracks three cohorts of first-time nursing home admissions in Ohio from 1994 through 2014. Each cohort was followed for a 3-year period. Study results report dramatic reductions in nursing home length of stay between the 1994 and 2011 cohorts. Reduction in length of stay has important implications for nursing home practice and quality monitoring. The article argues that administrative and regulatory practices have not kept pace with the dramatic changes in how nursing homes are now being used in the long-term services system.

Owner-managers are administrators that hold significant equity interests in the facility they operate. We examine how the presence of owner-managers is related to the workforce outcomes of retention and wages in nursing homes (NHs). Using a sample of for-profit NHs in Ohio from 2005 to 2015, multivariate regression analysis compares workforce outcomes in facilities operated by owner-managers to salaried managers. On average, owner-managed NHs have higher workforce retention rates, with larger effects among chain-affiliated NHs. Better retention is not achieved through higher wages, as we do not find higher wages at owner-managed NHs. Further qualitative studies are warranted to identify the exact mechanisms which lead to owner-managers having better staff retention rates. Plausible mechanisms include greater autonomy to allocate resources and create policies that foster a work environment that achieves better retention while maintaining financial sustainability.

Balance training decreases fall risk among older adults, but few participate in such training. We examined the association of exposure to social marketing to promote balance classes, personal characteristics and other factors, with older adults’ balance class participation. Adults aged ⩾60 years were eligible for this case-control study if they attended any church enrolled in a trial testing the effect of social marketing on balance class participation. Cases attended balance classes during the study period; controls were randomly sampled congregants who did not join a class. Cases were more likely to attend churches that received the social marketing program, and were older, more often female, and more frequently experienced “near falls” than controls. Participation was also associated with increasing age of the church’s leader and rural church attendance. Programs to promote balance classes may need to be tailored to target some risk groups, including men and urban and suburban congregants.

Flexibility in work schedule and work location have been suggested as being work features that may promote prolonged employment among older workers. This study focuses on the question whether access to workplace flexibility differs between male and female older workers and how potential differences can be explained. Analyses are based on data collected in 2015 among 4,813 Dutch older workers (age 60-65 years), who were employed in the government, education, care, and welfare sectors. Results show that the studied women on average perceive to have less workplace flexibility than men, both in work schedule and in work location. The gender difference in perceived location flexibility can be fully explained by differences in the human capital and job characteristics of male and female older workers. The gender difference in perceived schedule flexibility can be captured less clearly by these factors. This disadvantaged position of late-career women warrants attention in discussions about prolonged employment.

Background: Implementing care models that emphasize chronic disease self-management (CDSM) strategies may be an effective approach to the growing prevalence of chronic conditions in Iran. We, therefore, conducted a scoping review on CDSM among older Iranians to identify existing gaps and opportunities to improve chronic disease care. Method: We conducted a search in CINAHL, EMBASE, MEDLINE/PubMed, and Cochrane library. Selected articles were charted based on year of publication, language, objectives, methods, target chronic disease(s), sample demographics, self-management type, and key findings. Results: We selected 73 articles. The main components of CDSM addressed were social support, education, physical activity, nutrition, self-monitoring, spirituality, and financial support. Older Iranians reported low levels of physical activity. Conclusion: Enhancing the quality of CDSM research and provision of coaching to enhance older adults’ social and mental health are among the main strategies to enhance CDSM among the Iranian older population.