Old-old Adults Research Articles

Clarifying the Actual Situation of Old-Old Adults with Unknown Health Conditions and Those Indifferent to Health Using the National Health Insurance Database (KDB) System

Background/Objectives: This study aimed to investigate the actual situation of individuals with unknown health conditions (UHCs) and those indifferent to health (IH) among old-old adults (OOAs) aged 75 years and above using the National Health Insurance Database (KDB) system. Methods: A total of 102 individuals with no history of medical examinations were selected from the KDB system in a city in Japan. Data were collected through home visit interviews and blood pressure monitors distributed by public health nurses (PHNs) from Community Comprehensive Support Centers (CCSCs). The collected data included personal attributes, health concern levels, and responses to a 15-item OOA questionnaire. Semi-structured interviews were conducted with seven PHNs. The control group consisted of 76 users of the “Kayoinoba” service (Kayoinoba users: KUs). Results: Of the 83 individuals who could be interviewed, 50 (49.0%) were classified as UHCs and 11 (10.8%) were classified as IH, including 5 from the low health concern group and 6 who refused to participate. In the word cloud generated from the PHNs’ interviews, the words and phrases “community welfare commissioner”, “community development”, “blood pressure monitor”, “troublesome”, “suspicious”, and “young” were highlighted. In the comparison of health assessments between UHCs and KUs, “body weight loss” and “cognitive function” were more prevalent among KUs, and “smoking” and “social participation” were more prevalent among UHCs. Conclusions: The home visit activities of CCSCs utilizing the KDB system may contribute to an understanding of the actual situation of UHCs, including IHs, among OOAs. UHCs (including patients with IH status) had a higher proportion of risk factors related to smoking and lower social participation than KUs.

Development of a Predictive Model for Chewing Difficulty Using EuroQol-5 Dimension Among Korean Older Adults.

We aimed to develop a predictive model for chewing difficulty using the EuroQol-5 dimension measure (EQ-5D). We included 6643 individuals aged ≥ 65 years (mean age: 72.6 ± 4.96 years; women: 3761 [56.6%]) who had completed the sixth (2013-2015) and seventh (2016-2018) Korea National Health and Nutrition Examination Survey (KNHANES). The participants were further divided into young-old (65-74 years) and old-old (≥ 75 years) adults. Data from the sixth KNHANES were used to establish an internal validation model (overall, young-old and old-old adult populations were 3472, 2271 and 1201, respectively). Data from the seventh KNHANES were used to establish an external validation model (overall, young-old and old-old adult populations were 3171, 1879 and 1292 participants, respectively). We evaluated chewing difficulty using the EQ-5D (Model 1) and comparative models, subjective oral health status indicators (SOHSI) and objective oral health status indicators (OOHSI). Compared with SOHSI and OOHSI, EQ-5D showed similar predictive utility for chewing difficulty in both the internal and external validation models. Effect sizes, quantified using Cohen's d, indicated that EQ-5D parameters had a moderate impact on the prediction accuracy for chewing difficulties.

Is There a Link Between Older Adults' Frequency of (Face-to-Face and Remote) Contact with Grandchildren and Cognitive Functioning over 12 Years?

Past research has linked more frequent social contacts with better cognition and slower cognitive decline in older adults. An open question is whether face-to-face and remote contact with one's grandchildren can be beneficial. We analyzed data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) covering a span of 12 years and two age cohorts (young-old < 78, N = 1100; old-old ≥ 78 years, N = 705). We used latent growth curve models, to examine whether frequency of face-to-face or remote grandchild contact was associated with cognitive levels and decline and applied (random intercept) cross-lagged models to investigate if these associations were reciprocal. Face-to-face contact with grandchildren was positively linked to levels of cognition in young-old adults only. We found no associations with cognitive decline. Results of cross-lagged models suggested that grandparents with better cognition had more face-to-face (for young-old adults only) or remote (for old-old adults only) grandchild contact at subsequent waves. However, more grandchild contact was not associated with later cognition. Our findings suggest that grandparents with better cognition engage more with their grandchildren, but that frequency of grandchild contact is not a protective factor against later cognitive decline in older adults.

Changes in health-related quality of life in young-old and old-old patients undergoing elective orthopedic surgery: A systematic review.

There is a significant gap in research exploring changes in postoperative health-related quality of life (HRQoL) among patients aged 65 years and older undergoing hip or knee arthroplasty. To investigate the variations in HRQoL improvement, as evaluated by patient-reported outcome measures following total hip arthroplasty, total knee arthroplasty, and partial knee arthroplasty between the young-old and old-old adults. We searched six online databases (including MEDLINE, Embase) from their inception dates to May 15, 2023. We included studies using a validated HRQoL assessment tool to evaluate changes in HRQoL in patients aged ≥65 years undergoing hip or knee arthroplasty. These include the EuroQol five-dimension (EQ-5D), Short Form 36 (SF-36) and Short Form 12 (SF-12). The primary outcomes were postoperative HRQoL changes between young-old (65-74 years) and old-old groups (≥75 years). The secondary outcomes included complications, length of stay, and mortality. The search yielded 12,229 articles; twelve studies (n = 103,613) were included. Studies using EQ-5D found no significant differences between young-old and old-old patients after hip and knee arthroplasty. Analyses of SF-36 and SF-12 scales showed no significant age-related differences in postoperative improvements in physical and mental health. Our review of four studies that included multivariable analyses revealed inconsistent associations between age and EQ-5D. Comparisons between the young-old and old-old age groups in postoperative complications, hospital length of stay, and mortality revealed no associated age-related changes in HRQoL. The young-old and old-old patients exhibited comparable improvement in HRQoL following hip or knee arthroplasty. The older patients did not have higher postoperative complications rates, longer hospital length of stay, and increased mortality. While chronological age should be considered when planning hip and knee arthroplasty, greater emphasis should be placed on assessing the comorbidities and functional status of patients.

The Life-Space Mobility of Community-Dwelling Older Adults is Associated With Personality Traits.

Life-space mobility (LSM) in older adults is influenced by physical, cognitive, and psychological states. However, the relationship between LSM and personality traits remains unclear. Thus, our cross-sectional study investigated this correlation, which included 144 participants aged ≥60years. LSM was assessed using the life-space assessment (LSA), and personality traits were evaluated using the Japanese version of the Ten-Item Personality Inventory (TIPI-J). Physical data were also collected. Univariate analyses revealed that among young-older adults, extroversion in the TIPI-J showed a significant association with LSA scores in addition to handgrip strength. Among old-older adults, openness to experience in the TIPI-J demonstrated a significant association with LSA scores in addition to quadriceps strength. This study revealed correlations between personality traits (extroversion and openness to experience) and LSM, in addition to physical function. Considering older adults' personality traits is crucial for designing support and interventions to maintain and expand LSM.

Psychometric Properties and Measurement Invariance of the Awareness of Age-Related Change Short Form in Older Adult Samples From Taiwan and Germany.

This study examined the psychometric properties and measurement invariance of the 10-item Awareness of Age-Related Change Short Form (AARC-SF) questionnaire in a Chinese-speaking sample of older adults in Taiwan. Data from 292 participants (Mage = 77.64 years) in the Healthy Aging Longitudinal Study in Taiwan cohort were used for Study 1, whereas data from young-old adult samples in Germany were used for Study 2. Study 1 showed that the AARC-SF had satisfactory reliability and validity for assessing adults' AARC in Taiwan. Analyses confirmed the 2-factor structure of AARC-gains and AARC-losses. Study 2 demonstrated strong measurement invariance across men and women, whereas direct comparisons of the item scores between young-old adults and old-old adults need to be made with caution. Noninvariance of loadings indicated that certain items were more closely linked to AARC-gains and AARC-losses in Taiwan than in Germany. Noninvariance of intercepts suggested potential biases in comparing item scores between Taiwanese and German older adults. The AARC-SF emerged as a reliable and valid instrument for capturing positive and negative subjective aging experiences among Taiwanese older adults. However, it is noteworthy that some items on the AARC-SF may solicit different responses from individuals of different ages and different countries of origin, requiring caution with age group and cross-cultural comparisons.

Comparative analysis of successful aging in young-old and old-old adults based on Rowe and Kahn’s model: A secondary data analysis

Comparative analysis of successful aging in young-old and old-old adults based on Rowe and Kahn’s model: A secondary data analysis

Impact of Psychological Characteristics and Digital Literacy on Depression in Young-Old and Old-Old Adults

Impact of Psychological Characteristics and Digital Literacy on Depression in Young-Old and Old-Old Adults

Aging well in an aging society: physical health in older lesbian, gay, and bisexual adults.

Older sexual minority people meet a double stigma in our society related to their sexual identity and chronological age. The present study explores how experiences of discrimination and prejudice, coming out, and personal resiliency influence physical health of older lesbian, gay, and bisexual (LGB) adults. Respondents were recruited through online advertisements and an online-based survey. The sample included 82 Italian cisgender LGB adults over 65 years: young older adults (65-70 years; 78%) and old-old adults (over 71 years; 22%). Regarding sexual orientation, the sample was composed of sexual minority women (n = 30; 37%) and sexual minority men (n = 52; 63%). ANOVAs' findings showed that sexual minority women described lower levels of physical health compared to sexual minority men. At the same time, old-old adults reported higher experiences of discrimination and prejudice compared to young older adults. Moreover, findings from hierarchical multiple regression analysis described that coming out, higher levels of personal resiliency, and fewer experiences of discrimination were predictors of physical health, regardless of age and sexual minority categories. These findings seem to align with previous studies that underline the relevance of investigating aging well in sexual minority people. Knowledge and awareness of LGBTQ+ issues are necessary for recognizing the unique needs and resources of older LGB people for promoting a healthy aging process.

Older adults' online activities and cognition: Investigating the psychological mechanisms and age and gender differences

ObjectivesThis study aimed to investigate psychological mechanisms underlying the association between older adults' Internet use and cognition and examine potential age and gender group differences. Methods2064 older participants were extracted from the Waves 2012, 2013, and 2016 Health and Retirement Study. Internet use was measured by two sets of variables: Internet access and different types of online activities (i.e., informational use, social use, online shopping, and online banking). Path analyses were applied to test the proposed mechanisms via three mediators (i.e., loneliness, depressive symptoms, and perceived control). Multi-group analyses were conducted to examine the potential group differences. ResultsInternet use was positively associated with cognition. Despite the large direct effect, small but significant indirect effects via depressive symptoms and perceived control were identified across all online activities. Multi-group analyses revealed age-group differences in the mechanisms: depressive symptoms mediated the effects of all online activities on cognition among young-old adults, while perceived control mediated all the effects among old-old adults. Gender group differences were also identified: depressive symptoms mediated the effects of all online activities on cognition among older women and most online activities among older men, whereas perceived control mediated the associations between informational and instrumental (i.e., online shopping and banking) use and cognition among older men. DiscussionThis study highlights the mediating effect of depressive symptoms and perceived control and age and gender differences regarding the Internet use-cognition association. Internet-based cognitive interventions should consider these psychological mediators and age and gender differences for the best results.

Associations between information and communication technology use and frailty in community-dwelling old-old adults: results from the ILSA-J

Key summary pointsAimTo investigate whether ICT use is associated with frailty among community-dwelling older people aged 75 and older.FindingsHigher ICT use was linked to absence of frailty among persons aged 75 years and older, and comparable findings were observed when stratified by gender, years of education, and living arrangements.MessageThis cross-sectional study found that higher ICT use was associated with less frailty; ICT use and frailty are closely related and causal relationships need to be clarified in the future.

노인의 죽음 준비 잠재유형과 웰다잉 인식

Although social awareness of the importance of well-dying has increased, empirical evidence for well-dying policies and programs is very scarce. Additionally, there is limited research examining whether perceptions about dying well vary by the types of end-of-life preparation. Accordingly, this study sought to classify the end-of-life preparation among older Korean adults and verify differences in perceptions about well-dying according to subgroups. For this, older Korean adults aged 65 and above who participated in ‘2020 National Survey of Older Koreans’ were analyzed by dividing them into three groups: 5,977 young-old adults (65-74 years old), 3,333 old-old adults (75-84 years old), and 610 oldest-old adults (85 years old and above). End-of-life preparation was measured by four questions in the ritual aspect (e.g., preparing shrouds or funeral portraits), two questions in the psycho-social aspect (e.g., attending educational programs and writing a will), and two questions in the medical aspect (e.g., writing advance directives and pledging to donate organs). Perceptions about well-dying were measured using four items, assessing the importance of dying autonomously, without pain, in the company of family and acquaintances, and without burdening those around them. For statistical analysis, a three-stage latent class analysis and difference test which accounted for classification errors were conducted. As a result of the analysis, the young-old adults were classified into the ‘active preparation’ group, which showed a relatively active level of preparation, and the ‘no preparation’ group, which lacked preparation for end-of-life in all dimen sion s. The old-old and oldest-old adults were classified into the ‘active preparation’ group and the ‘passive preparation’ group, which was limited to end-of-life preparation only in the ritual aspect. In particular, the proportion of the ‘active preparation’ group in all generations was very low, ranging from 3 to 6%. The results of the difference test on perceptions of well-dying showed that among the young-old an d old-old adults classified into the ‘active preparation’ group, the scores for the importance of each item were significantly lower compared to those of the ‘no preparation’ or the ‘passive preparation’ groups. Among the oldest-old adults, the ‘active preparation’ group regarded end-of-life companionship with family and acquaintances as less important than the ‘passive preparation’ group. The results of this study suggest that the level of end-of-life preparation among older adults in Korea, from young-old to oldest-old, remains low and is predominantly focused on the ritual aspect. Furthermore, perceptions about well-dying vary according to the types of end-of-life preparation. The findings of this study underscore the need for tailored approaches in well-dying policies and programs, such as end-of-life preparation education, that consider the heterogeneity within the older population.

Socioeconomic differences in digital inequality among Chinese older adults: Results from a nationally representative sample.

The current study seeks to investigate digital inequality among older adults in China, specifically examining two socially defined age groups: young-old adults (aged 60-74) and old-old adults (aged 75+). Descriptive statistics and multiple regression were used to examine the prevalence of and identify the factors associated with Internet access, usage (frequency and breadth containing 11 activities), skills, and social support. The study used data from the 2018 China Longitudinal Ageing Social Survey (CLASS) which consisted of 11,419 respondents aged 60 years and older. We found that 40.22% of older adults had access to the Internet, and 18.27% used it regularly. Socioeconomic factors played a crucial role in determining Internet access and usage, with young-old adults with higher education using the Internet more frequently, deliberately, and competently. Those with higher economic status had greater social support to use it, and the old-old adults with higher socioeconomic status were more likely to have Internet access. This study has implications for prioritizing targeted policies and interventions aimed at supporting socioeconomically disadvantaged older adults and ensuring equal opportunities for all to access and benefit from the digital world.

Impact of age and apolipoprotein E ε4 status on regional white matter hyperintensity volume and cognition in healthy aging.

White matter hyperintensity (WMH) volume is a neuroimaging marker of lesion load related to small vessel disease that has been associated with cognitive aging and Alzheimer's disease (AD) risk. The present study sought to examine whether regional WMH volume mediates the relationship between APOE ε4 status, a strong genetic risk factor for AD, and cognition and if this association is moderated by age group differences within a sample of 187 healthy older adults (APOE ε4 status [carrier/non-carrier] = 56/131). After we controlled for sex, education, and vascular risk factors, ANCOVA analyses revealed significant age group by APOE ε4 status interactions for right parietal and left temporal WMH volumes. Within the young-old group (50-69 years), ε4 carriers had greater right parietal and left temporal WMH volumes than non-carriers. However, in the old-old group (70-89 years), right parietal and left temporal WMH volumes were comparable across APOE ε4 groups. Further, within ε4 non-carriers, old-old adults had greater right parietal and left temporal WMH volumes than young-old adults, but there were no significant differences across age groups in ε4 carriers. Follow-up moderated mediation analyses revealed that, in the young-old, but not the old-old group, there were significant indirect effects of ε4 status on memory and executive functions through left temporal WMH volume. These findings suggest that, among healthy young-old adults, increased left temporal WMH volume, in the context of the ε4 allele, may represent an early marker of cognitive aging with the potential to lead to greater risk for AD.

Impact of sleep duration and sleep disturbances on the incidence of dementia and Alzheimer's disease: A 10-year follow-up study

The nature of the relationship between sleep problems and dementia remains unclear. This study investigated the relationship between sleep measures and dementia in older adults (≥ 65) using data from the English Longitudinal Study of Ageing (ELSA) and further investigated the causal association in Mendelian randomization (MR) analysis. In total of 7,223 individuals, 5.7 % developed dementia (1.7 % Alzheimer's disease (AD)) within an average of 8 (± 2.9) years. Cox regression models and MR were employed. Long sleep duration (>8 h) was associated with 64 % increased risk of incident dementia and 2-fold high risk of AD compared to ideal sleep duration (7–8 h). This association was particularly evident in older-older adults (≥70 years) and those who consumed alcohol. Short sleep duration (<7 h) was associated with lower risk of incident dementia among older-older but higher risk among younger-older adults. Sleep disturbances and perceived sleep quality were not associated with dementia or AD. The MR study did not reveal causal associations between sleep duration and dementia. These findings suggest that self-reported short sleep in younger-older and long sleep in older-older adults and those with frequent alcohol consumption are associated with dementia. Early detection of these sleep patterns may help identify individuals at higher dementia risk.

지역사회 거주 후기노인의 칩거에 영향을 미치는 요인: 일상생활수행능력이 독립인 노인을 중심으로

지역사회 거주 후기노인의 칩거에 영향을 미치는 요인: 일상생활수행능력이 독립인 노인을 중심으로

Housing Preference for Ageing-in-Place: Are There Differences among Emerging-Old, Young-Old and Old-Old Adults Living in Hong Kong’s Private Housing Estates?

This study investigates housing preference among older adults in Hong Kong’s private housing estates across three age groups: emerging-old (50–65 years), young-old (65–75 years), and old-old (75 or above years). Findings highlight significantly increasing preferences for safety, thermal comfort, and physical periodicals for property services and health-related information with age. Respondents generally preferred proximity to facilities, on-site support, and social media for property information but were less attentive to home assessment. This study provides recommendations for improving housing design standards, property management practices, and public education programs for older adults.

Feasibility, acceptability, and preliminary efficacy of an internet-based CBT intervention for loneliness in older adults: A pilot RCT

BackgroundOlder adults are an important target group for loneliness interventions. However, most existing interventions aimed at older individuals do not focus on the strategy that has proven most effective (i.e., modifying maladaptive social cognition). Additionally, given the low mental health service use in this population, innovative treatment approaches are needed in order to provide support to this age cohort. The aim of the current study was to investigate the feasibility, acceptability, and preliminary efficacy of a newly developed internet-based cognitive behavioral therapy intervention for loneliness in older individuals using a pilot randomized controlled trial (RCT). MethodsIn the current study N = 36 older adults aged between 65 and 87 years were randomly assigned to either a 7-week internet-based intervention or a wait-list condition. Treatment satisfaction, usability, attrition, and adherence were assessed as indicators for feasibility and acceptability. To investigate preliminary treatment effects, measures on loneliness, depression, anxiety, self-efficacy, and life-satisfaction were administered. ResultsOverall, the intervention program was found to be acceptable and feasible. No significant difference between conditions on loneliness were observed; however, results indicated a trend towards lower reported loneliness levels in the treatment compared to the control group. Regarding secondary outcomes, results pointed at age-specific treatment effects, such that improvements on depression, anxiety, and life satisfaction were observed in the young-old, but not old-old adults in our sample. LimitationsThe sample was small and no follow-up assessment was included. ConclusionsAn internet-based CBT intervention for loneliness seems to be feasible and acceptable in older individuals.

Relationship between Walking and Driving, and Cognitive Functioning Common to Both Modes of Mobility, in Healthy Older Adults

Introduction: Driving and walking, the two main modes of mobility, require numerous common skills in the motor, sensory, and cognitive domains that deteriorate with age. The objective of this study was to investigate the relationship between walking and driving in healthy older drivers and to determine whether certain cognitive processes are involved in both modes of mobility. Method: Seventy-six older drivers from the Safe Move cohort were assessed in the following three domains: (1) cognition, using parts A and B of the Trail Making Test (TMT), the digit symbol substitution test (DSST), the Stroop test, and the Digit span; (2) gait, using a dual-task (DT) paradigm with a counting task; and (3) driving, assessed via a 40–50 min on-road test. Analyses were also performed on 2 subgroups: young-old (70–74 years old; n = 43) and old-old (≥75 years; n = 33). Results: Four significant correlations were found across the whole sample between gait performance under DT conditions and driving scores. One correlation was also found in old-old adults. None were found in young-old adults. Furthermore, several cognitive measures were significantly correlated to both modes of mobility: TMT-A and B completion time in the whole sample, and DSST performance in the whole sample and old-old adults. Discussion/Conclusion: Walking in complex conditions and on-road driving performance are closely related in healthy older drivers. Visuospatial attention, processing speed, and executive function are crucial and common cognitive processes to both modes of mobility in this population. Impairment in these cognitive functions should thus alert health professionals as it can quickly lead to mobility disorders, loss of autonomy and social isolation. Developing specific preventive programs and mobility support systems for healthy older adults is also crucial.

Exploring Older Adults' Perspectives on Digital Home Care Interventions and Home Modifications: Focus Group Study.

Emerging gerontechnology seeks to enable older adults (OAs) to remain independently and safely in their homes by connecting to health and social support and services. There are increasing attempts to develop gerontechnology, but successful implementations are more likely limited because of the uncertainty of developers about the needs and priorities of OAs. As the global population ages, the challenges faced by older OAs in maintaining independence and well-being within their homes have become increasingly important. With the proportion of OAs expected to triple by 2068, addressing the needs of this demographic has become a pressing social and public health priority. OAs often encounter various challenges related to physical, cognitive, and social well-being, including reduced mobility, memory impairments, and social isolation, which can compromise their ability to age in place and maintain a high quality of life. The goals of this qualitative research study are to (1) determine the best strategies for promoting aging well in the community with the support of gerontechnology, (2) establish the top priorities for implementing gerontechnology with OAs and their families, and (3) create a road map for the creation and application of gerontechnology for aging well in Manitoba. A total of 14 OAs participated in a qualitative research study conducted through a coconstruction workshop format, including a presentation of novel research facilities and a demonstration of research and development products. This activity was followed by an interactive discussion focused on revisiting the ongoing research and innovation programs and planning for a new research and innovation agenda. The workshop contents, notes, and recorded conversation underwent a data-driven inductive analysis. Emerging themes included home design, accessibility, and safety for OAs, particularly those with memory impairments. The participants also underlined the need for digital reminders and ambient technologies in current homes as a priority. Participants stressed the importance of including OAs in gerontechnology development programs and the need to consider dignity and independence as the guiding values for future research. This study presents a tentative road map for the development of gerontechnology in Manitoba. The main principles of our road map are the inclusion of OAs as early as possible in gerontechnology development and the prioritization of independence and dignity. Applying these principles would contribute to combatting digital ageism and the marginalization of OAs in technology development because of the perceived lack of technological skills and the stereotypes associated with this presumption.