Adults To Age In Place Research Articles

Feasibility of Fall-Risk Detection in Older Adults: Real-World Use of Sensor Data With Machine Learning.

To use machine learning techniques with sensor data to predict fall risk in older adults aging in place. We tested the feasibility of using anomaly detection on a dataset comprising 315 days of continuous unobtrusive sensor data obtained from a single participant to predict fall risk within a 10-day window. Predictions were validated with performance metrics, including accuracy, F1 score, and receiver operating characteristic-area under curve (ROC-AUC), using actual falls documented in the electronic health record. The model resulted with accuracy = 0.96 (95% confidence interval [CI] [0.94, 0.99]), F1 = 0.78 (95% CI [0.73, 0.83]), and ROC-AUC = 0.89 (95% CI [0.85, 0.93]). The application of anomaly detection on sensor data may provide a timely and valid indication of fall risk in older adults within a 10-day window. Further research and validation are warranted to confirm these findings and expand the scope of application in the domain of older adult care and health care support. [Journal of Gerontological Nursing, 50(10), 7-10.].

Assessment of needs, challenges, and re-design considerations for culturally sensitive provision and delivery of palliative care supports and services for older adults who prefer to age and die in place in diverse India.

As the global older adult population continues to grow, challenges related to managing multiple chronic conditions (MCCs) or multimorbidity underscore the growing need for palliative care. Palliative care preferences and needs vary significantly based on context, location, and culture. As a result, there is a need for more clarity on what constitutes palliative care in diverse settings. Our objective was to present an international perspective on palliative care in India, a culturally diverse and large ancient Eastern middle-income country. In this narrative review article, we considered three questions when re-designing palliative care for older adults aging-in-place in India: (I) what are the needs for palliative care for persons and their families? (II) Which palliative care domains are essential in assessing improvements in the quality of life (QoL)? (III) What patientreported measures are essential considerations for palliative care? To address these questions, we provide recommendations based on the following key domains: social, behavioral, psychological, cultural, spiritual, medical, bereavement, legal, and economic. Using an established and widely reported conceptual framework on aging and health disparities, we provide how these domains map across multiple levels of influence, such as individual or family members, community, institutions, and health systems for achieving the desired QoL. For greater adoption, reach, and accessibility across diverse India, we conclude palliative care must be carefully and systematically re-designed to be culturally appropriate and community-focused, incorporating traditions, individual preferences, language(s), supports and services from educational and health institutions, community organizations and the government. In addition, national government insurance schemes such as the Ayushman Bharat Yojna can include explicit provisions for palliative care so that it is affordable to all, regardless of ability to pay. In summary, our considerations for incorporating palliative care domains to care of whole person and their families, and provision of supports of services from an array of stakeholders broadly apply to culturally diverse older adults aging in place in India and around the globe who prefer to age and die in place.

Immigrant Older Adults' Experiences of Aging in Place and Their Neighborhoods: A Qualitative Systematic Review.

Engaging in one's neighborhood fosters independence, promotes social connectedness, improves quality of life, and increases life expectancy in older adults. There is a lack of evidence synthesis on immigrant older adults' neighborhood perceptions and experiences, essential for addressing neighborhood-level influences on aging in place. This study systematically synthesizes qualitative evidence on immigrant older adults' perceptions and experiences of their neighborhoods. A comprehensive search was conducted from inception to 5 April 2023, in multiple databases. This review considered studies including immigrant older adults aged ≥60 years, included studies from any country where the neighborhood was the focus, and only considered qualitative data while excluding review studies, theoretical publications, and protocols. Eligible studies were appraised using the JBI critical appraisal checklist for qualitative research. The Joanna Briggs Institute meta-aggregation approach was used to synthesize findings, and the ConQual approach established confidence in the synthesis. A total of 30 studies were included. Most studies were conducted in North America and explored phenomena such as aging in place, social capital, social cohesion, sense of community, and life satisfaction. Key contextual factors were walkable safe access to social spaces, accessible transportation to amenities, social cohesion with neighbors, and pre-migration neighborhood experiences. Immigrant older adults have varied experiences related to their sense of belonging and social cohesion. Factors such as racial discrimination, feeling unsafe, and social isolation contributed to negative perceptions. This review highlights the need for inclusive neighborhoods that align with the needs and values of immigrant older adults aging in place.

“I have the Feeling that the Person is Here”: Older Adults’ Attitudes, Usage Intentions, and Requirements for a Telepresence Robot

The social integration of older adults has been shown to be vital for successful aging. Innovative communication technologies, such as telepresence robots, can protect older adults against loneliness and social isolation by helping them stay connected to their social networks. This human-centered qualitative study aims to identify the attitudes (research question 1, RQ1), intentions to use (RQ2), and requirements (RQ3) of older adults for robot-mediated communication (RMC) via a telepresence robot. Semi-structured individual interviews were conducted with N = 30 older adults from Germany, who evaluated storyboard illustrations depicting a fictional RMC scenario between a grandparent and their adult grandchild. The study identified 3 attitude groups towards telepresence robots among participants: positive, negative, and conflicting attitudes (RQ1). Furthermore, based on their intentions of use, participants were classified into reluctant future users (n = 12), future non-users (n = 10), and enthusiastic future users (n = 8) (RQ2). Finally, the study identified technological, social, and age-related requirements of older adults for a telepresence robot (RQ3). Practical recommendations are provided based on these findings, such as leveraging older adults’ current technology-related skills, adapting technologies to older adults’ lifestyles and social networks, and designing technologies that contribute to older adults aging in place. This study contributes to the human-centered design of telepresence robots that support the social integration of older adults.

Aging in Place for Community-Dwelling Older Adults in India: A Qualitative Exploration of Prospects and Challenges.

As global population ages, "Aging in Place" is prioritized as the top aging strategy for many of the older adults worldwide. India, being a nation that is expected to hold the maximum share of the older adult population in the near future, has a huge responsibility vested in it to take care of the needs of older adults. The social structure of the nation has emphasized the importance of older adults to age in place, experiencing all the independence and autonomy at their own dwelling places for as long as possible. This study aims to provide a profound understanding of the meaning, attitude, and perceptions of older adults toward aging in place. Using a qualitative research design, in-depth interviews were conducted among 15 community-dwelling older adults who chose aging in place in Kerala, India. Following the interviews, thematic network analysis was done, inspired by Jennifer Attride-Stirling. Three global themes were derived, which include the older adults' perspectives on (1) determinants of aging in place, (2) challenges of aging in place, and (3) strategies for successful aging in place. The study evokes in-depth exploration of the experiences of older adults aging in place, which inform future evidence-based practices and policy-level implications.

THE POTENTIAL AND PITFALLS OF TELEHEALTH TO SUPPORT AN AGING POPULATION

Abstract As the population ages, telehealth services are becoming increasingly prevalent and important to help support older adults’ aging in place and manage their health at a distance. However, older adults often face barriers such as technology proficiency, physical and cognitive capacity, and lack of technical support to access and use telehealth. Designers and researchers need to design and evaluate telehealth interventions tailored to older adults’ needs to ensure these technology-based solutions meet their potential. This session will present a variety of technology-based research exploring the development, evaluation, and implementation of telehealth programs and interventions to better support older adults aging in place. L. Moo will present quantitative and qualitative data on challenges veterans experienced with clinical pharmacists’ video visits. L. Adepoju will present factors associated with in-person-only, telemedicine-only, and hybrid healthcare visits among older adults. P. Freddolino will present an evaluation of a telehealth 101 mini-course offered to older adults. F. Abujarad will discuss the development and evaluation of a digital health intervention (VOICES) to increase elder mistreatment identification. Finally, M. Gately will describe a study of person factors and environmental factors on older adults’ capacity to participate in video telehealth sessions. Older adult barriers and areas of improvement in telehealth design will be discussed throughout this session.

DO SLEEP QUALITY AND SOCIAL COHESION MEDIATE ASSOCIATION BETWEEN NEIGHBORHOOD DISORDER AND COGNITIVE FUNCTIONING?

Abstract Daily exposure to neighborhoods with high levels of disorder, such as public drinking, graffiti, and vandalism, has been linked to worse cognitive functioning and a higher risk for dementia in older adults. The present study examined the association between neighborhood disorder and cognitive functioning. This study also examined sleep quality and social cohesion as potential mediators of this association using Hayes’ (2013) Macro Process via bootstrapping method. The sample included cross-sectional data for 2,529 older adults (1,115 men and 1,482 women, age 70+) using the 2021 National Health and Aging Trends Study. Neighborhood disorder was measured as a 3-item scale capturing physical neighborhood characteristics completed by the interviewer (e.g., trash on sidewalks). The social cohesion scale measured participant agreement with 3 questions about their community (e.g., “People can be trusted”). The sleep quality scale measured participant responses to 3 questions about their sleep in the last month (e.g., taking 30+ minutes to fall asleep). Cognitive functioning was assessed using performance on tasks evaluating memory, orientation, and executive functioning. Results showed greater neighborhood disorder was associated with worse performance on cognitive tasks (B=-0.417; p<0.001). Results of mediation testing indicated that social cohesion was a significant mediator (B=0.224; p<0.0001). Though sleep quality was not a mediator, better sleep quality was associated with better cognitive functioning (B=0.053; p<0.05). Understanding the contribution of neighborhood disorder, sleep quality, and social cohesion to cognitive functioning will inform neighborhood-level interventions that can buffer cognitive decline in older adults aging in place.

SMART AGING: ENGAGING OLDER ADULTS TO GUIDE SENSOR DEVELOPMENT TO SUPPORT AGING IN PLACE

Abstract Over 80% of older adults want to live independently in their own homes and communities, maintaining quality of life, autonomy, and dignity as they age. We are using community engaged research methods to aid in developing in-home cost-conscious remote sensing technologies to support older adults age in place. To understand their needs, we engaged older adults in discussions on home-based sensing technologies. We used visuals and demonstrations to facilitate discussions, showing participants our sensor prototypes and a vignette describing the challenges an older adult and the family face managing a chronic condition. Participants voiced their interest in monitoring for select health conditions and situations when either they or the person(s) they care for are home alone. Discussants raised concerns about personal security/privacy, loss of independence, ethics of data collection and sharing, and being overwhelmed by collected data. Discussions have provided valuable feedback to help us develop a sensor system that is flexible enough to accommodate individuals in different life stages and comfort levels, with different home environments, levels of expendable income, and support structures. As a result, we have developed a system that uses nonvisual, non-wearable sensing that measures respiration and heart rates, and indoor location tracking to monitor the health and wellbeing of users. During this session, we will provide detailed results from our community discussions, and discuss the continuing role for community engagement as we move forward with sensor development and testing.

A semi-supervised approach to unobtrusively predict abnormality in breathing patterns using hydraulic bed sensor data in older adults aging in place

Shortness of breath is often considered a repercussion of aging in older adults, as respiratory illnesses like COPD11C2SHIP/CERT Website: https://www.eldertech.missouri.edu/. or respiratory illnesses due to heart-related issues are often misdiagnosed, under-diagnosed or ignored at early stages. Continuous health monitoring using ambient sensors has the potential to ameliorate this problem for older adults at aging-in-place facilities. In this paper, we leverage continuous respiratory health data collected by using ambient hydraulic bed sensors installed in the apartments of older adults in aging-in-place Americare facilities to find data-adaptive indicators related to shortness of breath. We used unlabeled data collected unobtrusively over the span of three years from a COPD-diagnosed individual and used data mining to label the data. These labeled data are then used to train a predictive model to make future predictions in older adults related to shortness of breath abnormality. To pick the continuous changes in respiratory health we make predictions for shorter time windows (60-s). Hence, to summarize each day’s predictions we propose an abnormal breathing index (ABI) in this paper. To showcase the trajectory of the shortness of breath abnormality over time (in terms of days), we also propose trend analysis on the ABI quarterly and incrementally. We have evaluated six individual cases retrospectively to highlight the potential and use cases of our approach.

Experienced barriers in the use of ICT for social interaction in older adults ageing in place: a qualitative systematic review protocol (SYSR-D-22–00848)

BackgroundSeveral information and communication technologies (ICT) have been developed to enhance social connectedness of older adults aging in place, although they are not accessible for all. Barriers in using ICT might for example relate to health issues, sensory loss, lack of technical skills, or reluctance to use technologies. Though knowledge on these barriers is crucial for the development and implementation of ICT for older adults, no systematic review was found on this subject. The proposed qualitative systematic review aims to explore barriers experienced by older adults aging in place in using ICT for social interaction.MethodsThe review will be conducted in accordance with the JBI methodology. Databases for search will include MEDLINE (via PubMed), CINAHL (via EBSCO), and Web of Science (ISI), among others. Included studies focus on older adults ageing in place 60 years or older. Pairs of authors will independently, by following agreed guidelines, assess the eligibility of studies, and extract data. The testing of eligibility criteria and screening of titles, abstracts, and full texts will be performed. The findings will describe for example populations, context, culture, and the phenomena of interest. Qualitative research findings will, where possible, be pooled by using JBI SUMARI for the meta-aggregation approach.DiscussionThe mapping of published studies has the potential to identify research gaps in the existing literature, which again may inform developers and stakeholders in designing more user-friendly and adaptive ICT solutions for older people ageing in place.Systematic review registrationCRD42022370044.

Exploring Differences in Home Modification Strategies According to Household Location and Occupant Disability Status: 2019 American Housing Survey Analysis.

Home modification is essential in helping older adults age in place safely and independently. The purpose of this study was to examine the impact of housing location and disability status on home modification projects among older adults using the 2019 American Housing Survey Data. The study found that recent home modification strategies were significantly different according to older adults' housing locations and health status. Older adults in non-metropolitan areas and with disability were less likely to make home modifications, and when they did so, they spent less money on the modifications. The findings highlight the importance of providing adequate home modification programs and resources for home modifications, as well as support and education from community organizations, particularly for older adults in non-metropolitan areas. The results of this study can assist in developing housing policies and guidelines to address these current and future challenges in home modification implementation for the aging population.

Role of OT in Aging-in-Place Initiatives

Abstract Date Presented 04/22/2023 This presentation will present evidence for OT-led falls prevention programs to support community-dwelling older adults aging in place. Established programs, multifactorial approaches, and funding options for implementation will be discussed. The authors’ intended context for application is a rural nonprofit Village-to-Village model community. Primary Author and Speaker: Colleen O'Hagan Additional Authors and Speakers: Seira Plouviez, Lauren Chan, Danielle Beck Contributing Authors: Amy Kashiwa, George Tomlin

Aging in Place Through the COVID-19 Pandemic: Perspectives from Aging Service Providers.

Formal and informal networks of resources are critical to supporting the growing number of older adults aging in place (AIP). Data are needed from aging-service providers about assets and barriers that impact their abilities to support AIP during the pandemic, as well as emergent needs resulting from response measures. A series of World Café workshops were conducted with aging-service providers in Salt Lake City, Utah, to understand supportive factors, service gaps, and future needs. Novel domains to support AIP in the context of the pandemic were identified: digital access and literacy, social isolation and mental health, and emergency preparedness. Issues related to access, equity, and affordability were identified as overarching themes across domains. Issues reflect concern over how the pandemic exacerbated socioeconomic and cultural disparities impacting older adults who benefit from aging services. Networks of advocacy and support are needed to bolster resources for older adults, caregivers, and aging-service providers.

Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality.

This study identifies differences in unmet mobility needs among older adults living in rural versus urban areas. We used data from Round 9 of the National Health and Aging Trends Study (NHATS), limiting our analyses to respondents who had not moved since baseline (average housing tenure of 27years; n = 3343). We conducted bivariate and multivariate analyses to detect rural/urban differences in unmet mobility needs, adjusting for socio-demographics, health status, and housing characteristics. Rural residence was associated with higher odds of any unmet mobility needs for older adults aging in place (adjusted odds ratio: 1.64, 95% confidence interval: 1.10-2.44, p < .05). The relationship between rurality and unmet needs for help with mobility limitations remained significant in fully adjusted models. Rural older adults aging in place have greater unmet needs for help with mobility limitations. This study highlights several important gaps in supporting rural older adults aging in place.

GEROFIT TO HOME (GTH) AS A NEW MODEL OF CARE

Abstract Gerofit, a facility-based program transitioned to GTH, a completely virtual structured exercise program, at the onset of the pandemic and previously demonstrated that Veterans already engaged sustained performance with this transition (In-Person vs GTH, n=46; arm curls 19.7 vs 19.0 reps; 30-second chair stand 14.3 vs 15.9 reps). This study investigated whether gains in performance are achieved and sustained in Veterans who participated in GTH only, as it is unknown if virtual programs are as robust as facility-based programs. Measures of performance (3-month mean change, n=45, Arm Curls +3.4 reps; 30-second chair stand +1.5 reps) and self-reported function (SF-36 + 1.8 points) will be assessed from baseline to 3,6, and 12 months. Pooled results from 14 sites have been accumulated and change scores, age and gender-based percentile changes and clinically meaningful thresholds will be presented. This knowledge can have implications to support programs for older adults aging in place.

THE IMPACT OF COVID-19 ON SERVICE USAGE IN A RURAL “VILLAGE”

Abstract The Covid-19 pandemic disrupted service access and use for many older adults aging in place. This study focuses on understanding how a rural “Village”, where services are primarily provided by volunteers to older adults, adjusted to Covid-19. The sample is drawn from service users of at least one or more services between January and October 2020 (N=233). Survey and qualitative data were gathered via telephone-interview (N=80). This study examined (1) the impact of Covid-19 on service use and ability to stay at home, 2) services offered, and 3) changes to day to day life. In the sample, 53.75% is 80+ in age, 70% female, and 43.75% lived alone. 15% of respondents reported reduction in service used, 10% an increase, 65% no change, and 6.25% used no services. Some services such as rides to medical care, and grocery delivery increased, other services (e.g., caregiving) were reduced. 26.24% respondents believed that the organization’s services helped them stay at home during Covid-19. Other services were developed to better serve older adults such as phone reassurance and expansion of delivery of medication and food. Open ended responses identified how Covid-19 impacted day to day life. While many reported negative ways such as changing mental health perspectives and limiting medical care, others report life being more peaceful and providing time to enjoy nature. Findings provide an understanding that services while disrupted continued for one volunteer organization with some service users showing resilience in their day to day lives.

The Impact of a Naturally Occurring Retirement Community Supportive Services Program on Older Adult Participants' Social Networks: Semistructured Interview Study.

Most older adults want to age in place, in their homes and communities. However, this can be challenging for many, frequently owing to lack of supports that allow for aging in place. Naturally occurring retirement community supportive services programs (NORC-SSPs) offer an approach to help older adults age in place. Although qualitative studies have examined the experiences of NORC-SSP participants, little is known about how participation in NORC-SSP programming affects participants' social networks. This study aimed to explore the experiences of 13 NORC-SSP residents who participated in Oasis Senior Supportive Living (Oasis) and how participating in NORC-SSP programming, specifically based on the Oasis model, influenced their social networks. Participants were recruited, using convenience sampling, from 4 naturally occurring retirement communities (NORCs) in Ontario, Canada. All participants (13/13, 100%) had participated in Oasis programming. Semistructured qualitative interviews were conducted with participants. Social network theory informed the interview guide and thematic analysis. In total, 13 participants (n=12, 92% women and n=1, 8% men) were interviewed. These participants were from 4 different NORCs where Oasis had been implemented, comprising 2 midrise apartment buildings, 1 low-rise apartment building, and 1 mobile home community. Overall, 3 main themes were identified from the interviews with Oasis participants: expansion and deepening of social networks, Oasis activities (something to do, someone to do it with), and self-reported impact of Oasis on mental health and well-being (feeling and coping with life better). Participants noted that Oasis provided them with opportunities to meet new people and broaden their social networks, both within and outside their NORCs. They also indicated that Oasis provided them with meaningful ways to spend their time, including opportunities to socialize and try new activities. Participants stated that participating in Oasis helped to alleviate loneliness and improved their quality of life. They noted that Oasis provided them with a reason to get up in the morning. However, the experiences described by participants may not be reflective of all Oasis members. Those who had positive experiences may have been more likely to agree to be interviewed. On the basis of the participants' interviews, Oasis is an effective aging-in-place model that has been successfully implemented in low-rise apartment buildings, midrise apartment buildings, and mobile home communities. Participating in Oasis allowed participants to expand their social networks and improve their mental health and well-being. Therefore, NORCs may offer an ideal opportunity to build strong communities that provide deep, meaningful social connections that expand social networks. NORC-SSPs, such as Oasis, can support healthy aging and allow older adults to age in place.

Home Modification for Older Adults Aging in Place: Evidence from the American Housing Survey

What is the impact of housing adequacy on recent home modification, controlling for demographics and housing characteristics? This study examined home modifications of households with a member aged 65 or older, focusing on relationships between selected demographic and housing variables and home modification. Binary logistic regression analysis was used on a sample of 6,627 homeowners from the newly released 2019 American Housing Survey (AHS) dataset. This analysis of the 2019 AHS data is important because of its pre-COVID pandemic era perspective in terms of home modifications and older adults aging in place. Results showed that recent housing modifications were significantly affected by select demographic and housing factors.

There’s no place like home: assessing trauma issues for older adults aging in place

ABSTRACT Trauma experiences and symptomatology may be overlooked by clinicians as a significant impediment to aging in place. This paper presents the types of traumas and the impact of culture and racism on older adults. Additionally, age-related stressors may influence the reemergence of trauma memories and reactions and therefore, impact aging in place. Assessment, case examples, and best practice issues are presented.

Age-Unfriendly by Design

Problem, research strategy, and findings The world’s population is aging at a rapid rate, yet many local built and social environments are not well suited to support older adults. Australia exemplifies the demographic–environmental disconnect because it is one of the world’s most suburban nations and has one of the proportionally largest baby boom generations. In this research we examined the relationship between built and social environments with respect to older adult vulnerability in Greater Melbourne (Australia). We found that neighborhoods with lower levels of built environment support also had lower levels of social infrastructure. The spatial imbalance across the region was most pronounced when considering the spatial distribution of older adults aged 85 years and older. Our analysis of policymaker interviews revealed a marked disconnect between the scale and scope of the challenges of suburban aging and the state and local government response. Limitations of the study included the operationalization of built environment and social infrastructure variables. Takeaway for practice Age-friendly planning and design cannot be limited to the “easier stuff” such as communication and information, social participation, and respect and inclusion. Suburban built environments require more effort and investment in transportation, housing, and outdoor spaces and buildings to support the physical and mental wellbeing of older adults aging in place. Walkable suburban neighborhoods with high levels of accessible social infrastructure will help build community connections and encourage older adult physical activity and social engagement.