Adults To Age In Place Research Articles

Functional resistance activities to impact frailty: A protocol for a randomized controlled trial involving home care aide and frail older adult dyads.

BackgroundA growing number of older adults use in-home Medicaid Waiver Home and Community Based services (HCBS) to facilitate aging-in-place. A primary service of this program is Home Care Aide assistance with activities of daily living and homemaker needs. Despite the known benefits of exercise, exercise programs are currently not offered to clients in the Medicaid Waiver system. Thus, the purpose of this paper is to describe a six-month Home Care Aide-led resistance exercise intervention protocol for frail older adults receiving Medicaid waiver services.Methods/designA randomized controlled trial will be used. We will enroll 126 Home Care Aide-client dyads for a 6-month exercise intervention. The intervention will consist of training phases to promote muscle strength, power, and endurance. We will use an intention to treat principle using mixed effects models for the quantitative outcomes. To analyze qualitative outcomes, we will use conventional content analysis to examine themes from participant program evaluations.DiscussionAs greater numbers of adults age in place with frailty and employ Home Care Aides to help manage functional limitations, interventions embedded within usual care services play a critical role in bringing exercise into the home setting. The research described in this protocol will provide important knowledge about the impact of a Home Care Aide-led exercise intervention in reducing frailty in older adults.Clinical Trials RegistrationClinicalTrials.gov Identifier: NCT02942992;

Community older adults’ attitude towards the use of assistive devices

This study investigates how older adults’ attitude patterns affect assistive devices’ (AD) use in a small-household context of Singapore. Community older adults with physical limitations (n = 481) completed face-to-face interviews for 90 min. Latent Profile Analysis analysed multiple indicators of attitudes towards ADs. Three groups were classified: positive attitude group (PAG); negative attitude group (NAG); and unwillingness to pay for ADs (UPG). PAG was most likely to use ADs, while UPG was least likely to use ADs. The findings are expected to help older adults age in place by improving equal distribution of technology resources that assist with daily tasks and activities.

Where does the neighborhood go? Trust, social engagement, and health among older adults in Baltimore City

Trust is often cited as a necessary predecessor of social engagement, and a public-health good. We question those suppositions through analysis of the life histories of lower-income older adults aging in place in Baltimore. These people desired to continue living independently, but also expressed a complex mix of trust and mistrust in their neighbors, neighborhoods, and broader environments. This was the product of interrelated processes of multilevel physical and social changes over time and space – and, we argue, often featured a “healthy mistrust” that pushed participants to pursue personally meaningful forms of social engagement, whether new or continued.

Variations on the Village Model.

Villages, which are community-based initiatives designed to help older adults age in place through a combination of services, participant engagement, and peer support, have expanded rapidly since their initial development in the early 2000s. Using a sample of Villages in the United States, we examined variations from characteristics of the Village model as portrayed by media and organizational leaders. Results indicate there is no uniform Village model that can be implemented and evaluated by policy makers, funders, service providers, and researchers. Based on the extent of member involvement, methods of service provision, and funding sources, we developed a conceptually and empirically informed typology of Villages that reflects the model's focus on consumer involvement. Descriptive analyses indicate potential differences in member, community, and organizational characteristics. This emerging typology has implications for understanding the implementation and sustainability of Villages, including whether specific Village types are best suited to certain community contexts.

Keeping It Safe: Aging in Place Among Rural Older Adults

The purpose of the study addressed in this article was to identify ways to reduce risk and improve safe aging in place among rural older adults. Resident and Extension faculty and county educators visited study participants at home to assess functional capacity and the home environment. Extension professionals may be uniquely positioned to provide programming to help older adults age in place. Aging in place programming may help improve quality of life for older adults and their family members and caregivers.

Mobile and Wearable Technology Needs for Aging in Place: Perspectives from Older Adults and Their Caregivers and Providers.

There is an increasing number of wearable trackers and mobile devices in the burgeoning world of digital health, the purpose of the study is to explore the role of these mobile and wearable tools among older adults aging in place. We conducted a cross sectional study using individual interviews with older adults and surveys with their caregivers or providers. We interviewed 29 residents living in a retirement community, and surveyed 6 caregivers or providers. The older adults had an average age of 88 years, most did not express interests on technology and heavily relied on providers for health tracking, while their professional caregivers or providers saw a great need to access older adults' health information collected from these mobile and wearable tools. Educating the older old on the benefits of mobile and wearable tools may address such discrepancy on needs of adopting mobile and wearable tools for aging in place.

Is Cost of Living Related to Living Alone Among Older Persons? Evidence From the Elder Economic Security Standard Index

This study examines whether the cost of living is related to the probability of living alone among unmarried persons age 65 years and older in the United States. Cost of living is measured at the metropolitan area level by the Elder Economic Security Standard Index, which takes into account geographic variability in cost of housing, food, transportation, and medical care. Using multilevel modeling, we find that higher cost of living is related to a lower likelihood of living alone net of personal resources. Results also show that the gap in the likelihood of living alone between high- and low-income older adults is slightly lessened in low-cost metropolitan areas. We conclude that the price of “purchasing privacy” is substantially higher in some metropolitan areas than in others. These findings inform policies designed to help older adults age in place.

Cognitive decline and the neighborhood environment

PurposeLittle research has looked beyond individual factors to consider the influence of the neighborhood environment on cognitive function. A greater density of physical resources (e.g., recreational centers and parks) and institutional resources (e.g., community centers) may buffer cognitive decline by offering opportunities for physical activity and social interaction. MethodsUsing data from the Chicago Health and Aging Project (1993–2011), a prospective cohort study of 6518 adults of age 65 years or older, we fit a three-level growth curve model to examine the role of individual and neighborhood factors (objectively observed at the block group level) on trajectories of cognitive function (composite of East Boston Memory Test, symbol digit test, and Mini Mental State Examination) in later life. ResultsNet of individual factors, residence in a neighborhood with community resources, proximity to public transit, and public spaces in good condition were associated with slower rates of cognitive decline, possibly by increasing opportunities for social and physical activities or access to destinations that facilitate engagement in activities. ConclusionsThese results highlight the role of neighborhood environments in buffering cognitive decline among older adults aging in place.

Dutch nurses' willingness to use home telehealth: implications for practice and education.

Home telehealth (HT) refers to the use of videoconferencing to provide care to patients remotely and can help older adults age in place. However, these technologies are unlikely to impact care unless health care providers are motivated to use them. Education may play a key role in increasing motivation to use and competence regarding HT. To help guide the development of nursing education to facilitate adoption and use, the current study examined predictors of Dutch nurses' willingness to use HT, based on a survey of 67 Dutch nurses with and 126 without HT experience. Nurses' willingness to use this technology was predicted by HT's (a) perceived usefulness to the client, (b) effort expectancy, (c) social influence, and (d) cost expectations. These observed relationships are anticipated to help with the development of effective educational programs to increase HT use and, therefore, improve older adults' quality of life. [Journal of Gerontological Nursing, 41(4), 47-56.].

The role of social engagement and identity in community mobility among older adults aging in place

The purpose of this study was to understand how neighbourhoods – as physical and social environments – influence community mobility. Seeking an insider’s perspective, the study employed an ethnographic research design. Immersed within the daily lives of 6 older adults over an 8-month period, auditory, textual, and visual data was collected using the “go-along” interview method. During these interviews, the researcher accompanied participants on their natural outings while actively exploring their physical and social practices by asking questions, listening, and observing. Findings highlight a process of community mobility that is complex, dynamic and often difficult as participant’s ability and willingness to journey into their neighborhoods were challenged by a myriad of individual and environmental factors that changed from one day to the next. Concerned in particular with the social environment, final analysis reveals how key social factors – social engagement and identity – play a critical role in the community mobility of older adults aging in place.Implications for RehabilitationIdentity and social engagement are important social factors that play a role in community mobility.The need for social engagement and the preservation of identity are such strong motivators for community mobility that they can “trump” poor health, pain, functional ability and hazardous conditions.To effectively promote community mobility, the social lives and needs of individuals must be addressed.

Home Sweet Home: Interprofessional Team Helps Older Adults Age in Place Safely

Home Sweet Home: Interprofessional Team Helps Older Adults Age in Place Safely

Optimizing Mobility in Later Life: The Role of the Urban Built Environment for Older Adults Aging in Place

Hazards in the urban built environment can create barriers to mobility among older adults aging in place. We investigated the relationship between urban built environment characteristics and 15-month trajectories of mobility disability in a sample of 1,188 older adults living in Detroit, MI, a city that has undergone rapid economic and structural decline. Data come from the Michigan Minimum Data Set for Home Care (2001-2008), an enumerative database of older adults in Michigan who qualify for federal or state-funded home and community-based long-term care through a Medicaid waiver program. Standardized assessments are made at intake and every 90days by case managers. Built environments were assessed with a virtual audit using the "Street View" feature of Google Earth. A summary accessibility score was created for each block based on a count of the number of accessible features (e.g., continuous barrier-free sidewalks and proximity of public transportation). Using growth mixture models, two latent trajectories of outdoor mobility were identified: one capturing occasional outdoor mobility (representing 83% of the sample) and one capturing almost no mobility outside the home. Controlling for sociodemographic and health risk factors, individuals living in more accessible environments had a 18% higher odds of being in the more mobile group (OR = 1.18, 95% CI = 1.01, 1.41). These findings emphasize the importance of the built environment for mobility among urban-dwelling older adults.

Older adults' participation in the development of smart environments: An integrated review of the literature

Smart environments are being developed to support older adults aging in place. However, the design contributions of the older users have not been explicated. The purpose of this review of literature was to determine how older adults' ideas are being incorporated into the design of smart environments. Twenty-one research articles, incorporating older adults' preferences into the design and evaluation of smart environments are presented. Although only one study was found that used findings from older adult focus groups in the design and development of their system, the findings indicate that older adults are open to living in technically advanced environments if doing so would improve their quality of life and help them stay in their own homes, and that incorporating older adults ideas about smart environments improve the desirability of smart homes.

Aging in Place at Home Through Environmental Support of Physical Activity: An Interdisciplinary Conceptual Framework and Analysis

This article presents a conceptual framework to link issues of health, services, physical activity, and environment to help older adults age in place in their own homes, which may reduce the demands on society to provide institutional long-term care. Using environments to promote physical activity has received attention by researchers, but its impact on aging-in-place at home has been largely ignored. This article interprets and synthesizes existing studies on aging-in-place in relation to health and services, contributions of physical activity to health and service accessibility, and environmental support of physical activity. The conceptual framework can serve as the core construct to address gaps in previous research and as a tool to refine practical targets for policies and interventions aimed at promoting healthy aging.

Nursing Strategies for Promoting and Maintaining Function among Community-Living Older Adults: The CAPABLE Intervention

Although many programs aim to help older adults age in place, few target both the home environment and individual physical function. We present an interprofessional intervention called CAPABLE-Community Aging in Place: Advancing Better Living for Elders. CAPABLE's innovative approach incorporates a nurse, occupational therapist (OT), and handyman to address both individual and environmental factors that contribute to disability. The nurse component of CAPABLE addresses key barriers to functional independence such as pain, depression, strength and balance, medication management, and poor communication with the primary care provider. This article focuses primarily on the nursing aspect of the intervention and how it interrelates with the content and processes of the OT and handyman.

Cost effectiveness of a home-based intervention that helps functionally vulnerable older adults age in place at home.

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control). Additional costs for 1 additional year of life was $13,179 for Model 1 and $14,800 for Model 2. Investment in ABLE may be worthwhile depending on society's willingness to pay.

Natural neighborhood networks — Important social networks in the lives of older adults aging in place

Neighborhoods are important places of aging and meaningful contexts of life for many older people. The overall aim of this study was to explore the public life of older people aging in place in order to understand neighborhoods as the material places where public life occurs, networks as the social places of public life, and to examine how these neighborhoods and networks influence the experience of aging and wellbeing. Adopting a friendly visiting methodology, data was collected over an 8-month period using participant observation, visual methods and an innovative interview technique called the “go along method”. Data were analyzed using grounded theory and a coding strategy that integrated textual, visual, and auditory data. Results provide insights into the micro-territorial functioning of neighborhoods and highlight third places and transitory zones as significant sites for older residents. Embedded within these places is a natural neighborhood network — a web of informal relationships and interactions that enhance well being and shape the everyday social world of older adults aging in place.

The U.S. Long Term Care System: Development and Expansion of Naturally Occurring Retirement Communities as an Innovative Model for Aging in Place

The current U.S. health and long term care systems are inadequately prepared to meet the diverse and changing needs of the rapidly growing senior population. This paper describes the importance of naturally occurring retirement communities (NORCs) to promote the health and mental well being of older individuals through the collaborative efforts of formal and informal home and community based services and support. NORCs are considered a crucial model for aging in place since older adults prefer to remain in the comfort of their homes, and services can be provided in a much more efficient and cost effective manner. This paper examines the strengths, opportunities, and challenges of existing NORCs and discusses the need for the development and expansion of additional NORC programs as an innovative and viable solution for older adults aging in place.

Care Coordination Improves Outcomes and Reduces Cost

Background: Older adults want to live independently at home and postpone or avoid nursing home placement Long term care expenses are expected to more than double between 2000 and 2040. To address these concerns, a new model of care using registered nurse (RN) care coordination coupled with in-home services was developed based on prior research helping older adults age in place. Built and operated by Americare, a leading long-term care provider, TigerPlace, an independent senior living facility, was designed as a demonstration site for the aging in place model. The Sinclair School of Nursing developed a home health agency to provide RN care coordination and home care services to TigerPlace and the surrounding community. Personal care, skilled nursing and hospice services are arranged to assist residents and health promotion activities are provided to maintain independence enabling aging in place.Purpose: Assess the impact of the aging in place model of care on costs and outcomes.Methodology: A semi-annual comprehensive health assessment including the mini-mental state exam, geriatric depression scale, minimum data set, fall risk assessment and SF-12 health survey was completed on all of the residents of TigerPlace (n=66) from 2005 to 2008. Adverse events and costs of services provided were also tracked. Statistical summaries were prepared about the clinical and cost data.Findings: RN care coordination reduces adverse health events, improves outcomes, reduces nursing home utilization and is cost effective. The cost for any resident (both care and housing) has never approached or exceeded the cost of nursing home care (average annual cost for care in 2008 was $3,594 plus housing costs).Summary Concluding Statement: RN care coordination coupled with in-home services can be a viable option for long term care while saving money and allowing older adults to remain independent in a pleasing, private apartment, congregate housing setting. Background: Older adults want to live independently at home and postpone or avoid nursing home placement Long term care expenses are expected to more than double between 2000 and 2040. To address these concerns, a new model of care using registered nurse (RN) care coordination coupled with in-home services was developed based on prior research helping older adults age in place. Built and operated by Americare, a leading long-term care provider, TigerPlace, an independent senior living facility, was designed as a demonstration site for the aging in place model. The Sinclair School of Nursing developed a home health agency to provide RN care coordination and home care services to TigerPlace and the surrounding community. Personal care, skilled nursing and hospice services are arranged to assist residents and health promotion activities are provided to maintain independence enabling aging in place. Purpose: Assess the impact of the aging in place model of care on costs and outcomes. Methodology: A semi-annual comprehensive health assessment including the mini-mental state exam, geriatric depression scale, minimum data set, fall risk assessment and SF-12 health survey was completed on all of the residents of TigerPlace (n=66) from 2005 to 2008. Adverse events and costs of services provided were also tracked. Statistical summaries were prepared about the clinical and cost data. Findings: RN care coordination reduces adverse health events, improves outcomes, reduces nursing home utilization and is cost effective. The cost for any resident (both care and housing) has never approached or exceeded the cost of nursing home care (average annual cost for care in 2008 was $3,594 plus housing costs). Summary Concluding Statement: RN care coordination coupled with in-home services can be a viable option for long term care while saving money and allowing older adults to remain independent in a pleasing, private apartment, congregate housing setting.

A Neighborhood Naturally Occurring Retirement Community: Views From Providers and Residents

Maximizing quality of life for older adults poses challenges for formal service providers. One strategy to identify and address factors influencing health/mental health and promoting autonomy of community-dwelling older people is through a Neighborhood Naturally Occurring Retirement Community (NNORC), a community development model of formal and informal home and community-based support. This article uses qualitative methods to report on critical themes generated from an initial evaluation of an NNORC using individual interviews with community partners that developed the program and Resident Council members living in the NNORC community. Findings reveal the need to support older adults aging in place, the importance of informal systems of care, access to trustworthy concrete service providers, and improved models of collaboration.