Older Partner Research Articles

School environment and adolescent health: Results from the HPTN 068 cohort

PurposeTo assess the relationship between school environment and health and behavior outcomes. MethodsData are from baseline and first follow-up of the HIV Prevention Trials Network (HPTN) 068 longitudinal trial established in 2012 of adolescent girls and young women in rural Mpumalanga Province, South Africa. Data from 2212 participants are included. We measured the association between four school environment domains: school resources, school safety, negative personal experiences, and school connectedness, and several health and behavior outcomes: depressive symptoms, low attendance, recent pregnancy, recent unprotected sex, transactional sex, and having an older romantic partner. We used a g-computation approach to estimate risk differences (RD) for the longitudinal relationship between the school environment (measured at the individual and school level) on individual health and behavior outcomes, controlling for baseline covariates. ResultsThe mean age of participants at baseline was 15.4; mean age at first follow-up was 16.6. Individual baseline perceptions of an unsafe school environment (RD = 3.1 %, 95 % CI: 1.3–5.2 %) and more frequent negative experiences (RD = 4.0 %, 95 % CI: 2.0–5.9 %) were associated with higher absolute risk of depressive symptoms at follow-up. There was an overall trend toward higher risk of pregnancy, unprotected sex, and having an older partner among those who reported fewer school resources, lack of school safety, more negative personal experiences, and lack of school connectedness. ConclusionsOur findings provide evidence of an overall trend toward higher risk of depression, pregnancy, unprotected sex, and having an older partner among those reporting a worse school environment across four school environment domains.

Intrinsic interpersonal emotion regulation strategy use and effectiveness across adulthood: The role of interaction partner age.

One way older adults may be able to maintain emotional well-being despite declining in cognitive ability is through leveraging social resources for intrinsic interpersonal emotion regulation. Additionally, given their increased life experience, older adults might also be particularly well-suited to regulate the emotions of others. To examine age difference in use and effectiveness of intrinsic interpersonal emotion regulation, community adults (N = 290, aged 25-85 years) were prompted 6×/day for 10 days to report their emotional experience, use of intrinsic emotion regulation strategies (including capitalization, social sharing, co-reappraisal, and reminiscing), and interaction partner age. Older age was associated with being less likely to engage in social sharing of negative emotions, and this effect was stable when controlling for negative emotion experience. Otherwise, there were no age differences in how often or how effectively people use intrinsic interpersonal emotion regulation. In terms of interaction partner age, older partner age was only associated with greater likelihood of using co-reappraisal and higher reports of negative emotion after social sharing. In summary, there was no strong evidence for the idea that interpersonal emotion regulation becomes more (or less) common or effective with age. However, though people may be less likely to share negative emotions and be seen as less effective partners for sharing these emotions later in life, older adults are preferable social partners for co-reappraisal potentially due to their life experience. Future work should explore motivational (i.e., attitudes toward negative emotions) and cultural (i.e., perceptions of roles and emotional abilities) mechanisms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Adoption of Artificial Intelligence-Enabled Robots in Long-Term Care Homes by Health Care Providers: Scoping Review.

Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)-enabled robots may solve such challenges and support person-centered care. There is a dearth of literature exploring the perspectives of health care providers, which are crucial to implementing AI-enabled robots. This scoping review aims to explore this scant body of literature to answer two questions: (1) what barriers do health care providers perceive in adopting AI-enabled robots in LTC homes? (2) What strategies can be taken to overcome these barriers to the adoption of AI-enabled robots in LTC homes? We are a team consisting of 3 researchers, 2 health care providers, 2 research trainees, and 1 older adult partner with diverse disciplines in nursing, social work, engineering, and medicine. Referring to the Joanna Briggs Institute methodology, our team searched databases (CINAHL, MEDLINE, PsycINFO, Web of Science, ProQuest, and Google Scholar) for peer-reviewed and gray literature, screened the literature, and extracted the data. We analyzed the data as a team. We compared our findings with the Person-Centered Practice Framework and Consolidated Framework for Implementation Research to further our understanding of the findings. This review includes 33 articles that met the inclusion criteria. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Strategies to mitigate these barriers were also explored: (1) accommodate the various needs of residents and health care providers, (2) increase the understanding of the benefits of using robots, (3) review and overcome the safety issues, and (4) boost interest in the use of robots and provide training. Previous literature suggested using AI-enabled robots to resolve the challenges of increasing care needs and staff shortages in LTC. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots. RR2-doi:10.1136/bmjopen-2023-075278.

Correlates of Adherence to Oral and Vaginal Pre-exposure Prophylaxis (PrEP) Among Adolescent Girls and Young Women (AGYW) Participating in the MTN-034/REACH Trial.

We evaluated correlates of adherence to PrEP, including daily oral tenofovir disoproxil fumarate in combination emtricitabine (oral FTC/TDF)and the monthly dapivirine ring (ring)among adolescent girls and young women (AGYW) in the MTN-034/REACH study. We enrolled 247 AGYW aged 16-21years in South Africa, Uganda and Zimbabwe (ClinicalTrials.gov: NCT03074786). Participants were randomized to the order of oral FTC/TDF or ring use for 6months each in a crossover period, followed by a 6-month choice period. We assessed potential adherence correlates-individual, interpersonal, community, study, and product-related factors-quarterly via self-report. We measured biomarkers of adherence monthly; high adherence was defined as > 4mg dapivirine released from returned rings or intracellular tenofovir diphosphate levels ≥ 700 fmol/punch from dried blood spots (DBS). We tested associations between correlates and objective measures of high adherence using generalized estimating equations. High adherence to oral FTC/TDF was significantly associated with having an older primary partner (p = 0.04), not having exchanged sex in the past 3months (p = 0.02), and rating oral FTC/TDF as highly acceptable (p = 0.003). High ring adherence was significantly associated with unstable housing (p = 0.01), disclosing ring use to a male family member (p = 0.01), and noting a social benefit from study participation (p = 0.03). All associations were moderate, corresponding to about 6%-10% difference in the proportion with high adherence. In our multinational study, correlates of adherence among African AGYW differed for oral FTC/TDF and the ring, highlighting the benefit of offering multiple PrEP options.

Socioecological Approach to Understanding Overnutrition Among Married and Cohabiting Women in Nigeria

Overweight and obesity are currently an epidemic affecting both developed and developing countries. Sub-Saharan Africa has a double burden of being underweight and obese and has recently been battling an alarming increase in the prevalence of overweight. This study investigates the predictors of overnutrition among married women of reproductive age in Nigeria using the socioecological model (SEM) as a framework. The study hypothesizes that the Southern region will have a higher burden of overnutrition than the Northern region. The 2018 Nigeria Demographic and Health Survey (NDHS) was analyzed. A total of 8,531 non-pregnant married women met the inclusion criteria. Hierarchical multilevel logistic regression models were fitted, informed by the SEM framework. The occurrence of overnutrition was found to be 31.4%, with regional variations showing 31.7% in the South and 31.3% in the North. When all covariates were fitted in a model, being older, being a Christian, having tertiary education, having an older partner with tertiary education, being wealthy, and living in the urban area were predictors of overnutrition in multivariate analysis. Overnutrition among Nigerian married women was high, especially in the Southern region. Predictors of overweight are at all the SEM levels; therefore, it is better to consider all the levels when planning public health interventions.

A Voice-Activated Device Exercise and Social Engagement Program for Older Adult-Care Partner Dyads: Pilot Clinical Trial and Focus Group Study Evaluating the Feasibility, Use, and Estimated Functional Impact of EngAGE.

Maintaining exercise is essential for healthy aging but difficult to sustain. EngAGE is a socially motivated exercise program delivered over a voice-activated device that targets older adult-care partner dyads. This 10-week pilot study aimed to assess EngAGE feasibility and use, obtain user experience feedback, and estimate potential impact on function. In total, 10 older adults aged ≥65 years were recruited from an independent living residence together with their self-identified care partners. EngAGE delivered National Institute on Aging Go4Life exercises to older adults daily, while care partners received progress reports and prompts to send encouraging messages that were read aloud by the device to the older adult. Older adults' use was tracked, and physical function was assessed at baseline and follow-up. Follow-up focus group data provided qualitative feedback. On average, participants completed 393.7 individual exercises over the 10-week intervention period or 39.4 exercises/wk (range 48-492, median 431, IQR 384-481, SD 112.4) without injury and used EngAGE on an average of 41 of 70 days or 4.1 d/wk (range 7-66, median 51, IQR 23-56, and SD 21.2 days). Mean grip strength increased nonsignificantly by 1.3 kg (preintervention mean 26.3 kg, SD 11.0; postintervention mean 27.6 kg, SD 11.6; P=.34), and 4 of 10 participants improved by a minimal clinically important difference (MCID) of 2.5 kg. Further, the time for 5-repeated chair stands significantly reduced by 2.3 seconds (preintervention mean 12, SD 3.6 s; postintervention mean 9.7, SD 2.7 s; P=.02), and 3 of 9 participants improved by an MCID of -2.3 seconds. Furthermore, 3-meter usual walk performance was brisk at baseline (mean 2.1, SD 0.4 s) and decreased by 0.1 seconds (postintervention 2, SD 0.4 s; P=.13), although 5 of 9 participants improved by a MCID of 0.05 m/s. Qualitative results showed perceived benefits, favored program features, and areas for improvement. We present a pilot study of a new voice-activated device application customized to older adult users that may serve as a guide to other technology development for older adults. Our pilot study served to further refine the application and to inform a larger trial testing EngAGE's impact on functional outcomes, a necessary step for developing evidence-based technology tools.

The prevalence of child sexual abuse with online sexual abuse added

Background and objectiveResearch efforts are measuring various forms of online sexual abuse. There is a need to incorporate such measures of online sexual abuse into the calculation of overall prevalence rates for child sexual abuse. ParticipantsA sample of 2639 respondents aged 18-to-28 was recruited from a nationally representative online panel. MethodsUsing an online questionnaire, respondents were assessed via self-report about 9 types of online sexual abuse in childhood and were also assessed with 2 questions that have been used to assess generic child sexual abuse prevalence in previous surveys. ResultsThe addition of the online abuse to the generic questions about child sexual abuse raised the overall prevalence rate from 13.5 % to 21.7 %. The rate for females increased from 19.8 % to 31.6 % and for males from 6.2 % to 10.8 %. The largest independent contribution to the overall combined increase were the offenses involving non-consensual image sharing and voluntary online sexual interactions with an impermissibly older adult partner. The inclusion of the online sexual abuse exposures also increased the ability to identify the survivors with the highest levels of current psychological distress. ConclusionThe study highlights the importance of counting and including online sexual abuse in efforts to estimate the overall prevalence of childhood sexual abuse. The paper proposes 2 or 3 questions that could be added to sexual abuse questionnaires to assess these online offenses efficiently.

Prenatal Exposure to Severe Stress and Risks of Ischemic Heart Disease and Stroke in Offspring

Prenatal stress is associated with increased risks of several cardiovascular risk factors later in life. However, knowledge regarding the role of prenatal stress in the development of ischemic heart disease (IHD) and stroke is very limited. To examine prenatal stress, defined as maternal bereavement, and risks of IHD and stroke in the offspring. A cohort study was conducted using data from Danish and Swedish registries. Live singleton births during calendar years 1973-2016 in Denmark (followed up until December 31, 2016) and during calendar years 1973-2014 in Sweden (followed up until December 31, 2021) were included in the analysis. Maternal loss of a close family member (partner, older children, parents, or siblings) the year before or during the pregnancy. Diagnoses of IHD and stroke. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs for IHD and stroke in the offspring according to maternal bereavement. The study included 6 758 560 births (39.4% from Denmark; 51.4% boys). During the median follow-up of 24.6 (IQR, 13.9-35.1) years, 8664 offspring (0.1%) were diagnosed with IHD and 13 094 with stroke (0.2%). Overall, maternal bereavement the year before or during pregnancy was not associated with IHD (adjusted HR [AHR], 0.98; 95% CI, 0.85-1.13) or stroke (AHR, 1.04; 95% CI, 0.94-1.16) in offspring. Similarly, no associations were observed when exposure was classified by the mother's relationship to the deceased individual, ie, loss of older child or partner (HR, 0.85; 95% CI, 0.64-1.14 for IHD and 0.98; 95% CI, 0.77-1.25 for stroke) or loss of parent or sibling (HR, 1.03; 95% CI, 0.87-1.21 for IHD and 1.06; 95% CI, 0.94-1.19 for stroke). However, associations between loss in the third trimester and IHD (AHR, 1.50; 95% CI, 1.06-2.13), and loss due to cardiovascular disease and stroke (AHR, 1.22; 95% CI, 1.03-1.44) were identified when exposure was classified by time of loss or the relative's cause of death. The findings of this study provide little support for the hypothesis that prenatal stress is associated with risks of IHD and stroke in the first 5 decades of life. However, the association observed between stress in the third trimester and IHD warrants further investigation.

“I Was Worshiped and in Control”: Sugar Arrangements Involving Transactional Sex from the Perspective of Both Sugar Babies and Sugar Benefactors

ABSTRACT Sugar dating arrangements involve an older partner (“sugar daddy/mommy”) who provides financial support to a younger partner (“sugar baby”) in exchange for intimacy. The current study recruited a U.S. and Canadian sample of sugar babies (n = 45) and sugar benefactors (n = 32) through social media sources to survey them about perceived power in their sugar arrangement, gender roles, and stigma. Sugar benefactors did not differ in perceived power from sugar babies, nor in endorsement of traditional gender roles or stigma. Directed content analysis analyzing open-ended responses about associated outcomes indicated that both partners placed strong emphasis on companionship despite the importance of sex within arrangements. Sugar babies reported that money drives participation, although arrangements fulfill other needs, such as pleasure. Other benefits include having an arrangement with clear boundaries and expectations. Disadvantages include concerns for safety, that being physical safety for babies, and reputation and being used for money for daddies. Notably, both groups perceived sugar babies as having equal or more power than sugar benefactors, although this was often attributed to sugar babies’ attractiveness and youth. Findings include insights from both babies and benefactors, and support perspectives that sugar dating is distinct from traditional sex work.

Integrated care for older persons who live with complex health and social care requirements: a core set of indicators

PurposePerformance measures are an important mediating mechanism that influences the design and delivery of care. Unfortunately, it is still commonly the case that acute care indicators are employed to assess the efficacy of integrated care. This hinders the ability to accurately assess and continuously improve integrated care efforts for priority populations, including older persons who live with complex health and social care requirements. A core set of indicators is needed from which to assess the quality and impact of integrated care on these older persons and care partners.Design/methodology/approachA modified Delphi process was employed that comprised of the following steps: (1) selection of an indicator inventory (2) defining criteria for ranking and achieving consensus, (3) recruiting participants, (4) iterative voting rounds and analysis and (5) selection of a core indicator set.FindingsThe study produced a core set of 16 indicators of integrated care that pertain to older persons who live with health and social care requirements. The set can be applied by health and social care organizations and systems to assess the quality and impact of integrated care for this population across the continuum of care.Research limitations/implicationsAlthough the gap in the availability of relevant indicators was the impetus for the study, this also meant there was a dearth of validated indicators to draw from. There are significant gaps in commonly used data sets with respect to indicators of integrated care as it relates to older persons and care partner.Practical implicationsThe indicator set is intended to follow the older person and care partner throughout their health journey, enabling a whole systems view of their care. The set can be used in full or in part by health and social care systems and organizations across various primary, acute, rehabilitative and community settings for program development and evaluation purposes.Social implicationsThe core set of indicators that emerged out of this study is a first step toward ensuring that older persons who live with complex health and social care requirements and their care partners receive quality integrated care across the continuum of care.Originality/valueThe findings are informed by the perspectives of older persons, care partners and healthcare professionals. Future research is needed to test, validate and potentially expand the indicator set.

The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study

Patriarchal systems in Africa can perpetuate inequitable gender norms and power differentials that disadvantage women. This study aimed to examine the influence of community and individual gender-equitable attitudes on adolescents’ sexual health and risk behaviour in rural Tanzania, and whether the association of those attitudes differs between males and females. We conducted logistic regression using longitudinal data from a cluster randomised controlled trial in rural Tanzania to examine the association of gender-equitable attitudes with the sexual risk behaviour of 2017 adolescent males and females. High community-level gender-equitable attitudes were significantly associated with higher odds of HIV testing (OR = 1.31, 95% CI [1.00–1.72]) and lower odds of age-disparate partnerships (OR = 0.52, 95% CI [0.30–0.88]) for the pooled male and female sample. High individual-level (but not community) gender-equitable attitudes were associated with increased condom (OR = 2.07, 95% CI [1.07–4.00]) and contraceptive use (OR = 2.08, 95% CI [1.04–4.13]) for girls. Among sexually debuted adolescents, no significant associations were found between community or individual high gender-equitable attitudes and transactional sex, early sexual debut, HIV testing, concurrent sexual partners, or number of sexual partners. We found evidence of effect modification by sex for community-level attitudes and age-disparate sex (p = 0.005) and individual-level attitudes and condom use (p = 0.051). Efforts to incorporate gender transformative programming for whole communities may increase gender-equitable attitudes. Plain language statement Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.

Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study

Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT03194477

Connecting Older Adults with Students Through Interprofessional Telecare (COAST-IT)

By 2030, it is projected that one in five people in the United States will be 65 years old and older. It is critical that future health care professionals are prepared to care for older adults. Students’ communication skills and attitudes toward older adults have been shown to benefit from a geriatric specific curriculum. Connecting Older Adults with Students Through Interprofessional Telecare (COAST-IT), a longitudinal program begun in 2020, pairs student partners (SPs) with older adult partners (OAPs) who have regular phone calls. This was implemented across various graduate health profession schools and aims to provide students the opportunity to learn and practice effective communication skills with older adults, while also decreasing social isolation and loneliness experienced by the older adult partner. This paper focuses on our initial results looking at the impact on students who participated. Students were surveyed pre- and post-participation in the COAST-IT program through a combination of open-ended questions and questions taken from the University of California, Los Angeles (UCLA) Geriatrics Attitude Scale. Students reported an improvement in their ability to communicate with older adults, increased confidence in their communication skills, and an improved understanding of ageism.Initially, OAPs were recruited from a variety of local facilities including the geriatric clinic associated with the University and the community of assisted living and long-term care facilities, senior living communities, and various community organizations that focus on serving older adults. The Director of Outreach Programs in the Multidisciplinary Center on Aging at the University of Colorado presented to civic organizations and older adults began volunteering. Word of mouth spread among OAPs, and they began recruiting their friends; there are now OAPs from nine states participating. The program received a Social Innovation Award from the National Area of Agencies in Washington D.C., which supported our university's Age Friendly University designation.Students are oriented to the program and process of conducting weekly phone calls by their faculty coordinator in each program. The COAST-IT mission, process information, and examples of communication techniques are provided to students through a student handbook and Learning Management System module. Students participate in an interdisciplinary formal orientation prior to engaging in their OAP encounters. Monthly synchronous online educational presentations are provided to all students. Topics include a variety of issues on aging with breakout sessions for discussion and networking among disciplines.

Violence Related to Daily Water and Sanitation Needs in South Africa.

There is a critical lack of research on violence experienced by women when meeting their daily water and sanitation needs. This short report describes the cumulative lifetime incidence of exposure to violence when using the toilet or collecting water (water, sanitation, and hygiene [WASH]-related violence) and identifies associated health and behavioral risks. Data from 1,870 participants collected in 2013-2015 from a longitudinal cohort of young women in rural South Africa were included in this analysis. We found that exposure to WASH-related violence was high: 25.9% experienced violence when collecting water or when using the toilet. Those who experienced violence were more likely to report pregnancy, an older partner, unprotected sex, experience of intimate partner violence, engaging in transactional sex, depressive symptoms, and anxiety. Future research should investigate the location and type of violence experienced and examine how WASH-related violence is related to health outcomes to identify gender-centered WASH interventions that reduce violence exposure.

INTERGENERATIONAL CONNECTIONS: TURNING POINTS IN COLLEGE STUDENT ATTITUDES ABOUT OLDER ADULTS AND AGING

Abstract Intergenerational Connections was a semester-long community-based engagement project in which thirty-four undergraduate students enrolled in a relational communication course met via Zoom with older adults in a long-term care facility for four dialogues about close relationships. The project used a Critical Interpersonal and Family Communication Pedagogy approach to have students critically engage with stereotypes and expectations about older adults through class readings, discussion, and interaction. The students wrote reflections after each dialogue and a final reflection expressing their expectations and experiences of interacting with an older adult. We analyzed the reflections using a turning point analysis and found two turning points related to Perceptions of Aging and Developmental Changes and Understanding and Expectations of Relationships. Students recognized stereotypes they held about older adults and aging and how engaging with an older adult dispelled many of those assumptions. Students were surprised by how much they had in common with their older adult partner. They learned about relationships through their dialogues with their partner and found many “words of wisdom” they wanted to incorporate into their relationships. In their final papers, students reflected on being advocates for older adults and how this project helped them understand that they can have conversations with older adults and not be afraid that they will not be able to connect. This paper will discuss how this community engagement project served to reframe aging for these young adults, and students’ recognition of the role that older adults play and the value that their involvement brings to society.

Vaccine Resistance and Hesitancy among Older Adults Who Live Alone or Only with an Older Partner in Community in the Early Stage of the Fifth Wave of COVID-19 in Hong Kong.

Vaccination is an effective way in providing protection against COVID-19 infection and severe outcomes. However, vaccine resistance and hesitancy are a great concern among vulnerable populations including older adults who live alone or only with an older partner. This study examined their vaccination status and reasons and associated factors of vaccine resistance and hesitancy. A cross-sectional study was conducted among older adults living alone or only with an older partner in communities in Hong Kong. Participants were interviewed between October 2021 and February 2022. Logistic regression analyses were employed to examine factors associated with vaccine resistance and hesitancy. Of the 2109 included participants, the mean age was 79.3 years (SD 7.6), 1460 (69.2%) were female, 1334 (63.3%) lived alone, and 1621 (76.9%) were receiving social security support. The vaccine uptake, non-uptake (i.e., resistance), and hesitancy rates were 50.1%, 34.4%, and 15.5%, respectively. The top four reasons for vaccine resistance and hesitancy were “Not feeling in good health” (27%), “Worry about vaccine side effects” (18%), “Feeling no need” (10%), and “Lack of recommendation from doctors” (9%). Vaccine resistance and hesitancy was significantly associated with older age, living alone, more chronic conditions, fewer types of social media use, and lower self-rated health status. Similar associations can be observed in their separate analysis for vaccine resistance and vaccine hesitancy, and ever hospital admission over the past 6 months was additionally related to vaccine hesitancy. Older people who live alone or only with an older partner had a low vaccination rate. Poor health or worry about vaccine side effects were the most common reasons for their vaccine resistance and hesitancy. Actions are greatly needed to improve the uptake rate among this vulnerable population, especially those who were older, have poorer health, and use less social media.

Implementing CAPABLE With Care Partners Through an Area Agency on Aging: Identifying Barriers and Facilitators Using the Consolidated Framework for Implementation Research.

Community Aging in Place, Advancing Better Living for Elders (CAPABLE) is an evidence-based intervention to promote aging in place. Although CAPABLE has been implemented in more than 40 community sites, wide variation in implementation exists. Guided by the Consolidated Framework for Implementation Research (CFIR), this study sought to determine key barriers and facilitators that may influence CAPABLE implementation with older adult and care partner dyads through an area agency on aging (AAA). A formative evaluation was completed using qualitative data from the pilot of a Hybrid Trial Type 1 study implementing CAPABLE in an AAA. Multiple sources of data were collected, including 2 focus groups, field notes, a tracking log, and meetings with CAPABLE interventionists. Data were analyzed using a framework method and validated through a negative case analysis approach in NVivo 12 Pro. Fourteen dyads enrolled in the pilot and 6 completed the CAPABLE intervention. Key themes aligned with 10 constructs from 5 domains of the CFIR. Facilitators included adaptability of the intervention, cost, networks and communication, and knowledge and belief of individuals. Barriers included intervention complexity, client needs and resources, and executing the planned process. Results enhance understanding of contextual factors that can influence the implementation of CAPABLE with care partners. Strategies to overcome barriers include simplifying recruitment materials and targeting older adults with recent onset of disability. The CFIR is a valuable resource for planning and evaluation of the implementation of evidence-based interventions to promote aging in place.

HIV Risk Factors and Risk Perception Among Adolescent Girls and Young Women: Results From a Population-Based Survey in Western Kenya, 2018.

In sub-Saharan Africa, HIV prevalence in adolescent girls and young women (AGYW) is 2-fold to 3-fold higher than that in adolescent boys and young men. Understanding AGYW's perception of HIV risk is essential for HIV prevention efforts. We analyzed data from a HIV biobehavioral survey conducted in western Kenya in 2018. Data from AGYW aged 15-24 years who had a documented HIV status were included. We calculated weighted prevalence and evaluated factors associated with outcomes of interest (HIV infection and high risk perception) using generalized linear models to calculate prevalence ratios. A total of 3828 AGYW were included; 63% were aged 15-19 years. HIV prevalence was 4.5% and 14.5% of sexually active AGYW had high risk perception. Over 70% of participants had accessed HIV testing and counseling in the past 12 months. Factors associated with both HIV infection and high risk perception included having an HIV-positive partner or partner with unknown status and having a sexually transmitted infection in the past 12 months. Having an older (by ≥10 years) partner was associated with HIV infection, but not high risk perception. Less than 30% of sexually active AGYW with 3 or more HIV risk factors had high perception of HIV risk. Gaps in perceived HIV risk persist among AGYW in Kenya. High access to HIV testing and prevention services in this population highlights platforms through which AGYW may be reached with improved risk counseling, and to increase uptake of HIV prevention strategies.

Determining HIV risk for Adolescent Girls and Young Women (AGYW) in relationships with “Blessers” and age-disparate partners: a cross-sectional survey in four districts in South Africa

BackgroundHIV incidence among adolescent girls and young women (AGYW) remains high, with their male partners a prominent factor in sustaining these elevated rates. Partnership characteristics remain important metrics for determining HIV risk, with evidence indicating that AGYW engaged in transactional and age-disparate relationships face greater HIV exposure. This study examines the risk posed to AGYW in a relationship with a “Blesser”, defined as male who provides his female partner with their material needs or desires in exchange for a sexual relationship, an age-disparate (5 or more years older) partner, and the potential compounded risk of being a relationship with a partner or partners who are considered both a “Blesser” and age-disparate.MethodsA cross -sectional household based representative sample of AGYW (aged between 12–24 years) were enrolled in the study (n = 18 926) from the districts of City of Johannesburg and Ekurhuleni in the Gauteng province and the Districts of eThekwini and uMgungundlovu in the province of KwaZulu-Natal (KZN) in South Africa between March 13, 2017 to June 22, 2018. Participants completed a structured questionnaire and provided finger-prick blood samples for laboratory measurements. Our analysis used descriptive statistics and multiple binary logistic regressions accounting for survey weights, clustering and stratification.FindingsThe median age of the sample was 21 years old (Interquartile range: 19–23) and nearly three quarters (73.7%) were currently attending school. Whilst all relationships exposed AGYW to potential HIV risk, multiple binary logistic regression analysis revealed that AGYW in a relationship with both a Blesser and an age-disparate partner were more likely to be HIV positive (AOR: 3.12, 95% CI: 1.76–5.53, p < 0.001), diagnosed with an STI (AOR: 4.60, 95% CI: 2.99–7.08, p < 0.001), had 2 or more sexual partners in the previous 12 months (AOR: 6.37, 95% CI: 3.85–10.54, p < 0.001), engaged in sexual activity at age 15 or younger (AOR: 3.67, 95% CI: 2.36–5.69, p < 0.001) and more likely to have ever been pregnant (AOR: 2.60, 95% CI: 1.24–5.45, p < 0.05) than those not in a relationship with either a Blesser or age-disparate partner.ConclusionDifferent relationships present different HIV risk to AGYW. AGYW who had engaged in relationships with both a Blesser and an age-disparate partner were at greater HIV risk when examined against these relationships independent of one another. The data reveals the compounded HIV risk of being in both a transactional and age-disparate relationship.

Dispensing care?: The dosette box and the status of low-fi technologies within older people's end-of-life caregiving practices.

Technology has been lauded as a solution to range of challenges presented by ageing population internationally. While the lion‐share of scholarship has focussed on high‐fi, digital technologies, there has been a recent shift to exploring the contributions mundane, low‐fi technologies make to older people's daily lives and our understandings of health, illness and care more broadly. Drawing from serial narrative interview data collected with 19 married couples aged 70 and over living in the U.K., this article explores the way one medical technology—the dosette box—was taken‐up and deployed in their end‐of‐life caring process. Informed by actor–network theory and critical feminist scholarship, this article considers how the dosette box played an active role in structuring relationships, scheduling daily care activities and enforcing medical compliance. In doing so, we suggest that the dosette box provided an unexpected companion and ‘weapon of the weak’ for older partner's attempting to assert their expertise and power while caring. We also explore how the dosette box demanded an even higher level of regular, vital care from older partner's once introduced into the home, thus entrenching the physical and emotional demands of dispensing care.