Number Of Older Adults Research Articles

International Medical Graduates and a Career as a Geriatric Psychiatrist

The population of the United States is aging. Currently people over the age of 65 years constitute 13% of the general population. By 2050 this number will rise to about 25% of the population. As the population ages, the number of older adults with mental illness will also rise. Available data indicates that there are inadequate numbers of trained geriatric psychiatrists in United States to care for older adults with mental illness. The additional burden for services in the future on an already strained healthcare system can lead to catastrophic failure of the system. International Medical Graduates (IMGs) constitute almost half of the work force of geriatric psychiatrists. The IMGs have had successful career as clinicians, educators, academics and researchers in geriatric psychiatry. In this symposium we will enumerate the unique challenges faced by the IMGs and strategies on enable them to integrate into the mainstream geriatric psychiatry workforce. We will review the roles of IMGs as private practitioners, educators, academicians and as researchers. We will also discuss how organizations like the AAGP can play a greater role in attracting larger number of IMGs to join the geriatric psychiatry workforce and also the AAGP. This will enable greater access to care for the older adults with mental illness and maintain the success of AAGP in being the national organization for geriatric psychiatry clinicians in the United States.

Context matters when implementing patient centred rehabilitation models for persons with cognitive impairment: a case study

BackgroundThere is a growing number of older adults with cognitive impairment (CI) that require inpatient rehabilitation, and as such patient centred rehabilitation models have been developed. However, implementing evidence-based models without attending to the fit of the model to the new context could lead to an unsuccessful outcome. Researchers collaborated with administrators and staff in one rural site to adapt a patient centred rehabilitation model of care in the Canadian province of Ontario. This paper reports on the contextual factors that influenced the implementation of the model of care.MethodsThe study takes a case study approach. One rural facility was purposefully selected for its interest in offering rehabilitation to persons with CI. Four focus group discussions were conducted to explore healthcare professionals’ perceptions on the contextual factors that could affect the implementation of the rehabilitation model of care in the facility. Twenty-seven professionals with various backgrounds were purposively sampled using a maximum diversity sampling strategy. A hybrid inductive-deductive approach was used to analyze the data using the Context and Implementation of Complex Interventions (CICI) Framework.ResultsAcross the domains of the CICI framework, three domains (political, epidemiological, and geographical) and seven corresponding sub-domains of the context were found to have a major influence on the implementation process. Key elements within the political domain included effective teamwork, facilitation, adequate resources, effective communication strategies, and a vision for change. Within the epidemiological domain, a key element was knowing how to tailor rehabilitation approaches for persons with CI. Infrastructure, an aspect of the geographical domain, focused on the facility’s physical layout that required attention.ConclusionsThe CICI framework was a useful guide to identify key factors within the context that existed and were required to fully support the implementation of the model of care in a new environment. The findings suggest that when implementing a new program of care, strong consideration should be paid to the political, epidemiological, and geographical domains of the context and how they interact and influence one another.

Selective Serotonin Reuptake-Inhibitors for Symptom-Based Treatment of Borderline Personality Disorders in Older Adults: An International Delphi Study.

ObjectiveInternational guidelines on symptom-based treatment of borderline personality disorders (BPD) in older adults are lacking. The number of older adults (≥ 65 years) with borderline personality disorder is rising. Effectiveness of Selective Serotonin Reuptake Inhibitors (SSRIs) on symptoms of BPD has only been investigated in younger adults and results are ambiguous. During life, serotonergic function changes, which can influence the indication and effectiveness of SSRIs in older adults with BPD. Aim of this study is to reach consensus on the suitability of SSRIs for the treatment of older adults with BPD.MethodsA Delphi study was conducted among eighteen international experts. In three successive rounds, a total of 16 statements addressing the treatment with SSRI’s in older adults with BPD were assessed. Consensus on specific statements was reached if at least two-third of these experts agreed.ResultsConsensus was reached on 11 statements related to the indication and effectiveness of SSRIs in the treatment of older adults with BPD.ConclusionThe results of this study suggest a valuable role for SSRIs in the treatment of affective instability, and to a lesser extent impulsive behavior, in older adults with BPD. Sertraline or citalopram are suggested to be the first-choice medication but should be prescribed with some caution. Treatment recommendations have been suggested (presented in a flowchart), but still have to be investigated in clinical practice.

SOCIAL JUSTICE AMONG ELDERLY ADULTS WITH DISABILITY: IMPLICATION FOR ACCESS TO SOCIAL BENEFITS

Late-life has traditionally been regarded as a time for relaxation and reflection upon the time spent in life. However, this experience is often not the case for older adults in developing countries. Despite the growing numbers of older adults and efforts to support this population, there continue to be significant setbacks emerging from a lack of policy sensitivity and numerous implementation challenges, especially for older adults with physical disabilities who seek to access social benefits. Many older adults with disabilities continue to experience diverse social, cultural, and economic challenges spanning from financial insecurity, social isolation, mental and physical health needs, and elder abuse. These challenges, confounded with the presence of a disability, may result in older adults taking up laboured activities, such as street begging in urban environments around the country or engage in subsistence farming as a coping mechanism to challenges they face in late-life. This paper looks into the characteristics of older adults Ghana and policies that affect their access to social benefits. Recommendations in this paper include a call for the Government of Ghana to revise the retirement age from 60 to 65 years and focus on challenges associated with reports of corrupt practices among appointees in the distribution of disability funds through local government structures. Keywords: Disability, older adults, Ghana, social benefits, retirement.

Age-Friendly Cities and Communities: State of the Art and Future Perspectives

The number of older adults is increasing rapidly, and this demographic shift places an increased level of strain and tension on the various international healthcare and welfare systems [...].

COMPARATIVE EFFECTIVENESS AND SAFETY OF VEDOLIZUMAB AND ANTI-TUMOR NECROSIS FACTOR AGENTS IN OLDER ADULTS WITH INFLAMMATORY BOWEL DISEASES IN MEDICARE ADMINISTRATIVE CLAIMS DATABASE

The number of older adults with inflammatory bowel diseases (IBD) is increasing. Older adults with IBD are less likely to receive effective immunosuppression. We aimed to determine efficacy and safety of biologic therapies in older adults with IBD.

Characteristics and patterns of older adult homicides in the United States

BackgroundNearly 1800 homicides were reported in 2018 among individuals aged 60 years or older in the US. The characteristics and circumstances of these homicides are understudied. We investigated the trends of homicides over time and compared victim, perpetrator, and incident characteristics by mechanism (firearm vs. non-firearm) among adults aged 60 years or older.MethodsWe examined cross-sectional restricted-access data from the National Violent Death Reporting System from 2003 to 2017. Fatal Injury Data by CDC provided age-adjusted homicide rates. We quantitatively summarized victim, perpetrator, and incident characteristics for firearm and non-firearm homicides. We also reviewed 150 qualitative narratives to better understand the context of older adult homicides perpetrated by firearms. All data were analyzed in February 2020.ResultsOverall and firearm-specific older adult homicide rates increased between 2014 and 2017. Of the 6188 victims, 62% were male. The majority of victims (68%) were killed at home. Firearms (44%), sharp (19%) and blunt weapons (15%) were common mechanisms used in older adult homicides. The perpetrator was an intimate partner in 39% of firearm homicides and 12% of non-firearm homicides (prevalence difference = 27%; 95% CI: 25, 30%). Similarly, homicide-suicides (prevalence difference = 21%; 95% CI: 19, 22%) and multiple-victim incidents (prevalence difference = 7%; 95% CI: 5, 8%) were more common in firearm (23 and 13%, respectively) than in non-firearm (2 and 6%, respectively) homicides. Common contexts of firearm homicides were familial/intimate partner problems, robbery/burglary, argument, and illness.ConclusionsA substantial number of older adults were killed with firearms and by their intimate partners. Further research to identify violence victimization prevention strategies in this group, especially those that limit access to firearms by potential perpetrators, is warranted.

Developing a master’s degree program in Gerontology

ABSTRACT The aging population is growing exponentially, and it is expected that soon the number of older adults within our population will outnumber the youth. To prepare for this shift in demographics, there is a need for educational programs in gerontology. The objective was to find out whether individuals in the community feel there is a need for a master’s degree in gerontology and if so, what topical areas should be covered. Participants indicated that there is a need for a master’s degree in gerontology and many professionals working with older adults would consider enrolling in the program. In addition, professionals, older adults, and undergraduate students shared many topics that should be covered in the programs, for instance, financial planning, caregiver stress, Medicare, and other social programs. In addition, findings indicate that an online program may be the best to meet the demands of the working professionals who would like to enroll in the program but are concerned about time and many other issues. The data collected from the present study, along with the core competencies put forth by the Academy for Gerontology in Higher Education (AGHE) will be used to design a master’s program at a university in New Jersey.

Management site and level of health care for cannabis- and synthetic cannabinoid-related poison control center cases involving older adults, 2016–2019

Increasing numbers of older adults use cannabis and cannabis-derived products that can have adverse effects. This study examined management site and level of healthcare services for older adult poison control center cases involving cannabis products. Using the American Association of Poison Control Centers’ (PCC) National Poison Data System, 2016–2019, we extracted the 3109 cases aged 50+ for which cannabis was the only or primary substance. Multinomial logistic regression models were fit to examine associations between specific cannabis forms and management/care site (on site [mostly at home], at a healthcare facility [HCF], or no follow-up due to referral refusal or leaving against medical advice) and level of healthcare services for cases managed at a HCF. The results show that between 2016 and 2019, PCC cannabis cases involving older adults increased twofold, largely due to cases of cannabidiol, edibles, and concentrated extracts. Plant form and synthetic cannabinoid cases declined substantially. Compared to plant forms, synthetic cannabinoid cases had 4.22 (95% CI = 2.59–6.89) greater odds of being managed at, rather than outside, a HCF and 2.17 (1.42–3.31) greater odds of critical care unit admission. Although e-cigarette cases, compared to plant form cases, had lower odds of being managed at a HCF, HCF-managed e-cigarette cases had 3.43 greater odds (95% CI = 1.08–10.88) of critical care unit admission. Synthetic cannabinoid cases also had 1.86 (95% CI = 1.03–3.35) greater odds of no follow-up, and the presence of a secondary substance was also a significant factor. Stricter regulations for listing chemical ingredients and providing safety guidelines are needed for cannabis-derived products.

Screening instruments to predict adverse outcomes for undifferentiated older adults attending the emergency department: Protocol for a prospective cohort study

Background: The number of older adults with complex medical comorbidities and functional impairment is increasing throughout the world. Frail older adults frequently attend the Emergency Department (ED) and are at increased risk of adverse outcomes following presentation. A number of screening tools exist that aim to screen older adults for frailty and identify those at risk of functional decline, unscheduled readmission, institutionalisation and mortality. We propose to determine the predictive accuracy of four commonly used screening tools, namely the Identification of Seniors at Risk Screening (ISAR), Clinical Frailty Scale (CFS), Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA 7) and InterRAI ED, to determine adverse events at 30 days and six months among older adults who present to the ED. Methods and analysis: This is a prospective cohort study where patients over the age of 65 will have four screening tools (ISAR, CFS, PRISMA 7, interRAI ED) performed by face-to-face interview with a research nurse during their index visit to one Irish ED. Older adults will be included if they are willing and able to provide written informed consent, have a Manchester Triage Category 2-5 and are resident in the hospital catchment area. Demographic information will be collected at the index visit. A telephone follow up will occur at 30 days and six months, completed by a research nurse who is blinded to the initial assessment. Outcome data will include mortality rates, ED re-attendance, hospital readmission, functional decline and institutionalisation. We will analyse the risk of adverse outcomes using multivariable logistic regression and we will report adjusted risk ratios (RR) with 95% CI. Dissemination: Study findings will be disseminated through publication in peer-reviewed journals and presentations at relevant academic and clinical conferences. National and International gerontology conferences will be targeted.

Immersive virtual reality as physical therapy in older adults: present or future (systematic review)

Increased life expectancy leads to an increase in the number of older adults and in the prevalence of aging-associated diseases and disabilities. Active aging strategies—particularly those based on physical exercise therapy— have great positive impact on older people’s health. Virtual reality (VR) represents an innovative approach to involve and motivate patients during therapy sessions. Exergaming programs based on VR technologies and commercially available gaming platforms are amenable to therapeutic use in older adults, according to various systematic reviews and meta-analyses. The use of immersive virtual reality (IVR) in the field of rehabilitation or physical skills training in seniors is understudied.In the present systematic review, we analyze the therapeutic use and application of IVR in older adults through physical activity. We describe the populations studied, the conditions of IVR application (device, session, physical, and virtual environments), its potential benefits, and its limitations. We found that most studies are feasibility pilot experiences, where the use and acceptability of the immersive platform were evaluated. Cumulative data suggest that the use of IVR with therapeutic intent in senior populations is in early stages of clinical development and shows promise as a complementary tool in the fields of health, rehabilitation, and active aging.

Vital Involvement: Design for Active Aging

Vital Involvement (VI) in older adulthood is a construct that underlies multiple aspects of elder well-being, engagement, activity, and psychosocial health. Designers’ term “active aging” fits well within this construct, and it offers a social-science and developmental scaffolding on which to “hang”/“pin” many elements of designing (e.g., clothing, accessories, objects, spaces, and social structures) to promote wellbeing in older adults. VI provides a set of ideas, goals, and criteria that can enable professionals to conceptualize designing in order to help elders remain actively, meaningfully engaged. In addition, designing for VI can encourage increasing numbers of older adults to become more engaged, and to experience associated increased wellbeing. The VI construct complements growing interest, in the fields of bio-ethics and citizenship, in what makes a “good life” in older adulthood.

Frailty in inflammatory bowel diseases: an emerging concept.

Inflammatory bowel diseases (IBD), consisting of Crohn’s disease and ulcerative colitis, are chronic remitting, relapsing inflammatory conditions of the gastrointestinal tract. While traditionally a disease of younger ages, the number of older adults with IBD is rising rapidly. Patients with IBD often experience geriatric syndromes at earlier ages. Older adults with IBD have poorer disease and treatment-related outcomes compared with younger adults with IBD. Applying the principles of geriatrics to understanding a chronic disease in older adults may improve health span. Better tools are needed to stratify IBD patients who are at high risk for adverse events. Frailty is a geriatric construct that may approximate biologic age. Frailty is a complex, multi-dimensional syndrome that leads to increased vulnerability to stress and decline of reserve across multiple physiologic systems. In this review, we present the leading conceptual models of frailty and discuss the applications of frailty in immune-mediated diseases. We also review chronic conditions where frailty has been applied successfully as a tool for risk stratification. Finally, we discuss in the detail the growing body of literature highlighting the relationship between frailty and IBD, the epidemiology of frailty in IBD, and ramifications of frailty in IBD.

Geriatric Conditions Among Middle-aged and Older Adults on Methadone Maintenance Treatment: A Pilot Study.

The number of older adults on methadone maintenance treatment (MMT) for opioid use disorder is increasing, but little is known about the characteristics and healthcare needs of this aging treatment population. This population may experience accelerated aging due to comorbidities and health behaviors. The aim of this study was to compare the prevalence of geriatric conditions among adults age ≥50 on MMT to a nationally representative sample of community-dwelling older adults. We performed a geriatric assessment on 47 adults age ≥50 currently on MMT enrolled in 2 opioid treatment programs, in New York City and in East Providence, Rhode Island. We collected data on self-reported geriatric conditions, healthcare utilization, chronic medical conditions, physical function, and substance use. The results were compared to 470 age, sex, and race/ethnicity-matched adults in the national Health and Retirement Study. The mean age of the study sample was 58.8 years and 23.4% were female. The most common chronic diseases were hypertension (59.6%) and arthritis (55.3%) with 66% reporting ≥2 diseases. For geriatric conditions, adults on MMT had a significantly higher prevalence of mobility, hearing, and visual impairments as well as falls, urinary incontinence, chronic pain, and insomnia than the Health and Retirement Study sample. Older adults on MMT in 2 large opioid treatment programs have a high prevalence of geriatric conditions. An interdisciplinary, geriatric-based approach to care that focuses on function and addresses geriatric conditions is needed to improve the health of this growing population.

Neighborhood Age Composition and Self-Rated Health: Findings from a Nationally Representative Study

ABSTRACT Neighborhood age composition is an understudied area. Furthermore, existing empirical and conceptual work is conflicting, with some scholarship-indicating neighborhoods with older adults are beneficial and other scholarship suggesting it can be detrimental. Combining data from 7,197 older adults from the first wave (2011) of the National Health & Aging Trends Study and census tract data from the National Neighborhood Change Database, the purposes of our study were to: 1) identify the characteristics of neighborhoods experiencing different types of changes in age composition, and 2) examine the association between neighborhood age composition and self-rated health. Findings indicate that neighborhoods experiencing Concentration (where the number of older adults are declining but their percentage of the total population are increasing), the majority of which are in urban areas, have less aggregate economic resources, more indicators of neighborhood disorder, and less access to services and supports. Regression models also suggest older adults living in Concentration neighborhoods reported lower self-rated health compared to those living in the other three neighborhood types. Findings point to the importance of considering neighborhood age composition when targeting interventions and resources, and the potential consequences of being stuck in place in a neighborhood that does not meet elders’ needs.

Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing

Advanced practice nurses (APRNs) make significant contributions to the mental health of older adults. Despite the surge in the number of older adults, the number of APRNs choosing educational preparation for geropsychiatric nursing (GPN) is limited. The purpose of the GAPNA GPN Position Statement is to sustain a new vision for the nursing profession that will improve the care of older adults with psychiatric and mental health disorders. This position paper was written by a diverse group of APRNs with the collective intent to reflect respect, decrease stigma, remove controversy, and uphold a positive, person-centered approach to mental disorders among older adults and their families. The GAPNA GPN Position Statement was written to advance excellence in the GPN subspecialty, provide holistic care for older adults and make recommendations for practice. Blending gerontological and psychiatric nursing results in a subspecialty at the top of the APRN Consensus Model pyramid.

Chinese American Caregivers of Older Adults With Alzheimer’s Disease and Other Dementias: A Scoping Review

With the rapid growth of aging populations, the number of older adults with dementia is increasing worldwide. While there is a significant amount of research on dementia caregivers, we know very little about Chinese American (the largest subgroup of the Asian American population in America) caregivers. Therefore, the aims of this study are to 1) conduct a scoping review by identifying existing studies on Chinese American dementia caregivers, 2) present the current state of the science on Chinese American dementia caregiving, and 3) provide direction for future research. Twenty-one studies were included in the final review with 3 main themes synthesized (care experience, utilization of programs/services, and recruitment for caregivers). Care experience included illness perception towards Alzheimer’s Disease and related dementia (ADRD) such as stigma and normalization of the disease process. Filial piety was another important cultural belief underpinning care experience. An underutilization of supportive programs/services among this population was identified. Additionally, the few existing programs/services for Chinese American caregivers as well as the barriers encountered when seeking these programs/services were seen in the literature. The strategies and barriers of the included research articles for recruitment of Chinese American caregivers are also discussed in this study. These findings provide an overview of the current knowledge about Chinese American caregivers and serve as a stepping stone for future studies on similar populations in promoting caregiver’s health and developing culturally sensitive caregiver support services.

Overcoming Ethical Challenges in Conducting Research Among Persons With Dementia

By 2060, the number of older adults with Alzhemier’s Disease or related dementias (ADRD) is expected to encompass approximately 13.9 million Americans. Recognizing this, the federal government has prioritized research on ADRD and their effect on the physical, emotional, and psychological well-being of persons with dementia (PWD). Such research is complicated by disease-associated decline in cognitive and functional capacity among PWDs which can impair participant ability to process and communicate information, potentially increasing their exposure to negative research-related experiences and compromising the accuracy and reliability of provided data. Nevertheless, as a key stakeholder group, PWD should have the right to participate in research on ADRD. This session will present a case study of ethical issues that emerged in an NIH-funded study utilizing mixed-methods to examine caregiving and care dyad relationships between PWD and their care partners over an 18-month follow-up period. Ethical issues examined will include: (1) PWD capacity to consent to research at baseline and (2) during follow-up visits, (3) Obtaining accurate and reliable data from persons with mild to moderate dementia, (4) Assessing PWD distress while engaging in data collection processes, and (5) Reporting of negative caregiving and life experiences, such as elder mistreatment. The discussion of these topics and presentation of lessons learned holds promise for improving research methodology in studies involving PWD and enabling researchers to increase the involvement of persons with mild to moderate dementia in research on ADRD.

Preparing Students to Interact With Persons With Dementia in a Research Context

By U.S. Centers for Disease Control and Prevention estimates, the number of older adults with Alzheimer’s Disease and related dementias (ADRD) is expected to increase 278% by 2060 to affect approximately 13.9 million individuals. Research is needed to not only improve understanding and treatment of ADRD but to also study its effect on the physical, emotional, and psychological well-being of persons with dementia (PWD) and their care partners (CP). However, due to the diminishing cognitive and functional capacities of PWDs associated with the progression of ADRD over time, research efforts are sometimes hampered by a plethora of potential scientific, logistical, ethical, and emotional barriers. This session will introduce an educational approach used to train students who are interested in conducting in-home research among PWDs and their CPs and share lessons learned through the program’s pilot training of undergraduate and graduate students (N=6). Through didactic training, role-playing exercises, and experiential learning processes, trainees are equipped to accompany research project interviewers into the homes of PWD and assist in implementing research protocols. Students receive extensive training in the disease trajectories of ADRD, the impacts of disease on PWDs and their CPs, ways to communicate and interact with PWDs, best practices in promoting the protection and autonomy of human subjects with dementia, and approaches to obtaining quality data for research.

Improving Healthy Behavior and Adopting Healthy Habits by Bodywise Program for Older Adult DC Residents

An increase in physical activity (PA) level is associated with reduction in chronic diseases. However, the number of older adults who meet the PA guideline is low and decreases with age. Bodywise is a free program that aims to promote healthy behavior and to encourage older adults who live in Washington, DC to adopt a healthy habit by increasing their PA. The Bodywise program offers water aerobics, yoga, low-impact aerobics, and chair exercise classes, conducted by trained instructors at the University of the District of Columbia. This study reports an evaluation of the implementation of this program based on the surveys completed by participants after finishing the classes. Participants were DC residents aged 60 or older. According to the surveys, 68% of participants have adopted one or more healthy habits since joining the Bodywise program. In addition, more than 62% of participants have an increase in awareness of healthy behavior through this program. Overall satisfaction with the Bodywise program is 93%, satisfaction with the variety of classes offered is 72% and satisfaction with offered skill levels is 75%. Furthermore, 81% of participants reported overall satisfaction with their instructor, specifically 100% satisfaction related to their knowledge and skill level, and appropriateness of selected music, moves, and exercises. In conclusion, the Bodywise program leads to an overall change in both awareness of healthy behavior and development of healthy habits in participants. Further research can investigate the correlation of health awareness and healthy habits with overall satisfaction with the program and the instructor.