Place For Older Adults Research Articles

Benefit-Cost Analyses of Hearing Aids, Over-the-Counter Hearing Devices, and Hearing Care Services.

Limited accessibility to hearing health care threatens healthy aging in place for older adults with hearing loss. A willingness-to-pay (WTP) approach was used to determine benefits and value of prescription advanced digital technology (ADT) hearing aids, over-the-counter (OTC) hearing devices, and rehabilitative services using benefit-cost analyses. This study was a cross-sectional survey with chart review of hearing aid users at two independent audiology practices. Seventy hearing aid users (response rate: 15.6%) provided their WTP for ADT prescription hearing aids, OTC hearing devices, and hearing rehabilitative services. Benefit-cost ratios and net social benefit were calculated using deterministic and exploratory approaches. Point estimates for benefit-cost ratios and net social benefit were derived using bootstrap sampling with replacement (N = 5,000). Median WTP for ADT prescription hearing aids and rehabilitative services were $2,000 and $250, respectively. WTP was lowest for OTC devices (Mdn = $0; maximum = $500). Benefit-cost ratios and net social benefit for ADT prescription hearing aids, OTC devices, and hearing rehabilitative services favored these interventions when out-of-pocket costs remained low. Benefit-cost analyses also produced results favoring prescription ADT hearing aid intervention with costs as high as $1,530 per device. WTP results indicated that all interventions under study have a measurable consumer-perceived benefit. Results of benefit-cost analyses favored the interventions but only when costs were lower than market prices. The benefit-cost analysis results for hearing care services underscore their value when provided as part of a comprehensive rehabilitative plan that may inform future health policy changes.

Housing Adaptations and Long-Term Care Facility Admissions among Older Adults with Care Needs in Japan

ObjectivesHousing adaptations may contribute to aging in place for older adults with care needs by reducing the risk of long-term care facility (LTCF) admissions, but this association remains unclear. We examined the association between housing adaptations and LTCF admissions among older adults with care needs. DesignRetrospective cohort study using data from a Japanese municipality. Setting/ParticipantsAdults aged ≥65 years who were newly certified with care needs under the public long-term care insurance system between April 2014 and March 2016. MethodsThe study exposure was the implementation of insurance-covered housing adaptations (maximum covered cost: ¥200,000) during the 2 years after certification. Based on this exposure, participants were assigned to a non-implementation group (no housing adaptations), sub-maximum cost group (housing adaptations below the maximum cost), or maximum cost group (housing adaptations at the maximum cost). A Fine-Gray subdistribution hazards model was used to analyze the associations between the exposure groups and new LTCF admissions after adjusting for various risk factors. Death was regarded as a competing risk, and participants were followed until March 2022. ResultsAmong 4610 participants, 1261 (27.3%) had implemented housing adaptations. Among these, 943 (74.8%) were in the sub-maximum cost group and 318 (25.2%) were in the maximum cost group. During the follow-up period (median: 51 months), the incidence of LTCF admission was 3.9/1000 person-months in the non-implementation group, 3.8/1000 person-months in the sub-maximum cost group, and 2.8/1000 person-months in the maximum cost group. The adjusted subdistribution hazard ratio of LTCF admission (reference: non-implementation) was 0.90 (95% CI: 0.75–1.08) for the sub-maximum cost group and 0.67 (0.49–0.93) for the maximum cost group. Conclusions and ImplicationsHousing adaptations can support aging in place for older adults with care needs. Health care professionals and policymakers should consider the suitability of housing environments to reduce the risk of institutionalization.

“I’ll fill in the gaps”: perspectives of HHAs on promoting aging in place for older adults with low incomes

ABSTRACT Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk of nursing home admission. Home health aides (HHAs) may have insight into how to optimize aging in place for this population, yet little is known about HHAs’ perspectives on this topic. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs in Pennsylvania and New Jersey. Transcripts were analyzed using qualitative thematic analysis, and three themes emerged. First, HHAs described the uniqueness of their role within multidisciplinary care teams. Second, HHAs shared concrete interventions they employ to help their clients improve their function at home. Third, HHAs discussed barriers they face when helping clients age in place. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and that their perspectives should be incorporated into care planning and intervention delivery.

Developing a person-centred care environment aiming to enhance the autonomy of nursing home residents with physical impairments, a descriptive study

BackgroundEnhancing autonomy is important within the context of the care environment in nursing homes. A nursing home is a place for older adults with physical impairments, who need assistance, to live and where staff work who help them to exercise autonomy. Previous research shows that older adults and staff are influenced by the care environment to apply autonomy-enhancing activities. Therefore, organisational policies regarding the care environment seem promising for enhancing autonomy. The aim is to gain a deeper insight into the development and implementation of organisational policies aimed to enhance the autonomy of older adults with physical impairments.MethodsA qualitative descriptive design was chosen, using two methods. A document study was conducted on the policies, plans and proceedings in two care organisations. Moreover, interviews were conducted with 17 stakeholders involved in the policies, such as managers and members of the client council. The fragments of the 137 documents and 17 verbatim transcripts were coded and deductively categorised into the seven aspects (i.e., power-sharing, supportive organisational systems, appropriate skill mix, potential for innovation and risk-taking, the physical environment, effective staff relationships and shared decision-making systems) of the key domain care environment, as defined in the person-centred practice (PCP) framework developed by McCormack and McCance.ResultsThe aspect of power-sharing was used the most in the policies of the two participating organisations. The organisations expected much from the implementation of indirect interventions, such as access to the electronic care plan for residents and the development of staff towards self-managing teams. Less attention was paid to interventions in the physical environment, such as the interior of the building and privacy, and the collaboration processes between staff.ConclusionsThe PCP framework poses that all aspects of the key domain care environment are important to develop a person-centred practice. This is not yet the case in practice and the authors therefore recommend using all seven aspects of the care environment in a balanced combination with the other key domains of the PCP framework to achieve person-centred practice and as a result the enhancement of the autonomy of nursing home residents with physical impairments.

Examining the Influence of Neighborhood Factors on Older Adult Health in a Developing Country

The aging population in Malaysia needs the development of age-friendly neighborhoods to support healthy aging. This study examined the neighborhood variables affecting the quality of life related to health among older adults through a questionnaire survey of 254 participants in Klang Valley, Malaysia. Significant determinants included accessibility, safety from crime, environmental quality, and addressing neighborhood problems. Additionally, the presence of third places, such as shopping centers and cultural/educational institutions, was found to promote health among older adults. The findings indicated that policymakers and developers should develop age-friendly neighborhoods that could effectively support aging in place for older adults.

Support Needs Among Older Tenants Living in Public Housing in Sweden: Perspectives of Janitors and Maintenance Staff.

Neighborhood support can improve aging in place for older adults, but research on the role of public housing staff in supporting older tenants is lacking. Twenty-nine participants (janitors, n = 11; maintenance staff, n = 18) collected data about critical situations among older tenants residing in apartments in Sweden. Modifying the Critical Incident Technique (CIT) and applying a mixed-methods design, quantitative and qualitative data were collected and analyzed with descriptive statistics and thematic analysis, integrated through narrative. We found that older tenants asked staff for help with daily tasks. The staff identified CI management dilemmas in meeting older tenants' support needs while following the housing company's regulations, maintaining professional responsibilities, respecting individual work attitudes and preferences, and experienced a lack of competencies in some situations. Staff members were responsive to offering support in simple, practical, and emotional situations and in addressing matters they perceived as deficits in social and health services.

Technologies for monitoring activities of daily living in older adults: a systematic review

Purpose As the older adult population rise globally, technologies to monitoring activities of daily living (ADL) may have a role in supporting aging in place for older adults. The objective of this systematic literature review was to study the scope, diversity and readiness of technologies developed to monitor ADL in older adults. Methods We systematically searched two scientific databases (CINAHL and IEEE), following Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA) guidelines. We included studies on technologies used to monitor older adults’ ADL in the home but excluded studies focused on communication technologies (phone calls, text messages) or monitoring postures alone. The JBI checklist for case series was used for quality assessment. Extracted details included population characteristics, ADL assessment outcomes, types of monitoring technology, and technology readiness and usability. Results The search found 147 papers, with 16 papers included in the final analysis. The literature described 48 types of technologies. Of moderate quality studies, five studies used wearables at technology readiness level 4–6 to monitor basic ADL (walking, transfers and walking up stairs) and one used ambient sensors to detect urinary incontinence. Conclusions Monitoring technologies remain at development stages. More research is needed to strengthen technologies that monitor activities of daily living. Implications for rehabilitation Monitoring activities of daily living at home remains focused on using wearables to assess in-home functional mobility to support rehabilitation. Technologies remain a 4–6 readiness level and there is a lack of evidence to recommend in-home monitoring technologies.

The Impact of a Two-Visit Occupational Therapy Home Modification Model on Low-Income Older Adults

Background: Various studies support the benefit of occupational therapist-led home modification to support successful aging in place for older adults. However, methodological differences limit generalizability. This study aimed to determine the impact of a replicable two-visit occupational therapy home modification program on occupational performance of low-income, community-dwelling older adults.

MULTI-CASE STUDY OF A NOVEL HEALTHCARE DELIVERY MODEL TO SUPPORT AGING IN PLACE IN RURAL, REMOTE, AND SMALL URBAN AREAS

Abstract Aging in place has long been a policy objective in Canadian healthcare, with accompanying concerns about older adults in rural and remote regions, and growing interest in small urban areas as distinct from large urban ones. As one of the six health authorities in British Columbia (BC), Interior Health (IH) developed and implemented an innovative healthcare delivery model to support aging in place for older adults, while addressing system issues of cost containment and resource allocation. By transferring funds from acute care to primary care, IH created Seniors Health and Wellness Centres (SHWCs) in two small urban areas (Kelowna and Kamloops) and a third one with two rural sites (Salmon Arm and Revelstoke). Our multi-case study aimed to compare how the SHWCs are meeting their objectives, and addressing the priorities of rural and small urban older adults and their social determinants of health (SDoH). We used mixed methods of data collection and analysis, including key informant interviews (n=9), service user questionnaires (n=10), document analysis (n=19), and secondary data analysis of service usage (n=2343) to answer research questions (RQs) on the outcomes and impacts of IH’s restructuring. The results show the outcomes (RQ1) to be three SHWCs which vary considerably in their design and usage, including access, quality, and continuity of care. Our findings on the impacts (RQ2) indicate the SHWCs are meeting their cost reduction aims while concentrating on some SDoH (income & dis/ability) and neglecting others (gender, racism, rurality), and progressing slowly in addressing certain priorities of older adults.

Experiences of ageing in place in Australia and New Zealand: A scoping review

AbstractThis review aimed to inform a deeper understanding of the varied experiences of ageing in place for older adults in Australia and New Zealand. Ageing in place involves older adults remaining in their own home or community as they age rather than moving into residential care. Our focus was on how ageing in place relates to older adults' mental health, life satisfaction, wellbeing, and overall ability to adapt well to ageing. This paper followed PRISMA‐ScR guidelines. Of the initial 210 papers identified, 20 met inclusion criteria and were retained. Four key themes related to experiences of ageing in place and the skills and strategies utilised to age in place were extracted from these studies. Themes encompassed older adults' individual characteristics and strategies, their connections to community, their home environment, and the appropriateness of support and services. We conclude that ageing in place should not be considered a “one size fits all” approach to ageing. Policymakers, researchers, and governments should acknowledge that older adults are a diverse group. Future ageing policy should strive to accommodate all older adults regardless of their circumstances or ageing preferences and researchers should include older adults from diverse populations and circumstances. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.

Residential Segregation, Social Cohesion, and Aging in Place: Health and Mental Health Inequities.

Research shows that living in segregated neighborhoods may have deleterious health outcomes via social, physical, and socioeconomic contexts that deepen existing inequities. However, there has been limited scholarship examining the effects of segregation on older adults, despite an increasing focus on aging in place. Guided by the Ecological Model of Aging, we examined the effects of segregation on older adults' self-rated health and mental health, accounting for both individual characteristics and neighborhood opportunities and risks (e.g., social cohesion) and the potential moderating role of race and economic vulnerability. We used data from the first 4 rounds of the National Health and Aging Trends Study (2011-2014) merged with tract-level census data for a final sample size of 3,084 community-dwelling older adults in urban areas. We conducted multivariate regression analyses after conditioning on residential location selection variables. There was no significant association between neighborhood segregation and self-rated health or between segregation and anxiety and depression symptoms. Consistent with the literature, perceived social cohesion was protective of health in each model. Our findings highlight the need for more rigorous research on segregation and older residents that utilize longitudinal and spatial data. Our findings also have implications for policies and programs that aim to support the ability to age in place for older adults who have different racial identities and live in different neighborhood contexts. Because social cohesion can be a protective factor for older adults' health and mental health, policymakers and practitioners should support initiatives to increase social cohesion.

User perspectives on emotionally aligned social robots for older adults and persons living with dementia.

IntroductionSocially assistive robots are devices designed to aid users through social interaction and companionship. Social robotics promise to support cognitive health and aging in place for older adults with and without dementia, as well as their care partners. However, while new and more advanced social robots are entering the commercial market, there are still major barriers to their adoption, including a lack of emotional alignment between users and their robots. Affect Control Theory (ACT) is a framework that allows for the computational modeling of emotional alignment between two partners.MethodsWe conducted a Canadian online survey capturing attitudes, emotions, and perspectives surrounding pet-like robots among older adults (n = 171), care partners (n = 28), and persons living with dementia (n = 7).ResultsWe demonstrate the potential of ACT to model the emotional relationship between older adult users and three exemplar robots. We also capture a rich description of participants’ robot attitudes through the lens of the Technology Acceptance Model, as well as the most important ethical concerns around social robot use.ConclusionsFindings from this work will support the development of emotionally aligned, user-centered robots for older adults, care partners, and people living with dementia.

Using Smart Speakers in Low-Income Senior Housing to Enhance the Aging in Place Experience: Stakeholder Views

Smart speakers provide a platform that can integrate smart home technology and/or safety devices within the home to enhance quality of life and independent living for older adults. However, few attempts to utilize this technology specifically within low-income senior housing (LISH) residents have been documented. Our purpose was to explore different stakeholder perceptions about the use of smart speakers to support aging in place in older adults living alone in LISH. Smart speakers were deployed in individual LISH apartments, equipped with a voice technology-based aging in place solution for the facility. A qualitative analysis of semi-structured interviews using a constant comparative approach for emerging themes was conducted (n=10: older adult users, n=2: housing staff, n=2: voice technology developers). The three participant groups showed diverging perceptions in terms of benefits, uses, and stakeholder interests. Older adults found smart speakers useful in four main areas: assistance with daily tasks, feeling connected, safety measures, and emotional wellbeing. The two other groups showed a broader interest in the use of the smart speaker device, such as residential management tools and communication channels in addition to its potential use as safety and wellness tools. Older adults experienced significant difficulty setting up desired functions or finding instructions, which restricted utilization of the technology to a limited set of tasks. All stakeholder groups addressed a need for formal training or personalized tech support for older adult users. Findings indicate the importance of developing deployment strategies tailored to the needs and characteristics of the target user group.

Evaluating Spaces for Older Adults Experiencing Homelessness: Findings From an Environmental Audit

Homeless populations require spaces and services that take into account their life trajectories. The Aging in the Right Place - Environmental Checklist (AIRP-ENV) is an environmental audit tool developed by our team to evaluate the accessibility and overall design features of housing targeted for aging individuals experiencing homelessness. Researchers in Vancouver, Calgary and Montreal employed this tool in 2021 to evaluate environmental features in selected promising practices to identify built environment factors that promote aging in the right place. Preliminary findings reveal the following themes across sites: access to communal and recreational spaces encourage social inclusion and meaningful recreation opportunities; barrier-free built environment features foster independence and safety; and access to services and amenities encourage community mobility. Findings demonstrate a need to employ a broader evaluative lens that incorporates psycho-social factors to gain a nuanced understanding of aging in the right place for older adults who have experienced homelessness.

Aging in Place: Social Connectedness and the Health of Older Subsidized Housing Residents

Abstract Findings on the prevalence and impacts of loneliness and social isolation on the lives of older adults have led to the lack of social connectedness being viewed as a major public health issue. Although an understudied population, emerging evidence suggests that for the nearly 3 million older low-income adults living in subsidized housing the impacts of lack of social connection may be especially profound. From a life course perspective, “cumulative economic disadvantage,” if combined with a “cumulative connectedness disadvantage,” may heighten exposure to health risk factors and negative health outcomes. Addressing social risk factors in this population thus may have the potential to reduce health disparities as well as improve quality of life. Decades of epidemiologic evidence suggest that social isolation is a key factor in disparate outcomes. Evidence-based interventions are needed to improve aging in place for this population, but little is known about the individual or contextual factors that influence social connectedness and health among this high-risk population of older adults. This symposium includes interdisciplinary perspectives and methods as well as present results from four studies that examine 1) perspectives on aging in place in subsidized housing, 2) relationship between social connection and food insecurity 3) relationship between social isolation and healthcare utilization and 4) between resident ties and links to health outcomes. Papers in this symposium will highlight the implications of study findings for informing future interventions to improve aging in place for older adults living in subsidized housing.

The challenges of aging in place for older adults at risk of self‐neglect and expectations regarding smart environments: Perspectives of older adults and their caregivers

AbstractBackgroundSelf‐neglect is a behavior found in older adults with cognitive deficits. It manifests through the refusal, or inability, to care for themselves and puts them at higher risk for institutionalization. In Quebec, administrators in home care services are increasingly open to offering smart environments as part of their services to this clientele as it can help identify unfulfilled needs. However, little information is available about the implementation of technology in home care services, including the perspective of this clientele and their family. An embedded case‐study was conducted to provide insight on their perception of obstacles for home care and their expectations of technological solutions.MethodThrough individual interviews, qualitative data regarding the perspectives of older adults at risk of self‐neglect (n = 5) and their caregivers (n = 3) was collected in regard to: 1) current obstacles at home; and 2) expectations toward technology to optimize their functional autonomy. Data was analyzed using the approach of Miles, Huberman and Saldana.ResultDespite the fact that some older adults (n = 3) presenting self‐neglect perceive themselves as functioning well at home and not needing more help than they already receive from home care service, all older adults (n = 5) perceived risks in their home environment and described difficulties with their memory (e.g. forgetting appointments) and mobility (e.g. falls). Similar difficulties were described by their caregivers, who also perceived some risks with remaining at home due to a deteriorating functional capacity. With respect to technology, it was identified that it could support the autonomy of the older adults in some aspects, but not replace current home services available. Technology also had to be easy to use and learn.ConclusionThis study suggests that older adults at risk of self‐neglect and their caregivers believe that technology can support aging in place but in combination with other solutions. When implemented, technology should be adapted to the needs, values, and preference of clients and their family, to address as many of the individual’s perceived risks as possible.

Engaging Stakeholders to Implement the Community Aging in Place, Advancing Better Living for Elders (CAPABLE) Program in a Local Area Agency on Aging

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) Program is a successful evidence-based intervention involving an OT, a nurse, and a handyman to promote aging in place for older adults. This presentation reflects important adaptations identified by stakeholders for implementation of CAPABLE through an Area Agency on Aging for a non-Medicaid population and reinforces the importance of early stakeholder engagement in knowledge translation. Primary Author and Speaker: Pamela Toto Additional Authors and Speakers: Beth Fields Contributing Authors: Caylee Yanes

Stimulating Research to Enhance Aging in Place.

Older adults may benefit from interventions to successfully age in place. Research has an opportunity to test interventions and implementation strategies to fulfill the needs of older adults through collective evidence building. The purpose of this article is to describe the proceedings of the American Occupational Therapy Foundation (AOTF) 2019 Planning Grant Collective and describe the areas of research that were identified as critical. The AOTF convened scientists with expertise in the area of aging in place to catalyze research on aging in place for older adults. Four priority areas in the aging in place literature were highlighted: (a) identification of factors that support aging in place, (b) classification of processes by which family members and care partners are included in aging in place efforts, (c) categorization of technology supporting older adults to age in place, and (d) development of science that clarifies implementation of evidence-based practice.

Aging in Place: Challenges of Older Adults with Self-Reported Cognitive Decline

BackgroundAn emergent concern related to the aging and the increased risk of cognitive decline is the institutionalization of older adults. Evidence has shown that aging in place leads to many benefits, including higher quality of life. In order to support older adults, it is imperative that we understand the challenges people with changes in cognition face while aging in place.MethodsA total of sixteen older adults with self-reported cognitive decline and six informal caregivers of individuals reporting cognitive decline, all of whom are living in independent residences, participated. Focus group sessions with semi-structured interviews were conducted, followed by thematic qualitative data analyses.ResultsThematic analyses led to the identification of six challenges to aging in place, including: 1) memory decline, 2) emotional challenges/low mood, 3) social isolation/loneliness, 4) difficulty with mobility and physical tasks, 5) difficulties with activities of daily living/instrumental activities of daily living, and 6) lack of educational resources on cognitive change.ConclusionThe themes identified in the current study represent common challenges in aging in place for older adults with self-reported cognitive decline. Identification of these themes allows for important next steps, which can focus on supports through targeted interventions.

Improving Aging in Place for Older Adults with Low Incomes: Perspectives of Home Health Aides

Older adults with low incomes experience disproportionate rates of cognitive and functional impairment and an elevated risk for nursing home admission. Home health aides (HHAs) can help older adults to age in place by optimizing function and engaging them in routine physical activity. Despite this potential role, little is known about HHAs’ perspectives on how to facilitate aging in place for this population. We conducted 6 focus groups with 21 English-speaking and 10 Spanish-speaking HHAs working in Philadelphia and New Jersey. Transcripts were analyzed using qualitative thematic analysis. HHAs described wearing multiple hats and pushing the boundaries of their role as a HHA to provide a “comfortable and safe” environment through nursing and emotional support. Many HHAs shared that they serve as surrogate family, often spending more time in clients’ homes than family members or other healthcare providers. This unique position provides HHAs with valuable insights into clients’ changing health which allows them to detect early warning signs of clients’ functional and cognitive decline, including falls, depression, and confusion. HHAs noted several factors that worsened clients’ decline including a lack of adaptive equipment, social isolation, and limited HHA input into clients’ care plans. They also pointed to factors that facilitated clients’ aging in place, including utilization of community-based services, family support, and communication between healthcare team members. Our findings suggest that HHAs have important insights into improving aging in place for older adults with low incomes and should be incorporated into care planning and intervention delivery.