Number Of Older Adults Research Articles

INFLUENCES OF CAREWORK INTENSITY ON DAILY TIME USE PATTERNS OF CAREGIVERS

With the aging of the Baby Boom generation, increasing numbers of older adults require assistance in their daily lives and most help comes from family members. Delays in childbearing mean many adult elder care providers are simultaneously raising children. Although past research has documented disparities in psychological distress and financial costs, less is known about the social costs resulting from elder caregiving and how this varies by parental status. We examine the social costs of elder caregiving by comparing elder and child care configurations to investigate three questions. First, do the daily time use patterns of elder caregivers differ by parental status? Second, do the daily time use patterns of elder caregivers differ by caregiving intensity? Third, does caregiving intensity moderate associations of elder caregiving and parental status on daily time use? We address these questions using nationally representative time diary data from the 2011-2017 American Time Use Survey (ATUS).

IDENTIFYING COMMUNITY PARTICIPATION CHALLENGES FOR ADULTS AGING WITH MOBILITY AND VISION DISABILITIES

There are growing numbers of older adults with mobility and vision disabilities acquired in early to mid-life who are a part of a population described as “aging with disability”. For these individuals, the addition of normative age-related declines (e.g., vision loss, arthritis) on top of a long-term disability can create extensive barriers to community participation. We present findings on activity challenges with community participation among older adults with long-term vision and mobility disabilities (N=120) from the Aging Concerns, Challenges, and Everyday Solution Strategies (ACCESS) interview study. Results provide detailed insights on the specific task-based challenges experienced when engaging in one’s community (e.g., going to entertainment events, doing activities with a group or organization, and participating in religious services and activities) as well as the solutions and strategies employed to overcome those challenges. Findings provide guidance for the design of supportive technologies that promote participation and independence for this understudied population.

INTERPROFESSIONAL SKILLS AND CULTURAL AWARENESS OF STUDENTS CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

Based on rapidly increasing numbers of older adults and growing populations of culturally diverse citizens, we developed and provided an interprofessional education program for graduate nursing and social work students that focused on the delivery of care to older adults and veterans with multiple chronic conditions. The students participated in multiple activities together over a year long period. Activities included an introductory IPE day with all students together and simulated patient cases that had required roles for the students’ specialties. Knowledge and skills of interprofessional collaborative practice were measured with the Interprofessional Self Assessment Competencies (IPEC) and Assessment of Interprofessional Team Collaboration Scale (AITCS). We also measured attitudes toward cultural differences using the Cultural Awareness Scale (CAS). The entire project was repeated a second year with a second cohort of students. Overall, our students were better able to understand and work collaboratively with other health care professionals after participating in this program. Regarding cultural awareness, both NP and SW students were more aware of and comfortable with cultural differences after participating in the program. After one year of experience, we wanted to know more about our students’ skills and attitudes. Focus groups were added to the design to dive deeper into the students’ perceptions about which activities were most impactful and recommendations for future IPE activities. This paper will describe these data and implications for future planning of more effective interprofessional and cultural programming for students caring for older adults and veterans.

BARRIERS AND FUTURE DIRECTIONS FOR SUFFICIENT ACADEMIC RESEARCH ON HOME MODIFICATION FOR OLDER ADULTS IN CHINA

Home modification has been perceived as an effective method to make current dwelling units more age-friendly and improve the well-being of older adults. In China, a country with an increasing number of older adults, home modification research is still in its infancy. By typing “适老化改造” (home modification for older adults) as a keyword for the theme of articles in China National Knowledge Infrastructure (CNKI), the most authoritative and comprehensive database for academic publication in China, only 158 related papers are found to be published until the end of 2017, among which the first was published in 2009. With an aim to determine the current state of home modification research in older adults and to determine what could be done to facilitate sufficient research on this topic, the present study conducted a systematical review of the 158 papers about home modification for older adults published in China between 2009 and 2017. Based on the systematical review, the present paper identifies four barriers to conducting this line of research and puts forward six practical suggestions for future research studies in this area so as to contribute to building age-friendly dwellings and promoting age-friendly China.

A MUSIC AND MINDFULNESS INTERVENTION FOR PERSONS WITH DEMENTIA AND THEIR CAREGIVERS

The number of older adults with Alzheimer’s Dementia is projected to increase by 28.6% in Florida by 2025. Cost-effective non-pharmacological interventions targeting both persons with dementia (PWD) and their family caregivers (FCs) are urgently needed. This small pilot study tested the feasibility of a music and mindfulness intervention in an assisted living community (ALC) in Tampa, FL. Methods: We used a mixed-methods single group pre-post study design. To date, a total of 5 PWD and 3 FCs were enrolled, and all completed the 4-week intervention (12 sessions for PWD and 4 sessions for FCs). Outcome measures include behavioral symptoms and sleep quality for PWD, and mindfulness, sleep quality and perceived stress for FCs. Outcome data were collected via survey questionnaires and focus group interviews (FCs and staff). Results: Preliminary analysis showed that the intervention is well-received by PWD, FCs, and ALC staff. PWD participants experienced a reduction in behavioral symptoms post-intervention (Cohen’s d=0.33). FC participants reported increased mindfulness and reduced stress. In focus group interviews, both FCs and staff corroborated the positive findings in residents’ mood and behaviors. Barriers to large scale implementation include intervention time commitment (ALC staff) and scheduling difficulties due to work (FCs). Both FCs and ALC staff recommended the continuation of the intervention and making it available to all memory care residents. Based on the initial results, additional testing of the intervention is currently in progress (10 PWD) and updated results will be reported. Implications for conducting community-based non-pharmacological interventions will be discussed.

LINKS BETWEEN LONELINESS AND HAPPINESS IN JAPAN’S AGING POPULATION

Fertility rates in Japan have been historically low over several decades while life expectancy remains among the highest in the world. Consequently, traditional social networks consisting of immediate family and relatives have shrunk, and a growing number of older adults in contemporary Japanese society report feeling lonely. Thus, the well-being of Japans aging population is a major concern. While the negative effects of loneliness on perceived well-being (e.g., happiness) in later life have been well documented in western nations, relatively little is known from a Japanese context. Thus, we utilized a sample (n = 258) of urban community-dwelling Japanese adults age 65 years and older from the 2012 Survey of Mid-Life in Japan (MIDJA) to examine the association between happiness and loneliness. Consistent with findings from western nations, we identified strong links between happiness and loneliness in Japan. Results from ordinal logistic regression models showed that loneliness (OR = 0.80, p < 0.05) was negatively associated with happiness even after accounting for sociodemographic characteristics. Additionally, this study examined relevant demographic and cultural characteristics in order to contextualize the findings and identify possible explanations. For example, the cultural importance of family ties and gendered family roles was discussed in relation to the likely impact that increased levels of loneliness will have on the well-being of older Japanese adults. In sum, if the well-being of Japan’s rapidly aging population is to be maintained (or possibly even enhanced), then the growing societal issue of loneliness must be addressed.

COGNITIVE AND HEARING IMPAIRMENTS IN OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY

As the number of older adults increases, increased prevalence of cognitive and sensory impairments pose growing public health challenges. Research on the relationship between hearing impairment and cognition, however, is minimal and has yielded mixed results, with some studies finding that hearing impairment is associated with cognitive decline, and others reporting that the association is weak or non-existent. Most of this research has been conducted outside of the U.S., and the few U.S.-based longitudinal studies have relied mostly on small, non-representative samples involving short follow-up periods. Further, despite known gendered patterns in cognitive and hearing impairments, no studies to date have examined whether the relationship between the two varies by gender. Our study addresses these weaknesses in the literature by utilizing nine waves of the Health and Retirement Study (1998-2014; n=14,169), a large, nationally representative, longitudinal study that facilitates examination of long-term interrelationships between hearing and cognitive impairments. In this study, we use autoregressive latent trajectory (ALT) methods to model: 1) the relationship between hearing impairment and cognitive decline, and 2) sex differences in the relationship. ALT models enable us to determine whether hearing impairment and cognitive impairment are associated, net of their common tendency simply to co-trend with age. Results indicate that hearing and cognitive impairments are strongly interrelated processes that trend together over time. Moreover, hearing impairment has an increasing impact on cognitive impairment across age while the effect of cognitive impairment on hearing impairment levels out over time. Sex differences in these patterns are discussed.

THE FEASIBILITY OF USING COMMUNITY PHARMACISTS TO COUNSEL OLDER ADULTS ON FALL PREVENTION

Despite recognition as a serious public health problem, older adults falls increased 30% between 2007-2016. Numerous evidence-based fall prevention programs exist, but may have inadequate reach. Pharmacists are highly trained and accessible clinicians who have potential to counsel on fall prevention. This study describes the reach of a fall prevention outreach conducted by a large national pharmacy chain in partnership with local area agencies on aging (AAAs). On August 7, 2018, the pharmacy chain held an outreach during which older patients were incentivized to speak with pharmacists about their fall risk and prevention strategies. In Ohio, AAAs provided pharmacists additional support and availability of AAA fall prevention programs. A random sample of pharmacists was sent a follow-up survey to assess the program’s reach, except in Ohio where all pharmacists received the survey. Response rates were 41% (N=111) and 59% (N=160) in Ohio and non-Ohio states, respectively. We estimate that pharmacists discussed fall prevention with an additional 57,642 on 8/7/2018. The difference in older patients counseled on fall prevention on 8/7/2018 vs. a typical day was significantly greater (p=0.03) for Ohio pharmacists (µ=9.28) compared to non-Ohio pharmacists (µ=5.94). The majority of pharmacists in Ohio and non-Ohio states were moderately or extremely confident in their ability to discuss fall prevention with older patients (69.82% vs. 72.72%) and play an important role in fall prevention (59.75% vs. 54.54%). This study demonstrates the feasibility of utilizing community pharmacists, in partnership with AAAs, to reach large numbers of older adults to counsel on fall prevention.

WHAT SHAPES ADULT SONS’ INCENTIVE FOR PARENT CARE IN JAPAN? EFFECTS OF WORK AND FAMILY CIRCUMSTANCES

In Japan, because of marked sociodemographic shifts such as a growing number of older adults in need of care and fewer siblings in younger generations, adult sons are increasingly likely to be called upon to meet parental care needs while at working age. Using data from 1,183 employed men (M age = 44.6), our aim in this study was to explore work- and family-related factors that affect their incentives for parental caregiving, a potential component of their psychological preparedness for fulfilling care responsibility. Specifically, focusing on these sons’ workplace environment, living arrangements, and the quality of relationship with parents, we sought to identify whether and how these factors influenced their desire to provide different types of care (e.g., domestic help, ADL assistance). Regression analysis revealed differential associations between work- and family-related factors and sons’ desire for parental caregiving depending on type of care and parents’ gender. For their desire to provide domestic help and attend parents when seeing a doctor, live-in sons were more likely to desire to provide care regardless of parents’ gender. Whereas the quality of parent-child relationships was significantly associated with their desire to care for both parents, whether they had a supervisor to talk with about family issues had a significant effect only on that for their mother. On the basis of these findings, we discuss workplace needs for support to help sons continue work when they need to provide care.

DESIGNING TECHNOLOGY TO SUPPORT HEALTHCARE FOR AGING ADULTS

Healthcare costs are rising in industrialized countries, partly as a function of managing costly chronic care conditions associated with aging populations. Of roughly 3 trillion USD expended in the U.S., almost 90% is spent on those with chronic conditions. Technology is touted as one tool to manage healthcare efficiently. However, human factors research has shown that technological systems that do not take human capabilities into account will fail to be adopted, or if adopted, will be abandoned by users. The Center for Research and Education on Aging and Technology Enhancement (CREATE) will describe research findings for four different facets of healthcare technology. Sara Czaja will provide an overview, describing technology for healthcare support. Caregiver needs are projected to rise rapidly, in part due to aging of the baby boom cohorts. We need new solutions for future generations of older adults as there will be insufficient numbers of caregivers to care for the increased number of older adults given changes in social structures. Wendy Rogers will discuss research on the design and use of televideo and robots to assist with healthcare. Neil Charness will discuss home monitoring technology, particularly practical issues around design, deployment, and maintenance, drawing on studies of heart failure patients and older adult controls. Walter Boot will discuss how gamification of healthcare interventions can help to address the adherence problem for behavior change. Scott Beach, Associate Director & Director of Survey Research Program, University Center for Social and Urban Research, University of Pittsburgh, will serve as discussant.

FACTORS ASSOCIATED WITH HOSPITAL-TO-HOME DISCHARGE: USING A DECISION TREE ANALYSIS

Because the number of older adults discharged home is increasing, a comprehensive geriatric assessment (CGA) becomes a helpful tool to make a decision about discharge destination. This study aimed to examine the predictors related with discharge destination using the component of CGA. We used decision tree analysis with the Classification and Regression Trees algorithm. Study participants were older adults over 65 years old who were admitted to geriatric department at a university-affiliated hospital in Korea. The older adults were assessed by multi-professional team at the initial stage of their hospitalization and received blood tests and the CGA. A total of 184 patients was included. The mean age was 84.6 years old and 61.6% were female. The analysis revealed arm circumference and level of frailty were significant predictors of home discharge. Specifically, 90.1% of patients had discharged home if their upper arm circumference was more than 18.3 centimeters, and 36.4% was discharged home if it was less than 18.3 centimeters. Among older adults with the arm circumference more than 18.3 centimeters, 57% of robust older adults and 91.7% of prefrail or frail older adults were discharged home. These robust older adults had relatively better daily living ability, and discharged to other facilities rather than home for rehabilitation. As many frail older adults are discharging to their own home, clinicians need to pay more attention to them. Also it is encouraged to perform the CGA, which includes nutritional assessment in it, for inpatient older adults.

SEQUENTIAL IMPLEMENTATION AS A LEARNING HEALTH ORGANIZATION: THE EQUIPPED GERIATRIC MEDICATION SAFETY MODEL

A learning health organization (LHO) is one that systematically integrates internal data and experience with external evidence to improve internal healthcare practice. Yet collaborative research networks implementing evidence-based interventions across sites with the goal of widespread dissemination are also effectively LHOs. The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) network formed to address an important public health issue: potentially inappropriate medications (PIMs) prescribed to older adults at discharge from hospital Emergency Departments (ED). EDs nationwide serve increasing numbers of older adults but lack clinical decision support to avoid prescribing PIMs associated with adverse events including hospitalization and death. The EQUIPPED geriatric safety program was adapted from the VA and implemented sequentially at three different academic institutions sharing the same electronic health record (Epic)(AHRQ R18HS24499). Implementation challenges, solutions, and innovations informed successive iterations. Using the Replicating Effective Programs framework, we conducted a process evaluation using data from implementation team focus groups (n=3), meeting minutes (n=98 hours), and organizational profiles (n =3) to understand how organizations working together within a research network build an intervention package for program scale-up. We present structural characteristics of the three organizations, implementation steps as they developed across three sites, and the resulting process protocol and a prototype toolkit. Lessons learned include having multiple internal champions at the intervention site, observing workflow pre-intervention, and streamlining data collection with a relational database and visualization software. Insights from the EQUIPPED experience can serve as a model for other systems and collaborative networks.

BOSTON AGING TOGETHER STUDY: ATTITUDES TOWARD OWN AGING AMONG OLDEST-OLD PARENTS AND CHILDREN

One consequence of modern longevity is the growing number of older adults with very old parents. While family members are often interdependent in their development and aging, less is known about how intergenerational relationships may influence individuals’ attitudes toward their own aging in later life. Using 70 dyads of oldest-old parents (Mage = 93) and their children (Mage = 67) from the Boston Aging Together Study, we examined the dyadic concordance in positive attitudes toward own aging, and how perceptions of giving and receiving care are associated with attitudes toward own aging for parents and children. On average, parents reported more negative attitudes toward own aging than did children. In less than half of all dyads (46%), both parents and children reported positive (i.e., score three or higher on a scale that ranged from one to five) attitudes toward own aging. T-test results showed that the dyads with positive attitudes toward own aging had more within-dyad age difference, better average self-rated health, fewer depressive symptoms and less loneliness than others. For children, higher level of caregiver’s burden was associated with more negative attitudes toward own aging. For parents, perception of received support was not associated with their attitudes toward own aging. This study sheds light on how both individual and family characteristics may influence individuals’ aging perceptions. Findings suggest the context of parent-child ties may particularly be relevant to those older adults who may have to deal with their own aging- related challenges as well as those of their parents.

LIFE RESTORATION AND CARE PREPARATION AMONG OLDER PARENTS WHO LOST THEIR ONLY ADULT CHILD IN SHANGHAI

The combination of aging and losing an only adult child challenges an increasing number of older adults in China. Current literature primarily focuses on older parents’ bereavement but seldom examines how they restore their lives. Guided by the Dual Process Model, this study explores how older parents who lost their only adult child restore their lives and prepare for future care in Shanghai. Twenty-four older adults were purposively sampled and participated in face-to-face, in-depth interviews. The findings suggest that participants tried to restore their lives by rationalizing grief and expanding their social networks. Despite their losses, participants remained in favor of family caregiving and reluctantly prepared for future care. They showed ambivalent attitudes toward current government support while proposing their preferred services. This study informs social work practice to incorporate caregiving plan services and emotional support for this vulnerable group.

SLEEP APNEA ASSOCIATED COMORBIDITIES AND MORTALITY IN AN OLDER VETERAN POPULATION

Evidence continues to mount that sleep apnea (SA) occurs in 10-25% of Americans and is associated with significant morbidity and mortality (Schulman 2018). Among veterans, SA has been reported four times more often as compared to other non-veteran cohorts. (Wong 2015). The risk of developing dementia is increased in older individuals with OSA (Shastri, Bangar, & Holmes, 2015). The prevalence and characteristics of older adults with dementia and sleep apnea is not well known and long-term population-based studies on mortality have been lacking. Recent studies have reported overall mortality rates of 19%, in those individuals with SA, an increased rate of 1.5-3 times the mortality rate as compared to those individuals those without SA. Current recommendations support SA screening of high risk individuals including those with symptoms of snoring, fatigue, memory and concentration problems and mood changes. (Krist 2018). Despite a large number of older adults with suspected SA and comorbidities, the majority are not screened, referred, diagnosed and treated. In this VA pilot study of outpatient older male veterans with dementia and SA, N=195, mean age 75.83 years, SD=9.1, 51.3% were white, 37.5% were black. Frequently found comorbidities were: hypertension 88%, congestive heart failure 41%, Diabetes. 62% and, stroke 21%. Of note, among those who died, SA was significantly related to congested heart failure (r=.32, p<.001) and COPD (r=.40, p<.001). The overall mortality rate of 27% was higher than previous reports. Further investigation is needed to better understand the relationship between comorbidities, and SA, screening, treatment and mortality.

FUTURE CARE PLANNING AND END-OF-LIFE CARE DECISION MAKING: INDIVIDUAL AND SOCIAL INFLUENCES

As a growing number of older adults reach very old age, future care planning and end-of-life care decision making becomes increasingly important. Previous studies have shown that concrete future care planning steps are related to improved ability to manage illness and to better mental and physical health outcomes among older adults. Yet, relatively few older adults sufficiently plan for their future care. The purpose of this symposium is to highlight a collection of studies that each brings a unique perspective to the issue, reporting on individual and social factors that influence future care planning, end-of-life care decision making, and strategies to enhance future care planning among older adults. First, Chen and Siconolfi address common barriers and facilitators across diverse domains of age-related planning using content analysis. Second, Boerner and colleagues focus on the completion of formal planning without discussing the contents and factors associated with formal planning completion. Third, Strum investigates the complexities of navigating “fair” later life decisions involving family resources. Fourth, Moorman examines the racial differences in decisions of euthanasia and physician assisted suicide. Finally, Lee and colleagues report the findings from a future care planning intervention with older adults in rural area. The discussion by Sörensen will integrate the five papers with the goal of connecting the current evidence for meaningful steps in research and practice related to future care planning in older populations.

TECHNOLOGICALLY MEDIATED INTERVENTIONS IN HOSPICE AND PALLIATIVE CARE: CONSIDERATIONS FOR RURAL ELDERS

Rural communities are home to a disproportionate number of older adults, many of whom are living with a serious illness or providing care to a seriously ill family member or friend. For these individuals, hospice and palliative care services can provide much-needed biopsychosocial and spiritual support, leading to an enhanced quality of life. Technologically-mediated interventions hold promise as a strategy to bridge geographic distances between healthcare providers and rural elders; however, the effect of such interventions may be greater when they are designed in a manner congruent with rural culture and compatible with the technological infrastructure common in rural areas. Informed by lessons learned during a pilot study of a telehealth intervention in one Midwestern state (R21CA191165), this presentation includes a discussion of strategies to more effectively recruit, engage, and retain rural older adults into studies testing technologically-mediated interventions for hospice and palliative care patients and their families.

Automated Speech Recognition Systems and Older Adults: A Literature Review and Synthesis

The number of older adults is growing significantly worldwide. At the same time, technological developments are rapidly evolving, and older populations are expected to interact more frequently with such sophisticated systems. Automated speech recognition (ASR) systems is an example of one technology that is increasingly present in daily life. However, age-related physical changes may alter speech production and limit the effectiveness of ASR systems for older individuals. The goal of this paper was to summarize the current knowledge on ASR systems and older adults. The PRISMA method was employed and 17 studies were compared on the basis of word error rate (WER). Overall, WER was found to be influenced by age, gender, and the number of speech samples used to train ASR systems. This work has implications for the development of future human-machine technologies that will be used by a wide range of age groups.

Is Testosterone Replacement Therapy in Older Men Effective and Safe?

The number of older adults over 65 years of age is expected to increase to almost 100 million in the US by 2050, more than double the current figure of 46 million. Advanced age is associated with increased frailty among older Americans and often leads to increased disability, hospitalization, institutionalization, and, eventually, mortality. In search of means to improve age-related risks for adverse health outcomes, the question of restoring diminishing sex hormones has gathered much interest and has led to the practice of sex hormone replacement therapies in older men. Recent data suggest that androgen prescription rates in the US for men older than 60years of age quadrupled from the years 2001 to 2011. While prescription sales of testosterone have increased from $150 million in 2000 to $1.8 billion in 2011, a significant portion of men prescribed testosterone replacement therapy did not meet the laboratory criteria for hypogonadism. While some clinical trials reported an association between testosterone insufficiency in older men and increased risk of death, the exact effects and consequences of testosterone replacement therapy, specifically in older men, remain unclear. This review is aimed at discussing the possible benefits and complications of testosterone replacement therapy in older men over 60 years of age.

Wireless Sensor Network for Fall Prevention on Geriatric Wards: A Report.

With regard to the growing number of older adults, it needs smart solutions for fall prevention. Especially at geriatric institutions, the risk of falling is very high and frequently leads to injuries, resulting in serious consequences. We present the Inexpensive Node for Bed Exit Detection (INBED), a comprehensive signaling system for fall prevention. The INBED system is based on a wireless sensor network infrastructure via IEEE802.15.4 and highly-specialized open hardware in-house developed wearable. The device, which will be attached to the patients, can detect several types of movement. Occurring events are forwarded to the nursing staff immediately by using the self-organizing and scalable network including wide area network integration. The system can help to relieve the staff while the personal freedom of movement and privacy of patients is increased. With this development, the energy-efficient, simple and intuitive mechanisms of proximity communication can be combined with broadband benefits.