Journal of Applied Gerontology

Recent policy shifts in the United States have created opportunities for managed care organizations (MCOs) to put in place care navigators, like Dementia Care Specialists (DCS), to coordinate care for older adults living with dementia and their families. This paper presents findings of the DCS training model developed primarily for nurse and social work care managers within ten MCOs that participated in California’s pilot program serving Medicare–Medicaid dual-eligible members as part of a contracted collaboration with state agencies and the Centers for Medicare and Medicaid Services between 2013 and 2018, along with updated training model resources for replication.

Care partners of hospitalized persons with dementia often experience significant burden at discharge. This study examined whether dementia care partner health literacy mediates the relationship between education and burden at hospital discharge. Data from 277 care partners in the Family-centered Function-focused Care (Fam-FFC) trial were analyzed using mediation analysis to assess indirect effects of education on burden (Short-Form Zarit Burden Interview [ZBI-12]) through health literacy (Rapid Estimate of Adult Literacy in Medicine-Short Form [REALM-SF]). Analyses were conducted using SPSS and AMOS. For medium education (B = −0.012; 95% CI = −0.019, −0.003), the indirect effect accounted for 18.5% of the total effect, while for high education (B = −0.018; 95% CI = −0.026, −0.006), it accounted for 21.4%, indicating partial mediation. Findings underscore the role of health literacy in reducing care partner burden and highlight the need to address education and literacy disparities to provide effective support at hospital discharge.

Modifiable risk factors account for nearly half of dementia cases, with the greatest impact on dementia prevention in midlife. Little is known about what motivates middle-aged adults to engage in healthy behaviors for dementia risk reduction. This study examined associations between motivation to make lifestyle changes for dementia risk reduction and engagement in health behaviors associated with dementia risk in 347 middle-aged adults. Multivariate linear regressions examined associations between motivation and engagement in health behaviors. Greater self-efficacy and higher education significantly predicted greater physical and cognitive activity and better sleep quality. Greater perceived barriers and general health motivation, lower self-efficacy, and younger age significantly predicted greater perceived loneliness. Self-efficacy consistently predicted engagement in health behaviors associated with dementia risk reduction in midlife. Thus, incorporating empirically supported strategies to increase self-efficacy in lifestyle interventions for dementia prevention may increase long-term adherence and overall success of dementia prevention efforts.

Chronic pain is prevalent among older people and significantly impacts daily life. Effective communication between healthcare providers and patients is essential for proper pain management, yet existing assessments frequently fail to capture the full complexity of chronic pain, especially in older populations. This study aimed to explore the lived experiences of chronic pain in older people to inform the development of more comprehensive pain assessment. Semi-structured interviews with 20 participants aged 60+ with chronic pain were thematically analyzed and mapped to the International Classification of Functioning, Disability, and Health framework. Chronic pain significantly impacted participants’ mobility, social interactions, and emotional well-being. Participants highlighted the need for a holistic pain assessment that includes psychological and social dimensions alongside physical symptoms. Holistic pain assessments addressing the multidimensional impacts of chronic pain are needed to enhance clinical care and improve older people’s quality of life.

To develop strategies to better meet palliative needs for older adults, it is critical to understand what factors influence the implementation and sustainability of palliative care (PC) in the outpatient setting. This study explored provider perceptions about multi-level factors impacting implementation of outpatient PC. Applying an implementation science framework, barriers and facilitators were identified for key implementation and sustainability concepts within the provider, organizational context, and external levels. Provider perceptions were explored using semi-structured group interviews (n = 11) with 9 outpatient specialty PC teams. Participants (n = 26) included outpatient PC team members and team leaders. Key considerations for health systems seeking to implement or expand outpatient PC include addressing misperceptions, co-location with referring clinical teams, and building the PC workforce to support interdisciplinary PC teams. To address challenges communicating benefits of PC, improved performance measures are needed to document and incentivize appropriate referral and use of PC throughout the continuum of care.

The Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial found that a nurse and social worker palliative telecare team (providing care via phone) improved quality of life in older Veteran patients with chronic illness. Our objective was to describe clinician and patient experiences of ADAPT and how ADAPT influenced Veterans’ quality of life. We used thematic analysis on structured interviews with 36 randomly selected patients, semi-structured focus groups with nine palliative care intervention team clinicians, and clinical intervention summaries of 147 patients. ADAPT proved to be an effective model for most Veterans by improving Veterans’ health care delivery and navigation and promoting timely and holistic health care and teaching skills that improved wellbeing. ADAPT also helped to improve patient engagement and sense of agency. These findings provide insights into how ADAPT improved Veterans’ quality of life through a nurse and social worker telecare team.

Randomized Control Trial Registry Number: CinicalTrials.gov NCT02713347.

URL For Trial Registry: https://clinicaltrials.gov/study/NCT02713347.

We describe the complex care needs faced by families in dementia care and specialized multidisciplinary palliative care delivered through home visits as a feasible way to support advancing stages of dementia. Participants with confirmed diagnosis of dementia were enrolled in home-based care as part of the neuropalliative and supportive care services. Disease severity, functionality, palliative care concerns, and caregiver burden were assessed at intake and three months at their homes. Forty-seven participants were enrolled. The mean age of participants was 65.48 (13.12); with more female patients (n = 27; 57%). 34/47 (72%) completed the reassessment. Moderate levels of caregiver burden were reported at 31.57 (17.9), range 18–80 at baseline, which showed a slight increase at three months follow-up, though palliative care concerns significantly reduced (Cohen’s d = 1.16). Multidisciplinary home-based palliative care is feasible and can reduce the palliative care concerns in dementia. Further longitudinal studies with robust methodology are needed to explore the specific outcomes.

Although the theory of relational ageism describes how ageism is reinforced through interpersonal interactions, it remains unknown whether peer support programs may help reduce ageism and enhance older adults’ well-being. We conducted a pilot and feasibility study of a manualized anti-ageism peer support program facilitated by trained older adults called “Aging Together.” Key components include peer support, education about ageism and health, and “tell your story of aging.” Six small groups of five-to-eight participants (N = 48 total) met for ten, weekly, in-person (60–90 minute) sessions in a U.S. Midwest city. Results indicate the program was feasible and acceptable overall (attendance rate = 88.91%, attrition rate = 6.25%, M acceptability score = 4.23/5). Wilcoxon signed rank tests (N = 28) indicated a significant decrease in relational ageism (M = 2.73/6 to 2.19/6; p ≤ .01) and depressive symptoms (M = 8.61/30 to 6.57/30; p ≤ .01). Future research should scale this program across diverse, geographical settings and explore potential mediating relationships between internalized/relational ageism and psychosocial well-being.

This study aims to investigate the impact of Home and Community Based Care and Services (HCBCS) on intergenerational support from offspring, specifically examining whether HCBCS acts as a substitute or supplement. Using four waves of data from the China Health and Retirement Longitudinal Study (CHARLS), we employ the difference-in-differences (DID) method, along with Logit, Oprobit, and OLS models. The findings show that HCBCS boosts economic support from offspring to older adults but reduces emotional and caregiving support, indicating HCBCS has both supplementary and substitutive effects. Also, the results emphasize that the effects of HCBCS are more prominent in households with multiple offspring and urban areas. These findings have important implications for HCBCS program design, providing insights into how such services can better complement and substitute family-based intergenerational support and offering valuable evidence for policymakers to assess and enhance the effectiveness of public elderly care services.

Telemedicine has become standard in health care, and telehealth access is increasingly important. Some populations such as older adults may not have the tools nor the understanding to successfully use telehealth. We describe two cases where GrandPad, a tablet designed for older adults, was implemented at the University of California, San Francisco in (1) a home-based primary care practice and (2) a dementia specialty clinic. Using the Consolidated Framework for Implementation Research, we assess the barriers and facilitators to implementing GrandPad and present user outcomes. Most participants found GrandPad easy and comfortable to use, though there were mixed results about connecting with the provider’s office. Our implementation science analysis demonstrates that GrandPad may best be used when there is otherwise no access to telehealth, where there are frequent visits, and a need for continuity of care. Successful implementation includes clear integration into existing clinic processes, understanding users’ abilities, reducing provider barriers, and fostering potential users’ interest.

With the growing global older population and the impact of loneliness and social isolation in this group, it is imperative to study resources to improve social connectedness. Artificial Intelligence (AI)-powered platforms are an emerging technology being utilized for this purpose. This systematic review investigated the impact of AI interventions on loneliness and social isolation in older adults. Eighteen studies were included in this systematic review. Conversational AI technology played a role in improving numerous areas that are known to increase social connectedness. Those areas included self and shared identity, social integration, usability and usefulness, social support, self-efficacy, and health outcomes. While some participants enjoyed the AI interaction, sensed relationships developed, and felt the AI was useful, others would like conversational AIs and AI chatbots to be more human-like and conversations to have more depth and provide help and information gathering more targeted to their needs.

This study examined how access to Information and Communication Technology (ICT) devices, prior online experience, and ICT training (with or without assistance) influenced eHealth use among homebound Medicare beneficiaries in the U.S. during COVID-19. Data were obtained from the National Health and Aging Trends Study, and participants (N = 653) were categorized as non-users, patient portal users, video telehealth users, or dual users. Multinomial logistic regression models showed that access to ICT devices was initially associated with eHealth engagement. However, this association became non-significant after accounting for prior online experience and ICT training. Prior online experience significantly predicted patient portal use, while ICT training, particularly when provided with assistance, significantly predicted video telehealth use and dual usage. The study highlights that providing ICT devices alone may be insufficient to reduce eHealth disparities among homebound older adults. Educational programs promoting digital engagement and targeted training are essential to ensure equitable healthcare access.

Studies have shown links between nutrition in older adults and marital status. Few studies explore the interaction of gender and marital status with a healthy diet in the US for older adults. Using a sample of oldest olds living in an independent, retirement community dwelling in Florida, we found a statistically significant difference in healthful diet between women and men, controlling for marital status, health status, social isolation, loneliness, and other covariates. We also found a significant negative relationship between healthful diet and widowhood (b = −3.85, p < .000). Likewise, older adults who were divorced or never married had lower healthful diet scores than those who were married or remarried (b = −7.31, p < .000), disability was associated with a lower healthful diet (b = −.30, p < .01), and loneliness was negatively associated with healthful diet. The results have important implications for medical advisers and those involved in providing support to these older adults.

Younger adults often hold negative perceptions toward older adults, which can compromise intergenerational relationships. This study examines interpersonal synchrony as a potential intervening venue. Past research shows that synchronous activities enhance positive interactions among same-generation individuals. We extend the investigation to young-old dyads. Adopting a pre-test and post-test design, this study examined whether synchronous walking improves younger adults’ sentiments toward older partners regarding perceived self-other merging, connectedness, general liking, and impression. Participants (N = 51; 64.7% female) were paired with an older adult, randomly assigned to synchronous, asynchronous, or no walking conditions. After walking, dyads had a conversation. Results indicated that synchronous walking (vs. asynchronous or no walking conditions) significantly improved all aspects of younger adults’ sentiments toward their older partners. Having conversations enhanced connectedness and impressions, but synchronous walking outweighed conversing for strengthening self-other merging. This study sheds light on interventions for improving intergenerational relationships, cultivating an age-friendly society.

This study examines whether caregiving presents an equal risk for diabetes among gender. This study uses data from the second wave of the Midlife in the United States Survey, which included biological markers. We tested the relationship between caregiving and risk of diabetes across various models, controlling for demographics, confounders, and mechanisms that can explain the relationship. Cross-sectional analysis of the Homeostatic Model Assessment of Insulin Resistance (HOMO-IR) determined that (1)men had a higher risk of diabetes than women overall; (2)male caregivers demonstrated a lower risk of diabetes compared to non-caregiving men; (3)female caregivers exhibited a non-significant elevation in diabetes risk compared with non-caregiving females. Findings establish the basis for future studies which identify cardiometabolic disease risks between genders. Our study also provides foundation for future studies to expand and identify differences in psychosocial resources among male and female caregivers which may mitigate cardiometabolic disease risk.

Aim: The aim of this study was to estimate the prevalence and determinants of aging in place (AIP) willingness among persons 60 years and older in a national cross-sectional community-based study in Thailand in 2022. Methods: Information was taken from the 2022 Health, Aging, and Retirement in Thailand survey. Only community-dwelling individuals aged 60 and above were included in the sample (analytic sample: n = 3648). AIP willingness was measured using established metrics. The factors influencing AIP willingness were evaluated using logistic regression. Results: The prevalence of AIP willingness was 88.3%. Logistic regressions showed that predisposing factors (increasing age, being retired, and female sex), enabling factors (satisfactory support from children), need factors (multimorbidity, fewer depressive symptoms, and fewer pain sites), and psychosocial factors (not agreeing on an elderly home, higher subjective life expectancy, and current non-smoking) were associated with AIP willingness. Conclusions: Our knowledge of the factors influencing AIP willingness in community-living people 60 years of age and older is improved by this national study. Health and welfare strategies to increase enabling factors (satisfactory support from children), decrease need factors (depression and multisite pain), and increase psychosocial factors (positive attitudes towards AIP and smoking cessation) may help in increasing AIP willingness.

Ensuring healthy aging and extending health span is critical, particularly in aging societies. This study analyzed patterns of risk for long-term care (LTC) certification within 3 years in rapidly aging areas of Japan using the Kihon Checklist (KCL) and machine learning models. Data from adults aged 65 years or older in Iiyama City (aging rate 37.0%) were analyzed using Exhaustive Chi-squared Automatic Interaction Detector decision trees. The dependent variable was LTC certification, and independent variables included age, sex, and six KCL domains: physical strength, nutrition, oral function, isolation, memory, and mood. Three risk patterns demonstrated consistent results across training and evaluation datasets. Age was the strongest determinant of LTC certification. Among those aged 80 years or older, low cognitive function and depression were key risk factors, while younger groups showed stronger associations with physical weakness. Results suggest age-specific segmentation of populations is crucial for designing effective interventions to prevent LTC certification.