Survey Of Older Adults Research Articles

Excess costs of depression among a population-based older adults with chronic diseases in Singapore.

There is limited evidence on the economic burden of depression among the older population in Singapore. We aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore. Using the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution). For total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490-14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7-475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163-1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418-12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346-1010; p < 0.001). This study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore's primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias. Depression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.

The Association Between Accelerated Biological Aging and Cardiovascular Outcomes in Older Adults with Hypertension.

Current hypertension treatments rely on chronological age, which may not reflect individual differences in aging and its impact on cardiovascular health. This study aimed to determine whether biological age can predict adverse outcomes in older adults with hypertension, independent of traditional risk factors including chronological age. An analysis of a prospective cohort was conducted using data from the Health and Retirement Study, a longitudinal survey of older adults in the United States. The Klemera-Doubal method was employed to calculate the biological age of the participants with hypertension at the time of enrollment in 2016. Discrete-time survival analysis was conducted to analyze the relationship between accelerated biological aging and the risk of mortality, heart disease, and stroke over four years of follow-up. A total of 4,442 individuals were analyzed. Of these, 2,438 showed decelerated aging, whereas 2,004 experienced accelerated aging (biological age > chronological age). The median age of the patients in both groups was around 70 years. Both groups had similar racial and ethnic distributions and predominantly consisted of non-Hispanic whites. The accelerated aging group had a higher prevalence of chronic diseases, lower education levels, and less wealth than the decelerated aging group. After adjustment for these differences, accelerated aging was associated with a higher risk of a composite outcome of death, heart disease, and stroke, with an adjusted hazard ratio (a-HR) of 1.62 (95% confidence interval: 1.27-2.06, p= 0.001). Accelerated biological age is a predictor of cardiovascular outcomes and death in patients with hypertension.

Supportive and Palliative Care Needs of the Older Adults with Stroke and Neurological Diseases: An Estimation using data from Longitudinal Ageing Study in India

Objectives: The prevalence and burden of neurological diseases are high among the older age group. Stroke and other neurological diseases significantly impair functional capacity and lead to poor quality of life. This study aims to provide a national-level estimate for palliative and supportive care needs among older Indian adults with stroke and other neurological diseases. Materials and Methods: The Longitudinal Ageing Study in India (LASI), a national-level survey of older adults, was used as a representative sample to estimate palliative and supportive care needs. The supportive and palliative care indicator tool income setting (SPICT-LIS) was used to identify palliative care needs in older adults with stroke and other neurological diseases. A total of 31,902 older adults aged 60 years and above were identified from the LASI data, and among them, 1458 older adults with stroke and other neurological diseases were selected for the analysis. The SPICT-LIS indicators were compared with the selected LASI data. Both univariate analysis and multivariate logistic regression were performed to determine the association between supportive and palliative care needs and background characteristics of older adults. Results: The analysis showed that 63.6% of older adults with stroke and other neurological diseases in India have supportive and palliative care needs. In regression analysis, the burden of supportive and palliative care needs was observed to be high among older adults who were in the underweight, overweight/obese category, who experienced ill-treatment, and who had diabetes and hypertension. In contrast, the burden of supportive and palliative care needs was observed to be low among older adults with stroke and neurological diseases who belonged to richer and richest economic quintiles, those receiving at least one social support scheme, those engaged in social activity and those performing physical activity. Conclusion: The palliative care needs among the older adult population with stroke and other neurological diseases in India are high. The findings of this study underscore the importance of screening for supportive and palliative care needs among patients with stroke and other neurological diseases to identify these unmet needs. The workforce trained in the provision of generalist and specialist palliative care will be required to meet this need, and the population of older adults is estimated to double in the next three decades.

Application of High-Dimensional Propensity Score Methods to the National Health and Aging Trends Study.

High-dimensional propensity scoring (HDPS) is a method for empirically identifying potential confounders within large healthcare databases such as administrative claims data. However, this method has not yet been applied to large national health surveys such as the National Health and Aging Trends Study (NHATS), an ongoing nationally representative survey of older adults in the United States and important resource in gerontology research. In this Research Practice article, we present an overview of HDPS and describe the specific data transformation steps and analytic considerations needed to apply it to national health surveys. We applied HDPS within NHATS to investigate the association between self-reported visual difficulty and incident dementia, comparing HDPS to conventional confounder selection methods. Among 7 207 dementia-free NHATS Wave 1 respondents, 528 (7.3%) had self-reported visual difficulty. In an unadjusted discrete time proportional hazards model accounting for the complex survey design of NHATS, self-reported visual difficulty was strongly associated with incident dementia (odds ratio [OR] 2.34, 95% confidence interval [CI]: 1.95-2.81). After adjustment for standard investigator-selected covariates via inverse probability weighting, the magnitude of this association decreased, but evidence of an association remained (OR 1.44, 95% CI: 1.11-1.85). Adding 75 HDPS-prioritized variables to the investigator-selected propensity score model resulted in further attenuation of the association between visual impairment and dementia (OR 0.94, 95% CI: 0.70-1.23). HDPS can be successfully applied to national health surveys such as NHATS and may improve confounder adjustment. We hope developing this framework will encourage future consideration of HDPS in this setting.

Transitioning an In-Person Survey of Older Adults to Multi-Mode Data Collection.

The first three rounds of the National Social Life, Health, and Aging Project (NSHAP) were in-person. Preparing for Round Four (R4), NSHAP began developing ways to collect complex questionnaire and biomeasure data remotely. R4 was scheduled to begin in 2020, but due to the coronavirus pandemic, NSHAP delayed R4 data collection and instead conducted a study on respondents' experiences during the pandemic, as well as pretests to strengthen NSHAP's remote data collection capability. This paper describes the methodology, results, and lessons learned from these efforts which were undertaken as a bridge between NSHAP's all in-person past and multimode future. The Covid-19 Study was a multimode survey of NSHAP respondents to assess the impact of the pandemic. The multimode approach allowed evaluation of the feasibility of using different modes of data collection with older adults. NSHAP adapted its in-person questionnaire for phone and web administration and conducted pretests of the full phone questionnaire and sections of the web questionnaire. The project developed and tested a "BioBox," a kit containing all the supplies and instructions for respondents to self-collect biomeasures remotely. The BioBox was tested through an in-lab and in-home pilot, followed by two larger-scale pretests. The Covid-19 Study and pretests achieved NSHAP respondent participation in remote questionnaire and biomeasure collection, despite being accustomed to fully in-person data collection. Our findings and experiences will inform the collection of NSHAP data in future rounds and could inform other panel studies of older adults considering multimode data collection.

Negative perceptions toward older adults and life satisfaction among community-dwelling older citizens in Japan

Background With the rapid aging of the population, increasing life satisfaction among older adults is essential. Negative perceptions of older adults are internalized, leading to poor mental health. This study hypothesized that participants with more negative perceptions of older adults would have lower life satisfaction. Methods A cross-sectional survey of older adults was conducted across five wards and four cities in Tokyo, Japan. Participants responded to questions regarding demographics, life satisfaction, and negative perceptions of older adults. Data from 285 participants (264 women, M = 71.97 years) were analyzed. Results The intraclass correlation coefficient for life satisfaction concerning residential areas was. 03 (95% confidence interval [CI] = [-.03, .10]). Instead of multilevel models, a multiple regression model with life satisfaction as the dependent variable and negative perceptions of older adults and demographics as the independent variables yielded the best fit. Results indicated that participants with more negative perceptions of older adults reported lower life satisfaction (β = -.16, 95% CI = [-.28, -.04], p = .008), supporting our hypothesis. Conclusions This study was constrained by limited variance in residential areas and a predominantly female participant pool. Previous studies have shown that higher life satisfaction is associated with increased social participation and extended life expectancy, and interventions aimed at enhancing life satisfaction in older adults are significant. Further exploration is warranted to ascertain whether a causal relationship exists, wherein more negative perceptions of older adults diminish life satisfaction.

Testing a Context-Enriched Model of Successful Aging in Multiple Large Data Infrastructures with Individuals in Advanced Old Age.

Few people who are ages 80+ meet the criteria of successful aging (SA) proposed by Rowe and Kahn. Going beyond the individual-level conceptualization, we argue that SA always operates in multiple contexts and that context may become most critical in advanced old age. However, we are not aware of any previous study providing an empirical test of how contexts for SA unfold across persons 80 years and older, including those living in institutions. We estimated and compared prevalences of successful aging based on a classic versus context-enriched understanding of SA in multiple large surveys of older adults, i.e., the D80+ study (N = 3.233) and the NRW80+ study (N [baseline] = 1.863). In addition to replication across independent samples, we investigated the stability of context-related SA across time. Prevalences of SA according to Rowe and Kahn were 9.1% in adults aged 80-84 and 0.7% in persons 90 years or older. However, prevalence rates for those with good contexts at their disposal even if not fulfilling Rowe and Kahn's criteria were much higher across all age groups (80-84 years: 54.9%, 90 years and older: 44.4%). Greater two-year stability was observed for contextual compared to individual criteria. Notably, positive effects of context on SA were stronger at onset compared to late fourth age. Our findings support a contextualized understanding of SA and inform policy that furthering SA in the fourth age requires the optimization of multiple contexts at the community level.

Leading Health-Related Concerns of Older Adults Before the 2024 Election

This national cohort survey of older adults assesses which health-related concerns they consider to be most salient in the 2024 election.

Older patients want to talk about sexual health in Australian primary care

Background Maintaining sexual health and function is important to many older adults. Although older patients are regular users of primary care, opportunities to address sexual health concerns are missed. Building on interview studies, this research aimed to collect a larger number of older adults’ perspectives to deepen understanding of sexual healthcare needs and formulate recommendations for the Australian primary care context. Methods As part of the SHAPE2 Survey of older adults’ sexual health information-seeking behaviours, participants (aged ≥60 years and living in Australia) were asked what sexual health issues were most important to them, and the barriers they experienced in managing their sexual health. Data were collected in 2021 in the form of free-text comments. The sub-set of comments that related to healthcare experiences were analysed using qualitative content analysis. Results Out of 1470 survey participants, 864 responded to the relevant questions, and of these 107 wrote about healthcare experiences. Some comments described positive experiences seeking sexual health care; however, the majority outlined barriers to accessing support. Barriers were categorised into seven categories: patient embarrassment, barriers to rapport, uncertainty about finding solutions, ageism, barriers unique to minorities, needing general practitioners to initiate conversations and structural barriers. Conclusions Older patients want general practitioners to initiate sexual health conversations as part of routine care, and, crucially, sexual issues raised by the patient should be legitimised and treated with due attention. Although challenges, such as time, embarrassment and pressing health concerns, may hamper sexual health discussions, it is important that this area of holistic care is given more attention.

Do pedestrian safety improvements affect older adults' health and social outcomes equitably? A quasi experiment in Singapore

IntroductionPedestrian-friendly neighborhoods are believed to encourage greater social participation, community engagement, and sense of social inclusion, which are important to older individuals at higher risk of being socially isolated. However, most studies on neighborhood walkability, social participation and social inclusion are cross-sectional, making it difficult to robustly establish causal links. Much research on neighborhood walkability is also based in North America and Europe, leaving a knowledge gap on the impact of walkability within other geographic contexts. Furthermore, there is a lack of empirical evidence about whether benefits from traffic calming schemes are distributed equitably. To reduce these empirical gaps, our study capitalises on a ‘quasi-experiment’ to estimate the impact of an infrastructure-focused pedestrian safety program “Silver Zones' in Singapore, a highly urbanised city state in Southeast Asia with an aging population. MethodsThis study utilises panel data from a high-frequency internet-based survey of older adults that has been administered from 2015 till present. We examine how changes in older residents' residential proximity to Silver Zones relate to changes in their social and health outcomes. We also test whether the relationship between Silver Zones and older individuals' health and social participation outcomes might be moderated by age and socioeconomic class. Finally, we interpret these findings in view of participants’ perceptions of Silver Zones. Results and conclusionWe find that the oldest participants with low SES -- a particularly vulnerable subgroup -- experienced negative changes after the opening of Silver Zones near them, as did those classified as mid SES. In contrast, our findings suggest that new Silver Zones might have a positive effect on older adults of high SES. These findings suggest that there might be inequities in the impact of pedestrian safety programs on residents' social outcomes. Additionally, while our findings were statistically significant, they also suggest that Silver Zones’ contribution to changes in participant outcomes were relatively small, which might be due to a mismatch between perceptions of Silver Zones, actual exposure, and participant outcomes. Our findings underscore the need for more outreach and publicity campaigns around pedestrian safety initiatives, as well as the importance of going beyond self-reported perceptions when assessing the success of pedestrian safety schemes like the Silver Zones.

Cross-sectional association of physical activity levels with risks of sarcopenia among older Taiwanese adults

ObjectivesThe updated World Health Organization 2020 guidelines strongly recommend an optimal physical activity level of 150–300 min/week for older adults. However, few studies have examined the relationship between different levels of physical activity and sarcopenia. Therefore, the purpose of this study was to investigate the cross-sectional associations between overall physical activity levels, gender, intensity, and the risk of sarcopenia among older Taiwanese adults.MethodsA nationwide cross-sectional telephone survey of older adults (≥ 65 years) was conducted in Taiwan from October 2019 to January 2020. Participants were interviewed to collect self-reported data on their level of physical activity (measured by the Taiwanese version of the IPAQ-SF), sarcopenia risk (measured by the SARC-F questionnaire), and sociodemographics.ResultsA total of 1068 older adults were surveyed. Compared with the optimal physical activity level recommendations in the WHO guidelines and after adjusting for potential confounders and proposing an association independent of sedentary behavior, older adults with insufficient physical activity levels (< 150 min/week) were more likely to have a higher risk of sarcopenia (OR: 3.24; CI: 1.67–6.27), whereas older adults who exceeded physical activity guidelines (> 300 min/week) were more likely to have a lower risk of sarcopenia (OR: 0.39; CI: 0.20–0.78). Maintaining moderate-intensity physical activity is essential for older adults, as physical activity that exceeds the guidelines can significantly lower the risk of sarcopenia; meanwhile, insufficient physical activity can greatly increase it. Also, there seems to be a similar association between sarcopenia risk across different physical activity levels in vigorous-intensity physical activities in older adults. However, due to the small number of sarcopenia-risk participants who met or exceeded vigorous-intensity physical activity levels, further comparisons between different vigorous-intensity physical activity levels did not show significant differences in sarcopenia risk. Additionally, insufficient physical activity was found to be an important risk factor for sarcopenia in both genders, while physical activity that exceeded the guidelines prevented sarcopenia in females.ConclusionsThe findings of this study highlight the potential dose-response relationship related to physical activity. The 2020 WHO guidelines provide the public with minimum recommendations for physical activity. However, exceeding these recommended levels appears to be more effective in preventing sarcopenia in older adults and may offer even greater health benefits. Future research should further explore whether exceeding these guidelines could result in additional health benefits.

Development of a frailty prevention program including nutrition and exercise interventions for older adults in senior daycare centers in South Korea using a mixed methods research design.

The growing aging population has led to an increased utilization of senior daycare centers. This study was conducted to design a program to enhance the health of older adults in senior daycare centers in Chuncheon City, South Korea. The study explored the health conditions and dietary patterns of older adults in senior daycare centers. Participants included staff and older adults from senior daycare centers in Chuncheon City. A mixed methods research design was used to obtain both qualitative and quantitative data. Qualitative insights were obtained through in-depth interviews with 26 staff members and older adults, coupled with observations made at 10 senior daycare centers. The quantitative component comprised structured questionnaires and physical measurements of 204 older adults at these centers. Many of the older adults relied on the meals provided by the center due to their limited cooking abilities. Dental health issues and dysphagia were common. Interviews highlighted the budgetary constraints of the centers in providing wholesome meals and the need for government support to alleviate meal expenses and enhance quality. A structured survey of older adults showed that the average age was 83.3 yrs, with an average of 2 chronic conditions per participant. Frailty analysis of the participants revealed that 56.2% were prefrail and 32.0% were frail. Almost half of the participants (47.0%) used dentures. Based on these findings, a preventive intervention program was proposed, addressing the specific needs and challenges of older adults while promoting overall well-being and preventing frailty. Tailored health promotion strategies are crucial in senior daycare centers. Recommended interventions include staff nutrition education, improved dietary plans, and cost-effective strength training programs. These interventions aim to reduce frailty and enhance the quality of life of older adults in the community via interventions in daycare centers.

Negative perceptions of older adults and life satisfaction among community-dwelling older citizens in Japan

Background With the rapid aging of the population, increasing life satisfaction among older adults is essential. Negative perceptions of older adults are internalized, leading to poor mental health. This study hypothesized that participants with more negative perceptions of older adults would have lower life satisfaction. Methods A cross-sectional survey of older adults was conducted across five wards and four cities in Tokyo, Japan. Participants responded to questions regarding demographics, life satisfaction, and negative perceptions of older adults. Data from 285 participants (264 women, M = 71.97 years) were analyzed. Results The intraclass correlation coefficient for life satisfaction concerning residential areas was. 03 (95% confidence interval [CI] = [-.03, .10]). Instead of multilevel models, a multiple regression model with life satisfaction as the dependent variable and negative perceptions of older adults and demographics as the independent variables yielded the best fit. Results indicated that participants with more negative perceptions of older adults reported lower life satisfaction (β = -.16, 95% CI = [-.28, -.04], p = .008), supporting our hypothesis. Conclusions This study was constrained by limited variance in residential areas and a predominantly female participant pool. Previous studies have shown that higher life satisfaction is associated with increased social participation and extended life expectancy, and interventions aimed at enhancing life satisfaction in older adults are significant. Further exploration is warranted to ascertain whether a causal relationship exists, wherein more negative perceptions of older adults diminish life satisfaction.

Mental health and aging in New Zealand: mixed-methods analysis of experiences of healthcare from a survey of older adults with mental health conditions

ABSTRACT Little is known about the experiences of older people who seek mental healthcare in New Zealand. From a survey of 227 older people, we explored the use of mental healthcare services with quantitative and qualitative questions. Mental health needs were not being met in nearly one in five; a similar proportion was not satisfied with services providing mental healthcare. Reasons included long waiting times, lack of continuity of care and cost. Better co-ordination of primary and secondary services and improved accessibility of mental health services for older adults is needed.

Co-occurrence of depressive and anxious symptoms and their influence on self-rated health: a national representative survey among Chinese older adults

Objectives The prevalence of the co-occurrence of depressive and anxious symptoms (CO) and their influence on perceived overall health were not clear in community dwelling Chinese older adults. The aims of the study were to investigate the prevalence of CO and to explore its influence on self-rated health (SRH). Method This study included 12301 individuals aged ≥65 years from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative survey of older adults in mainland China. Participants received face-to-face interviews and assessments of depressive symptoms and anxious symptoms via 10-item of the Center for Epidemiologic Studies Depression Scale (CES-D-10) and 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), respectively. SRH was measured by self-reported. A logistic regression model was used to examine the association between CO and SRH after adjusting for confounding variables. Results The average age was 83.4 (SD: 11.0) years and there were 6576 (53.5%) females. The age- and sex-standardized prevalence of depressive symptoms only (DSO) was 38.6%, anxious symptoms only (ASO) was 1.5%, and CO was 10.8%. Compared with those without depressive and anxious symptoms, the older adults with DSO or ASO were more likely to have significant influence on SRH. And particularly, CO was likely to produce the greatest decrement in the level of SRH. Conclusion CO was not rare in Chinese older adults nationwide. The older adults having CO had increased risk for lower level of SRH than having DSO or ASO. More attention should be given to CO among the older adults.

The predictive ability of ABSI compared to BMI for mortality and frailty among older adults.

To study the utility of A Body Shape Index (ABSI) alongside body mass index (BMI) to predict mortality and frailty in an aging community population. Participants (n = 1,580) were drawn from the first Israeli national health and nutrition survey of older adults ("Mabat Zahav") conducted from 2005 to 2006, constituting adults aged ≥65 years. Socio-demographic, clinical, behavioral, and psychosocial data were collected. Baseline weight, height, and waist circumference (WC) were measured and expressed as the allometric indices BMI (kg/m2) and ABSI, a BMI-independent measure of abdominal obesity [WC/(BMI2/3*m1/2)]. Mortality follow-up lasted through 2019. Frailty was assessed in 2017-2019 by the Fried Biological Phenotype in a sub-cohort of 554 survivors. Cox and logistic regression models assessed associations of BMI and ABSI with mortality and frailty. At baseline, mean [SD] age was 74.5 [6.1] years, and 52.4% were women. The correlation between BMI and WC Z scores was 0.71, reduced to -0.11 for BMI and ABSI. Over a median follow-up of 13 years, 757 deaths occurred. The multivariable-adjusted hazard ratios (95% CIs) for mortality per standard deviation increase in BMI and ABSI were 1.07 (0.99;1.17) and 1.13 (1.05;1.21), respectively. Among participants assessed for frailty, 77 (14%) met the frailty criteria. After multivariable adjustment, the odds ratios (95% CIs) for frailty were 0.83 (0.69-1.01) for BMI and 1.55 (1.34-1.79) for ABSI. In a nationwide cohort of older adults, ABSI was independently associated with mortality risk. Furthermore, ABSI, but not BMI, was a strong predictor of frailty.

Older Canadians' Perceptions of the Safety, Effectiveness and Accessibility of Cannabis for Medicinal Purposes: A Cross-Sectional Analysis.

Cannabis use is increasing among older adults, with use primarily for medicinal purposes. Much of the evidence on perceptions of cannabis is derived from younger populations and current users of cannabis. The purpose of this study was to describe community-dwelling older Canadians' perceptions of cannabis effectiveness, safety and accessibility for medicinal purposes and to identify factors influencing cannabis perceptions. An online survey of older adults' perceptions, knowledge and experiences with cannabis was completed between February and September 2022. The survey was open to English-speaking and French-speaking Canadians aged 50 years and older regardless of their cannabis use history. A total of 1615 Canadians completed the survey. Respondents identified primarily as men (49.7%) or women (48.5%) of Caucasian decent. The majority of participants viewed cannabis as a reasonable alternative (65.8%) and an effective (70.5%) treatment modality for symptom management in older adults. Few respondents (16.4%) felt that older adults compared to younger adults were at a higher risk of side effects and 34.5% felt that cannabis is safe to use with most medicines. Cannabis perceptions were influenced by gender, cannabis use history (prior use vs current use) and reasons for cannabis use (recreational purposes vs medicinal purposes vs both purposes). Older Canadians have a positive view of the role of cannabis in symptom management. The perceptions of cannabis safety and effectiveness were influenced by gender, cannabis use history and reasons for cannabis use. Healthcare professionals should leverage these perceptions when discussing cannabis with their older patient populations.

Attitudes on participation in clinical drug trials: A nationally representative survey of older adults with multimorbidity.

Older adults with multimorbidity are under-represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed. Cross-sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March-April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics. Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African-American respondents, and those ≥80 years). Sixty-five percent would join all in-person trials, 49% would join all-video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%). Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in-person visits are preferred. Proposed changes in trial design to increase enrollment of under-represented older adults may not align with patient-reported preferences.

Public Views About Nutrition and Brain Health: A Survey of Older Adults in New Zealand

Public Views About Nutrition and Brain Health: A Survey of Older Adults in New Zealand

Multiple Perspectives on the Adoption of SMART Technologies for Improving Care of Older People: Mixed Methods Study.

Despite the ever-increasing offering of SMART technologies (ie, computer-controlled devices acting intelligently and capable of monitoring, analyzing or reporting), a wide gap exists between the development of new technological innovations and their adoption in everyday care for older adults. This study aims to explore the barriers and concerns related to the adoption of SMART technologies among different groups of stakeholders. Data from 4 sources were used: semistructured in-person or internet-based interviews with professional caregivers (n=12), structured email interviews with experts in the area of aging (n=9), a web-based survey of older adults (>55 years) attending the Virtual University of the Third Age (n=369), and a case study on the adoption of new technology by an older adult care facility. Although all stakeholders noted the potential of SMART technologies to improve older adult care, multiple barriers to their adoption were identified. Caregivers perceived older adults as disinterested or incompetent in using technology, reported preferring known strategies over new technologies, and noted own fears of using technology. Experts viewed technologies as essential but expressed concerns about cost, low digital competency of older adults, and lack of support or willingness to implement technologies in older adult care. Older adults reported few concerns overall, but among the mentioned concerns were lack of ability or interest, misuse of data, and limited usefulness (in specific subgroups or situations). In addition, older adults' ratings of the usefulness of different technologies correlated with their self-rating of digital competency (r=0.258; P<.001). Older adults appeared to have more positive views of various technologies than professional caregivers; however, their concerns varied by the type of technology. Lack of competence and lack of support were among the common themes, suggesting that educationally oriented programs for both older adults and their caregivers should be pursued.