Journal of Applied Gerontology

For home care agencies and aides, the death of clients has important, yet often unrecognized, workforce implications. While research demonstrates that client death can cause grief and job insecurity for aides, we currently lack home care agencies’ perspectives on this issue and approaches to addressing it. This study uses key informant interviews with leaders from a diverse sample of eight New York City home care agencies to explore facilitators and barriers to agency action. We found that agencies engaged primarily in a range of informal, reactive practices related to client death, and relatively few targeted and proactive efforts to support aides around client death. While leaders generally acknowledged a need for greater aide support, they pointed to a lack of sustainable home care financing and policy resources to fund this. We recommend increased funding to support wages, paid time off, and supportive services, and discuss implications for future research.

The purpose of this study was to identify predictive factors of effort–reward imbalance (ERI) among employees in multiple long-term care settings in Japan. This cross-sectional study by convenience sampling included 944 participants providing three types of long-term care: home-based (n = 201), community-based (n = 128), and institutional (n = 615). Multiple logistic regression analysis was used to identify factors associated with self-reported ERI. Low job satisfaction, being a care manager, holding a position of department head, working long hours, and having family-related stress were the common factors associated with ERI in employees across all three types of long-term care setting. Long-term care providers should consider the needs of care recipients and their family, as well as the needs of care employees, maximizing rewards so that turnover can be reduced and the diversity of individual work–family needs can be accommodated across multiple forms of long-term care settings.

Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.

Family Councils are independent, self-determining groups composed of family members (inclusive of friends) who have assembled with the main purpose of protecting and improving the quality of life of those living in long-term care (LTC) homes. This study aimed to describe the prevalence and characteristics of Family Councils in British Columbia, Canada. We conducted a cross-sectional survey with administrators of 259 homes and received 222 usable surveys. Of the 151 LTC homes that had Family Councils, it was most common for the homes to be larger (>50 residents), accredited, privately owned, and located in urban areas. Perceived barriers to Family Councils included lack of interest, tendency to focus on individual complaints, and the transitory nature of families. Perceived benefits of Family Councils included enhanced communication between staff and families, peer support, and collective advocacy. Recommendations focus on enhancing accessibility, information sharing, and meaningfulness of Family Councils to improve family engagement.

Family involvement is critical to end-of-life (EOL) care among older adults. This study aims to examine the association and pathways between family relationships and older Chinese Americans’ attitude toward family involvement in EOL care discussions. Data were collected from 260 Chinese Americans aged 55 years and above. Structural equation modeling was used to examine the total and indirect effects of family relationships on attitude toward family involvement in discussing EOL care plans. Family relationships had a significant positive total effect on attitude toward family involvement in EOL care. Indirect effects of family relationships on attitude toward family involvement in EOL care through self-efficacy, perceived benefits, and perceived barriers of discussing EOL care with family members were all significant. Findings provide empirical evidence of how family relationships affect older Chinese Americans’ attitude toward family involvement in EOL care and underline the need for family-centered EOL interventions for this population.

The purpose of this study was to test a model of factors associated with participating in function focused care. Function focused care is a philosophy of care in which residents are encouraged to engage in functional and physical activities during care interactions. This was a secondary data analysis using data from the Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) study. Residents (n = 550) were recruited from 59 AL settings. The majority were female (n = 380, 69%) and White (n = 536, 97%). Model testing was done. Comorbidities, quality of interactions, environments, profit status, cognitive impairment, depression, and function were associated with function focused care and accounted for 17% of the variance. Next steps should include intervening on changeable factors (e.g., environments) and adding factors to better explain performance of function focused care such as motivation, resilience, and staff satisfaction.

Acculturation and racial discrimination have been independently associated with physical function limitations in immigrant and United States (U.S.)-born populations. This study examined the relationships among acculturation, racial discrimination, and physical function limitations in N = 165 African immigrant older adults using multiple linear regression. The mean age was 62 years (SD = 8 years), and 61% were female. Older adults who resided in the United States for 10 years or more had more physical function limitations compared with those who resided here for less than 10 years (b = −2.62, 95% confidence interval [CI] = [–5.01, –0.23]). Compared to lower discrimination, those with high discrimination had more physical function limitations (b = −2.51, 95% CI = [–4.91, –0.17]), but this was no longer significant after controlling for length of residence and acculturation strategy. Residing in the United States for more than 10 years is associated with poorer physical function. Longitudinal studies with large, diverse samples of African immigrants are needed to confirm these associations.

Preserving Quality of Life (QoL) in old age gains in importance, but Fear of Falling (FoF) considerably limits QoL. The aim of our study was to understand how physical mediators may translate FoF to QoL. At Time 1, FoF, subjective leg strength, balance, QoL, and objective gait speed were assessed. QoL was reassessed after 6 months, at Time 2 (n = 125). A sequential mediation analysis examined whether the relationship between FoF and QoL could be mediated by leg strength, balance, and gait speed. FoF was directly associated with QoL (β = −.27; 95% CI [−0.007, −0.001]) as well as indirectly via leg strength, balance, and gait speed (specific sequential indirect effect: β = −.03; 95% CI [−0.06, −0.001]; R² = .40 in QoL; controlled for age, QoL at Time 1). An intervention approach could be to address FoF and foster physical functioning and gait speed to maintain QoL.

Little is known about the impact of engagement in personally meaningful activities for older adults. Thus, this study examines the impact of engagement in one’s favorite activity on cognitive, emotional, functional, and health-related outcomes in older adults with and without cognitive impairment. Data were obtained from 1,397 persons living with dementia (PLWD) and 4,719 cognitively healthy persons (CHP) who participated in wave 2 of the National Health and Aging Trends Study (NHATS). Sociodemographic characteristics were examined by cognitive status. A multivariate analysis of variance indicated that, for PLWD, engagement in favorite activity was associated with greater functional independence and decreased depression. For CHP, engagement in favorite activity was associated with greater functional independence, decreased depression and anxiety, and better performance on memory measures. Findings suggest that engagement in valued activities that are considered personally meaningful may have significant and distinct benefits for persons with and without dementia.

This investigation sought to determine the associations between handgrip strength (HGS) asymmetries and limitations in individual activities of daily living (ADL). The analytic sample included 18,468 participants from the 2006 to 2016 waves of the Health and Retirement Study. Those with HGS >10% stronger on either hand had any HGS asymmetry. Individuals with HGS >10% stronger on their dominant or non-dominant hand had dominant or non-dominant HGS asymmetry, respectively. ADL abilities were self-reported. Those with any HGS asymmetry had 1.21 (95% confidence interval [CI] = [1.01–1.46]) greater odds for a toileting limitation and 1.25 (CI = [1.03–1.52]) greater odds for a transferring limitation. Individuals with dominant HGS asymmetry had 1.24 (CI = [1.01–1.53]) greater odds for a transferring limitation. Those with non-dominant HGS asymmetry had 1.39 (CI = [1.01–1.93]) and 1.44 (CI = [1.05–1.96]) greater odds for a bathing and toileting limitation, respectively. HGS asymmetries could help to identify future limitations in specific ADLs.

Geographic disparities in health and health care are increasingly well-documented, as are financial barriers to accessing care. Still, less is known about whether Medicare beneficiaries differ in their ability to pay for care by rurality. Using data from the 2016 Medicare Current Beneficiary Survey (n = 12,688 U.S. community-dwelling beneficiaries), we analyzed rural–urban differences in rates of collection agency contact for unpaid medical bills using chi-square tests and multivariable logistic regression for the full sample and by age (65+ and <65). Nearly 10% of Medicare beneficiaries had been contacted by a collection agency for medical debt in the previous year, with higher percentages among rural beneficiaries (8% for urban vs 10% for rural micropolitan and 11% for rural noncore, p < .05). This difference attenuated after adjusting for educational attainment and income, suggesting that attention to socio-economic status among rural Medicare beneficiaries would help to address financial barriers to care and decrease medical debt.

The Community Aging in Place–Advancing Better Living for Elders (CAPABLE) program reduces disability in low-income older adults. In this study, we used CAPABLE baseline and 5-month data to examine whether its effects in reducing activities of daily living (ADLs) and instrumental ADLs (IADLs) difficulties differed by participants’ financial strain status. At baseline, participants with financial strain were more likely to report higher scores on depression (p < .001), have low energy (p < .001), and usually feel tired (p = .004) compared with participants without financial strain, but did not differ in ADL/IADL scores. Participants with financial strain benefited from the program in reducing ADL (relative risk [RR]: 0.61, 95% confidence interval [CI]: 0.43, 0.86) and IADL disabilities (RR: 0.69, 95% CI: 0.54, 0.87), compared with those with financial strain receiving attention control. Individuals with financial strain benefited more from a home-based intervention on measures of disability than those without financial strain. Interventions that improve disability may be beneficial for financially strained older adults.

When people have more negative perceptions about aging or attribute health decline to old age, they engage in less health promotion behavior. We tested whether an intervention of brief anti-ageism messages addressing views of aging could motivate engagement in physical activities at senior centers. Attendees aged 50 and older (n = 349; M_age = 72, SD = 9) at seven centers were randomly assigned to read one of three intervention messages (different approaches addressing views of aging) or to not read a message before rating their likelihood of attending a variety of center programs, including physical activities. Multilevel regression models indicated the intervention increased motivation to attend physical activities compared with the control group among participants aged 72 and older. The three anti-ageism messages were similarly effective suggesting some flexibility in framing. The results indicate anti-ageism messages may be a scalable, low-cost approach to promoting physical activity in older adults.

This study evaluated a 12-week, home-based combined aerobic exercise (walking) and computerized cognitive training (EX/CCT) program on heart failure (HF) self-care behaviors (Self-care of HF Index [SCHFI]), disease specific quality of life (Kansas City Cardiomyopathy Questionnaire [KCCQ]), and functional capacity (6-minute walk distance) compared to exercise only (EX) or a usual care attention control (AC) stretching and flexibility program. Participants (N = 69) were older, predominately female (54%) and African American (55%). There was significant improvement in self-care management, F(2, 13) = 5.7, p < .016; KCCQ physical limitation subscale, F(2, 52) = 3.4, p < .039; and functional capacity (336 ± 18 vs 388 ± 20 m, p < .05) among the EX/CCT participants. The underlying mechanisms that EX and CCT targets and the optimal dose that leads to improved outcomes are needed to design effective interventions for this rapidly growing population.

The current study sought to determine the influence of initial sleep quality and body mass index on the cognitive and mood outcomes of a community-based cardio-dance exercise program. Thirty-two older African Americans who participated in a 5-month cardio-dance exercise program were propensity-matched to 32 no-contact controls. Participants completed neuropsychological tests of attention, executive function, and memory and a self-reported depression measure at baseline and post-test. Among exercise participants, we observed significant improvements in depression (baseline = 6.16 ± 5.54, post-test = 4.66 ± 4.89, η p 2 = . 12 , p = .009) and attention (baseline = 40.53 ± 14.01, post-test = 36.63 ± 13.29, η p 2 = . 12 , p = .009) relative to controls. Improvements in executive function and attention were most pronounced among exercise participants with poor sleep quality (baseline = 7.71 ± 1.25, post-test = 8.29 ± 2.06, η p 2 = . 41 , p = .04) and with obesity (baseline = 38.05 ± 12.78, post-test = 35.67 ± 13.82, η p 2 = . 30 , p = .001), respectively. This study provides novel evidence that exercise has the potential to improve depression in older African Americans. For those with poor sleep quality or obesity, exercise can also improve some cognitive outcomes.

The literature indicates that perceived neighborhood social cohesion is related to later life physical activity. However, there is no research that examines the role of childhood socioeconomic status (SES) in shaping this relationship. We use data from the Health and Retirement Study (2006–2016; N = 8,754) and a structural equation modeling approach to examine whether perceived neighborhood social cohesion and adulthood wealth mediate the relationship between childhood SES and physical activity. Perceived neighborhood social cohesion and adulthood wealth have small but statistically significant mediational effects in the relationship between childhood SES and physical activity. Research on the relationship between health and place should consider the potential impact of childhood circumstances on the neighborhood one lives in during adulthood.

Policymakers and community organizations have implemented numerous programs and services to support the more than 40 million family caregivers in the United States. However, the existence of such services is not sufficient to ensure equitable and optimal access and utilization. Using data from the Caregiving in the US study (2015; n = 1,185), we estimated that nearly one in five family caregivers do not meet broad eligibility criteria for support services. This resource gap was particularly likely to affect high-priority populations such as those caring for someone with a mental health problem. Furthermore, ineligible caregivers had lower service utilization and increased financial strain. The findings highlight a pattern of vulnerability among caregivers who do not meet broad eligibility criteria for financial support resources. Careful policy consideration is needed to determine how support services should be allocated to maximize caregiver and care recipient outcomes at the population level.

Home health care (HHC) clinicians serving individuals with Alzheimer’s disease and related dementias (ADRD) do not always have information about the person’s ADRD diagnosis, which may be used to improve the HHC plan of care. This retrospective cohort study examined characteristics of 56,652 HHC patients with varied documentation of ADRD diagnoses. Data included clinical assessments and Medicare claims for a 6-month look-back period and 4-year follow-up. Nearly half the sample had an ADRD diagnosis observed in the claims either prior to or following the HHC admission. Among those with a prior diagnosis, 63% did not have it documented on the HHC assessment; the diagnosis may not have been known to the HHC team or incorporated into the care plan. Patients with ADRD had heightened risk for adverse outcomes (e.g., urinary tract infection and aspiration pneumonia). Interoperable data across health care settings should include ADRD-specific elements about diagnoses, symptoms, and risk factors.

The current study examined the extent to which leisure activities were related to different forms of social support and its association with positive affect. A secondary data analysis was employed using data drawn from the Health and Retirement Study (HRS) in 2014. The study sample was composed of 4,303 individuals whose ages ranged from 65 to 105 (M = 75.78, SD = 7.42; 57.8% females). Employing bootstrapping technique, the hypothesized relationship between leisure, social support, and positive affect was examined. Mediating effect of social support was also determined. Results indicated that leisure activity, social support, and positive affect were significantly associated, but the relationship varied. The study findings expanded our understanding of the divergent leisure paths to positive social support and emotional well-being of the older adults. Promoting diverse recreational settings is necessary in leisure interventions that can facilitate frequent and positive social exchanges in both in-home and out-of-home environments.

Mobility and technology can facilitate in-person and virtual social participation to help reduce social isolation, but issues exist regarding older adults’ access, feasibility, and motivation to use various forms of mobility and technology. This qualitative study explores how a diverse group of low-income, urban-living older adults use mobility and technology for social participation. We conducted six focus groups (N = 48), two each in English, Spanish, and Korean at a Los Angeles senior center. Three major themes emerged from thematic analysis: using technology for mobility; links between mobility and social participation; and technology-mediated social participation. Cost, perceived safety, (dis)ability, and support from family and friends were related to mobility and technology use. This study demonstrates the range of mobility and technology uses among older adults and associated barriers. The findings can help establish a pre-COVID-19 baseline on how to make mobility and technology more accessible for older adults at risk of isolation.

Inflammation, particularly interleukin-6 (IL-6), is associated with chronic disease in older adults, but not all older adults have the same progression of poor health outcomes. Self-efficacy may play a role in buffering the inflammatory burden in chronic disease. To evaluate associations between self-efficacy and IL-6, 159 community-dwelling older adults (N = 159, M_age = 82 years, SD = 6.3 years) with one or more chronic illnesses were recruited for this cross-sectional study. Sweat IL-6 was collected using a noninvasive sweat patch worn for 72 hrs. Multiple linear regression with bootstrapping showed a significant association between social coping self-efficacy and IL-6 (β = −0.534, p = .010) after adjustment for age, sex, race, body mass index, financial strain, chronic conditions, and social support. Although preliminary, this study creates a rationale to explore the self-efficacy inflammatory biomarker association further. Enhancing self-efficacy might be a viable nonpharmacological treatment to lower or slow the inflammatory burden in older adults.