Journal of Applied Gerontology

This study compared potentially inappropriate medications (PIMs) using three criteria (BEERS 2019, STOPP v2, and FORTA 2021) in hospitalized older adults in Southern India. In this cross-sectional study of 597 patients (mean age: 72.80 ± 7.41 years), PIM prevalence was remarkably high across all criteria: BEERS (99.33%), STOPP (99.16%), and FORTA (99.83%). The mean PIMs per patient were: BEERS (3.89 ± 1.84), STOPP (3.77 ± 1.92), and FORTA (7.94 ± 3.22). Cohen’s kappa showed fair agreement between BEERS and STOPP criteria (κ = 0.252, p < .001), but poor agreement with FORTA. Bland–Altman analysis indicated acceptable agreement between each tool and mean standardized PIM value. The number of medications during hospitalization was the only significant predictor of PIM use in both BEERS (OR = 2.504, p = .008) and STOPP criteria (OR = 1.685, p = .008). Results highlight the need for systematic medication review.

Anxiety in older adults can negatively impact driving behaviors due to the associated symptoms and medications used to treat them. We aimed to investigate the effect of anxiety and anxiolytics on driving behaviors in older adults using data from participants enrolled in the multi-site AAA Longitudinal Research on Aging Drivers Study. A total of 2,832 participants met the eligibility criteria. Using generalized linear models, compared to participants without anxiety or anxiolytic use, those with anxiety alone (−540 miles/year, 95% CI = −1,002 to −78) and those with both anxiety and anxiolytic use (−1,777 miles/year, 95% CI = −2,910 to −644) drove fewer miles. Additionally, participants with anxiety (1.19, 95% CI = 1.08–1.32) and those with both anxiety and anxiolytic use (1.32, 95% CI = 1.02–1.67) experienced a higher rate of hard braking events. Older adults with anxiety conditions and taking anxiolytics should use caution when driving.

Meaningful moments are brief, non-pharmacological person-centered interactions or activities that evoke positive emotions in hospitalized patients living with dementia and connect them to their history, identity, or surroundings. The aim of the study was to (a) identify key elements of an innovation primarily designed for long-term care that would be suitable for facilitating meaningful moments for people with dementia in a hospital environment, (b) determine the preferred way of introducing these key elements into practice, and (c) map out determinants, implementation strategies, mechanisms, and outcomes using the Implementation Research Logic Model. Successful implementation required an approach focused on knowing the person, sharing meaningful moments, and incorporating those approaches into everyday care routines. Factors for success included an iterative feedback loop, persuasive education, clear roles, and effective leadership.

This study evaluated the psychological benefit of equine-assisted intervention (EAI) for older adults living with Alzheimer disease (AD). A non-randomized, controlled, multicenter study was conducted in 14 nursing homes. A total of 74 older adults were recruited and divided into three groups: a group benefiting from an EAI program, a group following an adapted physical activity program (APA), and a control group continuing their daily activities (CG). Psychological health was assessed. The results showed reduced psychobehavioral disorders by week six of EAI, improved quality of life, and slightly fewer depressive symptoms. No significant effect was found in the APA or CG groups. Conducted in response to the need for meaningful, non-pharmacological care approaches in AD, this study highlights the psychological benefits of EAI, partly due to environmental enrichment. EAI appears to be a promising complementary intervention to improve emotional well-being, quality of life, and comfort in individuals with AD, especially in institutional settings.

Dementia, marked by cognitive decline, significantly impacts daily life. With global prevalence rising, traditional treatments manage symptoms but have side effects and offer no cure. Non-pharmacological interventions, like serious games, are gaining importance. This study assesses the feasibility and benefits of serious games for people with mild to moderate dementia over a 10-week intervention. Sixty-one patients were recruited, with 35 completing the study. The intervention included six games focusing on physical and cognitive training. Outcome measures were motor function, cognitive assessments, quality of life, and depression. Results showed significant improvements in dynamic balance (p = .013) but no significant changes in other measures. The findings suggest that serious games are feasible and can improve motor functions like balance. However, short intervention periods may limit their impact on cognitive function and quality of life. Longer interventions and personalized game designs are recommended for greater benefits.

This study investigated the effectiveness of community health promotion programs based on the WHO ICOPE framework in improving the well-being of older individuals in rural Taiwan. Quantitative analyses, conducted using data from 52 rural communities on over 1000 participants, revealed a significant positive correlation between the number of program participation hours and improvements in subjective well-being, as measured using the World Health Organization WHO-5. The findings indicate that community health professionals should adapt ICOPE-based interventions to local contexts by adjusting program intensity, incorporating culturally relevant activities, and strengthening social support networks. Specifically, targeted interventions are needed in regions with lower well-being outcomes. At the policy level, this study underscores the need for regionalized funding models and cross-sectoral collaboration to ensure equitable access to community-based elder care services. The insights derived from this study may also inform the implementation of ICOPE-based health promotion initiatives in other settings, particularly rural or resource-limited settings.

The US Surgeon General declared loneliness and isolation a new public health epidemic. Intergenerational interactions can alleviate loneliness and isolation. To explore factors affecting and being affected by intergenerational interactions, we conducted interviews with 41 academic and professional experts in the US. The “4Ps” framework of social marketing (Product, Price, Place, and Promotion) was used to guide the data analysis. Experts reported benefits or positive outcomes (Product), including improved connectivity/cohesion and intergenerational learning, and risks or concerns (Price) like noise exposure and criminal danger. Experts also highlighted the importance of environmental factors (Place), such as shared public spaces, diverse housing options, and safe, walkable, and accessible environments. They mentioned that personal, social, programmatic, and policy factors (Promotion) are important for intergenerational interactions. Further research is needed to engage other stakeholder groups and investigate the causal impacts of readily modifiable environmental features and how such impacts may vary across diverse population groups.

The Nutrition and Aging Resource Center (NRCNA) provides the Senior Nutrition Program (SNP) network technical assistance and is dedicated to programming equity. This study aims to elevate Black, Indigenous, and People of Color (BIPOC) SNP professionals’ training needs and preferences by utilizing equitable evaluation practices. The objectives include (1) understanding BIPOC SNP professionals’ general characteristics and organization’s attributes, (2) identifying subject matter and training needs and preferences, and (3) contributing to equitable evaluation method literature. Snowball sampling through NRCNA and partner agencies yielded a final sample of 1910 aging professionals, with 9.9% identifying as BIPOC (n = 190). SPSS was used for data analysis with descriptive statistics, chi-square test of independence, and independent t-tests. Data disaggregation resulted in additional and unique characteristics, organizational attributes, and subject matter gaps for BIPOC respondents not identified through the collective sample. These findings can assist in creating more inclusive and supportive technical assistance and network.

Population-based self-report studies find older Blacks are at increased risk of financial exploitation victimization. We compared several psychological, cognitive, social, and physical health measures between Black women who were confirmed victims of financial exploitation (Successful Aging through Financial Empowerment (SAFE) participants) and a group of older Black women in the same community with no reported history of exploitation. SAFE participants were significantly older, less educated, and in poorer health than the community comparison participants. They also reported less social support, more depressive and anxiety symptoms, and a higher financial exploitation vulnerability than did the community comparison participants. In a logistic regression analysis, results indicated that only age, education, and financial exploitation vulnerability were associated with the participation of individuals in the SAFE financial exploitation group. The results underscore the multiple ways in which older Black women victims of financial exploitation are vulnerable compared to their community peers who were not exploited.

Humanoid social assistive robotics (SARs) can promote activity engagement for older adults living with dementia. Few studies, however, evaluate the capacity of humanoid SARs to encourage activity engagement in long-term aged care facilities (LACFs). The complexity of the environment, robot design, and personal attributes underscore the challenge of humanoid SARs to encourage activity engagement in practice. This study employed a mixed-methods approach involving nine participants (aged ≥65 years) with mild to moderate cognitive impairment from one aged care facility and seven carers from four different Australian states. Through the triangulation of observational engagement data, participants’ semi-structured interviews, and carers focus group discussion, six themes encompassing activity engagement were identified and are discussed for future application and evaluation of humanoid SARs in dementia care: (1) robot physical design, (2) interaction patterns, (3) activity guidelines, (4) intervention environment, (5) personal history, and (6) relationship establishment.

Everyday technologies, like smartphones, might improve care of persons living with Alzheimer’s disease and related dementias (PLWADRD) and reduce burden among care partners. However, care partners often report inadequate technical skills for using technology-based strategies. To address this need, we developed a manualized behavioral intervention called Technology Assistance in Dementia (Tech-AiD). We gathered feedback on the intervention concept from invested partners (10 care partners and 10 healthcare professionals) in a multimethod study. Quantitative results suggested very high intervention acceptability (4.55/5), appropriateness (4.36/5), and feasibility (4.11/5). Qualitative responses indicated a willingness to participate in Tech-AiD if available, described the program as a good fit for the needs of persons living with ADRD and care partners, and suggested that Tech-AiD’s delivery format was convenient. Qualitative responses also included specific suggestions to improve Tech-AiD (e.g., creation of a technology helpline, booster sessions). Results provide evidence of Tech-AiD’s readiness for a pilot trial.

This study constitutes both a scoping review and a concept analysis, as it systematically examines digital literacy across settings (home, assisted living facilities, and other long-term care facilities) in the context of persons with dementia and their caregivers. We performed a scoping review of 22 empirical studies to examine how the literature has defined digital literacy in dementia care, followed by a concept analysis to conceptualize digital literacy’s antecedents, attributes, and consequences. Our analysis revealed three antecedents of digital literacy: technology-enhanced support systems, individual characteristics, and sociodemographic characteristics, which collectively impact persons with dementia and their caregivers’ abilities to utilize digital resources effectively. We identified two critical attributes—technological skills and critical thinking skills—to evaluate digital health information. Our findings revealed that digital literacy is tied to several important consequences: technology acceptance, impacts on psychosocial factors, and the promotion of digital equity. These findings provide a foundation for future research that can incorporate the core components of digital literacy when designing technology-mediated interventions. While our findings conceptualized digital literacy among persons living with dementia and their caregivers, more research is needed to promote standardized terminology and consider the digital literacy level of end-users in developing technology-mediated interventions in the future.

The widespread adoption of Electronic Health Records (EHR) in the United States offers a transformative opportunity to enhance patient-provider interactions, yet the impact on the quality of care for older adults remains unclear. This study delves into how EHR use influences quality of care and whether Patient-Centered Communication (PCC) mediates this relationship, considering age and gender differences among adults 65 and older. Using data from the 2018–2020 HINTS survey, path analysis showed a significant indirect effect through PCC in the full sample (a*b = 0.12, p < .05). In addition, there were significant effects of PCC on quality of care in the full sample and all age and gender strata (p < .05). Remarkably, PCC mediates this relationship more strongly among individuals over 70 (a*b = 0.14, p < .05). These results highlight the demographic differences in how EHRs and PCC contribute to healthcare experiences in older adults, underscoring the need for tailored EHR design and communication strategies.

This study examined the relationship between the behavioral activation system (BAS) and fall risk awareness among Korean older adults, focusing on the mediating roles of optimistic bias and risk-taking. Data from 280 participants aged 60–84 were collected via an online survey. Using PROCESS Macro 3.5 Model 6, results showed that BAS positively correlated with optimistic bias, risk-taking, and fall risk awareness. However, optimistic bias and risk-taking were not directly correlated with fall risk awareness. A double mediation effect was observed, where optimistic bias and risk-taking sequentially mediated the BAS-fall risk awareness link. While BAS generally increased fall risk awareness, its influence became negative when mediated through optimistic bias and risk-taking. These findings suggest BAS affects fall risk awareness in complex ways, sometimes leading to lower awareness due to overconfidence and risk-taking behaviors.

While older adults are increasingly using a variety of information and communication technologies (ICTs), keeping them online and using these ICTs may be challenging when technology difficulties arise. Using data from an online survey of U.S. older adults, 65 years and older (N = 1173), we investigate the sources of technical support older adults draw upon when technical problems arise and the factors that influence which sources are used for technical support. Most reported fixing technical issue themselves (71%) or getting help from family (65%) at least some of the time. Higher online self-efficacy was positively associated with fixing technical issues themselves, finding answers online, and using more sources of technical support. Older adults with lower online self-efficacy were more likely to receive help from family. Those with more social support were more likely to get help from family and less likely to use customer support or fix technical issues themselves.

Despite their considerable potential to address health and cognitive challenges, mobile and wearable health devices remain underutilized by older adults compared to other smart products, suggesting skeptical attitudes toward these health devices in older adults. Using an online scenario-based survey describing hypothetical individuals with health vulnerabilities, we examined the attitudes of middle-aged and older adults (N = 737) toward mobile and wearable devices for (1) predicting cognitive decline, (2) suggesting health behaviors, and (3) diagnosing diseases. Our results showed that the presence of health vulnerability was associated with higher perceived usefulness, lower privacy concerns, and greater intention to adopt these devices. Additionally, technological readiness, experiences, and various demographic factors influence attitudes, highlighting the complex structure shaping attitudinal barriers against adoption of these devices. These results emphasize the need for more tailored market segmentation and strategies to enhance the adoption of health-related gerotechnologies while addressing privacy concerns.

In the context of a rapidly growing aging population, the United States must address challenges with long term services and supports as that is what the acronym refers to. These challenges include affordability and access to home- and-community-based services (HCBS). One country that has faced similar challenges but has taken a markedly different approach is Japan, with a model of care known as the Community-based Integrated Care System (CbICS). We describe two defining characteristics of the CbICS that could serve as a starting point for the US. The first is the implementation of a hierarchy of support for older adults that emphasizes self-support and mutual aid to offset expensive federal measures. The second is the integration and delivery of medical and social services through designated, community-based centers. The US may benefit from applying key lessons learned from the CbICS. Additionally, we evaluate characteristics of Japan’s integrated care approach and draw comparisons with US LTSS programs.

This study aimed to explore the feasibility, acceptability, and clinical outcomes of a best practice–aligned multidisciplinary allied health reablement model of care for older people. A mixed-methods pre-post-intervention study was conducted in two nursing homes and the community. Quantitative measures were collected for frailty, physical function, and quality of life for all participants pre-implementation and 12 weeks post-implementation. Semi-structured interviews were conducted with a sub-group of participants and allied health professionals involved in the intervention. Participants’ (n = 50) physical function increased (SPPB 4.2 vs. 4.9) while frailty (FRAIL-NH 6.0 vs. 5.5) and quality of life (16 vs. 16) were maintained. There was a high retention (93%) and attendance rate (84%), indicating acceptability. Participants received a daily median of 16 allied health minutes, costing $26AUD. Findings confirm acceptability and feasibility of the model with potential to maintain or improve clinical outcomes. Future work is needed to define long-term outcomes, scalability and sustainability. The study was registered with the ANZCTR [Trial ID: ACTRN12623000915651; Registration Date: 12/1/2024].

There is no consensus on the optimal self-rated successful aging (SRSA) cut-off point for determining whether aging is successful. The present study aims to address this gap by identifying reliable SRSA cut-off points through a comparison based on Rowe and Kahn’s (1997) successful aging model. A sample of 478 older adult residents of municipal centers and nursing homes aged ≥50 years (M = 72.11, SD = 10.43) were subjected to the single-item SRSA evaluation, as well as scale sets measuring Rowe and Kahn’s (1997) criteria. A receiver-operating characteristic analysis was then used to determine a range of potential SRSA cut-off points to discriminate between successful and not successful agers. The application of Rowe and Kahn’s (1997) successful aging criteria revealed an optimum cut-off point of ≥7, having the best balance of sensitivity (86.7 or 74.9%) and specificity (46.9 or 55.3%).