Journal of Applied Gerontology

Replications of evidence-based dementia care receiver–caregiver dyad interventions in the community are scarce. We aimed to assess the effectiveness of the Kansas City implementation of Reducing Disability in Alzheimer’s Disease (RDAD) among a convenience sample of dyads with moderate dementia, which addressed needs identified by nine participating community agencies. We hypothesized that dyads’ mental health and physical activity outcomes would improve from baseline to end-of-treatment. The final analytic sample included 66 dyads. Outcomes improved (p < .01) from pre- to post-intervention: behavioral symptom severity (range 0–36) decreased from 11.3 to 8.6, physical activity increased from 125.0 to 190.0 min/week, caregiver unmet needs (range 0–34) decreased from 10.6 to 5.6, caregiver behavioral symptom distress (0–60) decreased from 15.5 to 10.4, and caregiver strain (0–26) decreased from 11.1 to 9.7. This adapted implementation of RDAD leads to clinically meaningful improvements and might inform scaling-up.

Objectives: This study aimed to reveal the features of older adults’ advance care planning (ACP) discussions by identifying psychosocial factors related to their discussions in Japan, where people value family-centered decision making. Methods: A qualitative study using in-depth interviews was conducted with 39 participants (aged ≥65 years) recruited from the outpatient department of a community hospital in Fukushima, Japan. Data were analyzed using the grounded theory approach. Results: Through experiences of family caregiving, participants became aware of their own feelings about the end of life. Equal relationship with family members was important for lowering the threshold for having discussions. Some participants and their families in the same generation reached agreements on ACP; however, they were willing to yield to children’s decision making despite these discussions. Discussions: These findings provide insights into the psychosocial factors in relation to ACP discussions and support for the role of ACP discussions in the family-centered decision-making culture.

Cause of death is an important outcome in end-of-life (EOL) research. However, difficulties in assigning cause of death have been well documented. We compared causes of death in national death registrations with those reported in EOL interviews. Data were from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative sample of community-dwelling adults aged 50 years and older. The kappa agreement statistic was estimated to assess the level of agreement between two methods: cause of death reported in EOL interviews and those recorded in official death registrations. There was moderate agreement between underlying cause of death recorded on death certificates and those reported in EOL interviews. Discrepancies in reporting in EOL interviews were systematic with better agreement found among younger decedents and where the EOL informant was the decedents’ partner/spouse. We have shown that EOL interviews may have limited utility if the main goal is to understand the predictors and antecedents of different causes of death.

This study applied the theory of planned behavior to examine predictors of U.S. older adults’ (65+ years) intention and behavior of moving to a nursing home. Two waves of Health and Retirement Study data were used (N = 9,969). Moving intention was measured by respondents’ self-reported probability to move in the next 5 years in Wave 1. Moving behavior was measured by whether they actually moved in Wave 2. Structural equation modeling was used to examine the relationships of demographic and health predictors with moving intention and behavior. For both genders, advanced age, poorer health, having fewer children, and long-term care insurance were associated with higher levels of moving intention and behavior. Men’s intention was a significant predictor of subsequent moving behavior. However, women’s intention was not associated with moving behavior, probably due to inadequate resources to support their preference. The findings provide meaningful personhood-centered insights into nursing home entry decisions.

Although involuntary nursing home closures for operational and care-related reasons occur infrequently, few studies have examined the centrality of the actions of staff to facilitate residents’ relocation adjustment. We interviewed 18 administrators and 43 staff working at 27 facilities about the relocation process for residents from two facilities that lost their Medicare and State Medicaid certification due to ongoing care deficiencies. Thematic analysis revealed three major themes throughout each aspect of the relocation process: (a) staff expectations were not met, (b) barriers/challenges were persistent, and (c) resident/family involvement was minimal. We offer proactive participant-derived recommendations for policy and practice to strengthen involuntary relocation processes to ensure a cooperative work environment and residents’ well-being, regardless of the cause for involuntary closure.

Residents of long-term care (LTC) whose deaths are imminent are likely to trigger a transfer to the emergency department (ED), which may not be appropriate. Using data from an observational study, we employed structural equation modeling to examine relationships among organizational and resident variables and death during transitions between LTC and ED. We identified 524 residents involved in 637 transfers from 38 LTC facilities and 2 EDs. Our model fit the data, (χ² = 72.91, df = 56, p = .064), explaining 15% variance in resident death. Sustained shortness of breath (SOB), persistent decreased level of consciousness (LOC) and high triage acuity at ED presentation were direct and significant predictors of death. The estimated model can be used as a framework for future research. Standardized reporting of SOB and changes in LOC, scoring of resident acuity in LTC and timely palliative care consultation for families in the ED, when they are present, warrant further investigation.

A focus of community-based elder abuse response programs (EARP), such as Adult Protective Services, is to reduce the risk of revictimization among substantiated victims. While elder abuse (EA) risk factor research has predominantly focused on understanding the risk of initial EA onset among the general older adult population, understanding of revictimization risk among substantiated victims is weak. This study sought to identify conditions that perpetuate EA among substantiated victims. Data were collected from multiple sources: focus groups with multidisciplinary teams (n = 35), multidisciplinary team case revictimization risk evaluations (n = 10), and reviewing a random sample of case records (n = 250) from a large EARP in New York City. Sixty-two indicators of EA revictimization risk were identified across several ecosystemic levels: individual victim or perpetrator, victim–perpetrator relationship, and surrounding family, home, community, and sociocultural contexts. Findings carry implications for EARP practices to reduce EA recurrence and the development of measures to evaluate EARP intervention.

This study explored the relationship between the opioid epidemic and elder abuse. Twenty professionals from four states with working knowledge of elder abuse cases participated in focus groups. Thematic analysis revealed four themes characterizing the relationship between opioid misuse and elder abuse: (a) Opioid-Related Elder Abuse is an Escalating Problem; (b) Vulnerable Older Adults are Prisoners in Their Own Home; (c) Health Care Professionals Perpetrate Opioid-Related Elder Abuse; and (d) Older Adults Abuse and Deal Opiates. In addition, all participants noted the lack of reliable, retrievable data to address cases of elder abuse when opioids are involved. Findings lay the groundwork for further research to understand the breadth and depth of the opioid-elder abuse relationship that can ultimately be used to develop prevention and intervention strategies and policies to address this hidden but widespread concern.

The study aimed to develop and validate a tool to recognize the presence and to evaluate the level of self-neglect in community-dwelling older people. The cross-sectional study included 2,894 face-to-face interviews with randomly selected individuals from among the general population, social service users, and hospital patients. In addition, specially trained interviewers assessed the physical appearance and standards of living. Reliability, content, and construct validity were assessed. The Item Response Theory was used. The following scales were developed: the Self-Reported Self-Neglect Scale (SRSNS), the Objective Assessment of the Level of Self-Neglect–Physical Appearance (OALSN-PA) scale, concerning physical health risks based on the appearance of an individual, and the Objective Assessment of the Level of Self-Neglect–Standards of Living Arrangements (OALSN-SLA) scale, which assesses the physical and personal living conditions. The brevity of the scales makes them useful for the daily practice of health care and social care professionals.

This study aims to test the moderating effects of home health care, home-help service, and older adults’ attitudes toward aging on the relationship between social support and life satisfaction among Chinese older adults. The study used a sample of 5,578 Chinese home-dwelling older adults. Multiple linear regression analyses were performed to test the hypothesized effects along with gender and Hukou type differences. The results show that home health care significantly buffers the impact of social support on life satisfaction, and this buffering effect remains same across gender groups and Hukou groups. The findings of the study provide unique and contemporary theoretical and practical implications.

While the significance of social capital to the well-being of black South African grandmothers raising grandchildren has been well documented, few studies have systemically investigated the sources, types, and patterns of use of social capital in this population. The aim of the current qualitative study is to use the social capital framework to explore how 75 grandmothers accessed and utilized available social capital (i.e., bridging, bonding, and linking) to enhance their own and their families’ well-being. Results from a thematic analysis revealed an inside-out pattern of social capital; bonding and bridging social capital were the most significant sources of immediate support for grandmothers, with relatives providing emotional and instrumental support and neighbors and friends mainly providing informational support. Linking capital (i.e., government and community leaders) helped grandmothers access public resources. Implications for policy and practice are addressed.

Close social networks provide older persons with resources, including social support, that maintain their well-being. While scholarship shows how networks change over time, a dearth of research investigates changing social contexts as causes of network dynamics. Using the first two waves of the National Social Life, Health, and Aging Project survey (N = 1,776), this study shows how rising neighborhood-level concentrated disadvantage through the Great Recession of 2007–2009 was associated with smaller close networks, largely due to fewer new close ties gained, among older Americans. Worsening neighborhood circumstances pose obstacles to older residents’ acquisition of new close ties, including heightened fear, lower generalized trust, stress and depression, and declines in local institutions that attract both residents and nonresidents.

Driver training has the potential to keep older adults safe behind-the-wheel for longer, yet there is limited evidence describing factors that influence their willingness to participate in training. Focus groups with community-dwelling older drivers (n = 23; 70–90 years) and semi-structured interviews with driving instructors (n = 6) and occupational therapists (n = 5) were conducted to identify these factors. Qualitative descriptive analyses highlighted how self-awareness of behind-the-wheel abilities in later life can influence an older adult’s motivation to participate in driver training, as well as their willingness to discuss their behaviors. Collision-involvement and near-misses prompted participants to reflect on their driving abilities and their openness to feedback. Participants’ preferences for learning contexts that use a strengths-based approach and validate the driving experience of older drivers, while providing feedback on behind-the-wheel performance, were raised. Older driver training initiatives that consider the needs of the aging population in their design can promote road safety and community mobility.

The proportion of people aged 65 years and older regularly traveling in motor vehicles continues to grow worldwide. In a previous convenience sample, we observed many older people using comfort accessories when traveling in vehicles, and these may contribute to the known increased risk of injury in crashes among older people. In this study, we aimed to estimate population-level use of these devices and examine associations between demographic, health, and travel behavior factors and their use. The point estimate of self-reported use of comfort accessories was 25.7% (95% confidence interval [CI] = [19.6%, 31.9%]). Cushions on the vehicle seat were the most common type used (14.3%, 95% CI = [9.7%, 19.0%]), and increasing age, female gender, and frequent vehicle travel were significantly associated with their use. Less frequently used were seat belt padding (10.5%, 95% CI = [6.3%, 14.6%]) and back/neck supports (6.5%, 95% CI = [2.7%, 10.2%]). Back/neck and multiple area pain were significantly associated with the use of the latter.

Federal reporting of crash fatalities has limited age-by-sex stratification, but both age and sex are associated with driving reduction and cessation. We described older driver fatal crash involvement and fatalities using Fatality Analysis Reporting System data to calculate rates (per 100,000 licensed drivers, per 100,000 population) with age-by-sex stratifications. Nationally from 2000 through 2017, 110,422 drivers 65+ were involved in crashes resulting in at least one death within 30 days, and 67,843 of these older drivers died. Involvement and fatality rates per 100,000 licensed drivers in 2017 were lowest for females 65–69 (7.7 and 3.6, respectively) and highest for males age 85+ (34.3 and 25.5, respectively). Females had lower driver fatal crash involvement and fatality rates throughout the lifespan, even when rates generally decreased over time. Elaborating fatal crash trends and rates by age and sex helps to differentiate the public health burden of older driver crashes and fatalities.

Objectives: To address the issue of whether health behaviors are concordant within couples, this study identified dyadic profiles of health behaviors among Korean baby boomer couples (born 1955–1963). Methods: We analyzed a sample of 1,092 middle-aged couples from the Korean Baby Boomer Panel Study (2014). Latent class analysis and multinomial regression models were conducted to describe underlying health behavior profiles. Results: Four dyadic profiles of health behaviors emerged: (a) concordant—high health-promoting (26%), (b) moderate concordant—compensating (21%), (c) moderate concordant—low engaging (22%), and (d) less concordant—high health-promoting (31%). In addition, couples with higher levels of education, worse health, or better marital quality were more likely to belong to two high health-promoting profiles. Discussion: Encouraging husbands to engage in fewer health-compromising behaviors and acknowledging barriers to health-promoting behaviors for both spouses may contribute to healthier lifestyles among Korean couples.

With the graying workforce worldwide, identifying factors that facilitate older workers’ health is critically important. We examined whether gardening mitigates the relationship of work–family conflict with disability, chronic conditions, depressive symptoms, and self-rated health among older workers. We drew a subsample of older workers aged 55 years and above from the Health and Retirement Study (N = 1,598). Our results indicate that the relationships of work-to-family conflict at baseline with disability and with poorer self-rated health at a 2-year follow-up were stronger for those who gardened less than those who gardened more. No significant interaction was found between family-to-work conflict and gardening in predicting the health outcomes. This study is the first to show that gardening may have a protective effect against the adverse impact of work-to-family conflict on older workers’ health.

Few studies explore the differences between diverse stakeholders’ understandings of what constitutes “positive aging” for Latino older adults. To address this gap, we worked with a 20-member steering committee (SC) of community stakeholders to collect concept mapping data from 38 scholars and community workers. We generated 90 statements related to positive aging from the literature and produced concept maps based on four different stakeholder groups’ ratings of them. All stakeholders prioritized “Financial Security,” but scholars marked “Spirituality” as least important whereas community workers rated it second highest. The design of programs for Latino older adults should reflect such differences.

Hearing impairment impacts fluidity of communication and social interactions and thus may contribute to loneliness. We investigated the cross-sectional association between hearing impairment and loneliness in community-dwelling older U.S. adults using data from the National Social Life, Health, and Aging Project (N = 3,196). Individuals reporting fair/poor hearing had 50% (95% confidence interval [CI] = [1.09–2.05]) higher odds of any loneliness compared with those reporting excellent hearing after adjusting for comorbidity index, functional and cognitive ability, self-reported health, and demographic characteristics. Test for trend suggests a dose–response relationship over levels of hearing impairment. Hearing impairment is highly prevalent and may be an important target for consideration in interventions to reduce loneliness. Further investigation of whether treatment of hearing impairment alleviates loneliness and its disabling effects is also needed.

Wandering is a potentially dangerous event for individuals living with dementia and is equally as stressful for their caregivers. The purpose of the current study was to examine the validity of the Risk of Wandering (RoW) scale in terms of predicting wandering. We compared the RoW scale’s validity against two widely used scales that assessed dementia as reported by caregivers: Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE; Jorm) and Revised Memory and Behavior Problems Checklist (RMBPC; Roth et al.). The RoW scale predicted wandering events better than the IQCODE and comparably with the RMBPC, which is longer and less specific to wandering.

Resilience, a capacity for addressing, recovering, and growing from challenging situations, can mitigate dementia care partners’ burden. Three main theoretical models predominate, treating resilience variably as an outcome, a trait, or a process. In this scoping review, we examine how these three models inform definitions and measures of resilience in dementia care partners to understand whether there is a single coherent model and identify the gaps in conceptualizing and operationalizing resilience. We searched English-language peer-reviewed articles (January 1991–June 2019) that contained definitions and/or measures of resilience developed for or used with dementia care partners. Data were analyzed using content analysis. We found that perspectives from the three existing theoretical models can be integrated into a unified framework for the study of resilience in dementia care partners. However, major gaps remain in operationalizing resilience for research due to a paucity of resilience outcomes and knowledge about resilience-related behaviors.

With growing numbers of aging Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), the availability of culturally and linguistically appropriate screening tools for Alzheimer’s disease and its related dementias (ADRD) is needed. The aim of this scoping review is to summarize the tools that have been adapted for and validated among the AANHPI population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol for systematic reviews, six databases were searched for peer-reviewed articles describing ADRD among AANHPIs. Among 1,477 articles screened for inclusion, 15 articles were included in the final analysis. Results showed a paucity of studies that psychometrically validate tools among this population. Furthermore, studies that culturally adapted and/or translated existing tools mostly targeted East Asian American populations. Our review provides a first step in mapping the extant literature on ADRD screening tools for this underresearched population and will serve as a guide for future research, policy, and intervention.