Community-Living Older Adults Research Articles

Feasibility of a Telephone-Delivered Group Meditation Intervention for Chronically Ill Socially Isolated Older Adults

ABSTRACT Objectives This pilot study assessed the feasibility of a group-based telephone-delivered meditation intervention to reduce social isolation in older adults. It included weekly training sessions and daily practices of loving-kindness meditation in small groups via telephone conferences for six weeks and an extended group meditation practice for another six weeks. Methods Community-living older adults (age 60+) with multiple chronic conditions and experiencing social isolation were recruited. Each participant was assessed at the pretest, posttest, and follow-up (6 and 12 weeks after pretest). Outcome measures included social interaction, loneliness, and depressive symptoms. Open-ended questions were asked in the posttest and follow-up. Results Sixteen individuals enrolled, and fourteen completed the program (87.5% retention). Completers showed high levels of adherence (95% attendance to training) and acceptability and a statistically significant increase in social interaction at follow-up. Qualitative data suggest that participants experienced changes in emotion regulation, motivation and confidence, and sense of belonging. Conclusions A group-based telephone-delivered meditation intervention targeting chronically ill older adults who experience social isolation is technically feasible, very acceptable, and potentially beneficial to them. Clinical Implications Older adults enjoy learning meditation. Telephone conferencing is a low-cost tool for engaging socially isolated older adults in social interactions and group meditation.

Hamstrings-quadriceps strength ratio could be related to falls in community-living older adults

A prior study reported that the concentric strength imbalance between hamstrings and quadriceps is associated with falls in older adults. Given that the concentric strength may not be measured as conveniently as the isometric strength, it is meaningful to test whether the isometric hamstring-quadricep strength imbalance is related to falls among older adults. This study sought to explore whether the hamstrings-quadriceps ratio could differentiate fallers from non-fallers in community-dwelling older adults. One hundred and eleven older adults were included in this cross-sectional study. Their isometric knee joint strength capacity (extensors and flexors) was measured. Based on their fall history in the past year, they were classified as fallers (at least one fall) or non-fallers (no fall). The hamstrings-quadriceps ratio was compared between the faller and non-faller groups. The receiver operating characteristic analysis was used to determine the cutoff value of the hamstrings-quadriceps ratio able to best classify fallers and non-fallers. Fallers showed a significantly lower hamstrings-quadriceps ratio than non-fallers (p = 0.008). The receiver operating characteristic analysis identified 0.733 as the best ratio to differentiate fallers from non-fallers with an accuracy of 64.0 %. A 0.1-unit reduction in the hamstrings-quadriceps ratio increases the probability of falling by a factor of 1.30. The hamstrings-quadriceps ratio could be used as an additional fall risk factor when assessing the risk of falls among older adults. A smaller than 0.733 hamstring-quadriceps ratio may indicate a high risk of falls.

Comparison of mini nutritional assessment tool and geriatric nutrition risk index in predicting 12-year mortality among community-dwelling older persons

BackgroundMalnutrition is a common and dangerous condition in older adults, which has been associated with an increased risk of mortality. ObjectivesThis study aims to evaluate and compare the abilities of Mini Nutritional Assessment short form (MNA-SF), MNA full form (MNA-FF), and geriatric nutritional risk index (GNRI) to predict all-cause and expanded cardiovascular disease (CVD)-related mortality in community-dwelling older adults. MethodsThis research is an observational cohort study conducted in a community-setting, with a 12-year follow-up involving 1,001 community-living older adults aged ≥65 years who are enrolled in 2009 and followed up until 2021. Nutritional status assessment was carried out in 2009 using MNA-SF, MNA-FF, and GNRI. Multivariate Cox proportional hazards regression was applied to determine adjusted hazard ratios of mortality with 95% confidence intervals. ResultsA total of 368 deaths (36.76%) and 122 expanded CVD-related deaths (12.19%) were observed after a median follow-up of 12 years. Compared with normal nutritional status, poor nutritional status assessed by the MNA-SF, MNA-FF, and GNRI was found to be associated with an increased all-cause mortality in older persons. MNA-SF and MNA-FF, but not GNRI, were associated with expanded CVD-related mortality. The MNA-FF showed better discriminatory accuracy for all-cause and expanded CVD-related mortality (C-statistics = 0.77, 95% CI = 0.63–0.79; 0.79, 0.70–0.83) than MNA-SF (0.76, 0.73–0.79; 0.76, 0.72–0.81) and GNRI (0.75, 0.73–0.79; 0.76, 0.72–0.80). ConclusionsOur findings indicate that MNA-SF, MNA-FF, and GNRI were all independent predictors of all-cause mortality. In particular, the MNA-FF may be the best nutritional assessment tool for predicting all-cause and CVD-related mortality among older persons residing in community, compared with MNA-SF and GNRI.

Clinical effectiveness and cost-effectiveness of a multicomponent frailty management program “Say No To Frailty” in Singapore: A cluster-randomized controlled trial protocol

BackgroundA 12-week multicomponent frailty management program - Say No To Frailty (SNTF) consisting of interactive talks and fitness exercises led by a trained program leader has shown feasibility and positive health outcomes in community-living older adults with frailty and pre-frailty in Singapore. This study aims to evaluate the clinical- and cost-effectiveness of SNTF on physical functions, self-confidence, community participation, quality of life and fall reduction in the local community setting. MethodsThis study will use the cluster-randomization method to randomly allocate 12 participating centres into three arms. Centres under two intervention arms will conduct the same SNTF program but led by a program leader with different training backgrounds (an Allied Health Professional (AHP) v.s. a non-AHP), whereas centres under the control arm will continue their usual care without an additional intervention. Eligible participants at each participating centre will be recruited via the convenience sampling method in the community setting. Primary outcome measure (frailty level) and secondary outcome measures (e.g., physical functions, self-confidence, community participation, quality of life) will be conducted by the blinded assessors at baseline, immediate, 3 months and 9 months post-intervention. Fall data will be collected during the one-year study period. Outcomes between and within groups will be compared and analysed using STATA to evaluate the clinical effectiveness. Program costs and relevant healthcare costs during the follow-up phase will be recorded for cost-effectiveness analysis. ConclusionThis study will provide significant insights into conducting SNTF for Singapore community-living older adults with frailty and pre-frailty on clinical- and cost-effectiveness.Australia New Zealand Clinical Trials Registry: ACTRN12621001673831.

National Estimates of Short- and Longer-Term Hospital Readmissions After Major Surgery Among Community-Living Older Adults

Nationally representative estimates of hospital readmissions within 30 and 180 days after major surgery, including both fee-for-service and Medicare Advantage beneficiaries, are lacking. To provide population-based estimates of hospital readmission within 30 and 180 days after major surgery in community-living older US residents and examine whether these estimates differ according to key demographic, surgical, and geriatric characteristics. A prospective longitudinal cohort study of National Health and Aging Trends Study data (calendar years 2011-2018), linked to records from the Centers for Medicare & Medicaid Services (CMS). Data analysis was conducted from April to August 2023. Participants included community-living US residents of the contiguous US aged 65 years or older who had at least 1 major surgery from 2011 to 2018. Data analysis was conducted from April 10 to August 28, 2023. Major operations and hospital readmissions within 30 and 180 days were identified through data linkages with CMS files that included both fee-for-service and Medicare Advantage beneficiaries. Data on frailty and dementia were obtained from the annual National Health and Aging Trends Study assessments. A total of 1780 major operations (representing 9 556 171 survey-weighted operations nationally) were identified from 1477 community-living participants; mean (SD) age was 79.5 (7.0) years, with 56% being female. The weighted rates of hospital readmission were 11.6% (95% CI, 9.8%-13.6%) for 30 days and 27.6% (95% CI, 24.7%-30.7%) for 180 days. The highest readmission rates within 180 days were observed among participants aged 90 years or older (36.8%; 95% CI, 28.3%-46.3%), those undergoing vascular surgery (45.8%; 95% CI, 37.7%-54.1%), and persons with frailty (36.9%; 95% CI, 30.8%-43.5%) or probable dementia (39.0%; 95% CI, 30.7%-48.1%). In age- and sex-adjusted models with death as a competing risk, the hazard ratios for hospital readmission within 180 days were 2.29 (95% CI, 1.70-3.09) for frailty and 1.58 (95% CI, 1.15-2.18) for probable dementia. In this nationally representative cohort study of community-living older US residents, the likelihood of hospital readmissions within 180 days after major surgery was increased among older persons who were frail or had probable dementia, highlighting the potential value of these geriatric conditions in identifying those at increased risk.

A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial

BackgroundSocial isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults’ health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children.MethodsA non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling.ResultsNineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing.ConclusionsThe high program compliance and low attrition show that a 10-week intergenerational program embedded in the local community, designed for community-living older adults and preschool children, is feasible and acceptable to older adults. Our next trial will test the efficacy of intergenerational programs in this setting.

Scope and inclination of voluntary service for urban community-living older adults provided by volunteers with nursing background: A qualitative study.

With the growing challenge of an aging population, addressing the needs of elderly individuals who face living difficulties and lack family support becomes increasingly difficult. Volunteer services are crucial in this context, yet their effectiveness is hindered by unclear service scopes and uncertain volunteer inclinations. To explore the role and specific preference of volunteers with nursing backgrounds in support of older adults living in the urban community. DESIGN, SETTINGAND PARTICIPANTS: A descriptive qualitative study was conducted between September and October 2022. Twenty-three participants (hospital nurses [10], community nurses [4], nursing teachers [4]and nursing students [5]) were selected. Data analysis followed conventional content analysis. Nine major themes were identified based on interview data. Four themes described the service scope of nursing volunteers: (1) environment domain, (2) physiological domain, (3) psychosocial domainand (4) health-related behaviours domain. Another five themes highlighted the service inclination of these volunteers: (1) service frequency, (2) service duration per person/time, (3) service coverage, (4) service placeand (5) service object. This study clarifies the service focus and scope of necessary support for volunteers, exploring the potential service capabilities of scarce volunteers to the greatest extent. Meanwhile, the results of this study also provide a foundation for stakeholders to fully exploit the synergy. The important findings of this study will help the government and relevant authorities better understand the service attributes of nursing volunteers, allowing them to develop detailed training plans and provide nursing volunteers with targeted support and assistance to meet the health expectations of urban community-living older adults in need. Developing research questions, participation and conductand provision and interpretation of evidence.

ENHANCE: a comparative prospective longitudinal study of cognitive outcomes after 3 years of hearing aid use in older adults.

With an aging population, the prevalence of hearing loss and dementia are increasing rapidly. Hearing loss is currently considered the largest potentially modifiable risk factor for dementia. The effect of hearing interventions on cognitive function should therefore be investigated, as if effective, these may be successfully implemented to modify cognitive outcomes for older adults with hearing loss. This prospective longitudinal observational cohort study compared outcomes of a convenience sample of prospectively recruited first-time hearing aid users without dementia from an audiology center with those of community-living older adults participating in a large prospective longitudinal cohort study with/without hearing loss and/or hearing aids. All participants were assessed at baseline, 18 months, and 36 months using the same measures. Participants were 160 audiology clinic patients (48.8% female patient; mean age 73.5 years) with mild-severe hearing loss, fitted with hearing aids at baseline, and 102 participants of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging (AIBL) (55.9% female patient; mean age 74.5 years). 18- and 36-month outcomes of subsets of the first participants to reach these points and complete the cognition assessment to date are compared. Primary comparative analysis showed cognitive stability for the hearing aid group while the AIBL group declined on working memory, visual attention, and psychomotor function. There was a non-significant trend for decline in visual learning for the AIBL group versus no decline for the hearing aid group. The hearing aid group showed significant decline on only 1 subtest and at a significantly slower rate than for the AIBL participants (p < 0.05). When education effects on cognitive trajectory were controlled, the HA group still performed significantly better on visual attention and psychomotor function (lower educated participants only) compared to the AIBL group but not on working memory or visual learning. Physical activity had no effect on cognitive performance trajectory. Hearing aid users demonstrated significantly better cognitive performance to 3 years post-fitting, suggesting that hearing intervention may delay cognitive decline/dementia onset in older adults. Further studies using appropriate measures of cognition, hearing, and device use, with longer follow-up, are required.

Bibliometric Analysis on Geriatric Rehabilitation in Scopus Database (1948-2022)

Background: Aging presents both challenges and opportunities. It will increase demand for health care to restore function or enhance residual functional capability and improving the quality of life in older people. The objective of the present investigation was to offer perspectives into the worldwide research production concerning the geriatric rehabilitation. Methods: A bibliometric analysis was conducted utilizing the Scopus database covering the period of 1948 through 2022. Several methods and instruments were employed to scrutinize and illustrate the data. Results: The search strategy found 6630 articles. The United States was the most active country with the highest number of coauthors. VA Medical Center was the most active organization with Becker the most active author in Geriatric Rehabilitation research with 40 articles from Germany, followed by Hauer and Trabucchi with 39 and 37 articles, respectively. The most frequent words in this field were “rehabilitation, elderly, geriatrics, stroke, hip fracture, aged, dementia and activities of daily living.” The most influential articles were specified. In terms of journals, BMC Geriatrics was the most active, while the most cited article was “Gait Variability and Fall Risk in Community-Living Older Adults: A 1-Year Prospective Study” by Hausdorff in 2001. Conclusions: Geriatric rehabilitation has received special attention in the last decade. Current studies highlight the importance and understanding of the unique needs of older adults. The core for this area that includes impairment related to physical, cognitive, and functional needs is considered. Hence, health care practitioners and scholars must prioritize geriatric rehabilitation as a specialty and comprehend the optimal strategy for supporting elderly individuals to maintain their independence as much as feasible.

Assessing the Scalability of a Community-Based Self-Management Intervention for Older Adults with Diabetes and other Chronic Conditions – The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP)

Background: A multi-pronged approach was undertaken to assess the scalability of the Aging, Community and Health Research Unit – Community Partnership Program (ACHRU-CPP), a complex, integrated 6-month self-management program for community-living older adults with diabetes and multimorbidity and their caregivers, in two Canadian provinces. The ACHRU-CPP was co-designed by patients, caregivers, home and community-care providers, and researchers, in response to a gap identified by older adults in the self-management of their diabetes and other conditions. The intervention was tested in a feasibility study and an earlier pragmatic trial found that older adults who received the ACHRU-CPP experienced greater improvements in quality of life and self-management, and greater reduction in depressive symptoms, compared to those who received usual diabetes care, at no additional cost to society. Delivered by a collaborative team of primary care providers (registered nurses, registered dietitians) and a community program coordinator, key components include home visits, group wellness sessions, team-based case conferences, caregiver support, interprofessional collaboration, and nurse-led care coordination. Scalability assessment is an integral phase of the current research program, which evaluated the effectiveness and implementation of the ACHRU-CPP in four settings in Ontario (ON) and Prince Edward Island (PEI).&#x0D; Methods: Multiple methods were used to assess scalability of the ACHRU-CPP in ON and PEI: an environmental scan, individual key informant interviews, and qualitative and quantitative data from both the foundational studies and the current trial of ACHRU-CPP implementation and effectiveness. The Intervention Scalability Assessment Tool (ISAT) guided data collection and analysis. The environmental scan was conducted with strategic input from Scalability Working Groups in ON and PEI. These groups were comprised of members of the program’s governance structure, including patient and public research partners, researchers, primary care and community service providers and administrators, and policy- and decision-makers. These partners advised on relevant research and policy documents, identified potential key informants (i.e., policy- and decision-makers at the local, provincial, and national levels), and will participate in scalability assessment workshops in ON and PEI in late 2022, to finalize the scalability assessment, and identify components of the intervention to be strengthened, and barriers to be addressed to enhance the scalability of the program, in each province.&#x0D; &#x0D; Results: To date, the results of the scalability assessment have identified areas of strength and limitations within the program, most notably issues with health human resources, mixed results regarding the effectiveness of the program, and other resource gaps.&#x0D; Conclusion: This study has evaluated the scalability of a community-based program for older adults with diabetes and multiple chronic conditions that integrates primary and community care. It also provides valuable insight on the usefulness and feasibility of the ISAT for assessing scalability, as well as strategies to engage strategic practice, policy, and public partners in the process. &#x0D; Next steps: While scale-up of the ACHRU-CPP may be merited due to the prevalence of diabetes and multimorbidity among older adults, and alignment of this program with health policy, several barriers need to be addressed before scale-up can be recommended.&#x0D;

HEALTH-SEEKING BEHAVIOR OF COMMUNITY-LIVING OLDER ADULTS RELATES TO AWARENESS OF COMMUNITY SERVICES

Abstract Research has shown that older adults desire to age in their homes. To age at home safely and comfortably, there are a variety and number of community support services available, however, previous studies show older adults do not utilize these services fully. There is a need for clarity about this gap between availability and use. Understanding the construct of health-seeking behaviour by community-living older adults may provide insights into this identified gap. Therefore, the objective was to determine whether health-seeking behaviour in community-living older adults is related to: dimensions of wellness; awareness of community support services; living as an older man or woman; or being younger or older than 75 years. A cross-sectional study design involving 99 community-living older adults (≥ 65 years, without impaired executive function) employed validated outcome measures of physical function, fear of falling, personal resilience, social well-being, spiritual well-being, awareness of community support services, and health-seeking behaviour. Relationships were calculated using multiple linear regression. Health-seeking behaviour was positively correlated (R= 0.40, p&amp;lt;.01) with awareness of community support services. Health-seeking behaviour was not correlated with dimensions of wellness (i.e., physical function, fall risk, personal resilience, spiritual wellbeing, or social wellbeing). No difference between age groups (U=986.5, n1=68, n2=31, p=0.61) nor sex (U=931.5, n1=66, n2=33, p=0.24) was found for health-seeking behaviour. The findings indicate that awareness of community support services positively influenced health-seeking behaviour. The healthcare system should ensure equitable, accessible, age-friendly, and relevant information and distribution strategies to increase awareness of older adults for local supportive services.

PREVALENCE AND TYPES OF PATIENT PORTAL USE AMONG OLDER ADULTS RECEIVING HOME HEALTH CARE

Abstract Home health care (HHC) delivers skilled nursing and therapy services in the patient’s home and is a valuable source of care for community-living older adults, particularly those living with complex conditions such as dementia. However, lack of visibility into patients’ clinical records and difficulty communicating with other providers are perennial challenges to HHC quality. Patient portals― provider-sponsored online applications that allow patients to perform care management tasks including viewing health information and messaging providers―present a promising opportunity to bridge this gap. However, no prior work has examined patterns of portal use among HHC patients. We leveraged a unique dataset containing electronic health record and patient portal utilization data for 10,212 older adults who received HHC between 2017-2019. We found that 25% of HHC patients had an active patient portal prior to HHC and, of those with an active portal, 85% used their portal during HHC. Among those who used their portal during HHC, the most common portal activities were reviewing the clinical record (82%), managing appointments (60%), and seeking provider advice (45%). Compared to community-referred patients, hospital-referred patients were more likely to use their portal to manage appointments or review their clinical record. Compared to patients without dementia, patients with dementia were more likely to use their portal to message their provider but less likely to view their clinical record. Findings suggest that portal users are actively engaging with their portal during HHC, indicating an opportunity to empower patients to facilitate information transfer between HHC and other providers.

STATE GENEROSITY IN HOME- AND COMMUNITY-BASED SERVICES (HCBS): VARIATIONS AND IMPACT ON DEMENTIA OUTCOMES

Abstract To meet the needs of community-living older adults and reduce overall medical spending, home- and community-based services (HCBS) provide assistance and care for persons with significant physical and cognitive limitations. Together, Medicaid long-term services and supports (LTSS) coverage and the Title III program under the Older Americans Act (OAA) of 1965 support the majority of the HCBS for older adults living in the U.S. with low-income and/or disabilities. We evaluated state variations in generosity of supporting HCBS in recent years and how these variations affect the healthcare outcomes of community-living older adults and socio-economic and racial disparities in dementia outcomes. State HCBS generosity from the perspectives of program participation and intensity of services was defined by the exploratory and the confirmatory factor analysis with data from multiple sources, including state reports from the National Association of State Budget Officers. State data was linked to a nationally representative sample of older adults who enrolled in the Health and Retirement Study in 2020. Analyses revealed that overall state supports for HCBS increased over time in recent years while state Medicaid expenditures for institutional long-term care remained largely stable. State supports through both Medicaid and the OAA programs for HCBS varied substantially and persisted in recent years. Discussion will focus on instrumental variable analyses that determine the causal impact of state variations in HCBS generosity on health outcomes (i.e., unmet need; hospitalization) for persons living with dementia persons.

RISKS AND HEALTH OUTCOMES OF NEW ONSET OF UNMET NEEDS FOR HELP WITH ACTIVITIES OF DAILY LIVING

Abstract Twenty percent of community-living older adults who have difficulty completing mobility and self-care daily activities have unmet need for help with one or more daily activities. Prior research described correlates of existing unmet needs but did not consider which health characteristics and events increase risks for new onset of unmet needs. Data are from the 2011-2019 annual interviews of the National Health and Aging Trends Study. Onset of unmet need was calculated as having more unmet needs in the subsequent year compared to the prior year. Linear Mixed models were computed to assess which health characteristics and events increased risk for new onset of unmet need across 15,334 observations from persons who needed help with mobility tasks and 12,895 observations from persons who needed help with self-care tasks. Characteristics associated with new onset of mobility unmet needs were: age 80+, minority race, female sex, 2+ mobility limitations, 2+ chronic conditions, and dementia. Hospitalization during the yearly interval increased risk for new onset of unmet need for those with dementia (OR=3.01, 95%CI=2.62-3.44) and for those without dementia (OR=2.27, 95%CI=2.03-2.53). New onset of unmet need increased risk for nursing home or residential care placement (OR=1.63, 95%CI=1.31-2.03) and mortality (OR=2.10 95% CI =1.84-2.39) in the year following new onset of mobility unmet need. Results were similar for self-care daily activities. The findings inform the need for regularly assessing care needs, particularly after hospital discharge, with the goal of addressing new care needs to prevent new onset of unmet needs and its health consequences.

THE LONELINESS OF LOW-INCOME OLDER ADULTS IN A FEDERAL VOLUNTEERING PROGRAM: A MIXED-METHOD NETWORK PERSPECTIVE

Abstract Volunteering is considered an important way to prevent and address loneliness for community-living older adults by fostering social interactions. However, some social network studies conducted outside of the volunteering context suggest that increased interactions among lonely individuals can elevate network members’ loneliness through the co-rumination of negative emotions. To understand how and why interactions among older volunteers might protect against loneliness, this study conducted a concurrent mixed-method social network analysis among older volunteers within the Senior Companion Program (SCP) in Columbus, Ohio. These volunteers are 55 years or older, at or below 200% of the federal poverty line, and culturally/linguistically diverse. Qualitative and quantitative data were collected using focus groups and surveys respectively during an SCP monthly in-service training, N=41. A linear network autocorrelation model (LNAM) was constructed to quantify how individuals’ loneliness was correlated in SCP. A grounded theory approach informed the qualitative analysis. Mixed-method integration was conducted through a joint display table. LNAM results on the covariates were consistent with previous loneliness studies on diverse older adults. Furthermore, the negative network autocorrelation indicated that less lonely volunteers tended to interact with lonelier volunteers (ρ= -0.06, p&amp;lt; 0.05). Qualitative results also supported the aforementioned socialization pattern suggestive of altruistic motivations. In other words, the altruistic tendency to interact with other volunteers differing in loneliness may be an important pathway by which volunteering addresses loneliness. Future research shall further examine the mechanism between volunteering and older adults’ psychosocial well-being. Findings have implications for maximizing the health and social benefits of volunteering.

Factors associated with change in moderate or severe symptoms of anxiety and depression in community-living adults and older adults during the COVID-19 pandemic

ObjectivesFew are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors.MethodsThe current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow’s Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors.ResultsSociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP.ConclusionHealth and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.

Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults.

Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient's home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD). We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors. PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4% vs 32.1%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002). Findings highlight HHC's importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation.

Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience.

An increasing number of falls among community-living older adults are reported in emergency calls. Data on evidence of appropriate fall prevention interventions are limited and challenges in recruiting this population in randomized trials are acknowledged. The main aim of this study was to provide demographic data, circumstance and fall-related outcomes of the population in the RISING-DOM study [Impact d'une évaluation des facteurs de RISque de chute et d'une prise en charge personnalisée, sur la mortalité et l'institutionnalisation, après INtervention du SAMU chez la personne âGée à DOMicile], a multicenter, randomized interventional trial involving community-dwelling older adults who have experienced a fall at home and were not hospitalized. Additionally, the challenges of remote recruitment in this population were discussed. Participants were identified through the Occitania Emergency Observatory database. Participant recruitment and data collection were performed through telephone interviews (October 2019-March 2022). Additionally, a sample survey of Emergency Medical Services calls was carried out. Out of the 1151 individuals screened, a total of 951 participants were included in the trial follow-up, resulting in an acceptance rate of 82.62%. The screening delay was extended due to the COVID-19 pandemic. Recruiting difficulties were mainly related to identifying potential participants, unavailable contact information and unreachability. Participants' mean age was 84.1 years, 65.8% were women, and 44.3% lived alone. Pain was the most frequent outcome (53%). In the previous year, 73.5% of participants reported experiencing a fall, with 66.7% of those falls requiring assistance from Emergency Medical Services (EMS). Nearly, 40% did not take proactive steps to prevent future falls and walking aids (79.8%) were the most common preventive action. Indicators of a high-risk group of falls have been identified underscoring the need for appropriate fall interventions in the target population. Challenges of large sampling for randomized fall prevention trials were provided. Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.

A Qualitative Investigation on Chronic Disease Management and Prevention Among Older Adults During the COVID-19 Pandemic.

To qualitatively describe experiences of chronic disease management and prevention in older adults (age ≥65 years) during COVID-19. Qualitative descriptive approach. Data collected online via telephone and video-conferencing technologies to participants located in various cities in British Columbia, Canada. Data analyzed by researchers in the cities of Vancouver and Kelowna in British Columbia. Twenty-four community-living older adults (n = 24) age ≥65 years. Each participant was invited to complete a 30-to-45-minute virtual, semi-structured, one-on-one interview with a trained interviewer. Interview questions focused on experiences managing health prior to COVID-19 and transitioning experiences of practicing health management and prevention strategies during COVID-19. Audio recordings of interviews were transcribed verbatim and analyzed thematically. The sample's mean age was 73.4 years (58% female) with 75% reporting two or more chronic conditions (12.5% none, 12.5% one). Three themes described participants' strategies for chronic disease management and prevention: (1) having a purpose to optimize health (i.e., managing health challenges and maintaining independence); (2) internal self-control strategies (i.e., self-accountability and adaptability); and (3) external support strategies (i.e., informational support, motivational support, and emotional support). Helping older adults identify purposes for their own health management, developing internal control strategies, and optimizing social support opportunities may be important person-centred strategies for chronic disease management and prevention during unprecedented times like COVID-19.

Testing the Effects of a Multicomponent Frailty Management Program for Community-Dwelling Older Adults in Singapore: A Feasibility Study.

Frailty in later life is often associated with functional declines and reduced quality of life. A multicomponent frailty management program (mFMP) is lacking in Singapore. This study aimed to determine the feasibility and effects of an mFMP in reducing frailty and increasing participation among frail community-living older adults. Pre- and postassessments at three time points were conducted to compare the differences in body functions between the mFMP (experimental group [EG]) and a fitness program (control group [CG]). Recruitment, dropouts, and fall data were collected. Weekly field notes and semistructured interviews postintervention were thematically analyzed. Sixteen out of 23 participants (EG: eight; CG: eight) completed the 12-week interventions with reduced frailty immediately postintervention. At 3-month postintervention, 10 participants (EG: five; CG: five) being followed up had a sustained level of frailty (p < .05). The EG and CG reported zero and two falls, respectively. The mFMP demonstrated its feasibility and exhibited a trend to facilitate personal behavioral changes postintervention.