Diverse Populations Of Older Adults Research Articles

CORRELATES OF PHYSICIAN TRUST: DEMOGRAPHIC FACTORS AND EXPERIENCES OF MEDICAL CARE DISCRIMINATION

Abstract Lack of trust between older adults and their physicians may decrease adherence to medication or limit disclosure of information to healthcare providers. Trust may be shaped in part by demographic factors as well as previous experiences of discrimination in healthcare. We hypothesized that more experiences of discrimination in a medical care setting would be negatively associated with general physician trust. We used cross-sectional data from a follow-up visit (2013-2016) of the national REasons for Geographic and Racial Differences in Stroke (REGARDS) longitudinal cohort study. Our sample included participants who completed an 11-item general physician trust measure (score range=11-55) and a four-point item about discrimination in medical care settings (n=8,235, age 52-98, 31% Black, 45% men). We examined two sequential linear regression models with trust as the outcome, with the first model including demographic factors and the second adding discrimination in a medical setting. Female gender (β=-0.09, p<.05), Black race (β=-0.03, p<.05), and higher level of education (β=-0.8, p<.05) were each related to lower trust. Higher income (β=0.04, p<.05) and older age (β=0.12, p<.05) were associated with higher trust. Perceived discrimination had a negative association with physician trust (β=-0.14, p<.05) and the relationship between Black race and trust reversed direction and was no longer statistically significant (β=0.20, p=.298) with discrimination in the model. The potential impact of previous discrimination experiences in a medical care setting on physician trust should be considered when providing healthcare services to diverse populations of older adults.

LESSONS LEARNED FROM DIGITAL EQUALITY RESEARCH WITH COMMUNITY PARTNERS

Abstract Despite strong interest among policymakers and service providers and a pipeline of Federal funding for programs that address digital inequalities in older adults, there is limited research on the challenges and outcomes of programs designed to reduce the digital divide. To better understand these issues, we compared and contrasted challenges and lessons learned administering digital inclusion projects in California and Rhode Island. In California, challenges included the complexity of state and local interface, managing public-private partnerships, and deciding on and communicating roles and responsibilities through the required formal channels. In Rhode Island, timing and communication were challenging because universities and community partners operate on different calendar systems and cater to different demands. For both programs, ensuring that training and technical support were available, accessible, and appropriate for diverse populations of older adults was a challenge. However, the training and support approaches were different as California leveraged private and non-profit partnerships while Rhode Island used university student mentors. Further, the rollout and data collection needed to evaluate the programs created barriers and slowed the process, including partners’ language capabilities not matching the participants’ and the time-consuming nature of data collection via telephone. Nevertheless, in both states, research opportunities afforded by collaborating with state and local agencies and private sector providers were invaluable. Partnerships allowed older adults to participate in research via a trusted organization with linguistic and cultural sensitivity, and researchers accessed underserved populations less likely to participate in research.

IMPLEMENTATION SCIENCE: A STRATEGY FOR ADDRESSING HEALTH EQUITY AMONG RACIALLY DIVERSE OLDER ADULTS

Abstract Objective Implementation science as a strategy for helping diverse populations of older adults address barriers to mental treatment, has become increasingly important since COVID19. This paper disseminates information about the results of an interdisciplinary intervention that tailored mental health services to racially and ethnically diverse community-dwelling older adults. Method: An interdisciplinary team of researchers (MD, APRN, MSW) performed an intervention that consisted of weekly visits to the community and provided diagnostic, triage, and psychosocial services to older adults. Evaluation of the intervention included data collected at baseline and three-month follow-up visits. Results 350 elderly residents received mental health screening with some assessment of physical health and well-being. The number of visits per resident during the intervention phase, ranged from 1 to 11, with an average of 3. Tailoring the intervention to the specific cultural needs of the participants led to the development of a weekly community engagement group for monolingual Spanish-speaking residents and others. 49% of those receiving the intervention, self-reported their race and/or ethnicity as African American or Caribbean, 43% were Latino, and 8% were Caucasian, all of whom self-referred as participants in this health service outreach program. Initial evaluations resulted in referral to community providers (60%), team case management (20%), or no services needed (20%). Conclusion Research studies designed to have positive impacts on older adults that have been historically underrepresented in health services research may improve its effectiveness by tailoring processes to be community informed and culturally responsive to structural and system barriers to treatment.

Detection of mild cognitive impairment using digital assessments of cognition

AbstractBackgroundConventional cognitive assessment typically provides a single measure of performance at a single point in time in a laboratory setting. Smartphone‐based ecological momentary assessments (EMA) facilitate short‐term intensive assessment of cognitive performance in people’s natural environments. Though heterogeneous variance in digital cognitive assessments has been observed between older adults with mild cognitive impairment (MCI) and cognitively unimpaired (CU), the independent contribution of intra‐individual variability in performance to detection of MCI is poorly characterized in diverse populations of older adults. We examine the ability of digital cognitive assessments of processing speed in discriminating MCI from CU in older adults from a racially/ethnically diverse community sample.MethodEinstein Aging Study (EAS), smartphone‐based digital assessments of cognition, included the response time‐based symbol match test of processing speed. This was assessed 6 times per day over two weeks and was repeated annually. MCI was defined based on in‐house neuropsychological evaluations using Jak‐Bondi criteria. Statistical methods for modeling MCI using digital cognitive assessments include pattern‐mixture discriminant analysis based on heterogeneous linear mixed effects model for digital cognitive measures given MCI, joint modeling using shared random effects with random location scale for digital cognitive measures, and quadratic logistic regression models. All methods take into account the unbalanced adherence rate among individuals and control for covariates including age, sex, years of education, and race/ethnicity. Stratified analyses by race/ethnicity among non‐Hispanic (NH) Whites and Blacks were performed.ResultAmong 311 systematically recruited community‐dwelling non‐demented older adults from the EAS (Mean age = 77.5 years, SD = 4.8; 67.5% Female; 45.3% non‐Hispanic (NH) White, 40.8% NH‐Black), 97 (31.2%) individuals had MCI. Adherence to the EMA protocol was slightly better in individuals who were CU compared to those with MCI. Results from the quadratic logistic model (the easiest to apply) showed evidence of contribution from the quadratic terms that reflect heterogeneous intra‐individual variability in all samples and particularly among NH‐Blacks (p = 0.008).ConclusionWe observe evidence that intra‐individual variability in processing speed improves the ability to discriminate cognitive impairment, particularly among NH‐Black older adults. Leveraging digital technology and performance variability across frequent assessments in the smartphone‐based EMA offers novel opportunities to identify cognitive impairment.

Assessing feasibility of a novel approach to effective medication self-management for older persons

The fact that nearly one-half of patients take medications differently than as prescribed, combined with the predisposition of older persons to adverse events, suggests a need for new strategies supporting medication self-management for older persons. This pilot study describes the development, acceptability and feasibility of a novel toolkit approach focusing on a systematic 4-step process for ensuring medication appropriateness. A preliminary qualitative assessment of the toolkit's acceptability and feasibility was carried out using a convenience sample of 39 residents aged 62-97 years in two senior living facilities convened in focus groups. A facilitator guided participants through discussions of the 4-step process. All participants indicated they perceive that the toolkit's systematic 4-step process can help older persons successfully self-manage medications. The most common medication use challenges cited by participants were related to effectiveness (35%), followed by intended medical use (27%), safety (23%), and ability to take medications (15%). This preliminary investigation suggests that older adults resonate with use of this 4-step process to confidently self-manage medications and find it feasible and acceptable to use in assessing the appropriateness of their medications. More research is needed to establish the reliability and validity of this toolkit with more diverse populations of older adults.

ESPO AND HEALTH SCIENCES SECTION SYMPOSIUM: INCLUDING DIVERSE STAKEHOLDERS IN HEALTH INTERVENTION DESIGN: LESSONS LEARNED FOR ADVANCING HEALTH EQUITY

Abstract The COVID-19 pandemic exposed persistent disparities in the effectiveness of healthcare services and long-term care among the older adult population. For example, significant gaps disproportionately affected older adults living in rural areas, racial and ethnic minorities, individuals with cognitive impairments, and those from low socioeconomic backgrounds. To improve health equity, research is needed to design, implement, and disseminate health interventions that address the heterogeneity of older adults and caregivers. Reflecting on lessons learned from including underrepresented key stakeholder groups in intervention research may reveal strategies to design health interventions that are more accessible and effective for diverse populations of older adults and their caregivers. This symposium highlights five studies that included diverse populations of older adults and/or caregivers in the design of health interventions. Dr. Schiaffino will share how disparities in co-morbid cancer and dementia across racial, ethnic, and age groups will inform improvements to care delivery processes for this population. Ms. Crane will discuss barriers to designing exergame interventions that are accessible to older adults with multiple chronic conditions and functional limitations. Dr. Díaz-Santos will describe results of piloting and refining a social connection intervention to reduce loneliness among Latinx older adults at risk for dementia. Dr. del Pino will highlight strategies to improve implementation of a screening intervention for at-risk drinking among African American older adults living with HIV. Mr. Cotton will present results of tailoring a crisis intervention to improve cultural fit for African American caregivers of people with dementia.

DEVELOPMENT OF A HOPE-BASED HEALTH PROMOTION PROGRAM TO IMPROVE HEALTH BEHAVIORS AMONG DIVERSE OLDER ADULTS

Abstract Studies have shown that health education can improve dietary intake, exercise, and energy balance, which improves health outcomes and quality of life. However, diverse low-income older adults may have low self-efficacy coupled with potentially negative opinions regarding the aging process. Emerging research suggests that asset-based approaches utilizing persuasive and hopeful messages may be particularly effective with diverse populations of older adults who may be struggling with negative perceptions of self-efficacy. Research also shows that health behavior change interventions are most likely to be successful among diverse populations when they incorporate messages of resilience and facilitate information sharing and diffusion among participants. This presentation outlines the program curriculum development process of a student-led health promotion program by an interdisciplinary team of university researchers. Public health, dietetics, and communication faculty utilized Persuasive Hope Theory (PHT) and Self-Efficacy Theory to create a 15-week program to improve fruit and vegetable intake and physical activity among low-income adults aged 55+ living in Anchorage, Alaska. We will also detail the curricular components for this NIA-funded program which will be delivered in Fall 2022.

Leveraging technology to personalize cognitive enhancement methods in aging.

As population aging advances at an increasing rate, efforts to help people maintain or improve cognitive function late in life are critical. Although some studies have shown promise, the question of whether cognitive training is an effective tool for improving general cognitive ability remains incompletely explored, and study results to date have been inconsistent. Most approaches to cognitive enhancement in older adults have taken a 'one size fits all' tack, as opposed to tailoring interventions to the specific needs of individuals. In this Perspective, we argue that modern technology has the potential to enable large-scale trials of public health interventions to enhance cognition in older adults in a personalized manner. Technology-based cognitive interventions that rely on closed-loop systems can be tailored to individuals in real time and have the potential for global testing, extending their reach to large and diverse populations of older adults. We propose that the future of cognitive enhancement in older adults will rely on harnessing new technologies in scientifically informed ways.

Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis.

To analyse the effects of active video games on physical function in independent community-dwelling older adults. Systematic review and meta-analysis of randomized controlled trials. The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software. The analysis included 22 randomized controlled trials with a total of 1208 participants (all ≥55years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and-go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and-Go or velocity. Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and-go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited. Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.

Challenges of Implementing the PRISM 2.0 Trial for Supporting Social Connectivity Through Technology

Following the success of the Personal Reminder Information and Social Management (PRISM) trial, which found that a specially designed computer system for older adults can enhance social connectivity and reduce loneliness among older adults at risk for social isolation, the PRISM 2.0 trial sought to replicate and extend these results to a new technology platform (tablet rather than desktop) with expanded social features and diverse populations of older adults, including older adults living in rural areas, assisted living communities, and senior housing. This symposium discusses the aims of the trial conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE), challenges encountered (including challenges related to the COVID-19 pandemic), and solutions to those challenges. S. Czaja will begin with an overview of the PRISM 2.0 system and the trial. J. Sharit will discuss challenges encountered working within the context of assisted living facilities and with impaired participants. This will be followed by a discussion of technical challenges encountered during the course of the trial presented by N. Charness. W. Rogers will present training issues involved (both with respect to participants and assessors). Finally, W. Boot will describe challenges encountered with measuring and quantifying technology use during the trial. Lessons learned are applicable to many types of technology interventions administered in diverse contexts. D. Plude, Deputy Director in the Division of Behavioral and Social Research of NIA, will serve as discussant.

Engaging and Educating Older Adults and Caregivers in Age-Friendly Healthcare

As the Age-Friendly Health System initiative moves across the US and around the world, not only do health system staff require education about the 4Ms, but older adults, caregivers, and families need education. Engaging and empowering the community about the 4Ms can improve communication, clarify and improve adherence to treatment plans, and improve patient satisfaction. Many methods for engaging the community in age-friendly care are currently in development. Initiated by Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Programs (GWEPs), Community Catalyst is leading the co-design of Age-Friendly Health System materials with older adults and caregivers. Testing these materials across the country in diverse populations of older adults and caregivers will yield open-source documents for local adaptation. Rush University Medical Center is testing a method for identifying, engaging, educating, and providing health services for family caregivers of older adults. This unique program integrates with the Age-Friendly Health System efforts in addressing all 4Ms for caregivers. The Bronx Health Corps (BHC) was created by the New York University Hartford Institute of Geriatric Nursing to educate older adults in the community about health and health behaviors. BHC developed a method for engaging and educating older adults that is replicable in other communities. Baylor College of Medicine adapted and tested the Patient Priorities Care model to educate primary care providers about how to engage older adults in conversations about What Matters to them. Central to the Age-Friendly movement, John A. Hartford Foundation leadership will discuss the implications of this important work.

What Do Older Adults Consider a Good Death?

Without improved understanding and communication about what constitutes a ‘good death’, an extended dying process that does not attend to how serious illness affects older adults’ quality of life near the end of life is likely (IOM, 2014). The primary aim of this study was to understand the concept of a ‘good death’ as defined by older adults. A scoping literature review of qualitative and quantitative research studies (published in peer-review journals since 2000) involving only community-dwelling older adults was conducted, using key search words: good death, dying well, older adults/elderly/seniors, gerontology/geriatrics and Boolean operators in s in Social Gerontology, CINAHL Plus, PubMed, Academic Search Premier, PsychINFO. A total of 344 articles met the search criteria. Following initial systematic screening of titles/abstracts and full text review, five articles remained that met inclusionary criteria. Therefore, this analysis is based on a total of five articles. Each study was qualitative, with small samples and diverse populations of older adults. Among the factors perceived important, studies’ shared results were dying in sleep/natural death/peaceful; family connection (e.g. time for closure, not being a burden) and faith/religiousness (e.g. getting ‘right’ with God, living with faith). Conceptions of a ‘good death’ often reflect primarily psychosocial/quality of life aspects, in addition to medical concerns. Health professionals need to know how a good death is defined by each individual in order to ensure holistic care and quality of life at the end of life according to older adults’ expressed wishes.

Emerging Complementary and Integrative Therapies for Geriatric Mental Health.

PurposeThe use of complementary and integrative medicine (CIM) is on the rise among diverse populations of older adults in the USA. CIM is commonly perceived as safer, less expensive, and more culturally acceptable. There is a growing body of evidence to support the use of CIM, especially mind-body therapies, diet and nutritional supplements used for mental disorders of aging.Recent findingsWe summarize the results of the recent clinical trials and meta-analyses that provide the evidence for the role of CIM in treating older adults with mood or cognitive disorders that includes the use of diet and supplements, and mind-body therapies.SummaryDietary and mind-body therapies have become increasingly popular and show the strongest evidence of efficacy for mood and cognitive disorders. Although the use of vitamins and supplements is the most popular CIM practice, only mixed evidence supports their use with additional concerns for herb (supplement)-drug interactions. Despite increasing use of CIM by the general population, information to guide clinicians providing care for older adults remains limited with variable scientific rigor of the available RCTs for a large number of commonly used CIM interventions for the mental health of older adults.

INTEREST GROUP SESSION—MENTAL HEALTH PRACTICE AND AGING: INTEGRATION OF SOCIAL DETERMINANTS OF HEALTH IN DEFINING HEALTH BEHAVIORS AND OUTCOMES AMONG DIVERSE OLDER ADULTS

Social determinants of health (SDoH) are conditions in which individuals live, learn, work, and play. Specifically, they are influenced by the distribution of resources, money, and power, and have significant implications on health behaviors and outcomes across the life span. Existent data show the influence these indictors may have in the onset and progression of chronic illnesses. However, much of these data focus on the effect of race and health, as social determinants, but fail to adequately address the myriad other factors (e.g., health care, social and community context) that influence the social patterning across the life course. This symposium presents findings from several studies highlighting the nuanced role of SDoH across diverse populations of older adults. Scholars will present findings on the influence that identified determinants, such as social networks, lifestyle behaviors, and gender, have in defining health outcomes across the life course. Minahan presents the relationship between chronic illnesses and depression and compares depressive symptomatology according to disease cluster in a nationally-representative sample of older adults. Atakere discusses determinants of well-being among African American males with chronic illnesses and the challenges associated with this marginalized population. Booker examines spirituality as a mechanism for pain management among older African Americans and presents this as a crucial determinant of health. This symposium will expand on the existing body of literature by emphasizing social and cultural determinants, aside from race, that influence health behaviors and outcomes across the life span.

Cortisol and physical performance in older populations: Findings from the international mobility in aging study (IMIAS)

ObjectiveTo compare diurnal cortisol profiles across samples of older adults from diverse populations and to examine if differences in circadian cortisol secretion are associated with poor physical performance (SPPB<9). MethodsData were collected during the baseline survey of the International Mobility in Aging Study conducted in 2012 in Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania) and Manizales (Colombia). Salivary cortisol was collected from a subsample of 309 participants instructed to collect saliva on two consecutive days, and 5 different intervals each day: upon awakening (M1), 30min (M2) and 60min after awakening, at 15:00h and before bedtime (E). Cortisol was analyzed using enzyme immunoassay kits. Physical performance was measured by the Short Physical Performance Battery (SPPB). Mixed linear models were fit to assess the associations between cortisol diurnal output and physical performance, adjusting for potential confounders. ResultsKingston, Saint-Hyacinthe and Tirana residents had significantly higher cortisol values than their Manizales counterparts, with the population from Tirana showing the highest levels. Attenuated morning cortisol peak (M2) (p=0.025), higher cortisol bed time (E) (p=0.005), and lower M2/E ratio (p<0.001) were found among those with SPPB<9 compared with those with good physical performance (SPPB≥9). These results were not altered after adjustment by potential confounders. ConclusionCortisol profiles varied across four diverse populations of older adults. Circadian cortisol secretion is associated with physical performance as an attenuated morning response and higher bed time values were observed in older adults with SPPB<9.

Clinically relevant depression in old age: An international study with populations from Canada, Latin America and Eastern Europe

Our aim is to assess cross-national variations in prevalence of clinically relevant depression and to examine the relationships of social and health factors with depression in five diverse populations of older adults, from Canada, Brazil, Colombia and Albania. We used the data from the International Mobility in Aging Study. Clinically relevant depression was defined as a score of ≥16 on the Center for Epidemiologic Study Depression Scale (CES-D). Poisson regressions with robust covariance correction were used to estimate prevalence ratios associated with potential risk factors. Prevalence of clinically relevant depression across research sites varied widely, being consistently higher in women than in men. It was lowest in men from Brazil (6.3%) and highest in women from Albania (46.6%). Low education and insufficient income, living alone, multiple chronic conditions, and poor physical performance were all significantly associated with depression prevalence. Poor physical performance was more strongly associated with depression in men than in women. Similar factors are associated with clinically relevant depression among men and women and across research sites. The large variation in depression prevalence population rates is unexplained by the classical individual factors considered in the study suggesting the impact of country characteristics on depression among older populations.

Clinically relevant weakness in diverse populations of older adults participating in the International Mobility in Aging Study.

The aims of this study were to compare cut points for weakness proposed by Foundation for the National Institutes of Health (FNIH) Sarcopenia Project with cut points estimated with our own data; to assess the prevalence of clinically relevant handgrip strength (HGS) weakness according to published criteria across distinct populations of older adults; to estimate the ability of HGS weakness to identify slowness. This is a cross-sectional analysis of International Mobility in Aging Study (IMIAS) involving 1935 community-dwelling older adults, between 65 and 74years, who completed HGS and gait speed assessment. We used baseline data from Tirana (Albania), Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). Weakness was defined according to sex-specific HGS cut points associated with slowness proposed by FNIH Sarcopenia Project. Slowness was defined as gait speed <0.8m/s. IMIAS cut points for clinical weakness had good agreement with those proposed by FNIH. Weakness prevalence across the research sites ranged from 1.1% (Saint-Hyacinthe) to 19.2% (Manizales) among men. Women from Manizales (13.5%) and Natal (19.3%) had higher prevalence of weakness than their counterparts. FNIH cut points had a strong association with slowness, for both sexes. The IMIAS population generated cut points which were close to those proposed by FNIH. There was large variability in prevalence of weakness across our research sites. The HGS cut points for weakness proposed by FNIH performed well in IMIAS populations, providing a useful tool for screening older adults at risk for functional problems.

Early life adversity and C-reactive protein in diverse populations of older adults: a cross-sectional analysis from the International Mobility in Aging Study (IMIAS).

BackgroundRecent studies suggest potential associations between childhood adversity and chronic inflammation at older ages. Our aim is to compare associations between childhood health, social and economic adversity and high sensitivity C-reactive protein (hsCRP) in populations of older adults living in different countries.MethodsWe used the 2012 baseline data (n = 1340) from the International Mobility in Aging Study (IMIAS) of community-dwelling people aged 65–74 years in Natal (Brazil), Manizales (Colombia) and Canada (Kingston, Ontario; Saint-Hyacinthe, Quebec). Multiple linear and Poisson regressions with robust covariance were fitted to examine the associations between early life health, social, and economic adversity and hsCRP, controlling for age, sex, financial strain, marital status, physical activity, smoking and chronic conditions both in the Canadian and in the Latin American samples.ResultsParticipants from Canadian cities have less adverse childhood conditions and better childhood self-reported health. Inflammation was lower in the Canadian cities than in Manizales and Natal. Significant associations were found between hsCRP and childhood social adversity in the Canadian but not in the Latin American samples. Among Canadian older adults, the fully-adjusted mean hsCRP was 2.2 (95 % CI 1.7; 2.8) among those with none or one childhood social adversity compared with 2.8 (95 % CI 2.1; 3.8) for those with two or more childhood social adversities (p = 0.053). Similarly, the prevalence of hsCRP > 3 mg/dL was 40 % higher among those with higher childhood social adversity but after adjustment by health behaviors and chronic conditions the association was attenuated. No associations were observed between hsCRP and childhood poor health or childhood economic adversity.ConclusionsInflammation was higher in older participants living in the Latin American cities compared with their Canadian counterparts. Childhood social adversity, not childhood economic adversity or poor health during childhood, was an independent predictor of chronic inflammation in old age in the Canadian sample. Selective survival could possibly explain the lack of association between social adversity and hsCRP in the Latin American samples.

Aging, place, and technology: toward improving access and wellness in older populations.

To review the range of promising technologies (e.g., smart phones, remote monitoring devices) designed to enhance aging in place; identify challenges for implementation of those technologies; and recommend ways to improve access to technologies in older populations. A narrative review of research, practice, and policies from multiple fields, including information science, gerontology, engineering, housing and social services, health care and public health. Despite a wide range of emerging and current technologies, there are significant challenges for implementation, including an uneven evidence base, economic barriers, and educational and ergonomic issues that adversely affect many older adults. Recommendations for future development and adoption include improving the evidence base through field-testing of "packages" of devices in diverse populations of older adults; development of innovative funding mechanisms involving multidisciplinary teams, older adults, and caregivers; and promotion of safety and security in the use of these technologies in older populations.

Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.